Except for minor differences, our results are in agreement with published data on pemphigus regarding sex, age, and clinical presentation. According to our results, male sex is a predictor of poor prognosis as it is associated with poorer response to treatment and a higher rate of adverse effects and hospital admission.

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Correlation of the growth rate of melanoma with the temporal appearance of metastasis Editor In our daily clinical practice, we see that melanomas grow at different speeds. Following resection of the primary tumour, some tumours recur within a few months whereas others reappear several years later. The growth rate (GR) of a melanoma, calculated from the thickness of the lesion and its period of evolution as provided by the patient, is the only tool currently available to estimate this speed. 1 A rapid GR is related with a more aggressive phenotype of melanoma as well as with male gender and older persons. 2 GR has also been shown to be an independent prognostic factor for overall survival, 3 and is directly related with the temporal appearance of systemic metastasis and the death of the patient.From a retrospective historical cohort of 416 patients with localized melanoma (levels I and II) seen at the Dermatology Department of the Virgen de la Victoria hospital in Malaga, Spain, between 1990 and 2004, we studied those cases that developed systemic metastasis leading to death (N = 31 patients). The patients were grouped according to the GR of their tumours. For each group, data were collected on the means of three different time intervals: (i) time of clinical evolution of the lesion from its appearance as noticed by the patient to excision, (ii) the clinical appearance of systemic metastasis and (iii) date of patient death.Representation of the melanomas according to their GR ( Fig. 1) showed that the period of evolution until excision was inversely proportional to the growth rate. Thus, this period was just 4.6 months for melanomas with a GR > 1.01 mm per month, 22 months for melanomas with a GR of 0.11-0.3 mm per month, 15.6 months for melanomas with a GR of 0.31-0.5 mm per month, 8.4 months for melanomas with a GR of 0.51-1 mm per month and 76.8 months for melanomas with a GR < 0.1 mm per month.Systemic metastasis appeared earlier the faster the melanoma grew. Thus, for melanomas with a GR of > 1.01 mm per month the metastasis appeared after 10.2 months, 30.3 months for melanomas with a GR of 0.51-1 mm per month, 36.6 months for melanomas with a GR of 0.31-0.5 mm per month, 39 months for melanomas with a GR of 0.11-0.3 mm per month, and 113.8 months for melanomas with a GR < 0.1 mm per month.The information obtained from the clinical history provided a wider view of the evolution of a melanoma since the time it became visible. The GR, although it is subjectively based on the References 1 Scott JC, Wright DJM, Cutler SJ. Typing African relapsing fever spirochetes. Emerg Infect Dis 2005; 11: 1722-1729.Figure 1 Erythema migrans of the right thigh.

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