bluuebunny/crossref_metadata_2025 huggingface dataset:
The Laser Approach to Blepharoplasty
Authors: DAVID LAURENCE M.
Published: June 2013

Abstract. A new technique for upper and lower eyelid blepharoplasty, combining the advantages of the transconjunctival approach with those of the CO2 laser, is described. The use of the CO2 laser as the only cutting tool eliminates many of the most common and the most serious complications of blepharoplasty attributable to hemorrhage and hematoma. The transconjunctival approach yields superior cosmetic results to those of the more commonly performed traditional techniques, which sometimes results in unacceptable lower eyelid scars and/or lower eyelid retraction. Patient rehabilitation to normal activity is rapid because of decreased bruising and swelling. The laser procedure is well suited to the office‐based laser surgical practice, but requires a high degree of skill in CO2 laser excisional surgery. In the hands of the inexperienced operator, new and serious complications may occur.
One Variety of a Long, Nondelayed, Temporo‐Parieto‐Occipital Flap
Authors: NORDSTRÖM ROLF E.A.
Published: June 2013

Abstract. A design of a very long temporo‐parietooccipital flap that can be transposed nondelayed and in local anesthesia is presented. The benefits of such a flap are presented and discussed.
Basal Cell Carcinomas Arising in Chronic Lymphedema
Authors: BENSON PAUL M. , LUPTON GEORGE P. , WINTON GEORGE B. , PESSOA CORNELIA M.
Published: June 2013

Abstract. A unique case is presented of basal cell carcinomas arising in chronic lymphedema of the lower extremity. The lesions were successfully treated with the CO2 laser.
Flat Fixation Technique for Shave Biopsy Specimens: Stick & Shake
Authors: DRUMMOND CHRISTINA C. , HURWITZ ROBERT M.
Published: June 2013

Abstract. Curling of thin‐shaved biopsy specimens is not uncommon in formalin‐fixed tissue. The distorted tissue may cause improper orientation, with subsequent tangential sections by the histotechnician and misinterpretation by the pathologist. We describe a simple “stick & shake” fixation technique, performed by the surgeon at the time of shaving, which flattens the biopsy specimen, and thus reduces the possibility for curling. This technique is especially useful in the interpretation of difficult neoplasms, where visualization of the periphery (shoulders) is crucial for accurate diagnosis, e.g., dysplastic melanocytic nevi.
Keratinocyte Grafting: A New Means of Transplantation for Full‐Thickness Wounds
Authors: HUNYADI JÁNOS , FARKAS BEATRIX , BERTÉNYI CAMILLÓ , OLÁH JUDIT , DOBOZY ATTILA
Published: June 2013

Abstract. Twenty adult individuals with chronic leg ulcers caused by venous insufficiency, and 5 patients with full‐thickness burns were treated. Twenty of the patients (15 with leg ulcers and 5 with burns) were grafted with separated autologous keratinocytes. In these cases the cells were fixed to the wound bed by a fibrin net. Five other patients (with leg ulcers) were treated with fibrin without keratinocytes. In 16 of the 20 patients grafted with keratinocytes in a fibrin net, the defect healed completely in 14 to 21 days. On the other hand, the fibrin net without keratinocytes failed to significantly accelerate the process of reepithelialization. Our experience suggests that a rapid healing of full‐thickness skin defects can be achieved through keratinocyte grafting.
Revision of Full‐Thickness Skin Grafts Using the Carbon Dioxide Laser
Authors: WHEELAND RONALD G.
Published: June 2013

Abstract. The occasional hypertrophic scarring that occurs with full‐thickness skin grafting can be effectively revised using the carbon dioxide laser. This technique can be precisely performed due to the limited zone of destruction produced by this wavelength of laser energy when it has contact with living, soft tissue. Additionally, the hemostasis provided by this instrument allows excellent visibility and provides maximum opportunity for proper control. The technique utilized in this procedure will be presented.
Electrosurgery Principles: Cutting Current and Cutaneous Surgery—Part II
Authors: SEBBEN JACK E.
Published: June 2013

Abstract. The use of cutting current for electrosurgical excision is a valuable procedure for the cutaneous surgeon. Last month, the basic principles of cutting current were reviewed (J Dermatol Surg Oncol 14:29–31, 1988). This month, Part II will cover the technical aspects of cutting current administration.
Credentialing in Dermatologic Surgery
Authors: WEBSTER RICHARD C.
Published: June 2013

Abstract. Dermatologic surgeons' rights to perform surgery are being and will be challenged more and more. Some methods of peer review and credentialing are suggested and the specialty is urged to move ahead with formal planning for more training in the surgical aspects of dermatology.
Acute Pseudomonas Infection of the External Ear (Malignant External Otitis)
Authors: SCHERBENSKE JAMES M. , WINTON GEORGE B. , JAMES WILLIAM D.
Published: June 2013

Abstract. Pseudomonas aeruginosa commonly causes low‐grade infections of the external auditory canal. If these infections are inadequately treated, they can progress into a severe form of external otitis called malignant external otitis (MEO). MEO usually occurs in elderly diabetic patients and demands immediate diagnosis and medical therapy in order to prevent systemic invasion, neurologic sequelae, and even death. We present two cases of acute pseudomonas infections of the ear, neither of which progressed to MEO due to early implementation of antibiotic therapy.
Morpheaform Basal Cell Carcinoma in a Young Black Woman
Authors: LESHER JACK L. , d'aubermont PETER C. S. , BROWN VICKI M.
Published: June 2013

