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November 26, 1997, Vol 278, No. 20 >
ARTICLE | November 26, 1997

A 28-Year-Old Fair-Skinned Woman With Multiple Moles FREE

June K. Robinson, MD
[+] Author Affiliations

This conference took place at the Dermatology Grand Rounds of the Beth Israel Deaconess Medical Center, East Campus, on July 10, 1997.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY318, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1997;278(20):1693-1699. doi:10.1001/jama.1997.03550200069034
Text Size: A A A
Published online
Article
References

Dr DALEY:  Ms G is a 28-year-old single health care office worker who has had 2 abnormal moles removed in the past. She lives in greater Boston and is engaged to be married. Her health insurance is through a managed care plan in eastern Massachusetts.In 1994, a physician with whom Ms G works noted a "funnylooking" mole on her left ear and suggested that she have it evaluated. Ms G sought consultation from Dr V, a dermatologist, who noted more than 50 nevi over her body and 2 abnormal-appearing moles: one on her left ear and another on her anterior abdominal wall. Physical examination revealed each mole had the appearance of a dysplastic nevus. After a biopsy in October 1994, the ear lesion was noted to be a "lentiginous compound nevus with architectural features of a dysplastic nevus; the cytologic atypia is mild." The anterior abdominal wall lesion was

REFERENCES

1 +
Rigel DS, Friedman RJ, Kopf AW.  The incidence of malignant melanoma in the United States . J Am Acad Dermatol . 1996;;34:839-847.
2 +
Cancer Facts and Figures-1997. Atlanta, Ga: American Cancer Society Inc; 1997.
3 +
Graham S, Marshall JB, et al.  An inquiry into the epidemiology of melanoma . Am J Epidemiol . 1985;;122:606-619.
4 +
Armstrong BK, Kricker A.  Cutaneous melanoma . Cancer Surv . 1994;;19-20:219-240.
5 +
Berg P, Lindelof B.  Differences in malignant melanoma between children and adolescents . Arch Dermatol . 1997;;133:295-297.
6 +
NIH Consensus Development Panel on Early Melanoma.  Diagnosis and treatment of early melanoma . JAMA . 1992;;268:1314-1319.
7 +
Greene MH, Clark WH Jr, Tucker MA.  The prospective diagnosis of malignant melanoma in a population at high risk . Ann Intern Med . 1985;;102:458-465.
8 +
Rhodes AR, Weinstock MA, Fitzpatrick TB, et al.  Risk factors for cutaneous melanoma: a practical method of recognizing predisposed individuals . JAMA . 1987;;258:3146-3154.
9 +
Gallagher R, Mc Lean D, Yang P, et al.  Suntan, sunburn, and pigmentation factors and the frequency of acquired melanocytic nevi in children . Arch Dermatol . 1990;;126:770-776.
10 +
Greene MH, Young TL, Clark WH.  Malignant melanoma in renal transplant recipients . Lancet . 1961;;1:1196-1199.
11 +
Ruiz-Maldonado R, Orozco-Covarrubias M.  Malignant melanoma in children . Arch Dermatol . 1997;;133:363-371.
12 +
Holly EA, Kelly JW, Shpall SN, et al.  Number of melanocytic nevi as a major risk factor for malignant melanoma . J Am Acad Dermatol . 1987;;17:459-468.
13 +
Armstrong BK, Kricker A.  How much melanoma is caused by sun exposure? Melanoma Res . 1993;;3:395-401.
14 +
Green A, Bain C.  Hormonal factors and melanoma in women . Med J Aust . 1985;;142:446-448.
15 +
Kjems E, Krag C.  Melanoma and pregnancy . Acta Oncol . 1993;;32:371-378.
16 +
Tucker MA, Halpern A, Holly EA, et al.  Clinically recognized dysplastic nevi: a central risk factor for cutaneous melanoma . JAMA . 1997;;277:1439-1444.
