Journal of the American Academy of Dermatology

502 Pearls of wisdom March 1996

ning bed usage. The tanning bed used contained less than
1% UVB.
COMMENT: This case is unique because of the minimal
exposure to natural light throughout this woman's life.
The UVA tanning bed is strongly implicated in the
development of her skin cancer.
Jeffrey P. CalIen, MD
matched for major prognostic factors. In patients with in-
termediate-thickness melanoma treated with ELND, there
was no significant improvement in survival; the risk of
nodal metastases was not relatively more common than
that of distant metastases.
Elizabeth A. Abel, MD

The Rieger flap for nasal reconstruction

Johnson TM, N A Swanson NA, Baker SR, et al.
Surgical management of regional lymph nodes
Arch Otolaryngol Head Neck Surg 1995;121:634-7.
in patients with melanoma: experience with
4682 patients Reconstruction of the nose has well-known complica-
Slingluff CL, Stidham KR, Ricci WM, et al. Ann tions, including contouring, color and consistency match,
Surg 1994;219:120. texture, cosmetic deformity, and function. The authors
succinctly outline the uses of this flap and the surgical
Elective lymph node dissection (ELND) was per- techniques to get the best results.
formed in 911 of 3550 patients with melanoma who had
COMME~: This excellent article expands the uses of this
clinically negative lymph nodes. The incidence of patho-
flap in nasal reconstruction and should contribute signif-
logically positive nodes in the five melanoma thickness
icantly to cosmetic surgical repah's.
groups was: 0 (tumor thickness, 0.76 ram), 5% (0.76 to
1.5 mm), 16% (1.5 to 2.5 mm), 24% (2.5 to 4.0 mm), and Mary E. Maloney, MD
36% (>4 ram). Patients with clinically negative nodes
treated with and without ELND were compared and

IOTADERMA

No. 26. In Halzoun syndrome, what parasite migrates to the nasopharynx, produces large adults
that block the airways, and causes deafness and facial edema?
Jeffrey D. Bernhard, MD

Answer will appear in the April issue of the Jotma'4AL.

ANSWER TO IOTADERMA NO. 25:

Morton's neuroma. (Question: In what condition can pain and paresthesias of the forefoot that
occur during standing or walking be relieved by sitting and taking off the shoes?)

REFERENCE
Wiener SL. Differentialdiagnosis of acute pain by body region. New York: McGraw-Hill, 1993:694-5.