bluuebunny/crossref_metadata_2025 huggingface dataset:
Punch Biopsy of the Skin: Effect of Temperature and Local Anesthesia with Ethyl Chloride Freezing
Authors: SERUP JØRGEN
Published: June 2013

Abstract. The effect of local anesthesia with ethyl chloride freezing on biopsy size and quality for microscopy was studied postmortem. Fourmm punch biopsies were taken from the abdominal skin by different techniques: manual punch and drill (250 RPM) at 8°C and 33 to 36°C, ethyl chloride, and injection of lidocaine for local anesthesia. Histologic sections were assessed, and defatted dried weight (DW) was determined as an expression of biopsy size.

After ethyl chloride freezing, microscopy showed more trauma (p < 0.001) and characteristic, marginal tissue‐breaks (p < 0.01). More biopsies (p < 0.05) were not proper for microscopy. DW and the variances showed no differences.

It is concluded that local anesthesia with ethyl chloride freezing results in tissue trauma and inferior quality of the tissue specimens for microscopy.
Office Photography from the Surgical Viewpoint
Authors: SEBBEN JACK E.
Published: June 2013

Abstract. This article reviews the special considerations necessary for adequate photography in a surgical practice. The selection of film, camera, lens, and flash is discussed. Major emphasis is on proper framing and composition of the subject matter. Recommendations are made concerning consent forms and filing of slides.
How to Recognize and Control the Problem Patient
Authors: WRIGHT MARY RUTH
Published: June 2013

Abstract. All surgery has a psychological impact, but nowhere does the patient's psyche come into play more prominently than in the field of elective surgery. Psychological manifestations related to elective surgery must be recognized and controlled preoperatively, lest they control the operative outcome. This article discusses the personality characteristics associated with the potential problem patient; counseling and evaluative techniques; common psychogenic conditions; cause and management of patient dissatisfaction; and psychology of the terminal patient.
Differentiation Between Malignant B‐Cell Lymphomas and Pseudolymphomas of the Skin
Authors: BURG GÜNTER , KERL HELMUT , SCHMOECKEL CHRISTIAN
Published: June 2013

Abstract Among cutaneous pseudolymphomas (PL) in a strict sense, in which the etiology is largely unknown, B‐cell types, simulating malignant B‐cell lymphoma, and T‐cell types, simulating malignant T‐cell lymphoma of the skin, can be differentiated. Criteria favoring a pseudolymphomatous rather than a malignant lymphoid infiltrate of B‐cell type may be clinical (solitary lesion on the head), histologic (wedge‐shaped infiltrate with follicle formation and sharply demarcated germinal centers), or cytomorphologic (polymorphous infiltrate showing an admixture of great numbers of macrophages, plasma cells, and eosinophils). Additional information can be provided by enzymophenotyping of the cells, showing the typical starry‐sky pattern of the macrophages in pseudolymphomatous infiltrates, and by the demonstration of the polyclonality of the lymphoid cells in pseudolymphomas with respect to surface markers and intracytoplasmatic Ig production, as shown by immunophenotyping techniques.
Skin Involvement of Malignant B‐Cell Lymphomas
Authors: STERRY WOLFRAM , KRÜGER GERHARD R. F. , STEIGLEDER GERD‐KLAUS
Published: June 2013

Abstract In 1186 patients with systemic malignant B‐cell lymphomas, the skin was involved in 6.17% of low‐grade malignant, 9.7% of medium‐grade malignant, and 7.4% of high‐grade malignant lymphomas. Skin involvement is associated with an impaired prognosis in malignant B‐cell lymphomas, with the exception of medium‐grade malignant lymphomas.
Malignant Melanoma Prognostic Factors 4: Ulceration Width
Authors: DAY CALVIN L. , LEW ROBERT A. , HARRIST TERENCE J.
Published: June 2013

Abstract “Ulceration width” is superior to “ulceration per se” as a prognostic variable in patients with clinical stage I melanoma. Just as thickness has replaced level of invasion, “ulceration width” will replace ulceration.
Periungual Lipoma at an Unusual Site
Authors: BARAN ROBERT
Published: June 2013

Abstract A 41‐year‐old white male presented with a lipoma of the lateral nail fold of his right middle finger. This location seems unique in the literature.
Myxoid Cysts of the Proximal Nail Fold: A Surgical Approach
Authors: SALASCHE STUART J.
Published: June 2013

Abstract En bloc excision of the proximal and lateral nail folds as described by Baran and Bureau for the treatment of chronic paronychia is successfully adapted for treatment of myxoid cysts of the proximal nail folds.
Exacerbation of Facial Herpes Simplex after Phenolic Face Peels
Authors: RAPAPORT MARVIN J. , KAMER FRANK
Published: June 2013

Abstract The development of widespread herpes simplex on the face after phenolic face peels is not considered rare. Precaution in choosing patients is recommended. Four cases of acute exacerbation of herpes simplex are presented in patients who had recently undergone phenolic face peels.
Carbon Dioxide Laser Treatment of Oral Florid Papillomatosis
Authors: PERSKY MARK S.
Published: June 2013

Abstract Oral florid papillomatosis is an uncommon condition that has been treated with various forms of therapy in the past. This lesion is considered to be premalignant by most authors, and surgical therapy has ranged from local excision to radical resection. A case of oral florid papillomatosis involving the entire hard palate and extending over the superior alveolar ridge into the buccal‐gingival sulcus is presented. This patient was successfully treated by a two‐stage carbon dioxide (CO2) laser excision with excellent functional results and minimal morbidity.
Aromatic Retinoid in the Chemoprevention of the Progression of Nevoid Basal‐Cell Carcinoma Syndrome
Authors: CRISTOFOLINI MARIO , ZUMIANI GIUSEPPE , SCAPPINI PIERANTONIO , PISCIOLI FRANCESCO
Published: June 2013

