bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Factors in Thin Cutaneous Malignant Melanoma
Authors: SALMAN SALAH M. , ROGERS GARY S.
Published: June 2013

Abstract. A small subset of patients with thin (<0.76 mm thick) primary cutaneous malignant melanomas develop metastases. Features that may help differentiate higher and lower risk lesions in this thickness range are reported to include the patient's age and sex, anatomic site and diameter of the primary lesion, Clark level of invasion, development of a vertical growth phase, the mitotic index, ulceration, regression, and cellular aneuploidy. In this report, we review the literature regarding the significance of these factors on the patient's prognosis.
Rapid Instrument Sterilization
Authors: POLLACK SHELDON V.
Published: June 2013

Abstract. A rapid dry heat sterilization system has been found to be an effective alternative to other popular methods for assuring instrument sterility. Unpackaged instruments can be sterilized in as little as 6 minutes. This system would be of particular value to the dermatologist who performs a minimal amount of surgery or maintains only a small inventory of surgical instruments.
Method of Minimizing Hemorrhage in Excising Hemangioma
Authors: HARAHAP MARWALI , SIREGAR ARIFIN S.
Published: June 2013

Abstract. Subtotal excision of hemangioma may be indicated to improve contour and minimize body image distortion. A method has been employed to minimize intraoperative hemorrhage. The surgical excision is easily accomplished by using hemostatic sutures. The method is described.
Conservative Approach to the Treatment of Chemotherapy‐Induced Extravasation
Authors: TSAVARIS N.B. , KARAGIAOURIS P. , TZANNOU I. , KOMITSOPOULOU P. , BACOYIANNIS C. , KARABELLIS A. , PAPANICOLAOU V. , MYLONAKIS N. , KARVOUNIS N. , ZOANNOU A. , KOSMIDIS P.
Published: June 2013

Abstract. One of the local complications of certain chemotherapeutic agents is tissue necrosis resulting from extravasation. The purpose of this study was to evaluate the effectiveness of a conservative approach to treatment in order to minimize necrosis and the need for reconstructive surgery. Fifty‐three patients entered this study. Twenty‐one had old lesions while 32 had recent extravasations. Drugs responsible for the extravasations were doxorubicin, epirubicin, vinblastine, mitoxantrone, and mitomycin C. The basis of treatment was betamethasone ointment, which was applied to the lesion with a tight elastic bandage and was replaced every 12 hours for the first 2 days and then every 24 hours until complete healing. For old lesions a keratolytic ointment was initially applied, whereas in the new lesions multiple subcutaneous injections with hydrocortisone solution preceded the application of betamethasone ointment. None of our patients developed tissue necrosis and sloughing that necessitated surgery. All lesions healed in patients. Healing time varied with the different drugs used and was proportional to the extension of extravasation and to the time when therapy was begun. We conclude that the application of conservative measures in extravasated areas from chemotherapy may avoid tissue necrosis and reconstructive surgery.
Suture Tensor
Authors: WEBER PAUL J. , DZUBOW LEONARD M. , WULC ALLAN E.
Published: June 2013

Abstract. The suture tensor is a simple stainless steel device that pulls the ends of a running subcuticular suture in opposite directions, maintaining the desired closure. The benefits of the use of this device may include minimization of train‐track and excisional scarification (via the enhanced maintenance of “tenting”), time savings, and flexibility and durability for the sporting or physically active patient.
Does a History of Melanoma Correlate with the Clinical Presentation of Dysplastic Nevi?
Authors: GOLDMAN RHONDA J. , KOPF ALFRED W. , BART ROBERT S. , LEVENSTEIN MARCIA
Published: June 2013

Abstract. In order to determine the prevalence of key features concerning nevocytic nevi (NN) in 150 consecutive Caucasian patients with dysplastic nevi (DN), total‐body photographs were reviewed that revealed the following: 74% had ≧ 100 NN, 73% had NN 8 mm or more in diameter, and 81% had atypical NN. The patients were then divided into two subsets, those with a personal and/or family history of malignant melanoma (MM) and those without, to see if the proportion of these three features differed in these two groups. There were no statistically significant differences between the MM‐history‐positive and MM‐history‐negative subsets.
Triple Rhomboid Flap for Crown Alopecia Correction
Authors: STOUGH D. BLUFORD , STOUGH DOWLING B.
Published: June 2013

Abstract. The triple rhomboid flap offers significant advantages over previously described methods for reducing vertex alopecia. The circular area of alopecia is converted into a hexagon. The hexagon is then excised and closed by rotation of three rhomboid flaps from the hair‐bearing periphery. The specific indications for this flap are reviewed, the technical aspects are discussed, and illustrations are provided.
Cosmetic Leg Veins: Evaluation Using Duplex Venous Imaging
Authors: THIBAULT PAUL , BRAY ALAN , WLODARCZYK JOHN , LEWIS WARREN
Published: June 2013

Abstract. The records of 305 consecutive patients who had presented with cosmetic symptoms related to varicose and/or spider veins over a 12‐month period were studied. Following clinical assessment, 250 (82%) patients were referred for duplex venous imaging. A total of 500 lower limbs were evaluated; 236 (47%) were documented to have incompetence in the superficial venous system (long or short saphenous veins). Only 6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found to have perforator incompetence. Short saphenous vein incompetence was found in 59 (12%) limbs. In the long saphenous vein there was a consistent pattern of an increasing incidence of incompetence from the saphenofemoral junction down to the below‐knee segment. The duplex imaging findings were applied to determine the optimal treatment, ie, whether surgery, sclerotherapy, or a combination of both would provide the best short‐ and long‐term results. The possible etiology and pathophysiology of spider and varicose veins are discussed in relation to these results.
A Study of Estrogen and Progesterone Receptors in Spider Telangiectasias of the Lower Extremities
Authors: SADICK NEIL S. , NIEDT GEORGE W.
Published: June 2013

