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Autologous fat grafts have recently gained popularity in the treatment of soft tissue defects of the face. We report on two patients with circumscribed scalp alopecia and linear forehead depressions treated with a combination of scalp reduction and autologous fat implants. The patients had significant cosmetic improvement without complications.
A new procedure for reducing the area of baldness, the modified major scalp reduction, is presented. This operation provides an important alternative to either standard or major scalp reductions. The surgical technique is described in detail, and comparisons are made with regard to advantages and disadvantages.
The scalp of a 20-year-old woman with extensive cicatricial alopecia caused by x-ray irradiation for tinea capitis has been reconstructed by the use of tissue expansion. Two stages were required to reconstruct the large defect. The hair-bearing posterior scalp has been expanded to cover the whole irradiated area, creating a new anterior hairline and a pleasing cosmetic result.
Microcystic adnexal carcinoma (MAC) is a recently described rare adnexal neoplasm showing benign histologic features but a locally aggressive behavior. It has most commonly been reported to occur on the face but it has also been noted in the axilla and buttock. We describe a 41-year-old white male with a 5-year history of MAC on the scalp and treatment by Mohs micrographic surgery. To our knowledge, this is the first case of MAC reported to occur on the scalp.
The serious cosmetic problem posed by the vertical "strip" following scalp reduction may be eliminated. A technique combining scalp reduction with a small random flap is proposed. If necessary, the treatment can be completed with an advancement flap.
BACKGROUND: The differential diagnosis of nodular scalp lesions in a child is surprisingly extensive. OBJECTIVE: To present a case of eosinophilic granuloma that was manifested by a scalp mass in a pediatric patient. METHODS: The case is presented and the relevant literature is reviewed. CONCLUSIONS: The seriousness of some of these lesions requires a thorough evaluation, including noninvasive imaging, and carefully planned surgical intervention so that effective diagnosis and treatment are ensured. Surgical exposure of unsuspected central nervous system connections may lead to infection, hemorrhage, seizures, or other significant morbidity and mortality.
The idiopathic type of angiosarcoma most commonly occurs on the face and scalp of elderly persons. This rare tumor can be highly aggressive; however, if the diagnosis is made at an early stage, while the tumor is still localized and has a size that is less than 10 cm, surgical excision is the treatment of choice. We report a case whereby Mohs micrographic surgery was used to treat angiosarcoma of scalp.
BACKGROUND: Basal cell carcinoma (BCC) is the most common malignancy in whites, but it rarely occurs in dark persons. OBJECTIVE: To report a BCC on the hairy scalp of an Asian Indian female with no obvious risk factors except previous scalp trauma. METHODS: We review the English literature concerning BCC in Indians, and compare this with data for North American blacks and whites; and reports of BCC arising in areas of prior trauma. RESULTS/CONCLUSION: Skin cancer accounts for 1-2% of malignancies in blacks and Indians, compared with one-third of neoplasms in whites. BCC comprises 75% of skin cancers in whites, but squamous cell carcinoma represents 60-65% of skin cancers in blacks and Indians. Although most BCCs occur in sun-exposed areas in whites, blacks, and Indians, a significant percentage also develop in photoprotected areas. Trauma may be a significant risk factor for BCC, either with actinic damage or alone, as in our case.
Two children with acute lymphoblastic leukemia undergoing chemotherapy had a special form of scabies characterized by fine scaling of the scalp simulating seborrheic dermatitis. Pruritus was mild or absent. Immunocompromised children and adults should receive whole-body and scalp antiscabietic treatment.
Thirty-four infants and children were prescribed bifonazole 1% shampoo as a treatment for lesions of scalp seborrheic dermatitis. All but one were cured or showed improvement within a short period. No serious side effects were observed. We conclude that bifonazole 1% shampoo is an effective and safe treatment for lesions of scalp seborrheic dermatitis in infants and young children.
PURPOSE: We wished to determine whether continuous EEG source imaging can predict the location of seizure onset with sublobar accuracy in temporal lobe epilepsy (TLE). METHODS: We retrospectively analyzed the earliest scalp ictal rhythms, recorded with 23- to 27-channel EEG, in 40 patients with intractable TLE. A continuous source analysis technique with multiple fixed dipoles (Focus 1.1) decomposed the EEG into source components representing the activity of major cortical sublobar surfaces. For the temporal lobe, these were basal, anterior tip, anterolateral, and posterolateral cortex. Ictal EEG onset was categorized according to its most prominent and leading source component. All patients underwent intracranial EEG studies before epilepsy surgery, and all had a successful surgical outcome (follow-up >1 year). RESULTS: Most patients with ictal rhythms having a predominant basal source component had hippocampal-onset seizures, whereas those with seizures with prominent lateral source activity had predominantly temporal neocortical seizure origins. Seizures with a prominent anterior temporal tip source component mostly had onset in entorhinal cortex. Seizures in some patients had several equally large and nearly synchronous source components. These seizures, which could be modeled equally well by a single oblique dipole, had onset predominantly in either entorhinal or lateral temporal cortex. CONCLUSIONS: Multiple fixed dipole analysis of scalp EEG can provide information about the origin of temporal lobe seizures that is useful in presurgical planning. In particular, it can reliably distinguish seizures of mesial temporal origin from those of lateral temporal origin.