Abstract The management of nevoid basal‐cell carcinomas in this syndrome is sometimes very difficult, because of the high number of tumors and of their particular localizations. The authors reviewed the literature and here report their experience in the treatment of nevoid basal‐cell carcinoma syndrome with aromatic retinoid etretinate (RO 10–9359; Tigason).
Coping with the Complexities of Informed Consent in Dermatologic Surgery
Authors: REDDEN EILEEN M. , BAKER DANIEL C.
Published: June 2013

Abstract Few medico‐legal issues have generated as much controversy as informed consent—the right of patients to be fully informed about the risks, complications, and alternatives to a medical treatment or surgical procedure before deciding whether or not to submit to it. This paper discusses the complexities inherent in the legal doctrine of informed consent and their implications for dermatologic surgery. Particular emphasis is placed on the legal requirements for informed consent, as well as the problems associated with informing patients and their potential solutions.
Cellular Atypia in a Rheumatoid Nodule: A Diagnostic Pitfall of Aspiration Biopsy
Authors: YOUNGBERG GEORGE A. , FARNUM JAMES B.
Published: June 2013

Abstract A 63‐year‐old cachectic white male developed subcutaneous scalp nodules. Clinically these were felt most likely to represent metastatic tumor, although the patient was known to have rheumatoid arthritis. Aspiration cytology was interpreted as malignant due to the presence of atypical cells, but tissue biopsies demonstrated necrotizing palisading granulomas. The diagnostic hazard of cellular atypia in rheumatoid nodules is discussed.
A Multivariate Analysis of Factors Affecting Wound‐Healing Time
Authors: ROBINS PERRY , DAY CALVIN L. , LEW ROBERT A.
Published: June 2013

Abstract For post‐Mohs surgical defects of the head and neck, the width of the defect is the best predictor of the length of that time it will take the wound to heal. This conclusion is based on a multivariate analysis, testing the effect of the following factors on wound‐healing time: (1) age, (2) sex, (3) sound location, (4) wound width, (5) wound length, and (6) wound length × wound width.

After accounting for wound width, none of the other factors significantly influenced the rate of wound healing. The 64 wounds evaluated were dressed daily with one of five bandages.

When compared with the controls, and after correcting for wound width, each of the test bandages shortened wound‐healing time. Among the treatment groups, no significant differences were found in the cultures or in the appearance of the wounds.
A New Method of Donor Site Harvesting
Authors: UNGER WALTER P.
Published: June 2013

Abstract Paired or single donor rows separated from another pair of donor rows by a gap of intact skin approximately 12 mm wide and combined with suturing produces superior short‐term as well as long‐term scarring in punch transplant donor sites. Two variations of this general approach are described and discussed. Because donor scars are finer, it is possible to remove 10 to 15% more grafts from a patient using this approach.
Facelift Surgery Update: Suction‐Assisted Rhytidectomy and Other Improvements
Authors: CHRISMAN BRUCE B. , FIELD LAWRENCE M.
Published: June 2013

Abstract The steady development of facelift techniques and modifications has continued to make the rhytidectomy procedure safer and better. The remarkably rapid acceptance of lipo‐suction‐assisted rhytidectomy has significantly altered this form of cosmetic surgery, resulting in more pleasing results for patients and surgeons alike.
Scalp Reduction Surgery with the Carbon Dioxide Laser
Authors: WHEELAND RONALD G. , BAILIN PHILIP L.
Published: June 2013

Abstract When used in the focused cutting mode, the carbon dioxide (CO2) laser can permit virtually bloodless scalp reduction surgery as a function of its remarkable hemostatic properties. This instrument speeds the operating time and allows the surgeon to close the wound with confidence that postoperative bleeding is unlikely to compromise the results. The additional potential benefits of decreased swelling and pain due to sealing of lymphatics and nerve endings are more difficult to quantify. It appears that the CO2 laser offers many benefits in scalp reduction surgery and is a useful modification of the standard technique.
Zoon's Balanitis Treated by Circumcision
Authors: FERRÁNDIZ C. , RIBERA M.
Published: June 2013

Abstract Zoon's balanitis is a chronic balanitis affecting parts of the glans penis and prepuce, usually considered refractory to treatment. This article reports the study of seven cases successfully treated by circumcision.
Delayed Extensor Tendon Rupture: A Complication of Mohs Surgery
Authors: GASPARI ANTHONY A. , SUHGE d'AUBERMONT PETER C. , BENNETT RICHARD G.
Published: June 2013

Abstract A 63‐year‐old man is presented who developed a ruptured extensor tendon of the hand 3 days following Mohs surgery (fresh tissue technique) for a recurrent squamous‐cell carcinoma. Retrospective examination of this case led us to conclude that several different factors (partial tendon laceration, infection, and underlying medical problems) jointly contributed to this complication. These factors are discussed, along with recommendations for management of such cases.
Punch Transplantation in “Early” Androgenetic Alopecia
Authors: UNGER WALTER P.
Published: June 2013

Abstract
Despite the prognostic difficulties that punch transplanting into areas of “early” androgenetic alopecia presents, this approach has many advantages for most patients. Technical considerations as well as five case histories are presented here.
Single‐Hair Transplantation for Hairline Refinement: A Practical Solution
Authors: MARRITT EMANUEL
Published: June 2013

Abstract
Patients with dark, straight hair and light skin often demonstrate an unnatural abruptness of the hairline following traditional methods of hair transplantation. A rapid, practical technique of harvesting grafts of only one and two hairs from standard 4‐mm grafts, for the purposes of “softening” the hairline, is described. Recipient sites are made with a 16‐gauge angiocath, not a scalpel, for diminished bleeding and, it is hoped, more accurate placement of the graft.
Alopecia Reduction by Scalp Expansion
Authors: MANDERS ERNEST K. , III WILLIAM P. GRAHAM
Published: June 2013