Abstract. There is an association of some vascular tumors with estrogen receptors and an association of vascular telangiectasias with high levels of circulating estrogen. Because of this, a study of patients with lower extremity starburst telangiectasias and predisposing factors associated with hyperestrogenemic and hyperpro‐gesteronemic states was undertaken in order to look for estrogen and progesterone receptors in biopsy specimens of lower extremity telangiectasias noted to arise in this setting. Contrary to expected results, using immunocy‐tochemical techniques, no patient in this study was found to have estrogen or progesterone receptors present in their lower extremity telangiectasias. Possible explanations for these results are discussed.
Treatment of Massive Rhinophyma with the Carbon Dioxide Laser
Authors: HAAS ANN , WHEELAND RONALD G.
Published: June 2013

Abstract. A case of massive rhinophyma that produced significant functional and cosmetic difficulties was treated using the carbon dioxide laser. Minimal bleeding occurred during the operative procedure despite the grotesque enlargement and high degree of vascularity of the skin and soft tissue. Using this technique, restoration of normal function and excellent cosmesis was possible without complication.
Pigmented Streaks in Melanoma Scars
Authors: HO VINCENT C. , SOBER ARTHUR J.
Published: June 2013

Abstract. Fifty consecutive patients from our melanoma clinic were examined for the presence of transverse pigmented streaks in their melanoma surgical scars. Thirty‐four (68%) patients were noted to have pigmented streaks in their melanoma scars. Ten of these 34 patients also had similar pigmented streaks in their nonmelanoma surgical scars. Long‐term follow‐up (mean 81.7 ± 14.5 months, minimum 36 months) of these patients with the melanomascar pigmented streaks indicates that the streaks are benign. Histologic examination of a representative pigmented streak revealed basal layer hyper‐pigmentation without melanocytic hyperplasia. These streaks are frequently associated with the presence of freckles. However, this association may simply be coincidental.
The Keeler Panoramic Prismatic Loupe
Authors: FISH FREDERICK S.
Published: June 2013

Abstract. Panoramic prismatic loupes are optically superior to standard binocular Galilean loupes and are rivaled only by operating microscopes. Several companies offer these loupes. The Keeler loupe (Keeler Instruments, Inc, Broomall, PA) offers the most versatility, with seven different magnifications and three different working distances. In addition, all of the lenses are interchangeable on the same lightweight frame.
The Needle‐Scratch Technique
Authors: GOLDBERG LEONARD H. , ALCALAY JOSEPH
Published: June 2013

Abstract. An easy, convenient method of marking the borders of a cutaneous tumor before excision is presented. It enables the physician to see the preoperative clinical borders of a tumor without worry of erasing the inked borders with cleansing solution.
Nasal Tip Reconstruction: The Horizontal “J” Rotation Flap Using Skin from the Lower Lateral Bridge and Cheek
Authors: SNOW STEPHEN N. , MOHS FREDERIC E. , OLANSKY DAVID C.
Published: June 2013

Abstract. The horizontal “J” flap is a rotation flap that uses skin from the lower lateral bridge and cheek to repair full‐thickness skin defects of the nasal tip. Pertinent anatomic morphologic characteristics of the nasal tip skin that contribute to the unique character of the nose are discussed. The example defects presented resulted from the excision of skin cancers using micrographic surgery. Nasal tip reconstruction, using adjacent skin based on the nasal anatomic subunit principle, results in superior aesthetic repairs.
Embryologic Fusion Planes and the Spread of Cutaneous Carcinoma: A Review and Reassessment
Authors: WENTZELL J. MICHAEL , ROBINSON JUNE K.
Published: June 2013

Abstract It has long been held that embryologic fusion planes influence the spread of skin cancer. Embryologic fusion planes have been implicated in the depth of invasion, horizontal spread, and recurrence of cutaneous carcinoma. However, these structures have never been studied in detail. A review of the surgical literature reveals considerable confusion regarding the exact nature, location, and tumor interactions of these fusion planes. We review the gross and microscopic development of sites of embryologic fusion. We examine histologic sections through fusion sites in normally developed adult and fetal fresh cadaver specimens. Our studies, supported by our review of developmental anatomy, indicate that fusion planes do not persist as identifiable anatomic structures that would influence tumor spread.
Hydroquinone‐Induced Localized Exogenous Ochronosis Treated with Dermabrasion and CO2 Laser
Authors: DIVEN DAYNA G. , SMITH EDGAR B. , PUPO RAPHAEL A. , LEE MIKE
Published: June 2013

Abstract Exogenous localized ochronosis can result from the repeated use of hydroquinone‐containing creams, many of which are available over the counter. We report a case that was managed by dermabrasion and CO2 laser. The incidence and proposed etiologies of hydroquinone‐induced exogenous ochronosis are reviewed.
New Primary Basal Cell Carcinomas Arising in Skin Flaps Following Mohs Micrographic Surgery for Primary and Recurrent Basal Cell Carcinoma
Authors: WAGNER RICHARD F.
Published: June 2013

