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Biomedical subjects

A P Dorevitch

Publications and source records attributed to A P Dorevitch.

15 recordsLinked to original sources
PubMed1997

Who removes pigmented skin lesions?

BACKGROUND: Increasing numbers of pigmented skin lesions are being removed because of concern about possible malignancy. OBJECTIVE: Our purpose was to determine the ratio of benign to malignant pigmented tumors removed by different categories of physician and to verify whether any improvement had occurred after 5 years of educational programs. METHODS: All pigmented lesions submitted to a major histopathology service in the years 1989 and 1994 were assessed as to the category of physician who removed the lesion, tumor type, and age and sex of the patient. RESULTS: Dermatologists had the lowest benign/malignant ratio and general practitioners had the highest. General practitioners appeared to have difficulty differentiating both seborrheic keratoses and melanocytic nevi from malignant lesions; the frequency of these benign lesions was highly dependent on the age of the patient. During the 5-year period we observed an improvement among general practitioners in the benign/malignant ratio for melanocytic nevi, but not for seborrheic keratoses. CONCLUSION: There is room for improvement by physicians in differentiating both melanocytic nevi and seborrheic keratoses from melanomas. This is especially true for general practitioners, from whom the public in Australia and in other countries is encouraged to first seek advice about a suspect pigmented lesion.

Adult↗
PubMed1997

Differences in age and body site distribution of the histological subtypes of basal cell carcinoma. A possible indicator of differing causes.

OBJECTIVE: To assess if there are any significant differences in the sex, anatomical site, and age distribution of patients with different histological subtypes of basal cell carcinoma (BCC). DESIGN: Histopathology reports were analyzed with respect to the subtype of BCC, site of a tumor, and age and sex of a patient. SETTING: Histopathology reports were reviewed from 1 private laboratory that derived its cases from general practitioners, surgeons, and dermatologists. PATIENTS: Patients with BCC (N = 3885) for whom case data were received by the pathology laboratory from January 2, 1991, to June 12, 1991, were included in the study. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Superficial BCCs differed from other subtypes of BCC by occurring more commonly on the trunk and in younger patients. RESULTS: The mean age (56.8 years) of the patients with superficial BCCs was significantly lower than that of the patients with other subtypes of BCC who were examined (P < .001); the mean ages of the patients with these other subtypes were as follows: nodulosuperficial BCC, 62.9 years; nodular BCC, 63.9 years; nodulomorpheic BCC, 66.1 years; and morpheic BCC, 66.0 years. The majority of superficial BCCs occurred on the trunk and limbs (73.3%), while the majority of all other subtypes occurred on the head and neck. CONCLUSIONS: Superficial BCC differs from the other subtypes of BCC in terms of patient age and tumor site, and these findings may reflect differences in the etiology.

Adolescent↗
PubMed1990

Do all melanomas come from "moles"? A study of the histological association between melanocytic naevi and melanoma.

Histological examination of 1101 melanomas (990 superficial spreading and 111 nodular melanomas) from 1098 people revealed that 23.3% showed an associated melanocytic naevus. Of these, 56.5% were classified histologically as common acquired, 37.7% as dysplastic and 5.8% as congenital. Of the superficial spreading melanomas, 25.7% showed an associated naevus. By contrast, only 2.7% of nodular melanomas showed histological evidence of a coexisting naevus. When the superficial spreading melanomas were analysed by level, the presence of a naevus varied from 31.3% of level I melanomas to 21.3% of level IV melanomas. When thickness was measured, an associated naevus was found in 27.0% of superficial spreading melanomas less than 1.0 mm thick, and 14.8% of melanomas with a thickness of 1.0 mm or greater. These data suggest that most melanomas do not arise in pre-existing naevi, and accordingly public educational programs for the early detection of melanoma should focus on looking for changes in previously normal skin as well as in pre-existing moles.

Female↗
PubMed1989

The incidence of non-melanocytic skin cancers in an Australian population: results of a five-year prospective study.