Abstract
Areas of alopecia may be eliminated by scalp expanders. This is accomplished by subgaleal placement of soft tissue expanders under normal scalp adjacent to defect. Subsequent inflation and advancement of the expanded scalp resurfaces the defect with an excellent aesthetic result.
Scalp Kinetics in Multiple Excisions for Correction of Male Pattern Baldness
Authors: NORDSTRÖM ROLF E. A.
Published: June 2013

Abstract
The author placed tattoo marks in the scalp in a certain pattern in seven patients with male pattern baldness to ascertain the complex movement of the scalp due to serial longitudinal midline excision of the bald area.
Residents’Corner: Cheilitis Glandularis—A Disorder of Ductal Ectasia
Authors: RADA DAVID C. , KORANDA FRANK C. , KATZ FRED S.
Published: June 2013

Cheilitis glandularis is characterized by lip eversion and protrusion with obvious, mucoid‐secreting ductal orifices along the mucosal‐vermilion boundary. One may see confirmatory microscopic findings of ductal ectasia and metaplasia. Vermilionectomy can be efficacious.
Acne, Retinoids, and Dermabrasion
Authors: Jr. ROENIGK HENRY H. , PINSKI JAMES BERNARD , ROBINSON JUNE K. , HANKE C. WILLIAM
Published: June 2013

A group of nine patients with severe nodulocystic acne vulgaris were treated with oral 13‐cis‐retinoic acid and their acne cleared. During or after retinoid therapy, all patients underwent full‐face dermabrasion. Postoperative healing was normal, and no significant complications were seen.
Electrosurgery Using Insulated Needles: Epilation
Authors: KOBAYASHI TOSHIO
Published: June 2013

Abstract This paper deals mainly with histologic findings and clinical aspects of epilation using insulated needles. Patients were checked for hair regrowth after “thermolysis” epilation – a cycle of three to four treatments at roughly 3‐month intervals, within an observation period of 2 1/2 years. The results for 39 patients, compiled 6 months to 1 year after the final epilations, showed almost no or extremely reduced hair regrowth with almost no scarring.
SECOND PRIZE: Liposuction for Lipomas
Authors: RUBENSTEIN RICHARD , ROENIGK HENRY H. , GARDEN JEROME M. , GOLDBERG NEIL S. , PINSKI JAMES B.
Published: June 2013

Abstract Six cases of giant lipomas were treated by liposuction surgical removal. The method involves only a 1‐cm incision and insertion of a liposuction cannula. The fibrous stroma of the lipoma may be more difficult to remove. Liposuction is a safe and easy method of removing giant lipomas.
Reduced Epidermal Langerhans Cell Densities in Patients with Pulmonary Malignancies Do Not Correlate with Anergy or Nutritional Status
Authors: FOX J. L. , BERMAN B. , GOODMAN Ph R.
Published: June 2013

Abstract Epidermal Langerhans cell (ELC) densities are markedly reduced in a number of clinical situations including anergic sarcoidosis patients. To help determine whether this reduction is related to the anergic or nutritional status of the patient, we examined the non‐sunexposed epidermis of 23 hospitalized patients with various malignancies (MP), 10 hospitalized control (HC) patients without malignancy, and 24 biopsies from historical control (HIC) patients. There was no significant difference in the density of HLA‐DR+ ELC among HC, HIC, or patients with nonpulmonary malignancy (primary or metastatic). Six patients with pulmonary malignancy had significantly fewer HLA‐DR+ and OKT6+ epidermal cells. The reason ELC densities are reduced specificantly in pulmonary malignancies remains under study.
Effects of Systemic Corticosteroids on Post‐Cryosurgical Edema and Other Manifestations of the Inflammatory Response
Authors: KUFLIK EMANUEL G. , WEBB WILLI
Published: June 2013

Abstract. Severe edema can occur after cryosurgical treatment of malignant lesions on the eyelids and periorbital area. In a study of 134 patients, it was found that a short course of systemic steroids was able to reduce the severity of post‐cryosurgical edema. This can be beneficial for patients in whom periorbital edema can be expected to occur.
Residents’Corner: Diagnoses of Skin Disease: Dermatologists vs. Nondermatologists
Authors: WAGNER RICHARD F. , WAGNER DIANE , TOMICH JOHN M. , WAGNER KAREN DINEEN , GRANDE DONALD J.
Published: June 2013

Abstract. Health care professionals (medical students, practicing physician's assistants, and residents in the specialties of internal medicine, surgery, and dermatology) were evaluated for their ability to diagnose malignant and benign skin disease. It was found that dermatology residents did significantly better in the diagnosis of malignant and benign skin disease than all other groups, and there was no significant difference among medical students, physician's assistants, and residents in internal medicine or surgery. Findings suggest that the current ability of nondermatologists to correctly diagnose malignant and benign skin disease is not at a comparable level to that of dermatologists and that a 1‐month training period in the specialty of clinical dermatology during the primary care residency training period may be inadequate for training nondermatologists to distinguish malignant from benign skin disease. In some specialty areas, such as dermatology, specialization may be preferable to a primary care approach for initially evaluating skin disease.
Metastatic Squamous‐Cell Carcinomas Derived from Solar Keratosis
Authors: FUKAMIZU HIDEKAZU , INOUE KUNIO , MATSUMOTO KICHIRO , OKAYAMA HIDEYO , MORIGUCHI TAKAHIKO
Published: June 2013