Abstract Two patients developed new primary basal cell carcinomas (BCCs) in skin flaps used to reconstruct wounds that followed an earlier primary BCC and a recurrent BCC treated by Mohs micrographic surgery. Criteria for distinguishing a new primary BCC arising in a skin flap or full‐thickness skin graft at a previous treatment site for BCC from a truly recurrent BCC are presented. The distinction between a new primary BCC and true tumor recurrence is important for accurate clinical assessment and may have a dramatic impact on the type of subsequent treatment. In addition, there may be less medicolegal liability in the case of a new primary BCC arising at the site of a previously treated BCC than for a BCC that is determined to be recurrent.
Incidence of Side Effects in the Treatment of Telangiectasias by Compression Sclerotherapy: Hypertonic Saline vs. Polidocanol
Authors: WEISS ROBERT A. , WEISS MARGARET A.
Published: June 2013

Abstract. Two of the most common side effects of sclerotherapy of leg veins are telangiectatic matting (TM), and postsclerosis hyperpigmentation. A random sample of 113 female patients with similar treatment sites of telangiectasias (<1 mm in diameter) and venulectasias of 1–2‐mm diameter on the legs were treated by sclerotherapy and assessed at 1 and 6 months later for the presence of TM and hyperpigmentation. Patients received treatment with either 23.4% hypertonic saline (HS) alone (N = 74), 1% polidocanol (POL) alone (N = 21), or a comparison treatment with both HS and 1% POL (N = 18). A subgroup of patients received both 1% POL and 0.5% POL (N = 10). The incidence of hyperpigmentation was related both to vessel size and to sclerosing solution; only one patient showed hyperpigmentation in a vessel <1 mm, while in 1–2‐mm vessels the incidence was 10.9% for HS and 30.7% for 1% POL (p<.004) at 1 month. At 6 months postsclerotherapy, the incidence of pigmentation was 2% for HS and 7.5% for 1% POL. Both the type and concentration of sclerosing solution affected the incidence of TM; the incidence of TM was 33% for 1% POL, compared to only 13% for HS (p<.004). At 6 months follow‐up, the incidence of TM decreased to 2% for HS and 9% for 1% POL. Ten patients who developed TM with 1% POL were treated subsequently with 0.5% POL and demonstrated no matting. These data indicate that the incidence of side effects was affected by both the concentration and type of sclerosant.
Can Varicectomy be Performed if Deep Veins are Occluded?
Authors: BIHARI IMRE
Published: June 2013

Abstract. The problem of varicectomy in the setting of deep venous occlusion is discussed. A new and simple test is applied to determine if the resulting varicosity is necessary to contribute to venous circulation in the limb and if subfascial collateral pathways are sufficient to maintain it. The test is a modification of the Perthes test. Instead of a rubber‐strip tourniquet, a tensiometer cuff is used with 110 mmHg for 5 minutes on a walking patient. In negative cases the superficial varicosity can be removed radically, in spite of deep venous occlusion, to decrease the venous blood loading and ameliorate the venous drainage without risk to the blood circulation.
Oral Hairy Leukoplakia
Authors: ZUNT SUSAN L. , TOMICH CHARLES E.
Published: June 2013

Abstract. Oral hairy leukoplakia, usually observed on the lateral border of the tongue, may herald the development of symptomatic human immunodeficiency virus infection. This paper reviews the pertinent clinical features and differential diagnosis, histology, methods of establishing a definitive diagnosis, and management of the patient with this Epstein‐Barr virus‐associated lesion.
Neutralized Lidocaine with Epinephrine for Local Anesthesia — II
Authors: STEWART JAMES H. , CHINN SUSAN E. , COLE GARY W. , KLEIN JEFFREY A.
Published: June 2013

Abstract. The pain usually associated with intradermal injection of lidocaine and epinephrine is significantly attenuated by the addition of either sodium bicarbonate or sodium hydroxide to 1% lidocaine with epinephrine. This suggests that sodium bicarbonate attenuates pain by increasing the pH of the anesthetic solution. The clinical effects of a solution of lidocaine (1%) with epinephrine (1:100,000) and sodium bicarbonate (80 meq/L) were assessed after infiltration in skin. Anesthetic stored for 1 week caused nearly equal areas of anesthesia and vasoconstriction as an identical solution prepared on the day of use.
Enhancement of the Clinical Margins of Bowen's Disease by Acetowhitening
Authors: BAKER ERIC J. , HOBBS EDMUND R.
Published: June 2013

Abstract. Acetic acid was applied preoperatively to 12 lesions of Bowen's disease to determine if acetowhitening could more clearly define clinical margins. Acetowhitening disclosed the true margins better than unenhanced direct visualization, and subclinical extension of Bowen's disease was revealed by acetowhitening in three lesions. Acetowhitening can be a useful adjunct in the surgical management of Bowen's disease.
Foam‐Rubber Stents for Skin Grafts
Authors: LARSON PAUL O.
Published: June 2013

Abstract. A variety of stents are used to immobilize skin grafts and to hold them firmly to the recipient site. Tie‐down stents, the most common type, are constructed from bulky, sterile dressing and are overtied with suture material. These stents are often cumbersome to apply. As an alternative, stents made from foam‐rubber pads (Reston, 3M Company, St. Paul, MN) were stapled over skin grafts. These stents could be applied quickly, and they maintain continuous, uniform pressure on the immobilized grafts.
Collagen Sheeting Implants in Cosmetic and Reconstructive Surgery
Authors: PANJE WILLIAM R. , DOBLEMAN THOMAS J.
Published: June 2013

