722 Letters

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better appreciate the surface primary morphology of lesionsand we are fairly confident that most readers will agree that a magnifying lens is not normally thought of as a technological device. The use of a magnifying lens and a dermatoscope is considered by many dermatologists to be an integral component of a thorough clinical examination of pigmented lesions. Second, the melanoma misdiagnosis that we reported2 was not, as stated by Dr Flaxman, caused by dermatoscopic findings superseding clinical judgment. It was quite the contrary. Based on the patients history, a clinical inspection of the lesion with a magnifying lens, palpation of the lesion, and examination of the rest of the patients skin (the patient had many seborrheic keratoses [SKs]), it was the clinicians opinion that the lesion was probably a SK. To confirm this clinical impression, the clinician subsequently evaluated the dermatoscopic primary morphology of the lesion and found it to be indeed consistent with a SK. In retrospect, the dermatoscopic evaluation was an opportunity to raise a red ag that the lesion was suspicious. Why was this opportunity missed? The main message of our case report was to highlight errors of perception resulting in the incorrect interpretation of dermatoscopic images. This error may have resulted in the incorrect dermatoscopic conrmation (ie, search satisfaction error) of the clinicians naked eye impression (ie, anchoring bias) that the lesion was indeed a SK. Had the dermatoscopic image been interpreted with an unbiased eye, the clinicians index of suspicion should have been heightened, prompting a biopsy. Lastly, whether all dermatologists would have made in this case the correct clinical diagnosis of melanoma in the predermatoscopy era remains a matter for speculation. However, this case should, if anything, reinforce the benets of dermatoscopy in the clinical evaluation of lesions. Had the dermatoscopic view been interpreted correctly, it may have rescued the clinician from the incorrect clinical diagnosis of a SK. Juliana C. Braga, MD, Alon Scope, MD, and Ashfaq A. Marghoob, MD Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York Funding sources: None. Conicts of interest: None declared. Correspondence to: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St, 2nd oor, New York, NY 10022 E-mail: marghooa@mskcc.org

REFERENCES 1. Gachon J, Beaulieu P, Sei JF, Gouvernet J, Claudel JP, Lemaitre M, et al. First prospective study of the recognition process of melanoma in dermatological practice. Arch Dermatol 2005;141:434-8. 2. Braga JC, Scope A, Klaz I, Mecca P, Spencer P, Marghoob R. Melanoma mimicking seborrheic keratosis: an error of perception precluding correct dermoscopic diagnosis. J Am Acad Dermatol 2008;58:875-80. doi:10.1016/j.jaad.2008.06.002

Renements of the classication of polymorphic eruption of pregnancy To the Editor: I was interested to read the January 2008 article by Regnier et al1 of a further study of polymorphic eruption of pregnancy (PEP) which confirms a tendency to male fetuses and delivery by caesarean section in the PEP group. Our original classication2 proposed a much simpler terminology for the specific dermatoses of pregnancy. Unfortunately, Regnier et al1 made an error in their opening paragraph about our classification. We never included early onset prurigo of pregnancy3 or Spanglers papular dermatitis4 under the term PEP. Early onset prurigo of pregnancy3 clearly equates to prurigo gestationis of Besnier and now is classified as atopic eruption of pregnancy.5 Spanglers papular dermatitis4 was doubted by us to be a separate entity,2 and as a result of further studies has been shown to not exist,6 so we recommended that the term be abandoned. Martin M. Black, MD Department of Dermatological Immunopathology, St Johns Institute of Dermatology, St Thomas Hospital, London Funding sources: None. Conicts of interest: None declared. Correspondence to: Martin M. Black, MD, Emeritus Professor of Dermatological Immunopathology, St Johns Institute of Dermatology, St Thomas Hospital, Lambeth Palace Rd, London SE1 7EH, United Kingdom E-mail: munroblack@hotmail.co.uk
REFERENCES 1. Regnier S, Fermand V, Levy P, Uzan S, Aractingi S. A casecontrol study of polymorphic eruption of pregnancy. J Am Acad Dermatol 2008;58:63-7. 2. Holmes RC, Black MM. The specific dermatoses of pregnancy. J Am Acad Dermatol 1983;8:405-12. 3. Nurse DS. Prurigo of pregnancy. Australas J Dermatol 1968;9:258-67.