An 80-year-old man presented with a localized tumor of the right occipital scalp. The tumor was a 1-cm, bright red-purple, ulcerated, and crusted exophytic nodule on a smooth base (Figure 1). The lesion had grown asymptomatically over 18 months except for profuse bleeding induced by minimal trauma. It was extirpated with the clinical diagnosis of pyogenic granuloma vs. renal metastasis to the scalp. The patient's medical history included a transurethral prostatic resection 3 years earlier and, 1 year later, a right nephrectomy for a 2-kg kidney tumor verbally reported as "benign." The patient also had a 2-year history of untreated high blood pressure. Histopathologically, the excised tissue was an exo-endophytic nodule of a solid form composed of pleomorphic neoplastic cells with abundant clear cytoplasm, surrounded by fibrous collagen septae, blood vessel proliferation, and areas of hemorrhage (Figures 2 and 3). The histopathologic diagnosis of metastatic renal cell carcinoma was supported by immunohistochemistry with positive epithelial membrane antigen staining (Figure 4). Cytokeratins 7 and 20 were nonreactive. Laboratory studies revealed hematuria and elevated creatinine and urea nitrogen levels, but no malignant cells were observed in five urinary cytologies. Renal ultrasound showed the presence of two simple cysts in the left kidney and data compatible with chronic inflammatory disease.
The relevance of scalp EEG recording on the selection of patients for epilepsy surgery usually is based on the concordance between the location of the epileptogenic focus and the presumed ictal origin of clinical seizures visually identified or video recorded. Bilateralisation and/or spreading of the epileptiform events are among the causes of the relative lack of agreement between scalp topography and origin of EEG potentials. Computer methods mainly if they are adaptive and use multistrategic approaches improve the accuracy on the detection of the epileptogenic focus, extracting relevant information on the location and spreading of epileptiform events.
We report on an 84-year-old man with a solitary, nodular lesion on the scalp. The patient had been previously submitted to electrodessications of the scalp due to multiple solar keratoses. Histopathologically, the lesion showed features of a high-grade conventional osteoblastic osteosarcoma involving the dermis. Computed tomography showed no involvement of the underlying bone tissues. Clinical examination and extensive total body radiologic workup revealed absence of bone lesions in any body site, thus suggesting a final diagnosis of primary cutaneous extraskeletal osteosarcoma. The clinico-pathological features of the case are discussed in light of the rare cases previously described in the literature.
Nestin+ hair follicle-associated cells of murine skin can be isolated and differentiated in vitro into neuronal and glial cells. Therefore, we have asked whether human skin also contains nestin+ cells, and whether these can be differentiated in vitro into neuronal and/or glial cell populations. In this methodological pilot study, we show that both are indeed the case - employing purposely only very simple techniques for isolating, propagating, and differentiating nestin+ cells from normal human scalp skin and its appendages that do not require selective microdissection and tissue compartment isolation prior to cell culture. We show that, it is in principle, possible to maintain and propagate human skin nestin+ cells for extended passage numbers and to differentiate them into both neuronal (i.e. neurofilament+ and/or PGP9.5+) and glial (i.e. GFAP+, MBP+ and/or O4+) cell populations. Therefore, human scalp skin can serve as a highly accessible, abundant, and convenient source for autologous adult stem cell-like cells that offer themselves to be exploited for neuroregenerative medicine purposes.
Organ culture of human scalp skin is usually performed with serum-containing medium, which limits its analytical usefulness. Here we report that intact human scalp skin can be grown at the air/liquid interface in supplemented, serum-free William's E medium for more than 2 weeks. Active hair shaft growth was visible until day 16 and was significantly enhanced compared with minimum essential medium (MEM) + 10% fetal bovine serum (FBS). Moreover, William's E medium protected better against cell death than MEM + 10% FBS before day 12. Using quantitative immunochemistry, proliferating (Ki-67+) cells could still be observed in the epithelium of hair follicles even on day 17 of serum-free skin organ culture. The number of apoptotic (TUNEL+) cells in the skin epithelium rose steadily after day 5. Giemsa stains revealed mature skin mast cells even after 13 days in culture. The percentage of surviving hair follicles (mostly with catagen- or telogen-like morphology) gradually increased over time displaying mostly catagen hair follicles after 17 days of culture. Although epidermis and hair follicle epithelium showed increasing atrophy and degeneration, and their pigmentation decreased gradually over time, some long-term-surviving epithelial islands were found in association with remnants of follicular structures as late as on day 88. These preliminary data suggest that a very simple serum-free organ culture method allows prolonged human skin and hair follicle survival as well as some limited hair follicle cycling in intact skin for more than 2 weeks under well-defined experimental conditions. This pragmatic assay invites multiple uses, and may become a valuable tool for both skin and hair research.
Scalp cooling with gel packs was used to try to prevent alopecia in 31 patients being treated with doxorubicin (Adriamycin), 29 for advanced breast carcinoma and two for carcinoid tumour. Twenty-eight of the 31 patients tolerated the procedure well, and 22 of these had either no hair loss or only slight loss which remained acceptable and did not require a wig. The main factor limiting success was biochemical impairment of liver function, which occurred in nine patients; of these, six had severe or total alopecia despite scalp cooling. Conversely, the technique was successful in all 19 patients with normal liver function. Carried out properly, this simple and effective technique greatly diminishes socially unacceptable alopecia associated with doxorubicin, and merits wider use.
Blood loss from scalp lacerations may be considerable. Two cases are described to illustrate the hazards of transferring patients with head injuries without adequate attention to scalp wounds. In such cases referring clinicians must be satisfied that haemostasis is secure. Failure to do this may place the patient at increased risk as a result of the need for additional resuscitation, and therefore delay the definitive management.