Abstract. In this study, collagen sheeting is used for correction of various contour deformities of the face. This material, which was used in 16 patients, is easily implanted, does not lead to infection, and has an average resorption rate of 21% at 6 months. It provides excellent cosmetic results.
Extensive Keloids Following Hair Transplantation
Authors: BROWN MARC D. , JOHNSON TIMOTHY , SWANSON NEIL A.
Published: June 2013

Abstract. Hair transplant surgery is a highly successful procedure for improving alopecia. However, this procedure is not without its potential risks and complications. A case of a large keloidal scar following hair transplantation is presented. Those performing hair transplant surgery should be aware of this significant potential complication, especially in Black and Oriental individuals, who are more prone to keloid formation.
Melanoacanthosis (Melanoacanthoma) of the Oral Mucosa
Authors: TOMICH CHARLES E. , ZUNT SUSAN L.
Published: June 2013

Abstract. A pigmented lesion of the oral mucosa that bears histologic resemblance to the cutaneous melanoa‐canthoma is discussed. A study of 22 cases, including 4 in the current series, shows that the intraoral lesion occurs most commonly in adult black women on the buccal mucosa and lip. The lesion is known to regress. The term melanoacanthosis is suggested for this condition.
Facilitating Surgical Ablation of Lesions in the Conchal Cavum and Around the External Auditory Meatus, with Subsequent 2‐Stage Flap Reconstruction
Authors: FIELD LAWRENCE M.
Published: June 2013

Abstract. Coverage of surgical defects of the external auditory meatus and surrounding areas can be singularly challenging. Partial detachment of the lower pinna may facilitate surgical exposure and the movement of tissue from periauricular locations. A high level of esthetic reconstruction can be accomplished.
Treatment of Striae Distensae with Topical Tretinoin
Authors: ELSON MELVIN L.
Published: June 2013

Abstract. The experience of 20 patients with striae distensae of varying etiologies and the treatment with topical tretinoin is described. Of the 16 patients who completed the study, 15 had significant improvement in their clinical picture.
Immunosuppression in Patients with Metastatic Squamous Cell Carcinoma from the Skin
Authors: DINEHART SCOTT M. , CHU DAVID Z.J. , MANERS ANN W. , POLLACK SHELDON V.
Published: June 2013

Abstract. Sixteen of 70 patients with metastatic squamous cell carcinoma (SCC) from the skin had evidence of clinical immunosuppression. In addition to patients with lymphoproliferative disorders or renal failure, those with cicatricial pemphigoid and those undergoing chronic oral corticosteroid therapy were identified as being at high risk. Host immune surveillance appears to play a major role in determining the metastatic potential of cutaneous SCC.
The Use of VP16 and Cisplatin in the Treatment of Merkel Cell Carcinoma
Authors: DAVIS MELLAR P. , MILLER EDWARD M. , RAU ROBERT C. , JOHNSON OWEN E. , NAILLE RONALD A. , CRNKOVICH MARK J.
Published: June 2013

Abstract. A 70‐year‐old male with regionally recurrent Merkel cell cancer obtained a complete remission with three cycles of VP16 and cisplatin. His response was consolidated with local radiation therapy. Two additional patients have been reported to have responded to the same combination. Chemotherapy consisting of either cyclophosphamide, vincristine, and doxorubicin or VP16 and cisplatin should be considered in locally recurrent Merkel cell cancer.
Anatomic Rubber Stamps of the Face and Body to Document Procedures in Dermatologic Surgery: One Picture is Worth a Thousand Words
Authors: MOHS FREDERIC E. , SNOW STEPHEN N. , LARSON PAUL O. , OLANSKY DAVID C. , GOLDMAN PETER M. , KIVETT WILLIAM F.
Published: June 2013

Abstract. Representations of the anatomic surface location of cutaneous lesions and the surgical procedures performed on these lesions can be transferred to the medical charts using simple anatomic rubber stamps (ARS) of the body. The technique is exemplified with symbols to represent surgical excision, chemical face peel, dermabrasion, micrographic surgery, and the harvesting of flaps and grafts. ARS are also useful in liposuction surgery, punch grafts for pitted facial scars, hair transplantation, sclerotherapy, laser surgery, and other cosmetic dermatologic procedures. ARS are particularly valuable in micrographic surgery for skin cancer because they help document the depth and breadth of cancer invasion and aid in the follow‐up of recurrent skin cancer, especially when defects are reconstructed.
The Abraded Punch Graft for Pitted Facial Scars
Authors: MANCUSO ANGELO , FARBER GEORGE A.
Published: June 2013

The abraded punch graft procedure is one in which the surrounding scar area and the graft itself are superficially dermabraded before correction of the defect. This alternative procedure has distinct advantages over the standard punch graft and should be considered when contemplating the surgical correction of “ice pick” facial scarring. Following the normal reparative process, the abraded punch graft heals with a pleasing aesthetic appearance.
Prospective Follow‐Up for Malignant Melanoma in Patients with Atypical‐Mole (Dysplastic‐Nevus) Syndrome
Authors: TIERSTEN AMY D. , GRIN CARON M. , KOPF ALFRED W. , GOTTLIEB GEOFFREY J. , BART ROBERT S. , RIGEL DARRELL S. , FRIEDMAN ROBERT J. , LEVENSTEIN MARCIA J.
Published: June 2013

