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A case of excessive fetal bleeding following scalp blood sampling is reported. The literature is reviewed and recommendations are made to reduce the incidence of this potentially fatal complication.
Indications for biopsy of scalp skin are discussed and the technique for obtaining adequate tissue for histologic examination is described.
Surgical ablation of a giant congenital composite melanocytic nevus on a good part of the side of the face and scalp in a series of operations is described and illustrated. It was technically and cosmetically successful.
The clinical appearance, histopathology, and fulminating course of an angiosarcoma of the scalp in a 57-year-old man is described. It enlarged rapidly, developed satellite nodules, metastasized to the lungs, and was fatal within five months.
The pleomorphic lipoma is a benign neoplasm of lipocytes with atypical histologic features. The tumor shows a predilection for the region of the neck and shoulders of midde-aged and elderly men and must be differentiated from similar-appearing malignant entities such as liposarcoma and malignant myxoid fibrous histiocytoma. An occurrence of a pleomorphic lipoma in the scalp is reported and its histologic features described and discussed.
Large, aggressive basal-cell carcinomas of the scalp in young adults are widely and deeply invasive, and may be fatal for those reasons or because of metastatic spread. Five cases are presented that were treated by microscopically controlled excision (Mohs' fresh-tissue technique) after other methods of management had failed. The salient features of these cases and 17 similar cases from the literature and compared with those of basal-cell carcinomas in general.
Early problems with central sagittal scalp reductions are primarily medical and surgical. As they resolve with surgical experience, the cosmetic problems become more apparent. These problems and complications are outlined along with suggestions for prevention and correction.
Instead of risking the esthetic complication sometimes observed with the development of a vertical alopecic strip crossing the posterior aspect of the scalp, another method can be used to replace this. A small, round alopecic area similar to a small developing bald spot is created and eventually grafted later.
A technique is described for treating the alopecia resulting from scalp surgery repaired by split-thickness skin grafts with the method of marsupial minigrafts. This procedure provides an uncomplicated outpatient approach for treating this type of alopecia.
A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision and suture technique is described. Advantages of the technique over previously described procedures are presented. Measurements of individual scalp elasticity and alternating suture tension vectors help to produce an excellent cosmetic result with minimal complications.
Malignant cylindroma may develop via malignant transformation of cylindroma in rare instances or may develop de novo in others. We present a case of malignant cylindroma located on the left parietal-occipital scalp that was treated twice by Mohs micrographic surgery in an attempt to excise the tumor completely and to minimize the excision of normal tissue. Our case is the sixteenth reported case of malignant cylindroma in the world literature.
Application of the tumescent anesthetic technique in scalp surgery, dermabrasion, and soft tissue reconstruction is discussed. Vasoconstriction achieved by using tumescent anesthesia reduces bleeding even with dilute (1:320,000) epinephrine. Tumescent anesthesia also offers the advantages of decreased absorption at the site of infiltration, increased anesthetic infiltration, delayed absorption and lower peak blood plasma levels, and a longer lasting anesthetic effect.
A suture variation not commonly utilized in dermatologic surgery is helpful in approximating wound edges without the complications of excessive undermining or the scarring of conventional retention sutures. It is especially useful in scalp reduction surgery.
An ultrasharp tungsten electrode was used in several hundred scalp reduction procedures from 1988-1992 at Peterson Medical Institute, Santa Monica, California. This unique instrument has proved to be a useful adjunct in facilitating hair restoration surgery.
BACKGROUND: The bulbar region of the hair follicle contains the dermal papilla, hair germinative epithelial component, and active melanocytes. Thus, it has been assumed that the bulbar region plays a central role in hair growth, differentiation, and pigmentation. OBJECTIVE: To assess the regenerative capacity of human hair. METHODS: Individual anagen hair follicles were isolated from the occipital scalp and grafted onto the leg after removal of the bulb. RESULTS: The grafts of follicles from which the bulb and complete papilla have been excised regenerated new papillae and grew new pigmented hairs. CONCLUSION: The middle portion of the outer root sheath and dermal sheath may also contain epithelial, mesenchymal, and melanocyte reservoirs.
BACKGROUND: Nodular hidradenocarcinoma was first reported as clear-cell eccrine carcinoma by Keasby and Hadley in 1954 (Cancer 1954;7:934-52) and rare malignant tumor. Several synonyms and related terms for nodular hidradenocarcinoma have appeared in the literature. OBJECTIVE: They have potential for uncontrollable local recurrence, tend to metastasize, and often cause death. Most cases have been reported in the pathology literature with limited clinical information. METHODS: We report a 27-year-old woman with nodular hidradenocarcinoma on the scalp. RESULT: The management of rare cases is not well defined. In our case, she was only treated with a wide local excision, and no recurrence was observed 2 years after excision. CONCLUSION: Most authors have concluded that early wide surgical excision of the tumor is the treatment of choice. The efficiency of adjuvant therapy generally has not established.
BACKGROUND AND OBJECTIVE: Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive and infiltrative tumor that requires Mohs' micrographic surgery or wide excision to treat. Adequate excision often leaves a cosmetic disfiguring defect, particularly if the tumor is located on the head and neck. Complex defects of the face present special problems, such as distortion, ectropion, and retraction of normal tissues. PATIENT AND METHODS: We present a case of an infiltrating DFSP of the forehead and scalp in a young woman. The tumor was removed, and the defect was reconstructed with multistaged repair, which included bone coverage, local and regional flaps, and the use of expanders. RESULTS: A multistaged repair was performed with good clinical outcome and satisfactory cosmetic results. CONCLUSION: Multistaged repair of the face is a viable alternative surgical approach to preserve facial contours and minimize distortion in the treatment of DFSP. This case illustrates the degree of complexity that the treatment of DFSP may involve.
BACKGROUND: Verrucous carcinoma (VC) is a low-grade, well-differentiated squamous cell carcinoma of the skin or mucosae, and human papillomavirus (HPV) infection has been considered to be one of the causative factors of VC at three main sites, including the oral cavity, the genitoanal region, and the foot. However, the relationship between cutaneous VC at other sites and HPV infection remains obscure. OBJECTIVE: We describe a rare case of cutaneous VC originating in a burn scar on the scalp and our attempt to find HPV infection in the lesion. METHODS: We investigated the presence of HPV by polymerase chain reaction-restriction fragment length polymorphisms and immunohistochemical analysis. RESULTS: HPV type 33 was detected in the lesion, and positive stains for HPV were observed in several cell nuclei at the upper stratum malpighi. CONCLUSION: Since HPV type 33, as well as HPV types 16 and 18, is regarded as a high-risk, mucosal type, HPV type 33 infection likely contributed to the development of the lesion. We suggest that HPV infection should be relevant to a subset of cutaneous VC.