Search PubMed⌕ Search

Biomedical subjects

D J Leffell

Publications and source records attributed to D J Leffell.

At least 37 records · Page 2Linked to original sources
PubMed1995

The use of cryopreserved human skin allografts in wound healing following Mohs surgery.

BACKGROUND: Immediate reconstruction has become the preferred approach to management of full-thickness cutaneous defects following microscopically controlled excision (MCE) of tumors. In a minority of patients, however, large reconstructive procedures are contraindicated, and a long-term biological dressing that stimulates healing while minimizing wound care is desirable. OBJECTIVE: To assess the utility of cryopreserved human skin allografts (HSA) in wound care and wound healing following Mohs surgery. METHODS: Sixteen patients were treated with HSA following MCE and followed postoperatively for evidence of infection, involution, or survival of HSA, and granulation tissue production. Follow-up was 2-26 months. RESULTS: The use of HSA resulted in one of three general outcomes: rapid healing and rejection, subsequent full-thickness skin grafting, or persistence of HSA during prolonged healing. CONCLUSIONS: HSA are a safe alternative to immediate reconstruction in a carefully selected population of skin cancer patients. They minimize wound care while providing continuous wound coverage during healing, and are an efficient bridge to full-thickness skin grafting.

Adult↗
PubMed1995

Solitary syringoma. Report of five cases and clinicopathologic comparison with microcystic adnexal carcinoma of the skin.

Five cases of solitary syringoma (SS) were found by the authors in a search of adnexal neoplasms seen over an 18-year period. These tumors all occurred in adults as mobile, flesh-colored, circumscribed papules of the facial skin, measuring < or = 5 mm in greatest dimension. Each was cured by simple punch or shave biopsy excision. Comparison with nine histologically similar variants of microcystic adnexal carcinoma (MAC) showed that the latter lesions differed from SS in that they showed much deeper invasion, with regular involvement of the underlying subcutis and perineural or vascular-adventitial infiltration. Moreover, SS was wider than it was deep on microscopic examination, whereas the converse pertained to MAC. Knowledge of the typical clinicopathologic attributes of these two tumor types should prevent clinicians and pathologists from confusing them with each other.

Adenocarcinoma↗
PubMed1994

Nevoid basal cell carcinoma syndrome.

The nevoid basal cell carcinoma syndrome is an autosomal dominant disorder that predisposes to basal cell carcinomas of the skin, ovarian fibromas, and medulloblastomas. Unlike other hereditary disorders associated with cancer, it features widespread developmental defects. Laboratory studies of radiation sensitivity and chromosome instability over the past 20 years have generally yielded negative or inconclusive results. Recently, screening for allelic loss in sporadic and hereditary basal cell carcinomas, hereditary ovarian fibromas, and sporadic medulloblastomas provided evidence for a tumor suppressor gene on chromosome 9q, important in all three tumor types. Demonstration of a chromosome 9q deletion in an unusual patient with this syndrome and genetic linkage studies in large kindreds indicated that the nevoid basal cell carcinoma syndrome gene maps to the exact same location lost in tumors. These data show that tumors arise with homozygous inactivation of the gene and imply that it normally functions as a tumor suppressor. In contrast, hemizygous germ-line mutations lead to multiple congenital anomalies.

Alleles↗
PubMed1993

Mutation hotspots due to sunlight in the p53 gene of nonmelanoma skin cancers.

To identify the sites in the p53 tumor suppressor gene most susceptible to carcinogenic mutation by sunlight, the entire coding region of 27 basal cell carcinomas (BCCs) of the skin was sequenced. Fifty-six percent of tumors contained mutations, and these were UV-like: primarily CC-->TT or C-->T changes at dipyrimidine sites. Such mutations can alter more than half of the 393 amino acids in p53, but two-thirds occurred at nine sites at which mutations were seen more than once in BCC or in 27 previously studied squamous cell carcinomas of the skin. Seven of these mutation hotspots were specific to skin cancers. Internal-cancer hotspots not located at dipyrimidine sites were not mutated in skin cancers; moreover, UV photoproducts were absent at these nucleotides. The existence of hotspots altered the process of inactivating p53 in BCC compared to other cancers: allelic loss was rare, but 45% of the point mutations were accompanied by a second point mutation on the other allele. At least one of each pair was located at a hotspot. Sunlight, acting at mutation hotspots, appears to cause mutations so frequently that it is often responsible for two genetic events in BCC development.