A total of 357 white patients who had melanocytic nevi that fulfilled the clinical criteria for the “classic” atypical‐mole (dysplastic‐nevus) syndrome (100 or more melanocytic nevi; one or more melanocytic nevi 8 mm or larger in diameter; and, one or more melanocytic nevi with atypical features) were followed for the development of cutaneous malignant melanomas. Seventeen patients (4.8%) developed malignant melanomas during an average follow‐up period of 49 months. One patient developed two malignant melanomas. Eight of the malignant melanomas detected were in situ and ten were invasive melanomas (<0.86 mm in Breslow thickness), implying an excellent prognosis. The number of malignant melanomas detected in these patients exceeded significantly the number expected to occur in age‐and sex‐matched white controls. All groups were shown to have an increased risk for the development of malignant melanomas. Total‐body photographs were helpful in detecting changes in size, shape, and color that led to the diagnosis of malignant melanoma. These data support the concept that patients with this readily regionalized clinical presentation of classic atypical‐mole syndrome are at an increased risk for malignant melanomas and, therefore, should be examined regularly.
Sclerotherapy of Varicose and Telangiectatic Leg Veins: Minimal Sclerosant Concentration of Hypertonic Saline and Its Relationship to Vessel Diameter
Authors: SADICK NEIL S.
Published: June 2013

The author reports the results of a double‐blind, paired‐comparison study using saline sclerosant plus or minus heparin additive. The study was designed to elucidate the effects of increasing concentrations of hypertonic saline with regard to vessel diameter, clinical efficacy, complications, and discomfort. Six hundred women with bilaterally symmetrical starburst telangiectasias or varicose veins were entered into the study. Sodium chloride 11.7% appeared to be the minimal sclerosant concentration of saline that produced the most effective vein sclerosis of vessels of less than 8 mm in diameter, while producing the least morbidity. The optimal concentration of the sclerosant may vary with the diameter of the vessels under therapeutic consideration.
The Effectiveness of Occipital Artery Ligations as a Priming Procedure for Extensive Scalp‐Lifting
Authors: BRANDY DOMINIC A.
Published: June 2013

Extensive scalp‐lifting is a relatively new cosmetic scalp procedure that involves cutting both occipital arteries, which then allows undermining of the entire donor dominant scalp down to the hairline of the nape. Because of this more extensive undermining, dramatic improvements are accomplished even with one operation. Conversely, one can develop necrosis at the nuchal ridge because of a sudden curtailment of circulation in the occipital region. In an attempt to eliminate this complication, the author experimented with “horizontal incision ligations” of the occipital arteries 4 to 8 weeks prior to the surgery which resulted in a significant reduction in the average size of necrosis (from 3.1 cm2 to 1.6 cm2; P = .036) but no significant difference in the incidence (P = .49). When these patients did develop necrosis, it always occurred below the horizontal incisions—therefore, the procedure was changed to vertical incisions, which to date have yielded a significant protective effect when compared with the previous method of “horizontal incision ligations” (P = .014), and even greater significance when compared with the original method of no previous ligations (P = .012). Vertical‐incision ligation performed 4 to 8 weeks prior to surgery is an optimal method for preventing the complication of necrosis after extensive scalp‐lifting surgery.
Intraoperative Nasal Ala Stabilization Using the Foley Catheter
Authors: ALCALAY JOSEPH , GOLDBERG LEONARD H.
Published: June 2013

The authors describe a technique of intraoperative nasal ala stabilization to aid excision of skin lesions on the nasal ala and the surrounding skin. The fixation is achieved by inserting a Foley catheter into the nasal antrum and inflating the balloon. The inflated balloon produces pressure against the surrounding walls, allows convenient excision of skin lesions with good hemostasis, and is comfortable for the patient.
Liposculpture 3: Surgical Technique in Liposculpture
Authors: FISCHER GIORGIO
Published: June 2013

The guided liposuction cannula offers the surgeon the advantage of making tunnels that are parallel to the skin's surface. The tunnels are made approximately 1 cm from the skin surface, leaving a uniform fatty layer that covers the deeper tunneling performed with a swan‐necked cannula. Anesthesia is administered using the tumescent mixture. Vertical tunnels, parallel to the forces of gravity (when the patient is standing), are made to avoid the draping effect seen in tunnels made in a bicycle‐wheel pattern between 50 to 130 degrees and 230 to 210 degrees. The vertical tunnels are important for an acceptable cosmetic result.
Inflammatory Metastatic Carcinoma
Authors: DE ERENCHUN F. RUIZ , DOVAL J. VÁZQUEZ , VALÉRDIZ S. , SERNA M. J. , QUINTANILLA E.
Published: June 2013

The inflammatory metastatic carcinoma is a rare clinical entity, histologically characterized by lymphatic dermal invasion by neoplastic cells. We report three cases of inflammatory metastatic carcinoma, two of them secondary to a breast carcinoma, and the third secondary to a colon adenocarcinoma.
Malignant Schwannoma Treated by Mohs Surgical Excision
Authors: PADILLA R. STEVEN , SHIMAZU COLLEEN
Published: June 2013