17 +
Roush GC, Norlund JJ, Forget B, et al.  Independence of dysplastic nevi from total nevi in determining risk for non-familial melanoma . Prev Med . 1988;;17:273-279.
18 +
Hussussian CJ, Strewing JP, Goldstein AM, et al.  Germline p16 mutations in familial melanoma . Nat Genet . 1994;;8:15-21.
19 +
Bale SJ, Draopoli N, Tucker, et al.  Mapping the gene for hereditary cutaneous malignant melanomadysplastic nevus to chromosome 1p . N Engl J Med . 1989;;320:1372.
20 +
Rigel DS, Rivers JK, Kopf AW, et al.  Dysplastic nevi . Cancer . 1989;;63:386-389.
21 +
Goldstein AM, Clark WH Jr, Fraser MC, Tucker MA.  Apparent anticipation in familial melanoma . Melanoma Res . 1996;;6:441-446.
22 +
Kopf AW, Hellman LJ, Rogers G, et al.  Familial malignant melanoma . JAMA . 1986;;256:1951-1959.
23 +
Tucker MA, Fraser MC, Goldstein AM, et al.  The risk of melanoma and other cancers in melanoma-prone families . J Invest Dermatol . 1993;;100:350s-355s.
24 +
Kraemer KH, Lee MM, Scotto J.  Xeroderma pigmentosum: cutaneous, ocular, and neurologic abnormalities in 830 published cases . Arch Dermatol . 1987;;123:241-250.
25 +
Osterlind A, Tucker MA, Stone BJ, Jensen OM.  The Danish case-control study of cutaneous malignant melanoma . Int J Cancer . 1988;;42:319-324.
26 +
Elwood JM.  Melanoma and sun exposure: contrasts between intermittent and chronic exposure . World J Surg . 1992;;16:157-166.
27 +
Williams M, Pennella R.  Melanoma, melanocytic nevi, and other melanoma risk factors in children . J Pediatr . 1994;;124:833-845.
28 +
Weinstock MA, Colditz GA, Willet WC, et al.  Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age . Pediatrics . 1989;;84:199-204.
29 +
Zanetti R, Franceschi S, Rosso S, Colonna S, Bidoli E.  Cutaneous melanoma and sunburns in childhood in southern European population . Eur J Cancer . 1992;;28:1172-1176.
30 +
Movshovitz M, Modan B.  Role of sun exposure in the etiology of malignant melanoma: epidemiologic influence . J Natl Cancer Inst . 1973;;51:777-779.
31 +
Holly EA, Aston DA, Cress RD, Ahn DK, Kristiansen JJ.  Cutaneous melanoma in women, I . Am J Epidemiol . 1995;;141:923-933.
32 +
Holman CDJ, Armstrong BD.  Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma . J Natl Cancer Inst . 1984;;72:257-266.
33 +
Beral V, Evans S, Shaw H, et al.  Cutaneous factors related to the risk of malignant melanoma . Br J Dermatol . 1983;;109:165-172.
34 +
MacKie RM, Freudenberger T, Aitchison TC.  Personal risk-factor chart for cutaneous melanoma . Lancet . 1989;;2:487-490.
35 +
Hachman H, Freeman SE, Gange RW, et al.  Do pyrimidine dimer yields correlate with erythema induction in human skin irradiated in situ with ultraviolet light (275-365 nm)? Photochem Photobiol . 1991;;53:559-563.
36 +
Stenback F.  Ultraviolet light radiation as initiating agent in skin tumor formation by the two stage method . Eur J Cancer . 1975;;11:241-246.
37 +
Naylor MF.  Erythema, skin cancer risk, and sunscreens . Arch Dermatol . 1997;;133:373-375.
38 +
Spencer JM, Amonette RA.  Indoor tanning . J Am Acad Dermatol . 1995;;33:288-298.
39 +
Gange RW, Blackett AD, Matzinger EA, et al.  Comparative protection efficacy of UVA- and UVB-induced tans against erythema and formation of endonucleasesensitive sites in DNA by UVB in human skin . J Invest Dermatol . 1985;;85:362-364.