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4. Spangler AS, Reddy W, Bardawil WA, Roby CC, Emerson K. Papular dermatitis of pregnancy. A new clinical entity? JAMA 1962;181:577-81. 5. Ambros-Rudolph CM, Mullegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-centre study on 505 pregnant patients. J Am Acad Dermatol 2006;54:395-404. 6. Vaughan Jones SA, Hern S, Nelson-Piercy C, Seed PT, Black MM. A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles. Br J Dermatol 1999;141:71-81. doi:10.1016/j.jaad.2008.05.040

Reinterpreting the fate of manuscripts declined by the Journal of the American Academy of Dermatology To the Editor: In the October 2008 issue of the Journal of the American Academy of Dermatology (JAAD), Armstrong et al1 described the fate of 489 manuscripts declined by the JAAD and provided a table of the 10 journals that most frequently published these manuscripts. We update this data and add information on an alternative impact measure (h-index) and journal page charges (Table I).2-4 H-index is dened as the number (n) of journal articles that a journal has published that have been referenced at least n times (ie, to obtain an h-index of 10 [n = 10], a journal needs to have published 10 articles that have been cited at least 10 times). Unless otherwise specied, h-index calculations do not limit articles or citations to a specied time period. The h-index is an alternative journal impact measure that more closely reects our intuitions

regarding top journals than impact factor (IF). For example, the journal with the highest impact factor in 2006 was CA: A Cancer Journal for Clinicians (IF = 63; h-index = 51)while the journal with the highest h-index was Nature (IF = 27; h-index = 476).2,4 We feel intuitively more comfortable ascribing a higher impact to Nature than CA: A Cancer Journal for Clinicians (as reflected by the h-index but not IF scores). H-index has the added advantage of being available free of charge for more dermatology journals (in the category of dermatology journals, 104 have h-indices ratings and 39 have IFs).4 Using h-index causes a radically different interpretation for Armstrong et als results, because the JAAD has the highest journal h-index of any dermatology journal (Table II).4 Therefore, all declined articles were published in dermatology journals with lesser impacts than the JAAD when the results are interpreted using h-index as the measure of journal impact. Page charges for accepted publications may affect author submission choices. Only two of the journals, Acta Dermatologica Venereologica and Journal of Dermatology, had page charges (in Euros and yen, respectively). The preferred currency for these page charges also prompts us to wonder whether the European and Japanese geographic locations of author affiliations are correlated with submission to these respective journals. Robert P. Dellavalle, MD, PhD, MSPH,a,b and Cameron Harrison, MDc

Table I. Ten journals that most frequently published manuscripts declined by the JAAD*
Rank by no. of manuscripts Journal No. of manuscripts 2006 impact factor Journal h-indexy Page charges

Referent 1 2 3 4 5 6 7 7 7 7

(tied) (tied) (tied) (tied)

JAAD Clin Exp Dermatol J Eur Acad Dermatol Venereol Int J Dermatol Br J Dermatol Acta Derm Venereol Arch Dermatol Dermatol Online J Dermatol Surg J Dermatol J Drugs Dermatol

24 20 17 15 11 9 8 8 8 8

2.6 1.3 1.5 1.0 3.3 1.8 2.9 N/A 2.3 0.6 N/A

82 29 26 32 66 32 73 11 48 23 N/A

None None None None None 40 Euros per page None None None 5000 yen per page None

*Adopted from Armstrong et al1 (Table I). y Derived using the Scopus database (see info.scopus.com). The Scopus database includes articles from more than 15,000 peer-reviewed journals, 4000 publishers, 1200 open access journals, 500 conference proceedings, 600 trade publications, and 200 book series. All article types and their references are included. The database contained all references for the articles from March 2007 to 1996 and some references before 1996 when this measure was calculated.