When examining skin, pay particular attention to any “ugly duckling” lesion that does not match the others; this is the one to watch, remove or treat. I have found this tip especially helpful in individuals with an abundance of moles, freckles, or other skin lesions. — Michelle Owens, FNP, New Ulm, Minn. (177-6)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.