Abstract. Actinic squamous‐cell carcinoma has been described to have a low risk of metastasis. Reported here are four Japanese cases of lymphatic metastasis of squamous‐cell carcinoma derived form solar keratosis. The primary lesions were on the face in three cases and on the back of the hand in one. Two patients died, and others had recurrent incurable metastatic lymph nodes. Therefore, it is noteworthy that actinic squamous‐cell carcinoma in the Japanese can become so aggressive and metastasize.
Techniques of Sclerotherapy for Sunburst Venous Blemishes
Authors: BODIAN EUGENE L.
Published: June 2013

Sunburst varicosities of the lower extremities are unattractive and objectionable to many women. The treatment and eradication by sclerotherapy is simple, effective, and safe. The sclerosing agent of my choice is hypertonic saline since it is easily available, nonallergenic, inexpensive, and very effective.
Sebaceous Carcinoma of the Eyelid: Treatment with Mohs Surgery
Authors: DZUBOW LEONARD M.
Published: June 2013

Abstract. Sebaceous carcinomas of the eyelid are associated with high morbidity and mortality. Recurrence is common following conventional surgical or radiation therapy. Although Mohs surgery remains the treatment of choice, multicentric involvement and pagetoid spread may create outlying noncontiguous foci requiring careful follow‐up and possible secondary Mohs procedures.
Coexistence of Kaposi's Sarcoma and Angioimmunoblastic Lymphadenopathy
Authors: FRIEDMAN‐BIRNBAUM RACHEL , GILHAR AMOS , CARTER ANNA
Published: June 2013

Abstract. A 66‐year‐old woman who developed simultaneously angioimmunoblastic lymphadenopathy (AILD) and Kaposi's sarcoma (KS) is reported. A parallel course of the two diseases was evident. After a relatively short course of corticosteroid therapy, the clinical and laboratory signs of AILD regressed, and the patient is in remission 39 months after the beginning of the disease. At the same time a regression of KS lesions was also observed. The frequent association of KS and lymphoproliferative disorders in the same patient is discussed. As AILD is a lymphoma‐like syndrome, it is suggested that we might expect a more frequent association of this disease with KS in the same patient than the two cases reported to date.
A Brief Analysis of the Burow's Wedge/Triangle Principle
Authors: GORMLEY DANIEL E.
Published: June 2013

Abstract. The Burow's wedge/triangle principle is analyzed and related to a variety of closure techniques that bear various names. The rationale for the application of these principles is reviewed.
Punch Grafting the Crown and Vertex
Authors: GOLDMAN PETER M.
Published: June 2013

Abstract. Several different methods exist for surgical hair replacement of the vertex region of the scalp. Despite the more recent addition of alopecia reduction and flaps, small areas of crown baldness frequently, can best be handled cosmetically by well‐planned and technically well‐executed punch autografts. The methodology of hair transplantation of the vertex region of the scalp and the avoidance of cosmetic problems are discussed.
Basal Cell Carcinoma Associated with Keratoacanthoma
Authors: BRYANT JAMES
Published: June 2013

Abstract. This report describes a basal cell carcinoma associated with a keratoacanthoma, showing a histologic transition between the two lesions. Two previously reported cases of basal cell carcinoma are associated with keratoacanthoma, but do not show a transition between the two lesions. The malignant potential of the keratoacanthoma in this case is emphasized.
Marsupial Minigrafts for Alopecia following Surgical Procedures of the Scalp Repaired by Split‐Thickness Skin Grafts
Authors: WAGNER RICHARD F. , GRANDE DONALD J. , KORANDA FRANK C.
Published: June 2013

Abstract
A technique is described for treating the alopecia resulting from scalp surgery repaired by split‐thickness skin grafts with the method of marsupial minigrafts. This procedure provides an uncomplicated outpatient approach for treating this type of alopecia.
Cutaneous Metastases from Chondrosarcoma
Authors: SHERR DAVID L. , FOUNTAIN KAREN S. , KALB ROBERT E.
Published: June 2013

Abstract
This report describes a patient with histologically confirmed multiple cutaneous metastases from a skeletal chondrosarcoma and reviews the two previously published cases of this very unusual pattern of metastasis. We conclude that metastatic chondrosarcoma should be considered in the differential diagnosis of multiple cartilaginous tumors of the skin, and that radiotherapy may play a role in the management of metastatic chondrosarcoma.
Melanonychia Striata Longitudinalis: Multiple Benign Pigmented Streaks in a Caucasian
Authors: GOLDBERG DAVID J.
Published: June 2013

Abstract
Melanonychia striata, longitudinalis, or a pigmented longitudinal melanocytic streak of the nail, is distinctly uncommon in white patients. Such a finding is highly suggestive of a malignant melanoma. Reported herein is the first case report of a Caucasian with multiple pigmented streaks of the nail, the biopsy of one nail showing a lentigo.
The Biology of Basal Cell Carcinomas—A Revisit and Recent Developments
Authors: GRIMWOOD RONALD E. , SIEGLE RONALD J. , FERRIS CHARLES F. , HUFF J. CLARK
Published: June 2013

Abstract. This paper will review some of the present information on the biology of basal cell carcinoma. Recent developments include a better understanding of the basement membrane components surrounding the tumor nodules, as well as identifying the most actively dividing cells in solid basal cell carcinoma by autoradiographic techniques. The implications of a recently developed animal model will also be discussed.
Basal Cell Carcinoma with Eccrine Differentiation (Eccrine Epithelioma)
Authors: HANKE C. WILLIAM , TEMOFEEW RICHARD K.
Published: June 2013

Abstract. Basal cell carcinoma with eccrine differentiation is an invasive, slow‐growing tumor that usually occurs on the scalp. The histopathologic findings include basaloid epithelial elements, cystic spaces, and a fibrous or myxomatous stroma. The patient described in this report demonstrated epithelial elements with marked similarity to eccrine ducts. Mohs micrographic surgery, by virtue of the large number of frozen sections that are examined, provides an ideal way to study the characteristics of this unusual tumor.
Infiltrative Basal Cell Carcinoma: A Nonsclerosing Subtype
Authors: SIEGLE RONALD J. , MacMILLAN JULIE , POLLACK SHELDON V.
Published: June 2013

