Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Feb 2004
Case ReportsVulvar melanoma: diffuse melanosis and metastasis to the placenta.
Mucocutaneous melanoma, including vulvar melanoma, is rare and has a worse prognosis and higher recurrence rate than traditional cutaneous melanoma. Diffuse cutaneous melanosis is another rare clinical presentation of metastatic melanoma. It is essential for dermatologists to be alerted to rare presentations of melanoma, to facilitate early detection. ⋯ The genitalia should be included in routine total body skin examinations. Pregnant women with generalized melanosis may be at increased risk for placental metastasis of melanoma. Pregnancy does not alter the incidence or prognosis of melanoma; however, patients with a poor prognosis or high recurrence risk should be informed of potential pregnancy complications associated with melanoma recurrence or metastasis.
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J. Am. Acad. Dermatol. · Jan 2004
Randomized Controlled Trial Clinical TrialMedicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times.
In 2002, the Centers for Medicare and Medicaid Services implemented a 5.4% cut in Medicare physician payments, and further reductions are expected in 2004. These cuts have raised concerns that beneficiaries of Medicare will face significant problems obtaining needed physician services. Although there is clear evidence of poor access to care for patients with Medicaid, data measuring access to physicians for patients with Medicare are sparse. Given current lengthy appointment wait times resulting from a relative shortage of dermatologists, we hypothesized that patients with lower-paying coverage might be more likely to experience appointment refusals, longer wait times, or both. ⋯ Although overall access to dermatologists appears comparable for patients with Medicare and private insurance, some access limitations in "hot spots" where Medicare payments are low relative to commercial insurers suggest that patients in these areas may be most sensitive to further payment reductions. Significant access problems for beneficiaries of Medicaid, particularly in areas where Medicaid payments are relatively low, may be a harbinger of the potential consequences of sustained declines in Medicare physician reimbursement.
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J. Am. Acad. Dermatol. · Nov 2003
Case ReportsPyoderma gangrenosum in a patient with collagenous colitis.
The association between pyoderma gangrenosum and inflammatory bowel disease is well established. Collagenous colitis is one of the microscopic colitides, which are thought to be on the same spectrum of disease as Crohn's disease and ulcerative colitis. Before this study there had been no reported cases of pyoderma gangrenosum in the setting of collagenous colitis. We report a case of a 79-year-old woman with symptomatic collagenous colitis and refractory pyoderma gangrenosum.
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J. Am. Acad. Dermatol. · Oct 2003
Skin cancer prevention and detection practices among siblings of patients with melanoma.
Family members of patients with melanoma have an increased risk of the disease, and families with multiple affected members account for about 10% of melanoma cases. These statistics suggest that first-degree relatives of patients with melanoma, who are at particularly high risk, warrant targeted public health action. ⋯ Skin self-examination rates among these high-risk siblings are markedly higher than in population-based studies. However, many siblings were not screened for skin cancer by a dermatologist despite having strong risk profiles, being nearly fully insured, and being under care of primary care physicians. Improvements in communication between physicians and high-risk families and changes in office systems to assess family history of melanoma could increase screening rates for the estimated 1 million siblings of patients with melanoma.