40 +
Diffey BL, Farr PM.  Tanning with UVB or UVA: an appraisal of risks . J Photochem Photobiol B . 1991;;8:219-223.
41 +
Drobetsky EA, Turcotte J, Chateaneuf A.  A role for ultraviolet A in solar mutagenesis . Proc Natl Acad Sci U S A . 1995;;92:2350-2354.
42 +
Autier P, Joarlette M, Lejeune D, Andre J, Achten G.  Cutaneous malignant melanoma and exposure to sunlamps and sunbeds . Melanoma Res . 1991;;1:69-74.
43 +
Autier P, Dore JF, Lejeune F, et al.  Cutaneous malignant melanoma and exposure to sunlamps or sunbeds . Int J Cancer . 1994;;58:809-813.
44 +
Westerdahl J, Olsson H, Masback A, et al.  Use of sunbeds or sunlamps and malignant melanoma in southern Sweden . Am J Epidemiol . 1994;;140:691-699.
45 +
Stern RS, Nichols KT, Vareva LH.  Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA) . N Engl J Med . 1997;;356:1041-1046.
46 +
Granstein RD.  Photoimmunology . Semin Dermatol . 1990;;9:16-24.
47 +
Baird EA, McHenry PM, Mackie RM.  Effects of maintenance chemotherapy in childhood on numbers of melanocytic naevi . BMJ . 1992;;305:799-801.
48 +
Smith CH, McGregor JM, Barker JNWN, et al.  Excess melanocytic nevi in children with renal allografts . J Am Acad Dermatol . 1993;;28:51-55.
49 +
Greene MH.  Dysplastic nevus syndrome . Hosp Pract . 1984;;19:91-108.
50 +
Grob JJ, Bastuji-Garin S, Vaillant L, et al.  Excess of nevi related to immunodeficiency . J Invest Dermatol . 1996;;107:694-697.
51 +
Bouwes Bavinck JNB, Hardie DR, Green A, et al.  The risk of skin cancer in renal transplant recipients in Queensland, Australia . Transplantation . 1996;;61:715-721.
52 +
Gari LM, Rivers JK, Kopf AW.  Melanomas arising in large congenital nevocytic nevi: a prospective study . Pediatr Dermatol . 1988;;5:151-158.
53 +
Marghoob AA, Slade J, Salopek TG, et al.  Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma . Cancer . 1995;:75:707-714.
54 +
Berwick M, Begg CB, Fine JA.  Screening for cutaneous melanoma by skin self-examination . J Natl Cancer Inst . 1996;;88:17-23.
55 +
Whited JD, Hall RP, Simel DL, Horner RD.  Primary care clinicians' performance for detecting actinic keratosis and skin cancer . Arch Intern Med . 1997;;157:985-990.
56 +
Knable A, Hood AF, Pearson TG.  Undergraduate medical education in dermatology . J Am Acad Dermatol . 1997;;36:467-470.
57 +
Weinstock M, Goldstein M, Dube C, Rhodes A, Sober A.  Basic skin cancer triage for teaching melanoma education . J Am Acad Dermatol . 1996;;34:1063-1066.
58 +
Gerbert B, Maurer T, Berger T, et al.  Primary care physicians as gatekeepers in managed care . Arch Dermatol . 1996;;132:1030-1038.
59 +
Dolan NC, Jenny NG, Robinson JK, Rademaker AW. The effectiveness of a skin cancer control educational intervention for internal medicine housestaff and attending physicians. J Gen Intern Med. In press.
60 +
Friedman RJ, Rigel DS, Kopf AW.  Early detection of malignant melanoma . CA Cancer J Clin . 1985;;35:130-151.
61 +
Bartoli C, Bono A, Clemente C, et al.  Clinical diagnosis and therapy of cutaneous melanoma in situ . Cancer . 1996;;77:888-892.
62 +
Cascinelli N, Ferrario M, Tonelli T, et al.  A possible new tool for the clinical diagnosis of melanoma: the computer . J Am Acad Dermatol . 1987;;16:361-367.