Abstract. Infiltrative basal cell carcinoma is a distinct histologic subtype of basal cell carcinoma (BCC). Criteria for its diagnosis are presented and its nonsclerotic nature emphasized. Analysis of 174 consecutive BCCs referred for Mohs micrographic surgery showed the infiltrative subtype (29 tumors) to be significantly more destructive and difficult to treat than the more common nodular BCC.
Late Recurrent Basal Cell Carcinoma Presenting as a Unilateral Exophthalmos
Authors: TOMICH JOHN M. , WAGNER RICHARD F.
Published: June 2013

Abstract. A late recurrent basal cell carcinoma which presented as a unilateral exophthalmos is described. Published surgical protocols of the 1960's advocated deferring further treatment for incompletely excised cutaneous basal cell carcinoma unless there was clinical evidence of tumor recurrence. Our patient demonstrates that this approach may result in late, unusual, and fatal patterns of recurrence. Complete excision of primary basal cell carcinoma is advocated.
The Pulsed Dye Laser: Its Use at 577 nm Wavelength
Authors: GARDEN JEROME M. , TAN OON T. , PARRISH JOHN A.
Published: June 2013

Abstract. The ability to increase laser‐induced cutaneous blood vessel damage selectivity is dependent upon optimizing various intrinsic laser parameters. Varying the laser emission wavelength, pulse duration, and/or incident energy dosage allows the clinician potential improvement in the laser treatment of cutaneous small blood vessel processes such as port‐wine hemangioma and te‐langiectasia. The pulsed dye laser at 577 nm and a pulse duration of 300 to 400 μseconds, incorporates desired laser parameters into its design. Clinical evaluation of the therapeutic outcome with this laser reveals favorable results while significantly minimizing potential adverse side effects.
Treatment of Xanthelasma Palpebrarum with the Carbon Dioxide Laser
Authors: APFELBERG DAVID B. , MASER MORTON R. , LASH HARVEY , WHITE DAVID N.
Published: June 2013

Abstract. Six patients with xanthelasma palpebrarum of the eyelids have been treated with the CO2 laser and followed for periods varying up to 4 years. Satisfactory cosmetic results were achieved in all patients without significant scarring, and no recurrence has been discovered thus far.
New Developments with the Heavy Metal Vapor Lasers for the Dermatologist
Authors: GOLDMAN LEON , TAYLOR ALLEN , PUTNAM TIM
Published: June 2013

Abstract. In controlled studies the heavy metal vapor lasers are important for dermatologic surgery, for vascular lesions, and for skin malignancies, especially those malignancies which cannot be treated by conventional means. The flexibility of the fiberoptic system for transmitting the lasers lends itself to laser vascular surgery, cancers of the skin, and mucous membranes. The heavy metal vapor laser is one of the few laser systems for clinical practice which include two different systems, thereby increasing applications.
Laser Surgery for Children
Authors: BRAUNER GARY J. , SCHLIFTMAN ALAN
Published: June 2013

Abstract. Laser surgery can be effectively used in children with either local or general anesthesia. The laser must be used only in selected instances where other therapies have not been fruitful, such as congenital port‐wine stains or recalcitrant warts. Significant scarring is a potential sequela of the second degree burns produced by argon or carbon dioxide laser surgery, and is particularly a risk for children. Elective laser surgery, therefore, should be deferred until a child would be capable of cooperating fully with postoperative wound care. Parents must be appropriately informed about expectations for cure in certain diseases which may be only partially remedied. For instance, congenital melanocytic nevi may be improved, but are incompletely removed by laser surgery. Also, dramatic improvements in dynamic diseases such as adenoma sebaceum may represent only a temporary interlude.
CO2 Laser Treatment of Cutaneous Neurofibromas
Authors: ROENIGK RANDALL K. , RATZ JOHN LOUIS
Published: June 2013

Abstract. Cutaneous benign neurofibromas are the most common skin manifestation of Von Recklinghausen neu‐rofibromatosis (NF). An autosomal dominant disorder, NF has extraordinary clinical variability and multisystem involvement; many patients develop hundreds of cutaneous neurofibromas in a lifetime. This problem can easily and rapidly be treated using the CO2 laser with results equal to or better than excision. The procedure is very helpful for patients with large numbers of small‐ or medium‐sized cutaneous neurofibromas.
Superpulsed Lasers: Minimizing Thermal Damage with Short Duration, High Irradiance Pulses
Authors: HOBBS EDMUND R. , BAILIN PHILIP L. , WHEELAND RONALD G. , RATZ JOHN LOUIS
Published: June 2013

Abstract. Superpulsed carbon dioxide lasers emit a controlled train of short duration, high‐power pulses which minimize the protein coagulation effects of the laser. Very high irradiances can be used with superb control of vaporization without significant peripheral heating. In incisional work, superpulsing permits the surgeon to advance the hand piece as slowly and as accurately as desired, while experiencing a fraction of the necrosis attendant to conventional continuous‐wave lasers. In va‐porizational applications, target tissue volumes are flash vaporized before significant heat can be transferred to surrounding tissue, promoting faster wound healing and reduced scarring. The superpulse feature may significantly change the way in which the carbon dioxide laser is used in cutaneous surgery.
Article: Cardiovascular Effects of Topical 50% Trichloroacetic Acid and Baker's Phenol Solution
Authors: STAGNONE GREGORY J. , ORGEL MICHAEL G. , STAGNONE JAMES J.
Published: June 2013

Abstract. Phenol and trichloroacetic acid (TCA) are used for cosmetic face peeling. Deaths associated with phenol have been ascribed to the cardiotoxicity. Our purpose has been to study and compare the cardiovascular responses to these two agents in a rat model.