Abstract. Basal cell carcinomas are uncommon in black patients, and morpheaform basal cell carcinomas are an uncommon histologic subtype. This case report describes the rare occurrence of a morpheaform basal cell carcinoma in a relatively young black patient. This patient underwent Mohs micrographic surgery as the primary therapy for this tumor. Some features of morpheaform basal cell carcinomas are reviewed, and basal cell skin cancer in blacks is discussed.
MOHS SURGERY REPORT: False‐Negative Tumor‐Free Margins Following Mohs Surgery
Authors: DZUBOW LEONARD M.
Published: June 2013

Abstract. The inability to identify a neoplasm upon examination of an initial Mohs histologic section is not uncommon. Although often the neoplasm has been enclosed within the layer or extirpated by a prior biopsy, there are instances when the negative marginal reading is incorrect. This report describes circumstances when the initial Mohs layer failed to show positive tumor margins in the face of residual in situ neoplasm.
LASERS: Carbon Dioxide Laser Matricectomy
Authors: LESHIN BARRY , WHITAKER DUANE C.
Published: June 2013

Abstract. We have performed a total of 13 matricectomies in 9 patients utilizing the carbon dioxide laser. To date, there have been no complications and minimal morbidity from this technique. With follow‐up ranging from 8 to 24 months, no patient has experienced regrowth of nail at the treated site. In conclusion, we believe that carbon dioxide laser ablation is an effective technique for performing nail matricectomy.
ARTICLE: Paget's Disease of the Breast with Underlying Carcinoma Arising in Systemic Scleroderma
Authors: SUSTER SAUL , RONNEN MEYER , HUSZAR MONIKA , BUBIS JOSE J.
Published: June 2013

Abstract. A case is presented of Paget's disease of the breast with underlying infiltrating carcinoma arising in a 35‐year‐old woman with systemic scleroderma. The tumor arose in an area of the skin affected by the systemic scleroderma 4 years after the onset of her systemic disease. The possibility of a causal relationship between these two processes is discussed and a brief review of the literature is presented.
ARTICLE: Antihuman T‐Cell Leukemia/Lymphoma Virus Antibodies in Three Patients with Primary Cutaneous B‐Cell Lymphoma
Authors: BURG GÜNTER , VON DER HELM DOROTHEA , KAUDEWITZ PETER , KLEPZIG KRISTINA , BRAUN‐FALCO OTTO
Published: June 2013

Abstract. In 3 patients suffering from follicular center‐cell‐derived B‐cell lymphoma with primary cutaneous manifestation, antiadult T‐cell leukemia‐associated antigen antibodies were detected by the ELISA. In one of the patients, the husband and the dog had died from thymoma and from malignant lymphoma, respectively.
Determining Safe Limits for Untransfused, Outpatient Liposuction: Personal Experience and Review of the Literature
Authors: CHRISMAN BRUCE B. , III COLEMAN WILLIAM P.
Published: June 2013

Abstract. Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.
Blunt Liposuction Cannula Dissection With and Without Suction‐Assisted Lipectomy in Reconstructive Surgery
Authors: FIELD LAWRENCE M. , SKOUGE JOHN , ANHALT TODD S. , RECHT BERNARD , OKIMOTO JAN
Published: June 2013

Abstract. Efforts continue to expand the role of blunt liposuction cannulae in flap elevation and reconstructive surgery. Suction‐assisted lipectomy to reduce the actual volume of fat tissue present may allow the further reach and compressibility of mobilized flaps. These instruments find the safest possible plane for continued undermining dissection even at great distances. Applications yet unknown await discovery.
Liposuction Surgery Under Local Anesthesia: Limited Blood Loss and Minimal Lidocaine Absorption
Authors: LILLIS PATRICK J.
Published: June 2013

Abstract. A large volume of lidocaine with epinephrine can be administered in dilute concentrations into the subcutaneous space, resulting in minimal blood lidocaine levels. This allows large‐volume, multiple‐area liposuction to be done painlessly under local anesthesia with only oral and intramuscular sedation and analgesia. Other advantages include minimal blood loss, decreased patient morbidity and expense, and elimination of the risks of general anesthesia and intravenous anesthesia/sedation.
The Flashlamp‐Pumped 577‐nm Pulsed Tunable Dye Laser: Clinical Efficacy and In Vitro Studies
Authors: GLASSBERG EDWARD , LASK GARY P. , TAN ELAINE M.L. , UITTO JOUNI
Published: June 2013

Abstract. The 577‐nm flashlamp‐pumped tunable dye laser pulsed at 450 μs is rapidly becoming the treatment of choice for removal of port‐wine stains and other vascular ectasias. In this study, we examined the mechanisms of vessel destruction by determining the effects of laser irradiation on three types of primary target cells in vitro: erythrocytes, endothelial cells, and fibroblasts. Clinical studies were also performed, addressing the efficacy of this laser in the treatment of port‐wine stains of the head and neck, trunk, and extremities. In endothelial cell cultures, both [3H]thymidine (measuring cell proliferation) and [3H]leucine (measuring protein synthesis) incorporations were inhibited at energy levels of 5‐12 J/cm2 (p < 0.01). The laser energy in the range of 5‐8.5 J/cm2 had no effect on cell viability. Erythrocytes as target cells for laser energy demonstrated rapid, dose‐dependent lysis. Addition of erythrocytes into a co‐culture with endothelial cells abolished the direct inhibitory effect noted in cultures when endothelial cells alone were present. The results of the latter experiment imply that erythrocytes are the primary target cell absorbing the laser energy at 577 nm. However, direct laser effects on endothelial cells may also contribute to the mechanisms of ablation of the vascular ectasias by the tunable dye laser at 577 nm. Clinical trials on 28 patients with portwine stains of the face and neck using this laser demonstrated a 75% response rate with greater than 50% lightening of the lesions. Of 9 port‐wine stain lesions on the trunk and extremities (on a total of 6 patients), 8 (89%) demonstrated significant (>50%) fading of their lesions. Complications such as scarring or epidermal texture changes were minimal.
Treatment of Multiple Dermal Cylindromas with the Carbon Dioxide Laser
Authors: STONER MARY F. , HOBBS EDMUND R.
Published: June 2013

