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Biomedical subjects

B Leshin

Publications and source records attributed to B Leshin.

At least 19 recordsLinked to original sources
PubMed2000

Fusiform incisional biopsy for pigmented skin lesions.

Current recommendations for biopsy of a pigmented skin lesion suspected of being melanoma include complete excision when possible. Because benign pigmented lesions do not warrant excisional biopsy, especially when they are large and/or on cosmetically sensitive sites, incisional biopsy is desirable. For such lesions we recommend a fusiform incisional biopsy. This tissue sampling technique not only yields an excellent cosmetic outcome, but also provides the pathologist with an optimal biopsy specimen in which he/she can assess the symmetry, circumscription, breadth, and depth of the lesion.

Biopsy↗
PubMed2000

Utility of a bilayered banner transposition flap in reconstruction of the lower third of the pinna.

BACKGROUND: Reconstruction of the entire ear lobule is challenging and complex. We present a case in which a banner transposition flap from the preauricular and mandibular area of the cheek resulted in an excellent cosmetic outcome. OBJECTIVE: To demonstrate the utility of a bilayered banner transposition flap to reconstruct a full-thickness defect of the inferior one-third of the pinna. METHODS: The technique employed in this reconstruction is described and previously reported techniques are reviewed. RESULTS: A symmetrical earlobe with normal tissue consistency was created, as noted at 4 months postoperatively. CONCLUSION: Utilization of a banner transposition flap should be considered as an excellent method for reconstruction of full-thickness defects of the lower one-third of the ear.

Aged↗
PubMed2000

Utility of rush paraffin-embedded tangential sections in the management of cutaneous neoplasms.

BACKGROUND: Mohs micrographic surgery (MMS) modified by the use of tangential, formalin-fixed, paraffin-embedded histologic specimens is advantageous in treating selected skin neoplasms. OBJECTIVE: To review the use of our experience with a modification of MMS to treat lentigo maligna melanoma (LMM), lentigo maligna (LM) and other melanoma in situ (MIS) lesions, dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), and angiosarcoma. METHODS: Our experience utilizing a modification of MMS in the treatment of 77 patients with LM or other MIS, 23 patients with LMM, 11 patients with DFSP, 1 patient with AFX, and 1 patient with angiosarcoma was reviewed. Length of follow-up and rate of recurrence were examined. A literature review of this pertinent modification of the Mohs technique was performed. RESULTS: One hundred fourteen patients underwent MMS for melanocytic (LM, MIS, LMM), spindle cell (DFSP, AFX), and vascular malignant neoplasms. One patient developed locally recurrent LM and one patient with LMM developed satellite metastasis. Regional lymph node metastasis occurred in one patient with LMM and in a patient with angiosarcoma. CONCLUSION: The use of Mohs micrographic surgery in conjunction with rush formalin-fixed, paraffin-embedded tangential histologic sections provides the accuracy and tissue conservation of the Mohs procedure while ensuring more confident interpretation of histology in cases of lentigo maligna, lentigo maligna melanoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, and angiosarcoma.

Aged↗
PubMed1999

The role of a physician assistant in dermatologic surgery.

Physician assistants are physician extenders who can perform an invaluable role in dermatologic surgery and optimize physician efficiency. The well-trained physician assistant is a highly effective adjunct to patient evaluation and education and is capable of performing routine time-intensive procedures. When successfully integrated into a dermatologic surgery practice the physician assistant enhances patient care and satisfaction and permits the physician to focus on more complex medical decision-making and technically advanced procedures.

Curriculum↗
PubMed1999

Apocrine poroma: a distinctive case in a patient with nevoid basal cell carcinoma syndrome.

Traditionally, poromas have been classified as eccrine neoplasms, but several recent reports of poroid tumors with sebaceous, follicular, and apocrine differentiation have challenged this idea. In support of alternative differentiation, a case of an "apocrine" poroma is reported in a 19-year-old man with the nevoid basal cell carcinoma syndrome. A papule on the right cheek, thought clinically to be a basal cell carcinoma, was excised. Anastomosing lobules of small uniform basaloid (poroid) cells formed small ductular structures lined by eosinophilic cuticles and extended into the superficial reticular dermis. The neoplasm originated from follicular infundibula and was surrounded by a myxoid stroma. Focally, primitive hair bulb and papillae differentiation was present, and some of the ducts were lined by cells suggesting decapitation secretion. The histologic pattern and the common embryologic origin of the folliculosebaceous-apocrine unit support apocrine differentiation of this tumor. The association with the nevoid basal carcinoma syndrome appears to be unique. This case, in addition, demonstrates overlapping features with the infundibulocystic type of basal cell carcinoma commonly seen in the basal cell nevus syndrome.

Adult↗
PubMed1998

The simple excision.

