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To the Editor The study by Wolf et al1 highlights the low accuracy of smartphone applications for melanoma self-detection, and correctly concludes that these applications could harm patients by delaying melanoma treatment through incorrect diagnosis. The article also found 98% sensitivity with 30.4% specificity for pigmented lesion evaluation by store-and-forward teledermatology. We question whether the teledermatology results can be reproduced in a real-world setting.

Acanthosis nigricans (AN) is so closely linked with insulin resistance (IR) that it has been called a clinical surrogate for laboratory-determined hyperinsulinemia.1 The presence of AN can therefore indicate patients with IR, allowing implementation of interventions that may prevent progression to type 2 diabetes mellitus.2 We report 30 patients who presented with elevated body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) to correlate IR with different AN physical findings.