Abstract. The management of multiple cylindromas presents a therapeutic challenge to the clinician. The condition has significant cosmetic implications, and malignant degeneration can occur. Reported treatments include excision and repair of individual lesions, high‐dose radiation, and complete scalp removal with grafting. We review the proposed histogenesis of this tumor, discuss its associations, and report the first use of the carbon dioxide laser as a successful treatment.
Allergic Necrotizing Eosinophilic Granulomatosis
Authors: GAFFNEY MARGARET G. , HANKE C. WILLIAM
Published: June 2013

Abstract. Allergic necrotizing eosinophilic granulomatosis (ANEG) is a rare entity characterized by peripheral eosinophilia, hepatosplenomegaly, dyspnea, and lymphadenopathy. An unusual patient with ANEG is described in which the presenting feature was an extensive granulomatous lesion of the face. The patient's condition progressively deteriorated despite multiple therapies, and she finally succumbed to her disease.
Surgical Excision of Trauma‐Induced Verrucous Lupus Erythematosus
Authors: ESKREIS BEVERLY D. , ENG ANA M. , FUREY NANCY L.
Published: June 2013

Abstract. Verrucous papulonodules are an uncommon manifestation of chronic discoid lupus erythematosus. The differential diagnosis and pathogenesis of this rare entity are discussed. This is the first report of successful surgical excision of trauma‐induced lesions of verrucous lupus erythematosus.
Office Surgery: The Surgical Suite
Authors: TOBIN HOWARD A.
Published: June 2013

Abstract. A brief history of office based surgery as well as a guide to economic and practical considerations for new facility planning.
Aids to Scalp Reduction Surgery
Authors: ALT THOMAS H.
Published: June 2013

Abstract. Utilizing certain surgical techniques during scalp reduction surgery will assist the surgeon in achieving a carefully planned and more efficient result. Measurement of scalp depth will assist in predicting the amount of skin to be excised. A simple method of safe identification of the periosteum is described along with the description of an elevator which assists in rapid, safe, and extensive undermining in the galeal‐periosteal plane. An accessory supra‐auricular scalp incision can be employed to allow for extensive scalp undermining. A transverse incision into the skin flap to be advanced, allows the surgeon to safely approximate the amount of skin to be excised. When skin closure becomes impossible due to overzealous excision of bald skin, galeotomies can provide closure. A special order suture is described which allows for easier galeal closure. Surgical skin staples are recommended to provide a faster skin closure.
Skin Types in Dysplastic Nevus Syndrome
Authors: KOPF ALFRED W. , GOLDMAN RHONDA J. , RIVERS JASON K. , LEVENSTEIN MARCIA , RIGEL DARRELL S. , FRIEDMAN ROBERT J. , BART ROBERT S.
Published: June 2013

Abstract. In order to determine if individuals with dysplastic nevi (DN) are relatively more sun‐sensitive than controls who do not have DN, the sun‐reactivity skin types (based on the Harvard classification) were determined in these two groups. Compared with controls, sun‐sensitive types were significantly overrepresented in the DN group. This is consistent with the hypothesis that the fundamental defect in the dysplastic nevus syndrome is the genetically unstable melanocyte, which is susceptible to neoplastic transformation induced by sunlight.
Epidemiology of Malignant Melanoma: Intermittent or Total Accumulated Exposure to the Sun?
Authors: ARMSTRONG BRUCE K.
Published: June 2013

Abstract. In accordance with the sunlight hypothesis for its etiology, the incidence of malignant melanoma generally increases with increasing proximity to the equator. There are exceptions to this pattern, prominent among which is the tendency for incidence to increase with increasing distance from the equator beyond latitude 50° north in Europe. This anomaly is probably explicable in terms of climatic factors, geographic variation in skin pigmentation, and the sun‐seeking behavior of those in the north. The incidence of malignant melanoma is increasing at about 5% a year in most white populations, while there is no consistent tendency for it to increase in black populations. This difference suggests that the increase is due to increasing sun exposure. Evidence from recent case‐control studies is consistent with both intermittent intense exposure and total accumulated exposure to the sun causing an increase in risk of malignant melanoma. Reconciliation of these two different patterns of effect of sun exposure may lie in more careful measurement of sun exposure and analysis of exposure specific to the site at which each melanoma is observed to occur.
Impact of Ozone Depletion on Skin Cancers
Authors: KRIPKE MARGARET L.
Published: June 2013

Abstract. Because of recent growth in the uses and production of certain chlorofluorocarbon compounds, the ozone layer is at risk of diminishing. The major effect of a decrease in ozone will be an increase in the amount of UV‐B radiation in sunlight. Even a small increase in UV‐B radiation will almost certainly affect human health. The most obvious effect of increased UV‐B radiation will be an increase in the incidence of basal and squamous cell carcinomas. Other possible effects include a contribution to the development of cutaneous melanoma, ocular changes leading to the formation of cataracts, and immunologic perturbations.
Nonsurgical Treatments for Skin Cancer: Retinoids and α‐Interferon
Authors: LIPPMAN SCOTT M. , SHIMM DAVID S. , MEYSKENS FRANK L.
Published: June 2013