Fifteen rats underwent abdominal epilation. Two to six days later a surface area comparable to the human face (16 cm2) was delineated on the abdomen. Baker's phenol or 50% TCA was applied to this area. Cardiac rate and rhythm and arterial pressure were monitored. Once stable, the same agent was applied to the entire abdomen for further study.

TCA has been shown to be a safer agent than phenol in this rat model. Assuming that this model simulates the human response, monitoring would appear to be indicated during full‐face Baker's phenol peeling.
Fingernail Drill in Bone Surgery
Authors: SNOW STEPHEN N.
Published: June 2013

Abstract. The fingernail drill is useful in bone surgery. It is useful in aiding the excision of bone and in the stimulation of granulation tissue in exposed cranial bone. The drill is safe, efficient, and easy to operate.
Pyoderma Gangrenosum and Hairy Cell Leukemia
Authors: KAPLAN RICHARD P. , NEWMAN GERALD , SAPERIA DAVID
Published: June 2013

Abstract. Hairy cell leukemia (HCL) is an uncommon hematologic malignancy in which simultaneous cutaneous disturbances of various types have been reported. We report a case of a 62‐year‐old man with HCL who developed pyoderma gangrenosum (PG) at the site of incision for splenectomy. PG has been reported previously in a patient with HCL. Since splenectomy is important in the treatment of HCL, it is important for the clinician to know that surgical wound dehiscence may not be due to poor technique nor infection, but rather to pathergy.
Electrosurgery Using Insulated Needles: Basic Studies
Authors: KOBAYASHI TOSHIO , YAMADA SHIRO
Published: June 2013

Abstract We conducted basic studies to evaluate the effectiveness of our insulated needles using raw egg white and fish meat as test material. The basic studies we carried out confirmed that the needles' insulation would withstand the high frequency electric current passed through them. This research served as the foundation for our clinical applications.
Sclerosing Epithelial Hamartoma Associated with a Melanocytic Compound Nevus
Authors: PIMPINELLI N. , URSO C. , REALI U.M.
Published: June 2013

Abstract A case of sclerosing epithelial hamartoma in a 19‐year‐old female is reported. The lesion, presenting the distinctive clinical and histologic features, was associated with a melanocytic compound nevus. This unusual and interesting event is discussed.
Chemosurgical Report: Indications for a Geometric Approach to Wound Closure following Mohs Surgery
Authors: DZUBOW LEONARD M.
Published: June 2013

Abstract Complex geometrically designed closures of defects following tumor removal by Mohs surgery are often utilized when simpler methods of direct tissue apo‐sition would suffice. There are, however, specific advantages in certain instances of using a preplanned geometric closure. Utilization of the secondary defect created by movement of a rotation flap permits redirection of the forces of tension of wound closure. Preplanning of advancement flaps allows for selective placement of tissue dog ears and thereby allows for maximal camouflaging of excisional scars. The dynamics of these two flaps are discussed and specific examples illustrating the principles are reviewed.
International Dermatosurgery: Reconstructive Treatment of the Vulva—A New Procedure: Experience on 23 Cases over 4 Years
Authors: CAMACHO‐MARTÍNEZ F. , NAVARRO J. , MORENO J.C. , MIR J. SÁNCHEZ‐CONEJO , SÁNCHEZ‐PEDRENO P.
Published: June 2013

Abstract The postvulvectomy reconstruction caused the authors diverse problems in the first three operations. The use of a bipedicle advancement flap obtained from the anterointernal region of the thigh, modified depending on the extension of the vulvectomy and the elasticity of the skin allow us to suggest the use of this technique due to its safeness, the facility with which it is carried out, and reduction of the hospital stay, as this makes the method socially economical.
A Six‐Step Approach for the Treatment of Extensive Baldness
Authors: BRANDY DOMINIC A.
Published: June 2013

Abstract A combination of the bilateral occipito‐parietal flap, the bitemporal flap, conventional punch grafts and minigrafts is used to treat the patient with extensive male pattern baldness in six operations.
Postsclerotherapy Hyperpigmentation: A Histologic Evaluation
Authors: GOLDMAN MITCHEL P. , KAPLAN RICHARD P. , DUFFY DAVID M.
Published: June 2013

Abstract Linear or macular pigmentation occurs in 10–30% of patients following sclerotherapy of vessels between 0.1 and 5 mm in diameter. Its occurrence is related to solution strength, vessel fragility, injection pressure, and the type of solution used. This adverse sequela of treatment has been assumed, by some, to represent post‐inflammatory hyperpigmentation (incontinence of melanin pigment), and has been said to occur in individuals with this tendency. Histologic data presented in this paper suggest that this phenomenon does not represent melanocytic alteration, but is secondary to extravasation of red blood cells into the dermis following rupture of fragile vessels with resulting deposition of hemosiderin. Therapy has included bleaching agents (hydroquinones), trichloroacetic acid, and phenolic peeling agents with variable success. Eighty percent of patients who experience this adverse sequela will clear spontaneously within 6–24 months. The remaining patients will have persistence of pigmentation for up to 5 years, with a small number of patients having pigmentation persisting 5 years after therapy.
Tattoo Removal with Minimal Scarring: The Chemo‐Laser Technique
Authors: RUIZ‐ESPARZA JAVIER , GOLDMAN MITCHEL P. , FITZPATRICK RICHARD E.
Published: June 2013

Abstract. A method useful in the removal of decorative tattoos too large for simple excision, or tattoos located in anatomic areas prone to hypertrophic scarring, is described. The method employs the carbon dioxide (CO2) laser for partial ablation of the tattooed area, followed by the repeated application of a urea mixture to complete the removal of the dyes. (These applications continue until the wound is totally healed.) Results indicate that even in areas that typically develop hypertrophic scarring, such as the upper chest, breast, and upper arm, this technique can effectively remove over 95% of the pigment and leave a perfectly flat scar.
The Use of Minigrafts in Hair Transplantation Surgery
Authors: LUCAS MANFRED W.G.
Published: June 2013