63 +
Sober AJ, Fitzpatrick TB, Mihm MC, et al.  Early recognition of cutaneous melanoma . JAMA . 1979;;242:2795-2799.
64 +
Maize JC, Foster G.  Age-related changes in melanocytic nevi . Clin Exp Dermatol . 1979;;4:49-58.
65 +
Pennoyer JW, Grin C, Driscoll M, et al.  Changes in size of melanocytic nevi during pregnancy . J Am Acad Dermatol . 1997;;36:378-382.
66 +
Hanrahan PF, Hersey P, Menzies SW, Watson AB, D'Este CA.  Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions . Arch Dermatol . 1997;;133:301-311.
67 +
Menzies SW, Ingvar C, Crotty KA, McCarthy WH.  Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features . Arch Dermatol . 1996;;132:1178-1182.
68 +
Nachbar F, Stolz W, Merkle T, et al.  The ABCD rule of dermatoscopy . J Am Acad Dermatol . 1994;;30:551-559.
69 +
Robinson JK, Rademaker AW, Sylvester J, Cook B.  Summer sun exposure: knowledge, attitudes, and behaviors of midwest adolescents . Prev Med . 1997;;26:364-372.
70 +
Robinson JK, Rigel DS, Amonette R.  Trends in sun exposure knowledge, attitudes and behaviors: 1986-1996 . J Am Acad Dermatol . 1997;;37:179-186.
71 +
Goldsmith L, Koh HK, Bewerse BA, et al.  Proceedings from the Conference to Develop a National Skin Cancer Agenda: American Academy of Dermatology and Centers for Disease Control and Prevention, April 8-10, 1995, Washington, DC . J Am Acad Dermatol . 1996;;34:822-823.
72 +
Standards Australia and Standards of New Zealand. Sunscreen Products: Evaluation and Classification. Sydney: Government of Australia; 1997. Publication AS/ NZS 2064.
73 +
Elder DE, Clark WH, Elenitsas R, et al.  The early and intermediate precursor lesions of tumor progression in the melanocytic system: common acquired nevi and atypical (dysplastic) nevi . Semin Diagn Pathol . 1993;;10:18-35.
74 +
Koh HK, Norton LA, Geller AC, et al.  Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program . J Am Acad Dermatol . 1996;;34:971-978.
75 +
Leffell DJ, Chen YT, Berwick M, Bolognia JL.  Interobserver agreement in a community skin cancer screening setting . J Am Acad Dermatol . 1993;;28:1003-1005.
76 +
Kopf AW, Mintzis M, Bart RS.  Diagnostic accuracy in malignant melanoma . Arch Dermatol . 1975;;111:1291-1292.
77 +
Barnhill, RL, Roush GC, Ernstaff MS, Kirkwood JM.  Interclinician agreement on the recognition of selected gross morphologic features of pigmented lesions . J Am Acad Dermatol . 1992;;26:185-190.
78 +
Salopek TG, Slade JM, Marghoob AA, et al.  Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology, I . J Am Acad Dermatol . 1995;;33:441-450.
79 +
Salopek TG, Slade JM, Marghoob AA, et al.  Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology, II: definitive surgery for malignant melanoma . J Am Acad Dermatol . 1995;;33:451-461.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Rigel DS, Friedman RJ, Kopf AW.  The incidence of malignant melanoma in the United States . J Am Acad Dermatol . 1996;;34:839-847.
2 +
Cancer Facts and Figures-1997. Atlanta, Ga: American Cancer Society Inc; 1997.
3 +
Graham S, Marshall JB, et al.  An inquiry into the epidemiology of melanoma . Am J Epidemiol . 1985;;122:606-619.
4 +
Armstrong BK, Kricker A.  Cutaneous melanoma . Cancer Surv . 1994;;19-20:219-240.
5 +
Berg P, Lindelof B.  Differences in malignant melanoma between children and adolescents . Arch Dermatol . 1997;;133:295-297.