Abstract. Retinoids, the natural and synthetic analogs of vitamin A, and α‐interferon have been used effectively in the treatment of certain cutaneous premalignancies and malignancies. Retinoids have shown impressive activity against premalignant disorders of the skin (actinic keratoses, keratoacanthoma, epidermodysplasia verruciformis) and of other epithelial sites (oral leukoplakia, cervical dysplasia). In established basal cell skin cancers, topical retinoid treatment has produced a complete response rate of 33%, and systemic retinoids have produced an objective response rate of 51%. In advanced squamous cell skin cancers, systemic retinoids have produced a response rate of over 70%. Intralesional α‐interferon has produced impressive responses and systemic α‐interferon has produced a 50% objective response rate in basal and squamous cell carcinoma. Retinoid therapy and α‐interferon have produced modest overall results in melanoma, although striking individual responses have been reported. In cutaneous T‐cell lymphoma, which is notably refractory to chemotherapy, retinoids and α‐interferon have produced responses in 60%+ and 70%+ of cases, respectively. Retinoids and α‐interferon, either alone or in combination, offer exciting prospects for primary and neoadjuvant therapy for advanced malignancy. Retinoids also show promise as relatively nontoxic preventive and adjuvant therapy. Researchers should focus on integrating these drugs with other biological response modifiers, differentiation agents, and cytotoxic drugs for treating advanced malignancy.
The Biology of Melanoma Metastasis
Authors: FIDLER ISAIAH J.
Published: June 2013

Abstract. The process of cancer metastasis is sequential and selective and contains stochastic elements. The growth of melanoma metastases represents the endpoint of many lethal events that few tumor cells can survive. Primary tumors consist of multiple subpopulations of cells with heterogeneous metastatic properties, and the outcome of metastasis depends on the interplay of metastatic tumor cells with various host factors. This viewpoint is more optimistic than that of metastasis as a random process. A selective biological process is regulated by the interaction of tumor cells with their host, and these complex interactions can now be studied and manipulated.
Skin Cancer and Artificial Sources of UV Radiation
Authors: MORISON WARWICK L.
Published: June 2013

Abstract. Exposure of people to indoor ultraviolet (UV) radiation has vastly increased in the past one or two decades, mainly due to increased recreational exposure and partly as a result of therapy for skin disease. This trend will result in an increased incidence of skin cancer, but the magnitude of the increase is speculative at present because of a lack of information about the extent and nature of the recreational UV exposure.
Prevention of Skin Cancer
Authors: DELEO VINCENT A.
Published: June 2013

Abstract. Our understanding of the carcinogenic process as it relates to human skin cancer is growing rapidly. As this understanding increases, so will our ability to alter the process in a positive fashion. Presently, sun exposure is known to be the major carcinogen in human skin. The use of sunscreens is, and will continue to be, the most effective method of preventing human skin cancer. As these agents become more effective, especially against long‐wave UV radiation, and as patients begin to use them more conscientiously, we should experience a decrease in skin cancer rates. In addition, a number of chemical agents are presently being investigated as anticarcinogens, especially in those patients who are at high risk for the development of skin cancers. A number of these hold promise as safe and effective chemopreventatives in reducing the morbidity and mortality of cancer in human skin.
Outpatient Anesthesia
Authors: CHRISMAN BRUCE B. , WATSON MARK A. , MACDONALD DUNCAN E.
Published: June 2013

Abstract. More complex methods of outpatient anesthesia, including I.V. sedation and general anesthesia, have become commonplace. Patient selection and preoperative evaluation are discussed, as well as the choice of who will deliver anesthesia. Appropriate outpatient facilities and monitoring are reviewed. The authors' favorite methods of anesthesia, caveats, and suggestions are presented, as well as prevention and treatment of anesthesia problems and emergencies. J Dermatol Surg Oncol 1988; 14:939–946.
The Effect of Dacarbazine on Wound Healing
Authors: ROBINSON STEVEN J. , NAPPI JAMES F. , FALCONE ROBERT E.
Published: June 2013

Abstract. The effects of dacarbazine on wound healing were studied in an animal model. Sixty rats were divided into four groups. Each animal received a standard dorsal midline wound on day 0. Group 1 was injected with normal saline and acted as control; group 2 received 4 mg/kg of dacarbazine daily on days −3,−2,−1 (preoperative); group 3 received dacarbazine on days +1, +2, +3 (perioperatively); and group 4 received dacarbazine on days +5, +6, +7 (postoperatively). Wound bursting strength (WBS) was measured on days +7, +14, and +21. There was a significant decrease in WBS in experimental animals in groups 3 and 4 (perioperative and postoperative administration) compared to control animals, but no significant effect of preoperative dacarbazine on WBS in experimental animals (group 2). It is suggested that these effects are mediated through the late inflammatory phase of wound healing. J Dermatol Surg Oncol 1988; 14:975–978.
Syringe‐Assisted Liposuction: A Cosmetic Surgeon's Office Technique
Authors: BISACCIA EMIL , SCARBOROUGH DWIGHT A. , SWENSEN RICHARD D.
Published: June 2013

Abstract. Liposuction surgery is the fastest growing cosmetic surgical procedure in the United States. Our goal is to present a clinical review of our last 50 patients. We will present a technique of liposuction void of suction machine that is easily managed as an office surgical technique. The technique is modified from that of Dr. Fournier. We will outline the technique, including patient preoperative evaluation, monitoring, fluid management, postprocedure complications, photographic results, and, most importantly, patient selection. J Dermatol Surg Oncol 1988; 14:982–989.
The Use of Composite Auricular Grafts in Nasal Reconstruction
Authors: MAVES MICHAEL D. , YESSENOW RANDALL S.
Published: June 2013

