Biomedical subjects
Publications and source records attributed to P G Lang.
The case of a child with basal cell nevus syndrome whose condition was successfully managed for 10 years with a combination of topical 5-fluorouracil and tretinoin is reported. The concurrent use of these two agents prevented the development of new tumors, inhibited the growth of existing tumors, and caused the regression of superficially invasive basal cell carcinomas.
After his preauricular basal cell carcinoma had been excised by Mohs micrographic surgery, a patient took daily photographs of his 6 x 3-cm full-thickness wound as it healed by second intention over the next 44 days. Wound contraction produced a linear decrease in wound area between postoperative days 3 and 40 that accounted for 57% of the area of the original wound. The remainder of the wound was resurfaced by new epithelium, beginning on day 16. Few comparable reports address the contributions of contraction and re-epithelialization in large full-thickness human wounds.
Four patients with squamous cell carcinomas (SCCs) presenting as subcutaneous nodules of the head were referred for Mohs micrographic surgery. In each case initial histologic sections showed no connection between the tumor and epidermis, raising the possibility that each was a metastasis from an occult SCC. Careful searches for occult SCCs were unrevealing. Subsequent step sections through the entire tumors revealed narrow connections to the overlying epidermis in three of the four cases.
Because of its superior histologic control, when compared with conventional surgery, Mohs micrographic surgery offers 5-year cure rates of 98 to 99% when dealing with aggressive, extensive, and/or recurrent cutaneous neoplasms. Because the fresh-tissue technique is faster, less painful, and more tissue conserving, allows for immediate repairs, yields higher quality histologic preparations, and facilitates an interdisciplinary approach, it has become the preferred method of performing Mohs micrographic surgery. The fixed-tissue technique does offer certain advantages when dealing with (1) vascular neoplasms or tumors in vascular areas; (2) tumor in deep, narrow spaces; (3) tumor invading bone; or (4) tumors capable of implantation and metastatic spread. However, a modification of the fresh-tissue technique, the use of the CO2 laser, or an interdisciplinary approach may also allow the Mohs surgeon to effectively deal with these problem cases.
Mohs micrographic surgery is most suitable for cutaneous and mucosal neoplasms that exhibit a contiguous growth pattern and have minimal potential for metastases. Thus, a higher failure rate will be observed for tumors that exhibit multicentricity, disconnected foci, or give rise to metastases or satellite lesions. Because of its superior microscopic control, MMS offers the maximum chance for cure and preservation of normal tissue in properly selected tumors. Consequently, MMS is the treatment of choice for tumors located in cosmetically and functionally important areas of the head and neck (such as the periocular and perinasal areas), not only because of its tissue-sparing properties but also because tumors in some of these same anatomic areas also exhibit a high recurrence rate when managed by routine modalities. Variables to consider when selecting MMS to manage a neoplasm include, in addition to its anatomic location, its histology, its size, its tendency for recurrence, and whether or not it has been inadequately or previously treated. Field-fire BCC and ill-defined tumors are also best managed by MMS. When the management of a tumor exceeds the capabilities of the Mohs surgeon, an interdisciplinary approach utilizing other oncologic specialists is required (for example, reconstructive surgery, preservation of vital anatomic structures, deeply penetrating and extensive tumors, or the presence of or high risk for metastases). Because MMS is usually performed with local anesthesia on an outpatient basis, it is cost effective, safe, and extends operability to patients who are poor candidates for general anesthesia. However, when a multidisciplinary approach is employed, general anesthesia is often required. If the neoplasm is extensive, several operative sessions may be required to complete the extirpation of the tumor and the reconstruction of the defect. Although offering the greatest chance of cure for many difficult cutaneous neoplasms, MMS may at times become tedious and prolonged. Frozen sections are adequate in tracing out the microscopic extensions of most neoplasms; however, permanent sections may at times be required to provide the best microscopic control of margins, and this, too, may prolong the procedure. Histologic preparations must be of superior quality to ensure maximum microscopic control, and the surgical specimens removed must be properly oriented. On microscopic examination, benign, reactive changes and normal anatomic structures must be distinguished from tumor to avoid the unnecessary sacrifice of normal tissue, and inflammation, which may obscure tumor, must be carefully scrutinized.(ABSTRACT TRUNCATED AT 400 WORDS)
A patient with blue-gray discoloration of the face is described. Her history revealed that she had used bleaching creams containing mercury and hydroquinone for many years. Biopsy specimens of the hyperpigmented areas showed deposits that were compatible with both mercury deposition and the diagnosis of exogenous ochronosis. Dermabrasion was successfully employed to remove these deposits.
Chronic graft-vs-host disease (GvHD) is a common, severe complication of bone marrow transplantation that often results in sclerodermoid skin changes with chronic and recurrent skin ulceration. We describe a case of cutaneous squamous cell carcinoma presenting as an ulcer on the sole of a 20-year-old woman with chronic GvHD. Although such an association has not been previously described, we discuss why features of chronic GvHD could be expected to place affected patients at increased risk for cutaneous squamous cell carcinoma.
A patient with epidermolysis bullosa acquisita and prominent ocular involvement that resulted in blindness is described. Because the severe eye involvement dominated the clinical picture, she had been diagnosed as having cicatricial pemphigoid. Clinicians should be aware that epidermolysis bullosa acquisita may mimic cicatricial pemphigoid and bullous pemphigoid.
By means of a serial horizontal microscopic sections and a special computer, three-dimensional reconstruction of seven superficial multicentric basal cell carcinomas was carried out. All foci of tumor were observed to be interconnected, which suggests a unicentric origin for this subtype of basal cell carcinoma.
Explore the source record for details and available documents.
The pathologic specimens from forty-seven patients with fifty-one recurrent basal cell carcinomas referred for Mohs' surgery were studied. Specimens from the original tumor and from each subsequent recurrence were reviewed. Of the original tumors, 65% demonstrated an aggressive* histologic picture characterized by poor palisading and an infiltrating and/or micronodular pattern. In twelve cases the recurrent tumor developed a more aggressive histologic picture, but in seven cases the histologic picture became more benign. Electrodesiccation and curettage was the initial treatment for forty-one basal cell carcinomas. Ten tumors had been excised previously, with routine pathologic examination indicating tumor-free margins in six of these lesions. It can be concluded that many recurrent basal cell carcinomas are aggressive from the beginning, and this often can be predicted from the histologic picture. Lesions with an aggressive pathologic picture should not be managed by blind technics such as electrodesiccation and curettage and may defy routine pathologic examination of conventional excision specimens. Mohs' surgery appears to be the treatment of choice for such lesions.
A patient with recurrent adenoid cystic carcinoma of the skin managed by Mohs surgery is reported. The histopathologic features and differential diagnosis of this tumor are reviewed. Mohs surgery appears to be an ideal way to manage this neoplasm since recurrences after routine excision are common and metastases are uncommon.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A patient with quinidine-induced photosensitivity confirmed by photopatch testing is presented. The action spectrum for the reaction appeared to be in the UVA range, and the patient's minimal erythema dose was lower than expected while the patient was on quinidine.
A patient with lichen planus pemphigoides is reported. Initial pathologic and immunopathologic evaluation was consistent with coexisting bullous pemphigoid and lichen planus. However, further immunologic evaluation suggested that the circulating antibody was not directed toward bullous pemphigoid antigen but another basement membrane zone antigen. This finding indicates a need for immunologic re-evaluation of lichen planus pemphigoides.
Explore the source record for details and available documents.