6 +
NIH Consensus Development Panel on Early Melanoma.  Diagnosis and treatment of early melanoma . JAMA . 1992;;268:1314-1319.
7 +
Greene MH, Clark WH Jr, Tucker MA.  The prospective diagnosis of malignant melanoma in a population at high risk . Ann Intern Med . 1985;;102:458-465.
8 +
Rhodes AR, Weinstock MA, Fitzpatrick TB, et al.  Risk factors for cutaneous melanoma: a practical method of recognizing predisposed individuals . JAMA . 1987;;258:3146-3154.
9 +
Gallagher R, Mc Lean D, Yang P, et al.  Suntan, sunburn, and pigmentation factors and the frequency of acquired melanocytic nevi in children . Arch Dermatol . 1990;;126:770-776.
10 +
Greene MH, Young TL, Clark WH.  Malignant melanoma in renal transplant recipients . Lancet . 1961;;1:1196-1199.
11 +
Ruiz-Maldonado R, Orozco-Covarrubias M.  Malignant melanoma in children . Arch Dermatol . 1997;;133:363-371.
12 +
Holly EA, Kelly JW, Shpall SN, et al.  Number of melanocytic nevi as a major risk factor for malignant melanoma . J Am Acad Dermatol . 1987;;17:459-468.
13 +
Armstrong BK, Kricker A.  How much melanoma is caused by sun exposure? Melanoma Res . 1993;;3:395-401.
14 +
Green A, Bain C.  Hormonal factors and melanoma in women . Med J Aust . 1985;;142:446-448.
15 +
Kjems E, Krag C.  Melanoma and pregnancy . Acta Oncol . 1993;;32:371-378.
16 +
Tucker MA, Halpern A, Holly EA, et al.  Clinically recognized dysplastic nevi: a central risk factor for cutaneous melanoma . JAMA . 1997;;277:1439-1444.
17 +
Roush GC, Norlund JJ, Forget B, et al.  Independence of dysplastic nevi from total nevi in determining risk for non-familial melanoma . Prev Med . 1988;;17:273-279.
18 +
Hussussian CJ, Strewing JP, Goldstein AM, et al.  Germline p16 mutations in familial melanoma . Nat Genet . 1994;;8:15-21.
19 +
Bale SJ, Draopoli N, Tucker, et al.  Mapping the gene for hereditary cutaneous malignant melanomadysplastic nevus to chromosome 1p . N Engl J Med . 1989;;320:1372.
20 +
Rigel DS, Rivers JK, Kopf AW, et al.  Dysplastic nevi . Cancer . 1989;;63:386-389.
21 +
Goldstein AM, Clark WH Jr, Fraser MC, Tucker MA.  Apparent anticipation in familial melanoma . Melanoma Res . 1996;;6:441-446.
22 +
Kopf AW, Hellman LJ, Rogers G, et al.  Familial malignant melanoma . JAMA . 1986;;256:1951-1959.
23 +
Tucker MA, Fraser MC, Goldstein AM, et al.  The risk of melanoma and other cancers in melanoma-prone families . J Invest Dermatol . 1993;;100:350s-355s.
24 +
Kraemer KH, Lee MM, Scotto J.  Xeroderma pigmentosum: cutaneous, ocular, and neurologic abnormalities in 830 published cases . Arch Dermatol . 1987;;123:241-250.
25 +
Osterlind A, Tucker MA, Stone BJ, Jensen OM.  The Danish case-control study of cutaneous malignant melanoma . Int J Cancer . 1988;;42:319-324.
26 +
Elwood JM.  Melanoma and sun exposure: contrasts between intermittent and chronic exposure . World J Surg . 1992;;16:157-166.
27 +
Williams M, Pennella R.  Melanoma, melanocytic nevi, and other melanoma risk factors in children . J Pediatr . 1994;;124:833-845.
28 +
Weinstock MA, Colditz GA, Willet WC, et al.  Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age . Pediatrics . 1989;;84:199-204.
