Reagan B. Anderson Do, MPH

Topical corticosteroids remain the mainstay of treatment, especially in patients with erythematous, acutely inflamed psoriatic plaques. The topical immunomodulators tacrolimus and pimecrolimus are used to treat psoriasis, although neither has FDA approval for this indication. Unlike corticosteroids, immunomodulators do not cause skin atrophy, irreversible striae, acne, or tachyphylaxis. Newer topical vehicles of delivery (eg, foam clobetasol propionate) and newer drug combinations (eg, once-daily calcipotriene/betamethasone dipropionate ointment) may improve efficacy and reduce side effects. Reserve systemic therapy for patients with moderate to severe psoriasis. Until more long-term safety data become available, be cautious about prescribing biologic agents for patients at risk for infection (particularly tuberculosis) and malignancy.

ABSTRACT: Melanomas usually do not arise from nevi; they are thought to result from UV radiation-induced DNA damage and genetic factors. The most important risk factors for melanoma are a personal history of atypical nevi, a family or personal history of melanoma, and large numbers of nevi. The ABCD criteria (asymmetry, border irregularity, color variegation, diameter larger than 6 mm) help identify early, thin tumors that might otherwise be confused with benign pigmented lesions. The E criterion has recently been added: an evolving lesion (one that shows any change in size, shape, symptoms, surface, or color) warrants prompt evaluation. If melanoma is suspected, total excision--rather than shave biopsy--is required. Melanomas that are detected and treated in the radial or early vertical phase have an excellent prognosis.