Abstract. With the conventional hair transplantation method of Okuda‐Orentreich, the tuft effect and the creation of an abrupt hairline have been major problems. In the method presented here, minigrafts are exclusively distributed and transplanted over the entire surface. Through the use of this technique a more aesthetic pattern of hair growth is achieved than was possible before, even after only one treatment.
Rapid Development of Metastases from Basal Cell Carcinoma Presenting as Cranial Nerve Palsies
Authors: AMBROS ROBERT A. , STANDIFORD STEVEN B. , SOBEL HAROLD J. , HAIM ALAIM , MOHIT‐TABATABAI MIRYSED A.
Published: June 2013

Abstract. A case is reported of metastatic basal cell carcinoma presenting with multiple neurologic deficits 20 months after excision of the primary lesion with good local control. Many features associated with the development of metastasis from basal cell carcinoma were not present in this case.
Lower Eyelid Reconstruction
Authors: RODRIGUEZ‐SAINS RENE
Published: June 2013

Abstract. The Hughes procedure of tarsoconjunctival flap sharing for lower eyelid reconstruction following removal of basal cell carcinoma is described. Although this technique has the disadvantage of being a 2‐staged procedure that requires closure of the eyelid for 2–8 weeks, its cosmetic and functional results are outstanding. While the Hughes procedure is not the only technique for eyelid reconstruction, it is a time‐tested method commonly practiced by ophthalmic plastic surgeons.
The Single‐Pedicle Retroauricular Advancement Flap
Authors: FIELD LAWRENCE M.
Published: June 2013

Abstract. The single‐pedicle retroauricular advancement flap is very useful for defects of the posterior ear surface and along the helical rim. Design elements are simple, vascular support excellent, and the aesthetic reconstruction of involved areas highly acceptable. Several cases are demonstrated photographically along with appropriate commentary.
Electrosurgery Principles: Cutting Current and Cutaneous Surgery—Part I
Authors: SEBBEN JACK E.
Published: June 2013

Abstract. Cutting current is a valuable tool in the office surgical practice due to its speed, efficiency, and economy. Most electrosurgical generators produce a blended wave form that coagulates the tissue as it is cut. Care should be taken to see that the patient is adequately grounded with a dispersive electrode to prevent cutaneous burns. The cutting of the tissue should be brisk and with the smallest electrode and power setting possible. By using careful electrosurgical technique, the surgeon can produce an incised wound that heals as well as one created by cold steel excision.
Anesthesia for Dermatologic Surgery
Authors: WINTON GEORGE B.
Published: June 2013

Abstract. The increased scope and complexity of dermatologic surgery has led to a need for greater skill in the preoperative administration of local and regional anesthesia. This article reviews the mechanism of action of local anesthetic agents, their pharmacologic properties and adverse reactions, and describes accepted techniques for safely and effectively establishing local and regional anesthesia for skin surgery. The presentation is limited to those techniques of greatest use to the office practitioner.
The Modified Major Scalp Reduction
Authors: UNGER MARTIN G.
Published: June 2013

Abstract. A new procedure for reducing the area of baldness, the modified major scalp reduction, is presented. This operation provides an important alternative to either standard or major scalp reductions. The surgical technique is described in detail, and comparisons are made with regard to advantages and disadvantages.
Mohs Surgery Report: Design of an Appropriate Rhombic Flap for a Circular Defect Created by Mohs Microscopically Controlled Surgery
Authors: DZUBOW LEONARD M.
Published: June 2013

Abstract. The rhombic flap is a transposition flap based on exact geometric design. The rhombic transposition principle, however, can be applied to circular as well as to geometric wounds. A method is suggested by which the best rhombic flaps for any specific anatomic site can be generated without conversion of the wound to a rhombic design.
The Dermatologist as Cosmetic Surgeon: Recommendations for a High Quality Practice
Authors: CHRISMAN BRUCE B.
Published: June 2013

Abstract. The skills of a good cosmetic surgeon evolve over a period of time, through training, experience, and confidence. They are seldom acquired from residency alone, and this is why four or more specialties successfully do cosmetic surgery. A number of guidelines are of assistance in learning it. The dermatologic surgeon has a unique and unsurpassed background for becoming a skilled, competent, and sought‐after cosmetic surgeon.
Primary Mucinous Carcinoma
Authors: WEBER PAUL J. , HEVIA OSCAR , GRETZULA JOSEPH C. , RABINOVITZ HAROLD C.
Published: June 2013

Abstract. Primary mucinous carcinoma of the skin is a rare entity. It usually presents as a painless nodule, cyst, or ulcer in the head and neck region (especially the eyelid). These tumors have a low metastatic potential but tend to recur locally. Histologically, groups of light‐ and dark‐staining epithelial cells form cords, nests, and ducts separated by clear areas representing sialomucin. Due to tumor continuity and a low rate of lymphatic or hematologic spread, Mohs micrographic surgery appears to be an effective treatment. Herein, two cases of primary mucinous carcinoma are presented.
Mild Hemophilia A as a Cause of Bleeding in Dermatologic Surgery
Authors: CLARK DAVID P. , ZUROWSKI SUSAN
Published: June 2013

Abstract. A 63‐year‐old male had major postoperative bleeding complications following the excision of a basal cell carcinoma. The patient denied a prior history of bleeding complications and had normal coagulation screening studies. After coagulation evaluation, he was found to have mild hemophilia A with 23% of normal Factor VIII C. We discuss an approach to the evaluation of coagulation in patients with perioperative and postoperative bleeding. Also, we outline treatment alternatives for patients with hemophilia A who need cutaneous surgery.
SURGICAL GEM: Razor Blade Surgery of Large Vessels on the Nose
Authors: JOHANNESSON ANDERS
Published: June 2013