A 34‐year‐old white female with a 5‐cm malignant schwannoma of the upper thigh underwent complete removal of the tumor by fresh‐tissue Mohs surgical excision. The patient refused postoperative radiotherapy, and is without signs of recurrence 5 years after surgery. Mohs surgical excision in the treatment of malignant schwannoma has not to our knowledge been reported previously.
Venous Hypertensive Microangiopathy in Relation to Clinical Severity and Effect of Elastic Compression
Authors: CHRISTOPOULOS D. C. , NICOLAIDES A. N. , BELCARO G. , KALODIKI E.
Published: June 2013

Arterial inflow in mL/minute and perimalleolar skin blood flow were measured with venous occlusion air‐plethysmography and laser‐Doppler flowmetry in 20 normal limbs, 40 limbs with uncomplicated primary varicose veins, 32 limbs with primary varicose veins and skin changes, and 36 limbs with deep venous disease. Limbs with complicated varicose veins (skin changes) and deep venous disease showed a marked increase (2 to 4 times) in both arterial inflow and skin blood flow when compared with the normal controls and uncomplicated varicose veins. The measurements were repeated 30 minutes after the application of graduated elastic stockings. There was a 16% reduction in the mean arterial inflow (P < .01) and a 45% decrease in skin blood flow (P < .01). The results indicate that in limbs with chronic venous insufficiency and skin changes there is an increased blood flow which is mainly in the skin. This is irrespective of whether the venous problem is in the superficial or deep venous system. Elastic compression tends to reduce the hyperemia towards the normal range.
Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa
Authors: MENDONÇA HELENA , REBELO CLARISSE , FERNANDES APARÍCIO , LINO AMÉLIA , GARCIA e SILVA L.
Published: June 2013

The case reported concerns a 57‐year‐old man with a 35‐year history of hidradenitis suppurativa lesions confined to his buttocks and recently complicated by a large, ulcerated, well‐differentiated squamous cell carcinoma. Wide surgical excision and grafting, requiring temporary colostomy, were performed with no recurrence or metastasis during the following 12 months. The relevant literature is reviewed and discussed.
Mapping and Orienting Tissue During Mohs Micrographic Surgery
Authors: GRABSKI WILLIAM J. , SALASCHE STUART J.
Published: June 2013

An alternate method for mapping and orienting tissue during Mohs micrographic surgery is described. This quick and simple technique eliminates the application of indelible dyes to the tissue margins
Regional Anesthesia of the Hand for Dermatologic Surgery
Authors: HUTTON KATHLEEN P. , PODOLSKY ANATOL , ROENIGK RANDALL K. , WOOD MICHAEL B.
Published: June 2013

The basic principles of regional and local anesthesia of the hand are reviewed, and safe and effective methods for outpatient dermatologic procedures and three representative cases are discussed with respect to anatomy, local anesthetic agents, and techniques. Block techniques are preferred to local infiltration because they provide complete and long‐lasting anesthesia more comfortably.
Unusual Auricular Complications in Cutaneous Oncology
Authors: LESHIN BARRY , HESS SUZANNE P. , WHITE WAIN L. , MATTHEWS BRIAN L. , KOUFMAN JAMES A.
Published: June 2013

The anatomic complexity of the pinna predisposes that structure to a variety of unique, site specific postoperative complications following management of skin cancer. We describe four unusual auricular complications: 1) radiochondronecrosis; 2) autonecro‐sis of skin during second intention healing; 3) hearing loss secondary to tragal retraction over the external auditory canal; and 4) extension of tumor through fenestrated cartilage. Well‐known postoperative auricular complications are reviewed and anticipation and recognition of these unusual complications are emphasized.
Postoperative Elevation of Eyeglasses from the Nasal Bridge
Authors: FREITAG DAVID S. , BENNETT RICHARD G.
Published: June 2013

After surgery on the proximal nose, wearing eyeglasses can be difficult and uncomfortable. In addition, pressure on the skin underneath the eyeglass nose pads may modify wound healing. We describe simple techniques using readily available materials and optical devices that either reduce or remove pressure on the nose from eyeglasses.
Recurrence Rates of Treated Basal Cell Carcinomas: Part 4: X‐Ray Therapy
Authors: SILVERMAN MARK K. , KOPF ALFRED W. , GLADSTEIN ARTHUR H. , BART ROBERT S. , GRIN CARON M. , LEVENSTEIN MARCIA J.
Published: June 2013

This is the fourth report in a series that reviews the experience in the Skin and Cancer Unit, from 1955 through 1982, with the treatment of basal cell carcinomas (BCCs). It concerns 862 primary (previously untreated) BCCs irradiated by a “standardized” x‐ray therapy schedule. The overall 5‐year recurrence rate for these lesions, as determined by the modified life‐table method, was 7.4%. This rate was not significantly different from that experienced with 211 recurrent (previously treated) BCCs with a re‐recurrence rate of 9.5% (P = .552). For the primary BCCs, multivariate analysis showed that increasing BCC diameter was the only independent risk factor for high recurrence rates (P = .003). The patient's age or sex, the duration of the BCC, the anatomic site of the BCC, or time‐span treated (1955–1963, 1964–1972, 1973–1982) did not significantly affect the recurrence rate. Additional analysis showed that BCCs on the head less than 10 mm in diameter had a 5‐year recurrence rate of 4.4% whereas those 10 mm or greater in diameter had a rate of 9.5%. Lastly, the proportion of recurrence‐free treatment sites with a good or excellent long‐term cosmetic outcome after x‐ray therapy (63%) was lower than previous reports in this series with curettage‐electrodesiccation (91%) and surgical excision (84%). Thus, if the long‐term cosmetic outcome after treatment is not an overriding concern to the patient, x‐ray therapy is an effective modality for many primary and recurrent BCCs.
Consensus Paper on Venous Leg Ulcer
Authors: GOLDMAN MITCHEL P. , FRONEK A.
Published: June 2013