Two thousand, six hundred and sixty-nine persons who were aged 40 years and older attended for examination of the light-exposed areas of the head and neck, forearms and dorsa of the hands during a skin-cancer survey of the population of Maryborough, which was conducted annually for five years from 1982-1986 inclusive. Sixty (2.25%) persons--12 persons each with a squamous-cell carcinoma and 48 persons with a total of 51 basal-cell carcinomas--had at least one non-melanocytic skin cancer at the first examination. One thousand, nine hundred and eighty-one (74% of the study population) persons were seen on more than one occasion, which allowed for 6288 person-years of follow-up for the determination of the incidence of new cancers. The findings showed a calculated minimal age-standardized incidence rate of 873 non-melanocytic skin cancers/100,000 population each year. The minimal incidence rate for basal-cell carcinomas was 672 cases/100,000 population each year and for squamous-cell carcinomas was 201 cases/100,000 population each year. The rate ratio of the incidence of basal-cell carcinomas to that of squamous-cell carcinomas was 3.34 to one. Age, sex, skin reaction to sunlight and occupation all were significant factors in the determination of the risk of developing non-melanocytic skin cancers. The enormous costs that are involved in the treatment of non-melanocytic skin cancers and related lesions suggest that more time, effort and money need to be spent to reduce what has become a major public-health problem in Australia.

Adult↗
PubMed1987

Lupus and non-lupus cutaneous manifestations in systemic lupus erythematosus.

Mucocutaneous manifestations occur frequently in systemic lupus erythematosus (SLE). Common non-lupus dermatoses may be confused with lupus rashes, with important clinical consequences. A study of 84 consecutive patients with SLE was performed to determine the comparative frequency of lupus and non-lupus mucocutaneous abnormalities, the comparative sensitivity of routine histology and immunofluorescence in the diagnosis of lupus rashes, and the association of skin manifestations with other clinical and serological features. Thirty-five patients had dermatoses attributable to SLE (mean 3.7 per patient) and 58 had dermatoses which were not directly attributable to SLE (mean 2.1 per patient), highlighting the need for accurate diagnosis of skin rashes in SLE patients. Routine histology confirmed the clinical diagnosis of typical cutaneous lupus in 100% of malar lupus rashes and in approximately 90% of subacute cutaneous and discoid lupus rashes. Direct immunofluorescence of the affected skin provided supportive evidence of cutaneous lupus in 60% of malar lupus rashes and approximately 50% of subacute cutaneous and discoid lupus rashes. This reaffirmed the poor sensitivity of immunofluorescence, compared with routine histology, in the diagnosis of lupus rashes. The association of subacute cutaneous lupus with anti-Ro antibodies was confirmed.

Biopsy↗
PubMed1986

Squamous cell carcinoma of the skin. Accuracy of clinical diagnosis and outcome of follow-up in Australia.

The accuracy of the clinical diagnosis of 1292 non-melanotic skin tumours that were submitted to a private pathology service in 1980-1981 was determined. The clinical diagnosis that was written on the pathology slip which was submitted with the tumour was correlated with the histological diagnosis and the type of medical practitioner submitting the lesion. The clinical diagnosis was most accurate in the case of basal cell carcinoma; dermatologists most often reached this diagnosis correctly. For squamous cell carcinoma, although most frequently the lesions were diagnosed correctly clinically by dermatologists, their clinical diagnosis was confirmed in only 51% of cases. On average, 36% of squamous cell carcinomas were diagnosed clinically as basal cell carcinomas. The clinical course of 299 patients with a total of 305 squamous cell carcinomas that were selected from the squamous cell carcinomas that were submitted in 1980-1981 was traced. Four tumours (1.6%) which occurred in sun-exposed areas of the body metastasized, and 18 (7.5%) recurred locally. We conclude that those non-melanotic skin tumours which have the most potential to metastasize (squamous cell carcinomas) are those which are most poorly diagnosed clinically. It is recommended that patients with non-melanotic skin cancers should undergo biopsy as a routine to confirm the clinical diagnosis. Those who have a squamous cell carcinoma removed should be followed up for at least two years after the initial treatment.

Adult↗
PubMed1981

Rational use of psychoactive drugs in the geriatric patient.

It is impossible in an article such as this to present every aspect of psychopharmacology for the geriatric patient. Pharmacists occupy a unique position in the health care system that enables them to monitor and provide input into the pharmacotherapy of the elderly. The reader is encouraged to maintain competency in this important area of practice. Only by diligent attention to the problems experienced by the geriatric patient can we produce a framework of knowledge upon which to make rational therapeutic decisions.

Aged↗