Satellitosis/in-transit metastasis (S-ITM) has prognostic value in melanoma and Merkel cell carcinoma, but is not incorporated into cutaneous squamous cell carcinoma (cSCC) staging.
From our ...IRB-approved registry, patients with high-risk cSCC, including patients with S-ITM, were identified. Univariate (UVA) and multivariate (MVA) analyses were performed to compare disease progression (DP) and overall survival (OS). Cumulative incidence of DP and OS analyses were performed using Fine-Gray and Kaplan-Meier methods, respectively.
A total of 18 S-ITM subjects were compared to 247 high risk subjects including T3N0 (n=143), N1-N3 without extranodal extension (ENE) (n=56), N1-N3 with ENE (n=26) and M1 disease (n=22). Median follow up was 16.5 months. Three-year rates of DP were 22% for T3N0, 42% for S-ITM, 48% for T4 bone invasion, 50% for N1-N3 without extranodal extension (ENE), 53% for N1-N3 with ENE, and 66% for M1. Patients with S-ITM did not experience significantly worse DP compared to those with T3N0 (HR=1.96, 95%CI=0.8-4.9; p=0.14).
Cutaneous SCC patients with S-ITM experienced outcomes similar to locally advanced non-metastatic cSCC patients. Larger studies are needed to guide incorporation into staging systems.
Klippel–Trenaunay syndrome is characterized by a triad of varicose veins, cutaneous capillary malformation, and hypertrophy of bone and soft tissue. Appropriate evaluation and treatment of children ...displaying features of the disease may minimize morbidity. The clinical appearance, etiology, genetics, diagnostics, and treatment of Klippel–Trenaunay syndrome are herein explored.
Flaps and grafts reconstruction Zhang, Alexandra Y; Meine, Jon G
Dermatologic clinics,
04/2011, Letnik:
29, Številka:
2
Journal Article
Recenzirano
Reconstruction of Mohs surgical defects is a challenging venture. A thorough understanding of skin physiology and anatomy (cosmetic subunits, relaxed skin tension lines, underlying neurovascular ...structures at risk, potential functional compromise, character of adjacent skin, and so forth), careful wound analysis, and meticulous operative techniques is key to a successful reconstruction. This article discusses in detail the use of local skin flaps and graft reconstruction.
A 38-year-old man presented with a slow-growing, firm cutaneous mass beneath his left eyebrow. Histopathology and immunohistochemistry confirmed the diagnosis of dermatofibrosarcoma protuberans. The ...mass infiltrated the medial canthal tendon and anterior orbital fat and could not be completely excised with Mohs micrographic surgery. The patient underwent exenteration and dacryocystectomy with margin-controlled excision and remained free of disease 9 months after surgery. To our knowledge, no prior case of primary dermatofibrosarcoma protuberans involving the orbit has been reported.
Background Malignant melanoma presenting on the umbilicus is rare. Treatment of melanoma on the umbilicus is difficult because of the unusual anatomy of the umbilicus.
Objective To present the case ...of a patient with a primary malignant melanoma of the umbilicus and to discuss treatment concerns that are relevant to the umbilical anatomy.
Methods This is a case report as well as a review of the pertinent anatomy.
Results The initial excision was read as having clear deep and lateral margins on histopathologic examination. Postoperative complications led to a re‐excision down to and including the umbilical attachment to the peritoneum. The re‐excision revealed residual primary cutaneous malignant melanoma in a remnant umbilical cyst.
Conclusion When a malignant melanoma is located on the vertical sidewall or bottom of the umbilicus, one should consider surgical excision down to peritoneum, including the umbilical attachment to the peritoneum. Because this is beyond the scope of training for most dermatologic surgeons, it would be appropriate to refer these patients to a surgical oncologist or a plastic surgeon.
Background. Telangiectases are cosmetically concerning for millions of individuals who develop them on the face as they mature. The causative factors are numerous. Lasers have recently become the ...focus for treating small facial telangiectases because of their ability to selectively target vessels.
Objective. The purpose of this study was to compare the efficacy of four different frequency‐doubled neodymium:yttrium‐aluminum‐garnet (FD Nd:YAG) laser (532 nm) systems for the treatment of facial arteriolar telangiectases.
Methods. Forty adult subjects with Fitzpatrick skin phenotypes I and II were randomly assigned to four treatment groups. Each group, consisting of 10 subjects, had telangiectases less than 1000 μm in diameter treated with one of four different FD Nd:YAG laser systems with a wavelength of 532 nm. Patients were treated once and clinical improvement and potential adverse effects were assessed at 1 and 8 weeks after treatment.
Results. All treated patients showed improvement after one laser session. No patients were seen to have scarring or pigmentary changes. There was no significant difference in the clinical response following treatment with each laser.
Conclusion. The four different FD Nd:YAG lasers performed equally well in treating facial telangiectases. With a wavelength of 532 nm and pulse durations in the millisecond range, vessels can be selectively targeted with a minimal incidence of post‐operative complications.
background. The Erbium (Er):YAG laser represents a new laser approach for the treatment of rhytids and photodamaged skin. Because the Er:YAG laser's 2940‐nm wavelength is at the peak of water ...absorption, this laser produces minimal thermal damage.
objective. To document the Er:YAG laser's efficacy in the treatment of neck rhytids.
methods. Ten patients with neck rhytids were treated with the Er:YAG laser. All individuals were evaluated for clinical improvement, scarring, and pigmentary changes.
results. All patients showed fair to excellent results with no scarring or pigmentary changes at 6 months.
conclusion. The Er:YAG laser may be used to improve non‐facial photodamaged skin.
Klippel-Trenaunay syndrome is characterized by a triad of varicose veins, cutaneous capillary malformation, and hypertrophy of bone and soft tissue. Appropriate evaluation and treatment of children ...displaying features of the disease may minimize morbidity. The clinical appearance, etiology, genetics, diagnostics, and treatment of Klippel-Trenaunay syndrome are herein explored.
13C solid-state nuclear magnetic resonance at natural abundance was used to study isolated corneocyte envelopes from porcine stratum corneum. The presence of lipids covalently attached to the protein ...envelopes was detected by chemical shifts of methylene and methyl groups of the bound lipids. The corneocyte protein envelopes are rigid, as suggested by efficient 1H to13C cross polarization and 13C spin-lattice relaxation studies. The chemical shift of the carbonyl carbons of the protein envelopes supports the prediction that the chemically bound lipid envelope is attached to proteins arranged predominantly in the β-sheet conformation, allowing a dense palisade of ceramide molecules to form a water- impermeable external sheath.
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