Abstract. Composite auricular grafts are extremely valuable in head and neck reconstruction. They are most commonly used in reconstruction of the ear, eyelid, and nose. Composite grafting provides a relatively simple technique of reconstruction with excellent cosmetic and functional results. The advantage of a one‐stage reconstruction is particularly valuable to the patient. J Derm Surg Oncol 1988; 14:994–999.
Acanthoma Fissuratum
Authors: CERRONI LORENZO , SOYER HANS PETER , CHIMENTI SERGIO
Published: June 2013

Abstract. Five cases of acanthoma fissuratum observed in the last years are reported. These lesions, located along the retroauricular fold and on the nasal bridge, are caused by ill‐fitting eyeglasses. Clinically, acanthoma fissuratum is often mistaken for a basal cell epithelioma. The definitive diagnosis can be confirmed by characteristic histologic features in association with clinical and anamnestic data. Acanthoma fissuratum merits recognition as a distinctive lesion of importance for dermatologists and surgeons. J Dermatol Surg Oncol 1988; 14:1003–1005.
Periungual Hyperpigmentation Mimicking Hutchinson's Sign Associated with Minocycline Administration
Authors: MOONEY ELLEN , BENNETT RICHARD G.
Published: June 2013

Abstract. An assessment of the occurrence rate of periungual hyperpigmentation with subungual melanoma (Hutchinson's sign) and periungual hyperpigmentation with other subungual lesions has not been published, although periungual hyperpigmentation with a pigmented streak or other pigmented lesion of the nail has been considered pathognomonic for subungual melanoma for a century. We report a case of minocycline hyperpigmentation presenting as a longitudinal pigmented streak of the nail associated with periungual hyperpigmentation. These pigmentary changes could be mistaken for Hutchinson's sign. J Dermatol Surg Oncol 1988; 14:1011–1013.
Xanthoma Disseminatum: A Rare Condition with Non‐X, Non‐Lipid Cutaneous Histiocytopathy
Authors: SZEKERES ELENA , TIBA ANNAMARIA , KOROM IRMA
Published: June 2013

Abstract. We describe a 35‐year‐old man with cutaneous, mucosal, pulmonary, and bone involvement of xanthoma disseminatum. The 7‐year course of the disease and the results of light and electron microscopic and immunocytochemical examinations are presented. J Dermatol Surg Oncol 1988; 14:1021–1024.
Immunology of Injectable Collagen in Human Subjects
Authors: DELUSTRO FRANK , MACKINNON VICTORIA , SWANSON NEIL A.
Published: June 2013

Abstract. Associated with the use of Zyderm Collagen Implant (ZCI) for soft tissue augmentation, the rate of localized hypersensitivity reactions to the initial test injection of ZCI range from 3.0–3.5% in the literature, and subsequent reactions to treatment have reportedly ranged from 1.1–5.0%. The inflammatory symptoms to the Collagen Test Implant occur within 72 hours in 2% of those injected, indicating a preexisting sensitivity to bovine collagen in this healthy population. Most adverse treatment reactions follow the first treatment and after injection of <5 ml of collagen. Furthermore, antibodies against collagen in sera of subjects reporting localized symptoms of hypersensitivity at test or treatment sites are specific for bovine interstitial collagens and show no cross‐reactivity with human collagens. Thus, immunologic reaction to ZCI results in antibovine collagen antibodies and localized inflammatory symptoms in those few subjects who experience hypersensitivity to test or treatment.

Glutaraldehyde cross‐linked Zyplast Implant (ZI), has demonstrated a lower incidence of hypersensitivity reactions than ZCI. In examining patients tested with ZI or treated for intradermal and subdermal indications, we have experienced only 7 hypersensitivity reactions at test sites of ZI, out of 803 tested subjects, and only 3 reactions among 498 treated patients. Therefore, ZI appears to induce a lower incidence of hypersensitivity reactions than ZCI in man.
Electrodes for High‐Frequency Electrosurgery
Authors: SEBBEN JACK E.
Published: June 2013

Abstract. Among the varied types of electrosurgical electrodes available, many dermatologists find a tapered or needle‐shaped electrodesiccation electrode most useful. Cutting current procedures are best accomplished with fine needle or wire electrodes. Both monopolar and bipolar forceps are useful for pinpoint coagulation of small blood vessels. Because of increasing concerns about electrode contamination, several kinds of disposable electrodes are now available.
The Use of Carbon Dioxide Laser in Lichen Myxedematosus
Authors: KAYMEN AMELIA H. , NASR ANTHONY , GREKIN ROY C.
Published: June 2013

Abstract. Lichen myxedematosus is characterized by deposits of mucin in the dermis. Treatment can be systemic or local, depending on the clinical findings. We present a patient with pedunculated lesions on his nose, and a generalized thickening of his facial skin. The patient requested treatment of his nasal lesions. We elected to remove his nodules surgically using the carbon dioxide (CO2) laser. The technique is described and treatment options are reviewed.
Morphology and Localization of Sunburst Varicosities: An Electron Microscopic and Morphometric Study
Authors: WOKALEK H. , VANSCHEIDT W. , MARTAY K. , LEDER O.
Published: June 2013

Abstract. The results of light and electron microscopy of 18 punch biopsies of sunburst varicosities are presented. Sunburst varicosities are widened cutaneous veins located within the superficial vessel net as well as within descending branches, often with an asymmetrically thickened wall. The thickened vessel walls contain collagenous and muscle fibers. Only a few elastic fibers have been detected, as opposed to numerous oxytalan fibers. Electron microscopy reveals an interfibrillar collagenous dysplasia, lattice collagen, and some matrix vesicles. The center of sunburst vessels is found at depths ranging from 175 to 382 (μm below the stratum granulosum.
Sclerotherapy: A Personal Appraisal
Authors: BODIAN EUGENE L.
Published: June 2013