Elliptical excisional surgery offers several advantages over other cutaneous surgical techniques (i.e., shave excision, saucerization) which require healing by second intention. In general, an elliptical excision exhibits faster healing, better cosmesis, and yields a specimen for histologic exam and review of margins, and with proper attention to the details of cutaneous anatomy, familiarity with instrumentation, local anesthetics, suture materials, and observance of meticulous surgical technique, is performed with relative ease in the dermatology outpatient office setting.

Ambulatory Care↗
PubMed1998

Characteristics of office-based visits for skin cancer. Dermatologists have more experience than other physicians in managing malignant and premalignant skin conditions.

BACKGROUND: Actinic keratoses and skin cancer constitute a major public health problem for predisposed individuals. OBJECTIVE: The purpose of this paper is to determine the characteristics of office-based visits for actinic keratoses and skin cancer in the United States. METHODS: The National Ambulatory Medical Care Survey provided data on office-based physician visits for actinic keratoses and skin cancer in 1993 and 1994. RESULTS: There were 3.7 million visits per year for actinic keratoses, 3.1 million visits per year for nonmelanoma skin cancer (NMSC), and 430,000 visits per year for melanoma. Excisions and destructions of lesions accounted for 90%, 67%, and 62% of procedures for actinic keratoses, NMSC, and melanoma, respectively. Dermatologists (683), plastic surgeons (37), and general and family physicians (11) managed more visits per physician per year than other specialists. CONCLUSION: Dermatologists have significantly more experience managing skin cancer than do other physicians.

Clinical Competence↗
PubMed1997

Procedures for skin diseases performed by physicians in 1993 and 1994: analysis of data from the National Ambulatory Medical Care Survey.

BACKGROUND: The provision of ambulatory dermatologic procedural care is not well characterized. OBJECTIVE: Our purpose was to determine the frequency that different cutaneous procedures are performed by different physician specialties and the diagnoses corresponding to these procedures. METHODS: Outpatient dermatologic procedures recorded in the 1993 and 1994 National Ambulatory Medical Care Survey were analyzed. To define dermatologic procedures and diagnoses, the International Classification of Diseases diagnosis and procedure codes were identified that related to the skin and subcutaneous tissues. Sampling weights were applied to achieve the nationally representative estimates. RESULTS: During 1993 and 1994, an estimated 37 million dermatologic procedures were performed. Most were performed by dermatologists (69%) and by family and general practice physicians (15%). A single procedure, "Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue," constituted 65% of all of the dermatologic procedures. UV light treatments, ambulatory microscopic examination of skin specimens, and acne surgical procedures were performed almost exclusively by dermatologists. Most skin biopsies (82%) and excision/destruction procedures (71%) were performed by dermatologists. Actinic keratoses and viral warts accounted for 25% of all cutaneous dermatologic diagnoses treated. CONCLUSION: Dermatologists have far more experience performing skin biopsies and excision/destruction procedures than other physicians. Cost containment efforts that deny coverage for treatment of actinic keratoses and viral warts would affect a significant portion of cutaneous procedures.

Adult↗
PubMed1994

Sclerosing sweat duct carcinoma in an 11-year-old boy.

BACKGROUND: Sclerosing sweat duct carcinoma, or microcystic adnexal carcinoma, is a rare neoplasm of the skin with both pilar and eccrine differentiation. Previously this neoplasm has been reported only in adults. We describe a case of sclerosing sweat duct carcinoma in an 11-year-old white male. OBJECTIVE: Description of Mohs surgical procedure for successful management of sclerosing sweat duct carcinoma in a child. METHODS: Mohs micrographic surgery was performed on this rare neoplasm. RESULTS: The described procedure resulted in successful excision of this uncommon neoplasm. CONCLUSION: We present a case of sclerosing sweat duct carcinoma, an unusual cutaneous neoplasm, in an 11-year-old male that was successfully managed using Mohs micrographic surgery.

Carcinoma, Skin Appendage↗
PubMed1993

Management of lentigo maligna and lentigo maligna melanoma with paraffin-embedded tangential sections: utility of immunoperoxidase staining and supplemental vertical sections.

BACKGROUND: The use of frozen sections in the management of lentigo maligna and lentigo maligna melanoma has been the focus of some controversy. OBJECTIVE: Our purpose was to utilize paraffin-embedded tangential sections in the management of two cases of lentigo maligna and three cases of lentigo maligna melanoma. METHODS: A modification of Mohs micrographic surgery using rush paraffin-embedded sections with adjunctive immunoperoxidase staining (HMB-45) and supplemental vertical sections was employed. RESULTS: This method resulted in enhanced histologic evaluation of section margins and did not compromise the diagnosis of the primary invasive melanoma or Breslow measurements. CONCLUSION: Mohs micrographic surgery modified by the use of rush paraffin-embedded sections allows adjunctive immunoperoxidase staining and supplemental vertical sections that may be helpful in the management of lentigo maligna and lentigo maligna melanoma.