Abstract. Large vessels of the nose have been treated with razor blade shave technique in 5 patients. A good cosmetic result has been achieved.
REVIEW: Topical Hemostatic Agents for Dermatologic Surgery
Authors: LARSON PAUL O.
Published: June 2013

Abstract. Topical hemostatic agents are very helpful in attaining capillary and small vessel hemostasis in dermatologic surgery. The commonly used topical hemostatic agents, including oxidized cellulose, absorbable gelatin, and thrombin are reviewed, along with newer agents such as microfibrillar collagen, fibrin sealants, and acrylates. Agents best suited for certain situations are recommended.
Metastatic Umbilical Cancer—Sister Mary Joseph's Nodule: Report of Two Cases
Authors: CABALLERO LUIS REQUENA , LÓPEZ FRANCISCO VÁZQUEZ , CABALLERO CÉSAR REQUENA , HERNANDO SUSANA URRUTIA , LÓPEZ MANUEL SÁNCHEZ , YUS EVARISTO SÁNCHEZ , MORO BENEDICTO HERNÁNDEZ
Published: June 2013

Abstract. Two cases of metastatic umbilical carcinoma (Sister Mary Joseph's nodule) are reported. In one of the cases, the umbilical metastasis was the first sign of the disease, whereas in the other case, the patient had a 5‐year history of internal malignancy when the umbilical nodule appeared. In both cases, the cutaneous metastasis was followed by death in a short period of time.
Noncosmetic Applications of Liposuction
Authors: COLEMAN WILLIAM P.
Published: June 2013

Abstract. Noncosmetic applications of liposuction have continued to appear since its introduction into the United States in 1982. Although the most common use is in removing lipomas, liposuction has also been used for benign symmetric lipomatosis, flap undermining, flap defatting, gynecomastia, pseudogynecomastia, breast reduction, buffalo hump, hypertrophic insulin lipodystrophy, lymphedema, evacuating hematomas, emergency neck defatting for airway restoration, and axillary hyperhidrosis. Other uses remain to be discovered.
Safety of Liposuction: A Review of 9478 Cases Performed by Dermatologists
Authors: BERNSTEIN GERALD , HANKE C. WILLIAM
Published: June 2013

Abstract. Complications and methods of anesthesia were reviewed in 9478 patients who had undergone liposuction surgery often in several areas. Seventy‐one percent of the patients were treated under local anesthesia and the overall level of complications was extremely low. The results of the survey reflect the large number of liposuction procedures that are being performed by dermatologists with a high degree of patient safety.
Warning: Traditional Liposuction Cannulas May Be Dangerous to Your Patient's Health
Authors: WEBER PAUL J. , WULC ALLAN E. , JAWORSKY CHRISTINE , DZUBOW LEONARD M.
Published: June 2013

Abstract. Liposuction is the most frequently performed invasive cosmetic procedure in the United States. The vast majority of liposuctions are performed using mechanical aspirators that are connected by sterile tubing to a cannula. Although liposuction cannula shaft designs have been modified and “perfected” to various extents, little attention has been paid to the handle and handle/shaft junction. Herein we present an inherent designinduced difficulty of traditional liposuction cannulas, the inability to be optimally cleaned. In addition, we present a solution.
Liposuction Surgery of the Lateral Thigh
Authors: NARINS RHODA S.
Published: June 2013

Abstract. We report our experience in 50 patients who underwent liposuction surgery of the lateral thighs with or without concomitant liposuction surgery of the hip and buttock areas. This procedure has proven to be a remarkably safe and effective method for removal of fat in properly selected individuals. The operation avoids the problems of blood loss and scarring associated with other operations used to remove fat and makes for extremely satisfied patients.
Refinements in the Technique of Liposuction
Authors: ASKEN SAUL
Published: June 2013

Abstract. While liposuction can be used to change the contour of practically the entire body, it has limitations. Because of the nature of the technique employed during the procedure, it also has a certain inherent possibility for complications. One hopes to avoid these by using sound judgment in choosing patients and by employing prudence and good technique during surgery. In addition, the surgeon's artistry is of paramount importance; one truly performs plastic (plastikos = to mold) surgery when resculpturing a patient's body.
Wound Healing of Skin Incisions Produced by Ultrasonically Vibrating Knife, Scalpel, Electrosurgery, and Carbon Dioxide Laser
Authors: HAMBLEY RICHARD , HEBDA PATRICIA A. , ABELL EDWARD , COHEN BERNARD A. , JEGASOTHY BRIAN V.
Published: June 2013

Abstract. An ultrasonically vibrating knife has been developed for producing surgical incisions with reduced hemorrhage. Tissue injury and wound healing of porcine cutaneous incisions produced by this instrument, conventional scalpel, electrosurgery, and CO2 laser were compared regarding clinical, histopathologic, and tensile strength differences. Scalpel incisions had the least tissue injury and fastest healing, but the ultrasonically vibrating knife produced less tissue injury and faster healing than electrosurgery or CO2 laser.
Lichen Planus of the Nail Presenting as a Tumor: Diagnosis by Longitudinal Nail Bed Biopsy
Authors: LAMBERT DAVID R. , SIEGLE RONALD J. , CAMISA CHARLES
Published: June 2013

Abstract. Our patient presented with a keratotic tumor of the nail bed that simulated a neoplasm. Longitudinal nail bed biopsy showed lichen planus, sparing the patient excisional surgery. We review the differential diagnosis of nail bed tumors, nail biopsy techniques, and the findings of lichen planus of the nail.