Abstract. Sclerotherapy undoubtedly remains an effective treatment for sunburst varicosities. This article reviews the types of sclerosants currently available, complications of treatment, and proper injection technique.
Sclerotherapy: Review of Results and Complications in 200 Patients
Authors: PUISSEGUR LUPO MARY L.
Published: June 2013

Abstract. Sclerotherapy is enjoying great popularity as a technique to eliminate unsightly spider and varicose veins. This study of 200 charts reveals a high success rate and a low incidence of long‐term adverse sequelae. To minimize complications, several suggestions are made based on clinical observations. As with any procedure, experience, meticulous technique, and good patient rapport are at the heart of its success.
Cryostat Use and Tissue Processing in Mohs Micrographic Surgery
Authors: HANKE C. WILLIAM , LEE MELISSA W.
Published: June 2013

Abstract. Information on cryostat use and reliability was collected from 130 members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. The Damon IEC International cryostat was utilized by 38% of the survey participants, followed by the Reichert Histostat (18%) and the LabTek/TissueTek (13%). Data were also collected on methods of frozen‐section embedding and technical training.
Narrow Versus Wide Margins in Malignant Melanoma
Authors: ROGERS GARY S.
Published: June 2013

Although wide surgical excision is the accepted treatment for thin malignant melanomas, there is reason to believe that narrower margins may be adequate. A randomized prospective study to assess the efficacy of narrow excision (excision with 1‐cm margins) for primary melanomas no thicker than 2 mm was conducted at the National Institute of Health in Milan, Italy, and five other countries.

Narrow excision was performed in 305 patients and wide excision (margins of 3 cm or more) in 307 patients. The major prognostic criteria were well balanced in the two groups. The mean thickness of the melanomas was 0.99 mm in the narrow‐excision group and 1.02 mm in the wide‐excision group.

The subsequent development of metastatic disease involving regional nodes and distant organs was not different in the two groups (4.6% and 2.3%, respectively, in the narrow‐excision group as compared with 6.5% and 2.6% in the wide‐excision group). Disease‐free survival rates and overall survival rates (mean follow‐up period was 55 months) were also similar in the two groups. Only three patients had a local recurrence as a first relapse. All had undergone narrow excision, and each had a primary melanoma with a thickness of 1 mm or greater.
The Role of Skin Testing in the Use of Collagen Injectable Materials
Authors: ELSON MELVIN L.
Published: June 2013

Abstract. The experience of 400 consecutive patients evaluated for soft tissue augmentation for a variety of contour defects is reviewed here. The first 200 patients were evaluated with only a single skin test prior to treatment, whereas the second group were skin tested twice. The rate of hypersensitivity to the first skin test was the same in both groups, 5 out of 200 (2.5%). In the 195 patients receiving treatment after a single negative skin test, 6 (3.1%) developed hypersensitivity reactions at treatment sites. In the second group, where double skin testing was employed, an additional 7 patients had a positive second skin test (3.5%). There were no allergic reactions in the 171 patients who received treatment after two negative skin tests.
Microcystic Adnexal Carcinoma with Mandibular Invasion and Bone Marrow Replacement
Authors: BIRKBY CRAIG S. , ARGENYI ZSOLT B. , WHITAKER DUANE C.
Published: June 2013

Abstract. A 51‐year‐old man with microcystic adnexal carcinoma of the face is reported. In addition to extensive soft tissue invasion by the cancer, there was direct bone invasion into the marrow of the mandible as well as perineural spread along the mental and inferior alveolar nerves. This represents the first case of microcystic adnexal carcinoma with documented bone invasion. Recognition of the aggressive nature of this cancer with potential for invasion into the skull is important for proper evaluation and treatment.
Long‐Term Recurrence Rates in Previously Untreated (Primary) Basal Cell Carcinoma: Implications for Patient Follow‐Up
Authors: ROWE DAN E. , CARROLL RAYMOND J. , JR. DAY CALVIN L.
Published: June 2013

Abstract. We reviewed all studies (since 1947) reporting recurrence rates for treatment of primary (previously untreated) basal cell carcinomas using surgical excision, radiotherapy, cryotherapy, curettage and electrodesiccation, and Mohs micrographic surgery. Our findings indicate that recurrences following treatment of primary basal cell carcinoma appear later than is generally acknowledged in the literature. We found that less than one‐third of all recurrences appear in the first year following treatment; only 50% appear within the first 2 years following treatment; and only 66%, or nearly two‐thirds, appear within the first 3 years following treatment. A good rule of thumb is that the 10‐year recurrence rate is double, or 2 times, that of the 2‐year recurrence rate. Furthermore, 18% of recurrences appear between the fifth and tenth year following treatment. These results held true, irrespective of treatment modality examined. Seventy‐two studies reporting short‐term recurrence rates (follow‐up less than 5 years) had a weighted average recurrence rate of 4.2%, whereas 34 long‐term studies (follow‐up of 5 years) had a weighted average recurrence rate of 8.7%, or more than 2 times the short‐term rate. Five‐year recurrence rates by treatment modality are as follows: Mohs micrographic surgery 1.0%, surgical excision 10.1%, curettage and electrodesiccation 7.7%, radiation therapy 8.7%, and cryosurgery 7.5%. We conclude that the reporting of recurrence rate data for basal cell carcinoma should be standardized using 5‐year life table analysis, and even more important is our conclusion that lifetime follow‐up is necessary after treatment of primary basal cell carcinoma in order to detect both recurrences and new primaries.
Postirradiation Extensive Cicatricial Scalp Alopecia Treated by Tissue Expansion
Authors: MOSCONA RONY , ULLMANN YEHUDA , BERGMAN REUVEN , FRIEDMAN‐BIRNBAUM RACHEL
Published: June 2013

