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Biomedical subjects

Glenn D Goldman

Publications and source records attributed to Glenn D Goldman.

6 recordsLinked to original sources
PubMed2006

Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment.

BACKGROUND: Lentigo maligna (LM) is a subtype of melanoma in situ that typically develops on sun-damaged skin. Presentation may be quite subtle and delayed diagnosis is common. Clinical margins are often ill defined. Histologic evaluation can be difficult due to the widespread atypical melanocytes that are present in the background of long-standing sun damage. Recurrence following standard therapies is common. OBJECTIVE: To review the clinical features, histopathology, and treatment options for LM. Emphasis is placed on recent advances in the treatment of LM. METHODS AND MATERIALS: Literature review. RESULTS: The estimated lifetime risk of LM progressing to LM melanoma is 5%. Standard excision of LM with 5 mm margins is insufficient in 50% of cases. The recurrence rate with standard excision ranges from 8 to 20%. Mohs surgery and staged excision may offer better margin control and lower recurrence rates (4-5%). Estimates of recurrence rates following nonsurgical therapies such as cryosurgery, radiotherapy, electrodessication and curettage, laser surgery, and topical medications range from 20 to 100% at 5 years. CONCLUSIONS: Adequate treatment of LM requires a comprehensive knowledge of the diagnostic features, histopathology, and treatment options. Surgical modalities with meticulous evaluation of tissue margins appears to offer the lowest rates of disease recurrence.

Cryotherapy↗
PubMed2005

The dorsal nasal flap.

As dermatologists and plastic surgeons have focused more effort on nasal repair, the dorsal nasal flap has been revitalized as an elegant repair for distal nasal defects. Small modifications of the flap provide for flexibility in execution. The viability of the dorsal nasal flap are unparalleled. When properly designed and executed , the dorsal nasal flap can reproducibly succeed in the repair of many challenging distal nasal wounds.

Humans↗
PubMed2005

Rotation flaps.

BACKGROUND: Rotation flaps are arcuate repairs that redistribute tension vectors and recruit adjacent and/or distant tissue laxity. Rotation allows for the closure of wounds that cannot be repaired along a single tension vector. A rich and evolving literature details the evolution of rotation as an elegant method of repair for surgical wounds. OBJECTIVE: The goal of this article is to understand the basic principles and proper execution of tissue rotation for the repair of facial operative wounds, with special attention given to the concept of pivotal restraint and with a step-by-step regional approach. METHODS AND MATERIALS: A review of the literature of dermatologic surgery, plastic surgery, and otolaryngology leads to a detailed understanding of rotation flap design and execution. RESULTS: Proper rotation flap design allows for the closure of large and complex wounds that will not close along one motion while minimizing tension vectors that affect adjacent free margins. CONCLUSIONS: The concept and execution of rotation are integral to the practice of dermatologic surgery. Proper design and undermining are essential to create an adequately sized flap and to free pivotal restraint to facilitate wound closure. In many cases, the arc of a rotation flap may be hidden within a natural cosmetic boundary, allowing for an elegant and minimally visible reconstruction.

Humans↗
PubMed2002

Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer.

BACKGROUND: The use of escharotic or caustic pastes to treat skin cancer is based on the centuries-old observation that selected minerals and plant extracts may be used to destroy certain skin lesions. Zinc chloride and Sanguinaria canadensis (bloodroot) are 2 agents that are used as part of the Mohs chemosurgery fixed-tissue technique. The use of escharotics without surgery has been discredited by allopathic medicine but persists and is promoted among alternative practitioners. Patients may now purchase "herbal supplements" for the primary self-treatment of skin cancer, and physicians will see patients who elect this therapy for their skin cancers. OBSERVATIONS: We reviewed the history of escharotic use for skin disease and performed an Internet search for the availability and current use of escharotics. Our search located numerous agents for purchase via the Internet that are advertised as highly successful treatments for skin cancer. We report 4 cases from our practice in which escharotic agents were used by patients to treat basal cell carcinomas in lieu of the recommended conventional treatment. One patient had a complete clinical response, but had a residual tumor on follow-up biopsy. A second patient successfully eradicated all tumors, but severe scarring ensued. A third patient disagreed with us regarding his care and was lost to follow-up. One patient presented with a nasal basal cell carcinoma that "healed" for several years following treatment elsewhere with an escharotic agent but recurred deeply and required an extensive resection. The lesion has since metastasized. CONCLUSIONS: Escharotic agents are available as herbal supplements and are being used by patients for the treatment of skin cancer. The efficacy of these agents is unproven and their content is unregulated. Serious consequences may result from their use. Conventional medicine has an excellent track record in treating skin cancer. Physicians should recommend against the use of escharotic agents for skin cancer, and the Food and Drug Administration should be given the authority to regulate their production and distribution.

Administration, Topical↗