Cutaneous Malignant Melanoma: Screening and Diagnosis

Fatemeh Akbarian, MD,¹ Mehdi Aarabi, MD,² Ali Vahidirad, MD,³ Mehrdad Ghobadi, MD,⁴ Mohaddeseh Ghelichli MD,⁵
Mohammad A. Shafiee, MD, MSc, FRCPC,^6
1Dermatologist, Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. ²Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. ^3,4,5Joint, Bone, Connective Tissue Research Center, Golestan University of Medical Sciences, Iran. ⁶Division of General Internal Medicine, Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.

Abstract
Cutaneous Malignant Melanoma has the highest morbidity and mortality among different types of skin cancers; as one of the most common malignancies in the world. Early detection and diagnosis of Cutaneous Malignant Melanoma followed by adequate surgical excision are the most important tasks in management of this potentially curable skin cancer. Screening methods and diagnostic criteria including clinical and dermoscopic findings will be discussed in this article.
Keywords: Melanoma, Dermoscopy, UV Exposure, Epiluminescence Microscopy (ELM).

A Moustache for a Good Cause

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Impetigo is a gram-positive bacterial infection of the superficial layers of the epidermis. There are two forms of impetigo: bullous and nonbullous. Diagnosis of impetigo is usually based solely on the history and clinical presentation. Culture and sensitivity results can help the physician choose appropriate antibiotic therapy. Treatment of impetigo typically involves local wound care, along with antibiotic therapy, either topical alone or in conjunction with systemic therapy. For mild or localized cases, topical mupirocin or topical fusidic acid applied 2 to 3 times daily for 7 to 10 days are adequate treatment. Systemic antibiotics are indicated for widespread, complicated, or severe cases associated with systemic manifestations of impetigo. Beta-lactam antibiotics remain an appropriate initial empiric choice, with coverage against both Staphylococcus aureus and Streptococcus pyogenes. For patients with recurrent impetigo or Staphylococcus aureus nasal carriers, topical mupirocin cream or ointment can be applied inside the nostrils 3 times daily for 5 days each month to reduce colonization in the nose.
Keywords: Impetigo, Staphylococcus aureus, Group A beta hemolytic streptococci Bullous impetigo, Nonbullous impetigo.

A Facial Rash Recalcitrant to Treatment with Topical Corticosteroids

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Periorificial dermatitis is a common eczematous eruption on the face. Clusters of follicular papules, vesicles, and pustules on an erythematous base are usually found in a perioral distribution. Other common locations include the nasolabial folds and periocular area. An underlying cause may not be found in all cases, but the use of topical corticosteroids on the face may precede onset of symptoms. Periorificial dermatitis is diagnosed clinically and no specific investigation is required. Topical anti-inflammatory therapies (such as metronidazole and erythromycin) are appropriate in mild cases. In severe cases, systemic treatments such as tetracycline or one of its derivatives are beneficial. Patients should be warned that symptoms might worsen before improvement is apparent. This complication is more commonly seen when topical corticosteroids are withdrawn.
Keywords: periorificial dermatitis, perioral dermatitis, facial rash, steroid-induced.

Top Ten Tips for Atopic Tots

Katia Faustini, Faculty of Medicine, McGill University, Montreal, Quebec.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia.

Abstract
Atopic dermatitis is the most common inflammatory skin condition affecting children. Given the complex waxing and waning nature of this common dermatologic condition, patient education and frequent family physician involvement, is the key to proper long term management. While topical steroids have long been accepted as the standard therapy in management of eczema, concern over its side effects by both family doctors and patients greatly impact compliance. Topical steroids are safe and efficacious if used properly. This article examines the top ten things to know about atopic dermatitis in order to properly and safely manage this chronic disease.
Keywords: atopic dermatitis, inflammatory skin condition, topical corticosteroids.