Abstract. The scalp of a 20‐year‐old woman with extensive cicatricial alopecia caused by x‐ray irradiation for tinea capitis has been reconstructed by the use of tissue expansion. Two stages were required to reconstruct the large defect. The hair‐bearing posterior scalp has been expanded to cover the whole irradiated area, creating a new anterior hairline and a pleasing cosmetic result.
Trichloroacetic Acid Peels Revisited
Authors: COLLINS PAUL S.
Published: June 2013

Abstract. Trichloroacetic acid (TCA) is a time‐honored peeling agent that has no known systemic toxicity. Recent interest in reversing the effects of actinic damage has led to the utilization of combination therapies. Retinoic acid, solid CO2, pyruvic acid, Jessner's formula, and other agents have been used to increase the effectiveness of TCA and enhance peeling results. Repetitive peels with low concentrations of TCA can be effective for areas prone to scarring.
The Jessner's + TCA Peel: A Medium‐Depth Chemical Peel
Authors: MONHEIT GARY D.
Published: June 2013

Abstract. The Jessner's + TCA peel, a method of chemexfoliation, is a combination of two acidic compounds. It has been found to be an effective peeling procedure that produces a medium‐depth peel for photoaging skin, actinic keratoses, and rhytides.
Variations and Comparisons in Medium‐Depth Chemical Peeling
Authors: BRODY HAROLD J.
Published: June 2013

Abstract. Two effective methods in chemical peeling, solid carbon dioxide plus trichloroacetic acid and Jessner's solution plus trichloroacetic acid, were compared clinically with photographs and histologically with serial biopsies. Carbon dioxide produced a deeper wound than Jessner's solution, and CO2+ TCA was slightly deeper than Jessner's + TCA but was probably not significantly deeper from a clinical standpoint except in correcting scarring. Triple consecutive applications of TCA can substantially increase wound depth with both combination peels.
Occluded Baker‐Gordon Chemical Peel: Review and Update
Authors: ALT THOMAS H.
Published: June 2013

Abstract. The Baker‐Gordon phenol chemical peel is a safe and effective method to improve fine and moderate depth wrinkles as well as actinically damaged skin. Indications, applications of the chemical, taping, and pre‐and postoperative care are reviewed.
Unoccluded Baker‐Gordon Phenol Peels—Review and Update
Authors: ASKEN SAUL
Published: June 2013

Abstract. Phenol is used to induce peeling of certain superficial skin lesions, for improving eyelid rhytides, and for total facial rejuvenation. Contraindications and complications of the phenol chemical peel are examined. Phenol solution formula and mechanism of action are described along with techniques for sedation, cleansing, application, and postoperative care.
Aesthetic Problems in Chemical Peeling
Authors: GOLDMAN PETER M. , FREED MICHAEL I.
Published: June 2013

Abstract. Questionnaires were mailed to six physicians experienced in chemical peels regarding common problems encountered in the procedure. They are: Thomas H. Alt, M.D., Minneapolis, MN; Samuel J. Stegman, M.D., San Francisco, CA; James J. Stagnone, M.D., Albuquerque, NM; Robert Kotler, M.D., Los Angeles, CA; William H. Beeson, M.D., Indianapolis, IN; and Paul S. Collins, M.D., San Luis Obispo, CA. Their answers are presented in a panel format.
Evaluating Blood Flow in Full‐Thickness Skin Grafts Utilizing the Laser Doppler
Authors: MULVANEY MICHAEL J. , SALASCHE STUART J. , GRABSKI WILLIAM J.
Published: June 2013

Abstract. Full‐thickness skin grafts follow a consistent clinical pattern of color and textural changes. Measurements with the Laser Doppler Velocimeter correlate with these observed changes, yielding reproducible temporally associated blood flow rates. Previous physiologic and histologic studies for skin grafts are discussed.
The Role of Topical Agents in the Healing of Full‐Thickness Wounds
Authors: WATCHER MELISSA A. , WHEELAND RONALD G.
Published: June 2013

Abstract. Eight topical agents in current use were studied for their effects on wound contraction and rate of reepithelialization of full‐thickness excisions using a porcine animal model. The following agents were applied daily for a period of 27 days: scarlet red ointment, benzoyl peroxide lotion, bacitracin ointment, silver sulfadiazine cream, aloe vera gel, tretinoin cream, capsaicin cream, and mupirocin ointment. The rate of reepithelialization was significantly enhanced by treatment with capsaicin, bacitracin, silver sulfadiazine, and scarlet red, and was markedly retarded by treatment with tretinoin. Wound contraction was significantly retarded by mupirocin, bacitracin, and silver sulfadizine. Knowledge of the effects of topical agents on various aspects of healing allows the clinician to choose the most appropriate material to use in a given clinical situation to optimize the healing process and produce the best final result.
Donor Island Harvesting for Micro‐ and Minigrafting
Authors: COHEN IVAN S.
Published: June 2013

Abstract. Donor island harvesting, a method of obtaining micro‐ and minigrafts from the hair‐bearing strip between donor rows, is described.
The Precision Binocular Loupe
Authors: SIEGEL DANIEL M.
Published: June 2013