29 +
Zanetti R, Franceschi S, Rosso S, Colonna S, Bidoli E.  Cutaneous melanoma and sunburns in childhood in southern European population . Eur J Cancer . 1992;;28:1172-1176.
30 +
Movshovitz M, Modan B.  Role of sun exposure in the etiology of malignant melanoma: epidemiologic influence . J Natl Cancer Inst . 1973;;51:777-779.
31 +
Holly EA, Aston DA, Cress RD, Ahn DK, Kristiansen JJ.  Cutaneous melanoma in women, I . Am J Epidemiol . 1995;;141:923-933.
32 +
Holman CDJ, Armstrong BD.  Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma . J Natl Cancer Inst . 1984;;72:257-266.
33 +
Beral V, Evans S, Shaw H, et al.  Cutaneous factors related to the risk of malignant melanoma . Br J Dermatol . 1983;;109:165-172.
34 +
MacKie RM, Freudenberger T, Aitchison TC.  Personal risk-factor chart for cutaneous melanoma . Lancet . 1989;;2:487-490.
35 +
Hachman H, Freeman SE, Gange RW, et al.  Do pyrimidine dimer yields correlate with erythema induction in human skin irradiated in situ with ultraviolet light (275-365 nm)? Photochem Photobiol . 1991;;53:559-563.
36 +
Stenback F.  Ultraviolet light radiation as initiating agent in skin tumor formation by the two stage method . Eur J Cancer . 1975;;11:241-246.
37 +
Naylor MF.  Erythema, skin cancer risk, and sunscreens . Arch Dermatol . 1997;;133:373-375.
38 +
Spencer JM, Amonette RA.  Indoor tanning . J Am Acad Dermatol . 1995;;33:288-298.
39 +
Gange RW, Blackett AD, Matzinger EA, et al.  Comparative protection efficacy of UVA- and UVB-induced tans against erythema and formation of endonucleasesensitive sites in DNA by UVB in human skin . J Invest Dermatol . 1985;;85:362-364.
40 +
Diffey BL, Farr PM.  Tanning with UVB or UVA: an appraisal of risks . J Photochem Photobiol B . 1991;;8:219-223.
41 +
Drobetsky EA, Turcotte J, Chateaneuf A.  A role for ultraviolet A in solar mutagenesis . Proc Natl Acad Sci U S A . 1995;;92:2350-2354.
42 +
Autier P, Joarlette M, Lejeune D, Andre J, Achten G.  Cutaneous malignant melanoma and exposure to sunlamps and sunbeds . Melanoma Res . 1991;;1:69-74.
43 +
Autier P, Dore JF, Lejeune F, et al.  Cutaneous malignant melanoma and exposure to sunlamps or sunbeds . Int J Cancer . 1994;;58:809-813.
44 +
Westerdahl J, Olsson H, Masback A, et al.  Use of sunbeds or sunlamps and malignant melanoma in southern Sweden . Am J Epidemiol . 1994;;140:691-699.
45 +
Stern RS, Nichols KT, Vareva LH.  Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA) . N Engl J Med . 1997;;356:1041-1046.
46 +
Granstein RD.  Photoimmunology . Semin Dermatol . 1990;;9:16-24.
47 +
Baird EA, McHenry PM, Mackie RM.  Effects of maintenance chemotherapy in childhood on numbers of melanocytic naevi . BMJ . 1992;;305:799-801.
48 +
Smith CH, McGregor JM, Barker JNWN, et al.  Excess melanocytic nevi in children with renal allografts . J Am Acad Dermatol . 1993;;28:51-55.
49 +
Greene MH.  Dysplastic nevus syndrome . Hosp Pract . 1984;;19:91-108.
50 +
Grob JJ, Bastuji-Garin S, Vaillant L, et al.  Excess of nevi related to immunodeficiency . J Invest Dermatol . 1996;;107:694-697.
51 +
Bouwes Bavinck JNB, Hardie DR, Green A, et al.  The risk of skin cancer in renal transplant recipients in Queensland, Australia . Transplantation . 1996;;61:715-721.