Aged↗
PubMed1993

The effect of pre-education on patient compliance with full-body examination in a public skin cancer screening.

BACKGROUND: Public skin cancer screening has become increasingly common in recent years. However, currently there is no standardized procedure for these screenings. Full body skin examination as opposed to examination of sun-exposed areas offers several advantages, including the opportunity to diagnose early melanoma in areas normally covered by clothing. Disadvantages of full body skin examination include patient resistance because of inconvenience and concerns about privacy and modesty. The additional time involved in full body skin examination may also be an impediment. OBJECTIVE: In a randomized double-armed study, we studied whether patients were more likely to develop a positive attitude towards full body skin examination if they were advised beforehand, in writing, of the logic underlying the need for a complete examination. METHODS: Patients presenting to a public skin cancer screening were divided into two groups. Group A (N = 111) received a written explanation of the need for full body skin examination and Group B (N = 175) received no information. Patients were then surveyed, after the screening, about their attitudes towards full body skin examination. RESULTS: Those who received pre-education were less likely (P < .05) to be concerned about a genital examination. Those who were concerned about a genital exam were compared with those who were not concerned about a genital exam, the former patients were: 1) younger (P < .05); 2) more concerned about privacy (P < .001); and 3) preferred a physician of the same sex (P < .001). CONCLUSION: Providing patients with information about the need for full body skin examination decreases concern about undergoing a skin genital exam and may minimize resistance to full body skin examination in public skin cancer screenings.

Adult↗
PubMed1993

Nonexcisional treatment of benign and premalignant cutaneous lesions.

The correct diagnosis of benign and premalignant cutaneous lesions requires appropriate biopsy techniques that reflect an understanding of the specific cutaneous pathology. Violation of the basement membrane zone generally results in scarring. Knowledge of the healing processes of the epidermis, dermis, and subcutis permit the least destructive diagnostic and treatment techniques, resulting in the best functional and cosmetic results. Excessive scarring or procedures inappropriate to the lesion under consideration should be avoided.

Biopsy↗
PubMed1992

Developmental defects in Gorlin syndrome related to a putative tumor suppressor gene on chromosome 9.

Gorlin syndrome is an autosomal dominant disorder that predisposes to basal cell carcinomas of the skin, ovarian fibromas, and medulloblastomas. Unlike other hereditary disorders associated with cancer, it features widespread developmental defects. To investigate the possibility that the syndrome is caused by mutation in a tumor suppressor gene, we searched for loss of heterozygosity in 16 sporadic basal cell carcinomas, 2 hereditary basal cell carcinomas, and 1 hereditary ovarian fibroma and performed genetic linkage studies in five Gorlin syndrome kindreds. Eleven sporadic basal cell carcinomas and all 3 hereditary tumors had allelic loss of chromosome 9q31, and all informative kindreds showed tight linkage between the Gorlin syndrome gene and a genetic marker in this region. Loss of heterozygosity at this chromosomal location, particularly in hereditary tumors, implies that the gene is homozygously inactivated and normally functions as a tumor suppressor. In contrast, hemizygous germline mutations lead to multiple congenital anomalies.

Basal Cell Nevus Syndrome↗
PubMed1992

Lasers in dermatology and ophthalmology.

Dermatology and ophthalmology are two specialties that have made exceptional use of laser technology. In dermatology, port wine stains and hemangiomas, neoplastic lesions, and adnexal tumors are amenable to laser treatment. In ophthalmology, the use of lasers to effect photocoagulation, photoradiation, photovaporization, photodisruption, and photodecomposition has permitted the treatment of vascular retinal disease, macular edema, intraocular tumors, open angle glaucoma, and angle closure glaucoma. Although great strides in laser technology have been made, the future is even more promising as laser devices are further modified to treat specific disease processes.