Aged↗
PubMed1993

Management of patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.

BACKGROUND: The use of anticoagulants and platelet inhibitors can increase the risk of intraoperative and postoperative hemorrhagic complications in cutaneous surgery. Currently there are no general guidelines and no consensus among dermatologic surgeons on how to manage patients taking these medicines. OBJECTIVE: To address many of the issues involved in the management of these patients. CONCLUSION: General recommendations are made for managing patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.

Anticoagulants↗
PubMed1993

Absence of human papillomavirus in squamous cell carcinomas of nongenital skin from immunocompromised renal transplant patients.

BACKGROUND AND DESIGN: Human papillomavirus (HPV) is accepted as a factor in the pathogenesis of genital squamous cell carcinomas. The incidences of both HPV infection and squamous cell carcinoma are increased in immunocompromised renal transplantation patients. The purpose of this study was to determine if HPV DNA is present in squamous cell carcinomas of nongenital skin in immunosuppressed patients. Amplification of HPV DNA was performed using the polymerase chain reaction. The sensitivity and specificity of the polymerase chain reaction was assessed on 19 positive and six negative control specimens. Twenty genital squamous cell carcinomas from nonimmunocompromised patients and 28 nongenital squamous cell carcinomas from renal transplantation patients were then analyzed. RESULTS: Human papillomavirus DNA was identified in 18 of 19 positive control specimens and zero of six negative control specimens. Human papillomavirus DNA was identified in four of 20 genital squamous cell carcinoma specimens. In comparison, no HPV DNA was identified in 28 nongenital squamous cell carcinomas from immunosuppressed hosts (Fisher's Exact Test, P < .025). CONCLUSIONS: These findings support a role for HPV in genital skin cancers and suggest that HPV does not play a role in the increased incidence of squamous cell carcinoma in renal transplantation patients.

Carcinoma, Squamous Cell↗
PubMed1992

Livedo vasculitis: vasculitis or thrombotic vasculopathy?

Elevated fibrinopeptide A levels, suggestive of a thrombogenic state, were observed in six patients with livedo vasculitis. Serological studies demonstrated normal complement levels, and circulating immune complexes were not identified by standard assays. Morphological studies showed no evidence of immune complex deposition or a neutrophilic vascular reaction. These results support classification of this disorder as a thrombogenic vasculopathy rather than as a small vessel vasculitis. Further investigations into the thrombotic abnormalities underlying this entity are warranted.

Adult↗
PubMed1992

Dermal granulomatous inflammation to cornified cells. Significance near cutaneous squamous cell carcinoma.

BACKGROUND: Discrimination of benign from malignant is fundamental to accurate histologic diagnosis. This article describes a series of nine patients with cutaneous squamous cell carcinoma who were noted to have in the vicinity of their neoplasm seemingly benign but biologically significant dermal granulomatous inflammation to cornified cells (GRC). OBSERVATIONS: Two patients were reported as having this finding alone on incisional biopsy specimens only to have subsequent biopsy specimens demonstrate bona fide malignant neoplasms. On Mohs' frozen sections, four patients were noted to have GRC without concomitant tumor and four patients had GRC admixed with tumor. Two patients who demonstrated GRC but no neoplasm on final Mohs' sections had development of recurrent neoplasm after the initial procedure. CONCLUSIONS: In the setting of suspected or proved cutaneous squamous cell carcinoma, GRC signifies the presence of viable neoplasm and warrants additional tissue resection.

Adult↗
PubMed1992

Eyewear, cataracts, and periorbital basal cell carcinoma.

Ultraviolet exposure is an important risk factor for basal cell carcinoma. Since eyewear may have a photoprotective effect, this study evaluated the use of prescription eyeglasses and sunglasses in patients with periorbital basal cell carcinoma compared with other facial sites. There was no difference in prescription eyewear use between the groups, and only four patients in each group had regularly worn glasses since childhood. There was an increased occurrence of cataracts and cataract surgery in the group of patients with periorbital tumors, which may indicate a greater cumulative ultraviolet exposure to the orbital and periorbital sites in these patients.

Basal Cell Carcinoma↗
PubMed1991

Vulvar pyoderma gangrenosum.

Pyoderma gangrenosum is an idiopathic dermatologic disease manifested by painful cutaneous ulceration. The ulcers are characterized by their undermined, violaceous borders and necrotic tissue at the ulcer base. The lesions may have an unusual response to physical manipulation known as pathergy, a phenomenon that is manifested by rapid progression following debridement. Pyoderma gangrenosum is frequently associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis and hematologic malignancies. Conservative wound care and systemic corticosteroids are usually effective therapy. We report the second case in the gynecologic literature of a patient with vulvar pyoderma gangrenosum.

Adult↗