This is a condensed consensus report, summarizing the present status of various aspects of epidemiology, diagnosis, and treatment of venous ulcers. There are conflicting results regarding the prevalence of venous ulcers ranging from 0.18 to 1.3%, depending on the types of ulcers reported. With regard to macrovascular changes preceding venous leg ulceration, ambulatory venous hypertension is the common pathway, usually related to incompetent perforating veins and the deep venous system. Obstruction of the deep venous system seems to be less frequently related to venous ulcers. Microvascular changes have been recently studied in more detail; morphologic as well as functional changes are summarized and considered from the viewpoint of various hypotheses, including fibrin cuff, leukocyte adhesion, etc. Various investigational approaches are summarized and recommendations for the most cost‐effective diagnostic tests are given. Finally, conservative medical as well as surgical treatment avenues are evaluated. Emphasis is given to the normalization of ambulatory venous pressure by sclerotherapy, ligation, or other surgical procedures, in addition to compression. The consensus report is concluded by detailed recommendations for future clinical trials.
Total Upper Lip Reconstruction with Bilateral Fan Flaps
Authors: CAMACHO FRANCISCO , MORENO J.C. , CONEJO‐MIR J.S.
Published: June 2013

Reconstruction of the total upper Up may be easily performed using fan flaps. However, two details must be taken into consideration: 1) the wide pedicle in the commissural angle, including the facial artery, must be designed, and 2) the mucosal flap must be 8 mm longer, in the inner portions, than the skin flap used to reconstruct the lip semimucosa.
The Vertical Wedge Biopsy
Authors: GROSS DANIEL A.
Published: June 2013

The vertical wedge biopsy technique provides rapid “set‐up” of minimal and inexpensive material, good quality biopsy specimens, no alteration of tumor margins and thus does not alter future therapeutic options.
Clinical Use of the Q‐Switched Ruby and the Q‐Switched Nd:YAG (1064 nm and 532 nm) Lasers for Treatment of Tattoos
Authors: KILMER SUZANNE LINSMEIER , ANDERSON R. ROX
Published: June 2013

background. The desire to remove tattoos has probably been around as long as their existence. Recent technological advances in lasers have finally made it possible to remove tattoos without leaving an equally undesirable scar.

objective. The purpose of this article is to review the use of the Q‐switched ruby (694 nm) and the Q‐switched Nd:YAG (532 and 1064 nm) lasers for effective removal of tattoo ink, with cosmetically appealing results.

results. The Q‐switched ruby laser (694 nm) effectively removes blue‐black and green ink, may treat other colors less efficiently, and is frequently associated with transient pigmentary changes, including rare depigmentation. The Q‐switched Nd:YAG laser at 1064 nm quickly removes black ink, as well as other colors less efficiently; pigmentary changes are much less frequent, correlating with its lower absorption by melanin. The 532‐nm wavelength treats red ink effectively, but also leads to temporary hypopigmentation. Transient textural changes may be noted at all three wavelengths discussed, but scarring is rare.

conclusions. Q‐switched lasers can remove tattoos without residual scarring. Efficacy of ink removal is dependent on the wavelength used for the targeted pigment.
Treatment of Port‐Wine Stains for the 1990s
Authors: WHEELAND RONALD G.
Published: June 2013

background. A dramatic improvement in the treatment of patients with port‐wine stains has occurred over the past 20 years owing to the availability of a variety of different laser systems. The argon laser was the first system to offer an advantage over the older surgical techniques that had previously been used to manage these patients. However, many new lasers have since been developed that further improved the treatment results while simultaneously reducing the risks, even when treating children.

objective. To present the current status of laser surgery for port‐wine stains and describe how the many newer systems are being used to more effectively manage these patients.

methods. A thorough review of the medical literature was conducted on the use of new lasers, delivery systems, and treatment techniques for the management of port‐wine stains.

results. The biggest advance in laser treatment of port‐wine stains resulted from the development of systems that are capable of delivering yellow light. The improved precision provided by these lasers serves to minimize epidermal injury, limit nonspecific thermal damage, and permit treatment of newborns and young children without a significant risk of scarring.

conclusion. Major benefits in the treatment of portwine stains have resulted from the recent development of many new laser systems and laser accessories that provide a more precise response with less potential for complications than had been previously attainable with older technologies.
The Copper Vapor Laser for Treatment of Cutaneous Vascular and Pigmented Lesions
Authors: DINEHART SCOTT M. , WANER MILTON , FLOCK STEPHEN
Published: June 2013

background. Clinical experience has shown that a variety of skin lesions are treatable with rapidly pulsed yellow and green light of the copper vapor laser.

objective. To review the development, use, complications, and efficacy of the copper vapor laser when utilized for cutaneous lesions.

methods. Articles were identified through a MEDLINE search, review of these articles' bibliographies, and advice from expert physicians who have used the copper vapor laser.

results. A variety of vascular and pigmented cutaneous lesions are effectively treated with the copper vapor laser. A distinct advantage for hypertrophic or cobblestoned port‐wine stains and most types of facial telangiectasia is seen when this laser's results are compared with the results of other available laser systems. Complications, including scarring, are rarely observed.

conclusion. The copper vapor laser is a useful addition to the family of lasers that are used for cutaneous conditions.
Clinical Misdiagnosis of Squamous Cell Carcinoma In Situ as Seborrheic Keratosis A Prospective Study
Authors: SLOAN JOANNA B. , JAWORSKY CHRISTINE
Published: June 2013

BACKGROUND. Seborrheic keratoses have on rare occasion been reported to undergo malignant transformation.

