Biomedical subjects
Publications and source records attributed to G R Mikhail.
Meibomian carcinoma is rare but carries a grave prognosis. The lesion may be easily mistaken for inflammatory condition. Therefore, any nodular or recurrent lesion on the eyelid of an elderly person should be examined histologically. A case is presented in which the tumor was successfully treated by the Mohs microscopically controlled excision.
Leukoplakia penis and balanitis xerotica obliterans are precancerous lesions. Bowen's disease, erythroplasia (Queyrat), and extramammary Paget's disease are carcinomas in situ. Lesions of both types may closely mimic benign skin conditions that may occur in the genital region. Histologic examination is usually the only certain means of diagnosis. The same considerations apply to pseudomalignancies, e.g., giant condyloma acuminatum (Buschke-Loewenstein), which clinically behaves as a carcinoma but histologically appears benign, and Bowenoid papulosis, a new entity that is believed to be benign although it has histologic features of a carcinoma in situ.
We report a case of generalized malignant acanthosis nigricans (AN) secondary to metastasizing squamous cell carcinoma of the cervix uteri. The disease initially manifested in the perineum as condyloma acuminatum-like lesions. Subsequently, most of the cutaneous surface and the mucosa of the vulva, mouth, tongue, and the palpebral conjunctiva became involved. The association of AN with a squamous cell carcinoma is rare, and conjunctival involvement is unusual.
Dermatofibrosarcoma protuberans is a well-differentiated sarcoma that rarely metastasizes but is characterized by a high recurrence rate. This is due to clinically undetectable, microscopic extensions into the surrounding dermis. Chemosurgery (Mohs) is effective in the ablation of this tumor because the extensions can be identified and eradicated.
In 93 reported cases of metastatic basal cell carcinoma (BCC), 76 had spread through lymphatics or blood vessels. Two more cases are presented, bringing the total to 78. Metastasis to regional lymph nodes was the most frequent, followed in frequency by lungs, bones, and other organs. The size of the primary tumor, its site, its resistance to x-ray therapy, and the effects of radiation appeared to contribute to the occurrence of metastasis. However, in an appreciable number of cases, tumor dissemination was related to incomplete excision followed by immediate wound closure, particularly by grafting. It is recommended that wound grafting be delayed for at least six months after excision or large or recurrent BCC in order to assure complete removal.
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Synthetic fluorinated derivatives of cortisone, when topically applied, are absorbed readily and may suppress adrenal function. In the case presented here, large quantities of topically applied triamcinolone acetonide were used in the treatment of atopic dermatitis. This caused a noticeable decrease in the plasma cortisol level. That this was the result of adrenal suppression rather than insufficiency was indicated by a satisfactory response of the plasma cortisol levels to a cosyntropin injection test. In patients with a history of recent and extensive use of topically applied corticosteroids, appropriate diagnostic and therapeutic measures are indicated to avoid postoperative adrenal insufficiency.
Excision of penile carcinoma by chemosurgery (Hohs' technique) is as nearly ideal as can be because it assures removal of the neoplasm with maximal preservation of normal tissue and function.
A linear form of porokeratosis, with features that we believe have not been previously described, is presented. The lesions occurred in a dermatome distribution; some of them had a central mass of parakeratotic keratin, shaped like a horn, which we designated a "giant cornoid lamella."
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