Eye Diseases↗
PubMed1992

Water-in-oil emollients as steroid-sparing adjunctive therapy in the treatment of psoriasis.

An open label study of ninety-six patients with chronic plaque-type psoriasis demonstrated the efficacy of the addition of water-in-oil emollients to a topical corticosteroid regimen. Twice daily application of betamethasone dipropionate cream and once daily application of both betamethasone dipropionate cream and either a water-in-oil based moisturizing cream or lotion were equivalent in efficacy (p = 0.05). Once daily application of both betamethasone dipropionate cream and either a water-in-oil based cream or lotion was significantly better than once daily application of betamethasone dipropionate cream alone (p = 0.05). Water-in-oil emollients are useful in the therapy of chronic, plaque-type psoriasis and provide a steroid-sparing effect.

Administration, Cutaneous↗
PubMed1991

Aggressive-growth basal cell carcinoma in young adults.

Aggressive-growth basal cell carcinoma (AG-BCC) defines a group of basal cell cancers that are histologically and clinically aggressive. This group includes morpheaform, infiltrating, and recurrent BCCs. Because of the clinical observation that the incidence of AG-BCC may be increased in patients under 35 years of age, compared with those older, we performed a retrospective study. We reviewed the pathologic findings of 3381 patients diagnosed with BCC, including 102 patients with BCC referred for Mohs surgery to determine whether AG-BCC occurs with increased frequency in patients younger than than 35 years of age. Among patients under 35 years of age, 38% of women had AG-BCC compared with 9% of women in the older age group. Similarly, 25% of men under 35 years of age had AG-BCC compared with 11% among men in the older age group. Aggressive-growth BCC is more frequently noted in patients under 35 years of age than in those older. Failure to diagnose this type of BCC, which may be clinically subtle, may lead to incomplete or inadequate treatment. Because of the tendency of these tumors to recur, greater long-term morbidity may result.

Adult↗
PubMed1991

An educational device for Mohs micrographic surgery. A three-dimensional model of basal cell carcinoma.

Mohs micrographic surgery for skin cancer (fresh-tissue technique) involves the processing of tissue in a complex fashion. The advantages of this method relate to the asymmetric three-dimensional growth of basal cell carcinoma (BCC). A device is described here based on published knowledge about the growth of BCC. The model demonstrates the precise way in which Mohs surgery varies from other surgical approaches to yield higher cure rates in specific circumstances. This device may be helpful in educating residents and medical students about Mohs surgery and in preparing patients for this procedure.

Basal Cell Carcinoma↗
PubMed1989

Laser vaporization: a novel treatment of botryomycosis.

Botryomycosis is an uncommon, chronic infection of the skin most often caused by Staphylococcus aureus. It has been successfully treated using carbon dioxide laser vaporization in a case in which antibiotic therapy failed, and surgical excision was not feasible.

Carbon Dioxide↗
PubMed1988

In vivo fluorescence of human skin. A potential marker of photoaging.

Fluorescence is a feature of elastin and collagen, both major compounds of human dermis that are altered by age and photoexposure. We studied the intrinsic fluorescence of skin in vivo in 28 human volunteers to determine whether photoaging and chronologic aging of the skin could be evaluated by this noninvasive technique. We demonstrate that the excitation of skin autofluorescence by laser ultraviolet radiation yields characteristic tissue fluorescence spectra that are unrelated to age, pigmentation, or skin thickness. The differences in skin autofluorescence appear to be related to photoexposure. Thus, laser-induced fluorimetry, a noninvasive technique, may be adaptable as a marker of photoaging.

Adult↗
PubMed1986

Familial multiple lipomatosis. Report of a case and a review of the literature.

Familial multiple lipomatosis is a hereditary syndrome of multiple lipomas occurring in a particular distribution. It is clinically distinct from multiple symmetric lipomatosis with which it is frequently confused in the dermatologic literature. A case of familial multiple lipomatosis is reported and a review of this condition is presented in an effort to resolve the confusion in the literature about familial multiple lipomatosis and multiple symmetric lipomatosis.

Adult↗