OBJECTIVE. Our purpose was to examine the incidence and distribution of squamous cell carcinomas (SCCs) in situ arising in clinically banal‐appearing seborrheic keratoses.

METHODS. We prospectively selected such cases over a 6‐month period of time from routinely accessioned specimens to a dermatopathology service.

RESULTS. We found 1.4% of clinically diagnosed seborrheic keratoses to be SCCs in situ. These lesions were more common in elderly persons and were more likely to occur on the head and neck, suggesting the role of cumulative sun damage in the transformation of such lesions.

CONCLUSION. Malignant transformation of seborrheic keratoses, although rare, appears to occur more frequently in the elderly on the head and neck. Because this change is not necessarily accompanied by clinically discernable changes, more careful scrutiny of such lesions may be of therapeutic rather than cosmetic significance in this population.
A Vein Has a Preferential Axis of Flattening
Authors: VAN CLEEF JEAN‐FRANÇOIS
Published: June 2013

BACKGROUND. A vein is a collapsible tube. As such, has it one or several axes of flattening?

OBJECTIVE. The objective is to demonstrate that several venous parts, like valves or orifices of tributary veins, are directed towards one axis.

METHODS. With dynamic endoscopies for superficial veins and with anatomical injections of latex for deep veins.

RESULTS. All the valvular free borders of the superficial veins are parallel to the skin's surface, all the terminal orifices of the perforator are really situated on the commissure linear (linear joining two superposed valvular commissures) of the deep veins.

CONCLUSION. A vein has a preferential axis of flattening, and its cross‐section configuration can be defined as: two wallsides and two borders. The bicuspid valve's cornua are situated on the borders of the vein. The terminal orifices of the perforators are situated on the borders of the deep veins. The models of the musculovenous pump of the calf have to be altered.
Lichen Myxedematosus Treated with Chlorambucil
Authors: WIEDER JOSHUA M. , BARTON KEVIN L. , BARON JOSEPH M. , SOLTANI KEYOUMARS
Published: June 2013

BACKGROUND. Chemotherapy with various alkylating agents has been reported to be successful in the treatment of lichen myxedematosus. However, serious toxicities have accompanied such use.

OBJECTIVE. To report a case of treatment of lichen myxedematosus with chlorambucil.

RESULT. There was a favorable response using chlorambucil as an alternative therapeutic agent.
Assessing the Impacts of E. coli Laden Streambed Sediment on E. coli Loads over a Range of Flows and Sediment Characteristics
Authors: Pandey Pramod K. , Soupir Michelle L.
Published: June 2013

Understanding sediment Escherichia coli levels (i.e., pathogen indicators) and their contribution to the water column during resuspension is critical for predicting in‐stream E. coli levels and the potential risk to human health. The U.S. Environmental Protection Agency's current water quality testing strategies, however, rely on water borne E. coli concentrations to assess stream E. coli levels and identify impaired waters. In this work, we conducted a scenario analysis using a range of flows, sediment/water bacteria fractions, and particle sizes to which E. coli attach to assess the impact of E. coli in streambed sediments on water column E. coli levels. We used simple sediment transport theory to calculate the potential total E. coli concentrations in a stream with and without the resuspension process. Results clearly indicate that inclusion of resuspending sediment attached E. coli is necessary for watershed assessments and data on sediment attached E. coli concentrations is much needed. When neglecting the streambed sediment E. coli concentrations, the model predicted average E. coli loads of 107 Colony Forming Units (CFU)/s; however, when streambed sediment E. coli concentrations were included in the model, the predictions ranged from 1010 to 1014 CFU/s. To evaluate the predictions, E. coli data in the streambed sediment and the water column were monitored in Squaw Creek, Iowa. Comparisons between measured and predicted E. coli loads yielded an R2‐value of 0.85.
Loss Rates from Lake Powell and Their Impact on Management of the Colorado River
Authors: Myers Tom
Published: June 2013

As demand for water in the southwestern United States increases and climate change potentially decreases the natural flows in the Colorado River system, there will be increased need to optimize the water supply. Lake Powell is a large reservoir with potentially high loss rates to bank storage and evaporation. Bank storage is estimated as a residual in the reservoir water balance. Estimates of local inflow contribute uncertainty to estimates of bank storage. Regression analyses of local inflow with gaged tributaries have improved the estimate of local inflow. Using a stochastic estimate of local inflow based on the standard error of the regression estimator and of gross evaporation based on observed variability at Lake Mead, a reservoir water balance was used to estimate that more than 14.8 billion cubic meters (Gm3) has been stored in the banks, with a 90% probability that the value is actually between 11.8 and 18.5 Gm3. Groundwater models developed by others, observed groundwater levels, and simple transmissivity calculations confirm these bank storage estimates. Assuming a constant bank storage fraction for simulations of the future may cause managers to underestimate the actual losses from the reservoir. Updated management regimes which account more accurately for bank storage and evaporation could save water that will otherwise be lost to the banks or evaporation.