Abstract. The binocular loupe has long been used by dermatologists to improve their visualization of skin disease and for fine surgical work. As more and more dermatologists perform sclerotherapy and laser surgery, the popularity of magnifying loupes will increase.
Tissue Movement–A Macrobiomechanical Approach
Authors: DZUBOW LEONARD M.
Published: June 2013

Abstract. The surgical movement of skin involves both a respect for the biological integrity of the involved tissues and an understanding of its mechanical properties. The interaction of tissue biology and mechanics on the level of the organism therefore represents a macrobiomechanical approach to tissue movement. An understanding of anatomy and tissue movement dynamics is key in the performance of successful cutaneous surgery.
Postoperative Trichosporon Beigelii Soft Tissue Infection
Authors: GREENBERG ROBERT G. , BERGER TIMOTHY G.
Published: June 2013

Abstract. A case of postsurgical cutaneous infection with Trichosporon beigelii in an apparently immunocompetent individual is reported. This is a rare surgical complication and the first report of localized skin infection by this organism postoperatively.
Aging Hands: A Technique of Hand Rejuvenation by Laser Resurfacing and Autologous Fat Transfer
Authors: ABERGEL R. PATRICK , DAVID LAURENCE M.
Published: June 2013

Abstract. Hands are a primary target for actinic damage and premature aging. Until recently, very little could be done to successfully erase the various signs of photo‐aging. This article presents a simple technique, combining fat transfer and laser resurfacing, to safely and effectively rejuvenate hands and erase the signs of aging.
Flashlamp‐Pumped Pulsed Dye Laser Therapy for Poikiloderma of Civatte
Authors: WHEELAND RONALD G. , APPLEBAUM JAY
Published: June 2013

Abstract. The use of pulsed yellow light from a flash‐lamp‐pumped pulsed dye laser has provided a successful form of therapy to remove both the telangiectasias and irregular pigmentation associated with poikiloderma of Civatte. The short pulse duration and specificity of the interaction between yellow light and hemoglobin permit this technique to be performed on the thin skin of the neck without textural changes or scarring. Furthermore, use of the large beam diameter of this laser system allows for rapid treatment of large areas in a short period of time.
Hair Transplant Surgery: Innovative Designs
Authors: NORWOOD O'TAR T. , TAYLOR BRUCE J.
Published: June 2013

Abstract. Two new designs for hair transplant surgery are presented. Both designs are safer and will provide a more natural appearance in some patients than standard designs. The advantages are listed for both.
A Superior Method of Tattoo Removal Using the Q‐Switched Ruby Laser
Authors: SCHEIBNER ADRIANNA , KENNY GRAHAM , WHITE WILLIAM , WHEELAND RONALD G.
Published: June 2013

Abstract. The Q‐switched ruby laser was used to treat 101 amateur and 62 professional tattoos in 80 patients over a period of 22 months. Using a 5‐ to 8‐mm spot size and energy fluences of 2–4 joules/cm2, an average of three retreatments resulted in complete pigment removal in four, nearly complete pigment removal in 84, significant pigment removal in 11, and minimal pigment removal in two amateur tattoos. Using identical parameters for professional tattoos, there was complete pigment removal in two, nearly complete pigment removal in five, significant pigment removal in 18, minimal pigment removal in 25, and very little pigment removal in 12. Professional tattoos with red, yellow, and green pigments faded, but required multiple retreatments. While transient hypopigmentation occurred in many patients, skin texture and hair growth returned to normal in all cases and no hypertrophic scarring was seen.
Quantitative Assessment of Augmentation Therapy
Authors: GORMLEY DANIEL E. , EREMIA SOREN
Published: June 2013

Abstract. We report the results obtained from 18 women whose facial folds and furrows were treated with augmentation therapy. The results of treatment with microlipoinjection and injectable collagen were measured and compared at regular intervals for a period of 1 year using a method of optical profilometry. Subsidence was noted with both modalities. Collagen gave consistent results. Seventy‐five percent of correction on the average is lost at 6 months, but 22% of the collagen‐treated subjects maintained at least 30% correction 1 year from the time of treatment. Autologous fat gave unpredictable results ranging from poor to excellent. A good result at 6 months is likely to be maintained until 1 year from the time of treatment. Forty‐four percent of fat augmented subjects maintained at least 30% correction 1 year after treatment.
Current Trends in the Practice of Dermatologic Surgery
Authors: HANKE C. WILLIAM , BAILIN PHILIP L.
Published: June 2013

Abstract. In a 1984 survey, 2750 members of the American Academy of Dermatology were asked which dermatologic surgery procedures they performed and which procedures they expected to be performing in 5 years. A similar survey was completed by the American Society for Dermatologic Surgery in 1988. In this article, the results of the 1988 survey are presented and compared to that of 1984. J Dermatol Surg Oncol 1990; 16:130–131.
Dermatologic Cosmetic Surgery
Authors: III WILLIAM P. COLEMAN , ALT THOMAS H.
Published: June 2013

Abstract. Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face‐lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.
Research in Dermatologic Surgery and Oncology
Authors: POPKIN GEORGE L.
Published: June 2013

Abstract. The American Society for Dermatologic Surgery and The Skin Cancer Foundation have each helped to promote advances in dermatologic surgery and oncology by funding basic research. Their activity is presented.
The Use of Meshed Advancement Flaps in the Treatment of Lesions of the Lower Leg
Authors: MOTLEY RICHARD J. , HOLT PETER J. A.
Published: June 2013

Abstract. We describe the use of meshed local advancement flaps to repair surgical defects of the lower leg. The procedure produces a lattice of small cutaneous defects that heal rapidly by second intention. The technique is simple to perform and is suitable for large defects of the lower leg. Only minimal supervision is required postoperatively, and the wound causes virtually no pain.