Learning dermatology in medical school: analysis of dermatology topics tested in popular question banks

Given the lack of formal dermatology education in medical schools, dermatology principles covered in board exam preparatory resources remain the only standardized concepts that all medical students across the USA universally learn. The primary objective of this study was to quantify the dermatology topics represented in UWorld and AMBOSS Step 1 and Step 2CK question banks. Our study found that 49% of the 655 questions on dermatology assessed the top 10 most prevalent skin diseases encountered in clinical practice with a variety of rare conditions also tested. Step 2CK question banks had a higher proportion of questions that assessed management of dermatological conditions. Furthermore, there was a large variability in the proportion of questions that included images of the condition. This study highlights the need and opportunity for standardization of dermatology teaching in medical school curricula to optimally prepare graduating physicians for future practice.

Genodermatoses associated with melanocytic nevi

Though melanocytic nevi are ubiquitous in the general population, they can also be key cutaneous manifestations of genetic syndromes. We describe genodermatoses associated with melanocytic nevi and discuss their clinical characteristics, cutaneous manifestations, underlying genetics, and, if applicable, guidelines for when genetic testing should be performed. We categorized these genodermatoses based on their association with congenital nevi, acquired nevi, or nevi whose first appearance is unknown. In many cases, the distinctive morphology or distribution of melanocytic nevi can be an important clue that an underlying genetic syndrome is present, allowing both the patient as well as family members to be screened for the more serious complications of their genetic disorder and receive education on potential preventative measures. As we continue to advance our understanding of how various genotypes give rise to the wide spectrum of phenotypes observed in these genodermatoses, we shall be able to better stratify risk and tailor our screening methods to clinically manage the heterogeneous manifestations of genodermatoses among these patients.

Immune biomarkers are more accurate in prediction of survival in ulcerated than in non-ulcerated primary melanomas

INTRODUCTION

Ulcerated melanomas may have a unique biology and microenvironment. We test whether markers of immune infiltration correlate with clinical outcome in ulcerated compared to non-ulcerated primary melanoma tumors.

METHODS

Sixty-two stage II-III cutaneous melanomas, 32 ulcerated and 30 non-ulcerated, were analyzed for tumor-infiltrating lymphocytes (TILs). Immunohistochemistry (IHC) was performed for CD2, a marker previously shown to correlate with overall survival (OS) and recurrence-free survival (RFS) in this patient population. IHC using antibody, VE1, to BRAF V600E was also performed on a subset of 41 tumors to assess the relationship of BRAF mutation to immune markers.

RESULTS

We found, using Cox regression models, that the presence of TILs was associated with improved OS (p = 0.034) and RFS (p = 0.002) in ulcerated melanoma tumors, but not in non-ulcerated melanoma (p = 0.632, 0.416). CD2 expression also was correlated with improved OS (p = 0.021) and RFS (p = 0.001) in ulcerated melanoma, but no relationship was seen in non-ulcerated melanoma (p = 0.427, 0.682). In this small population, BRAF status did not correlate with TILs or CD2+ count.

CONCLUSION

Our data show that immune markers including TILs and CD2 count correlate more closely with survival in ulcerated melanomas than that in non-ulcerated melanomas. We propose that immune biomarkers may be particularly relevant to ulcerated, as compared to non-ulcerated, melanomas and that this merits study in larger populations.

Panic disorder and alcohol misuse

The literature on the relationship of panic disorder to alcoholism is reviewed. Four cases of panic disorder are presented, illustrating instances in which the diagnosis of panic disorder was delayed or obscured by alcoholism. Professionals in alcoholism treatment should therefore be better able to recognize panic disorder. Also, since tricyclic antidepressants are very effective in the treatment of panic disorder, the opposition in the alcoholism field to the use of any medication is criticized.