52 +
Gari LM, Rivers JK, Kopf AW.  Melanomas arising in large congenital nevocytic nevi: a prospective study . Pediatr Dermatol . 1988;;5:151-158.
53 +
Marghoob AA, Slade J, Salopek TG, et al.  Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma . Cancer . 1995;:75:707-714.
54 +
Berwick M, Begg CB, Fine JA.  Screening for cutaneous melanoma by skin self-examination . J Natl Cancer Inst . 1996;;88:17-23.
55 +
Whited JD, Hall RP, Simel DL, Horner RD.  Primary care clinicians' performance for detecting actinic keratosis and skin cancer . Arch Intern Med . 1997;;157:985-990.
56 +
Knable A, Hood AF, Pearson TG.  Undergraduate medical education in dermatology . J Am Acad Dermatol . 1997;;36:467-470.
57 +
Weinstock M, Goldstein M, Dube C, Rhodes A, Sober A.  Basic skin cancer triage for teaching melanoma education . J Am Acad Dermatol . 1996;;34:1063-1066.
58 +
Gerbert B, Maurer T, Berger T, et al.  Primary care physicians as gatekeepers in managed care . Arch Dermatol . 1996;;132:1030-1038.
59 +
Dolan NC, Jenny NG, Robinson JK, Rademaker AW. The effectiveness of a skin cancer control educational intervention for internal medicine housestaff and attending physicians. J Gen Intern Med. In press.
60 +
Friedman RJ, Rigel DS, Kopf AW.  Early detection of malignant melanoma . CA Cancer J Clin . 1985;;35:130-151.
61 +
Bartoli C, Bono A, Clemente C, et al.  Clinical diagnosis and therapy of cutaneous melanoma in situ . Cancer . 1996;;77:888-892.
62 +
Cascinelli N, Ferrario M, Tonelli T, et al.  A possible new tool for the clinical diagnosis of melanoma: the computer . J Am Acad Dermatol . 1987;;16:361-367.
63 +
Sober AJ, Fitzpatrick TB, Mihm MC, et al.  Early recognition of cutaneous melanoma . JAMA . 1979;;242:2795-2799.
64 +
Maize JC, Foster G.  Age-related changes in melanocytic nevi . Clin Exp Dermatol . 1979;;4:49-58.
65 +
Pennoyer JW, Grin C, Driscoll M, et al.  Changes in size of melanocytic nevi during pregnancy . J Am Acad Dermatol . 1997;;36:378-382.
66 +
Hanrahan PF, Hersey P, Menzies SW, Watson AB, D'Este CA.  Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions . Arch Dermatol . 1997;;133:301-311.
67 +
Menzies SW, Ingvar C, Crotty KA, McCarthy WH.  Frequency and morphologic characteristics of invasive melanomas lacking specific surface microscopic features . Arch Dermatol . 1996;;132:1178-1182.
68 +
Nachbar F, Stolz W, Merkle T, et al.  The ABCD rule of dermatoscopy . J Am Acad Dermatol . 1994;;30:551-559.
69 +
Robinson JK, Rademaker AW, Sylvester J, Cook B.  Summer sun exposure: knowledge, attitudes, and behaviors of midwest adolescents . Prev Med . 1997;;26:364-372.
70 +
Robinson JK, Rigel DS, Amonette R.  Trends in sun exposure knowledge, attitudes and behaviors: 1986-1996 . J Am Acad Dermatol . 1997;;37:179-186.
71 +
Goldsmith L, Koh HK, Bewerse BA, et al.  Proceedings from the Conference to Develop a National Skin Cancer Agenda: American Academy of Dermatology and Centers for Disease Control and Prevention, April 8-10, 1995, Washington, DC . J Am Acad Dermatol . 1996;;34:822-823.
72 +
Standards Australia and Standards of New Zealand. Sunscreen Products: Evaluation and Classification. Sydney: Government of Australia; 1997. Publication AS/ NZS 2064.
73 +
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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