Prolonged survival of angiosarcoma on the nose: a report of 3 cases

The nose is a rare site for presentation of angiosarcoma. Although this presentation if difficult to study because of its rarity, previous authors have suggested improved survival in patients with angiosarcoma on the nose compared with other anatomic sites. If true, improved survival may be a result of early detection, small tumor size at time of presentation, and increased likelihood of combined surgery and radiation treatment. We report the cases of 3 patients who presented with nasal angiosarcoma and then survived 7, 7, and 4 years to date.

Treatment of giant keratoacanthoma with intralesional 5-fluorouracil

Giant keratoacanthomas measure greater than 2 cm and have a predilection for the nose and eyelids. As a result, they often present a significant therapeutic challenge. A 36-year old woman was referred for evaluation of a 4.0 x 4.0 cm giant keratoacanthoma on the nose. The patient was treated with intralesional 5-fluorouracil, and the tumor underwent complete regression leaving a full thickness nasal cleft. The defect was then reconstructed with a paramedian forehead flap with good cosmesis.

The use of photodynamic therapy in dermatology: results of a consensus conference

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

Office accreditation in dermatology

Health care accreditation is a process of demonstrating compliance with nationally-recognized standards of excellence. Compliance with standards is verified during an on-site survey by specially-trained surveyors. Office-based surgery accreditation is available to dermatologists through the Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Poly-L-lactic acid as a facial filler

Poly-L-lactic acid is a filler recently approved by the US FDA for the correction of facial lipoatrophy in patients infected with the human immunodeficiency virus (HIV). Currently, poly-L-lactic acid, sold under the brand name Sculptratrade mark (Dermik), is the only product approved by the FDA specifically for this indication. The market for poly-L-lactic acid will likely be larger than the HIV-infected population, as physicians use poly-L-lactic acid off-label to correct lipoatrophy associated with the normal aging process in non-HIV-infected patients. The benefits of poly-L-lactic acid are limited by the fact that multiple treatments are necessary to achieve the desired correction; its results are temporary and its cost is high.

Dioxin toxicity and chloracne in the Ukraine

Dioxin toxicity can lead to severe cutaneous and systemic disease. The poisoning of Ukrainian President Viktor Yushchenko dramatically illustrates the damage dioxin can inflict. The hallmark of dioxin toxicity is chloracne and should alert the clinician to this diagnosis, which can be confirmed by blood tests. Olestra, a non-absorbable, non-digestible fat substitute is a promising new treatment to lower systemic dioxin levels.

Preparation of frozen sections

BACKGROUND

For dermatologists the preparation of frozen sections means micrographic surgery. The preparation of frozen sections is meant to be rapid, but has multiple, discrete steps that demand attention to detail.

OBJECTIVE

The objective was to summarize both the proven and the cutting-edge techniques of frozen section preparation.

MATERIALS AND METHODS

Reports from the medical literature were used to augment techniques used in our practices.

CONCLUSION

We dissect each step of micrographic cancer removal, report on the standard and preferred methods of tissue preparation, and summarize the progress achieved in the past decade.

Poly-L-lactic acid: a temporary filler for soft tissue augmentation

A number of soft tissue filling agents are available in the U.S. and Europe. In Europe, poly-L-lactic acid was approved for soft tissue augmentation and correction of wrinkles in 1999. The clinical results from this synthetic implant may last up to two years. In this article, we report our experience using poly-L-lactic acid for correction of facial lipoatrophy and wrinkles in 300 patients since 1999. Poly-L-lactic acid is an ideal, resorbable filler material for soft tissue augmentation, especially in the lower one-half of the face. The aesthetic results are excellent and long-lasting. Clinical results and side effects are generally technique-dependent. The clinical results using poly-L-lactic acid for soft tissue augmentation are comparable to autologous fat grafting. However, surgical fat harvesting is not necessary, and treatment can be extended to elderly individuals and patients with infectious diseases who have little body fat.

A new ePTFE soft tissue implant for natural-looking augmentation of lips and wrinkles

BACKGROUND

Expanded polytetrafluoroethylene (ePTFE) implants have been used for augmentation of thinning lips and wrinkles due to aging for more than 10 years. The aesthetic results have often been excellent, but complications such as infection, extrusion, migration, shrinkage, and hardening have occurred in some patients.

OBJECTIVE

To assess short-term results and complications in patients undergoing augmentation of the lips, nasolabial folds, and marionette lines with a newly designed ePTFE implant.

METHODS

Thirty patients received 60 Advanta ePTFE implants for augmentation of the lips, nasolabial folds, or marionette lines.

RESULTS

All patients received a natural-looking augmentation following 3-4 days of noticeable swelling. The only significant complications involved two upper lip implants that were removed for suspected infection.

CONCLUSION

In a preliminary series, Advanta ePTFE implants provided effective, natural-looking augmentation of the lips and nasolabial folds with minimal complications.

Mohs surgery revisited: 25 key articles

It has been over 30 years since Dr. Mohs first realized the potential for the surgery that now bears his name, and since then hundreds of articles have been published in dozens of Journals regarding his research and clinical experience, and the work of those who followed him. Collated in his memory by Drs. David Goldberg and C. William Hanke, and Ronald Moy, these 25 articles are meant to represent a cross-section of the most important articles ever published on the subject of Mohs surgery, and provide an excellent resource for those interested in learning about its development and refinement over the years.

Unilateral acquired nevus flammeus in women

Congenital nevus flammeus is a benign vascular tumor characterized by pink to pale red patches that thicken as the patient ages, producing a dull red to reddish blue, cobblestone-textured plaque. We present the cases of 3 women with unilateral acquired nevus flammeus on the cheek whose lesions resolved after minimal treatment with a 585-nm pulsed dye laser. The etiology of acquired nevus flammeus is reviewed and tumor response rates to laser surgery are discussed.

A history of dermatologic surgery in the United States

BACKGROUND

Dermatologic surgery has a long and distinguished history in the United States.

OBJECTIVE

To examine the specific contributions of American dermatologic surgeons.

METHOD

The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched.

RESULTS

Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy.

CONCLUSION

Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future.

Morbidity and mortality related to liposuction. Questions and answers

Reports of fatalities following liposuction have lead to investigations by state medical boards. The risk of complications and fatalities is clearly different for liposuction under local anesthesia and intravenous sedation. Thousands of patients have been treated with true tumescent liposuction as described by dermatologist Dr. Jeffrey A. Klein, with no reports of fatalities. Patients should seek physicians who are experienced in this extremely safe method of liposuction.

Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction?

BACKGROUND

There is increasing national dialogue on who should perform liposuction and where it should be performed.

OBJECTIVE

To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims.

METHODS

Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed.

RESULTS

Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction.

CONCLUSION

Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements.

Infusion rates and levels of premedication in tumescent liposuction

BACKGROUND

Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete.

OBJECTIVE

To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication.

METHODS

Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients.

RESULTS

Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed.

CONCLUSION

Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication.

Cutaneous resurfacing

Cutaneous resurfacing can be accomplished with application of acids, abrasive modalities, or the new generation of carbon dioxide lasers. Ultimately, the universal goal is removal and replacement of the epidermis and dermal collagen remodeling. The indications range from therapeutic and reconstruction to the treatment of the stigmata associated with senescence. The indications are not technique-specific, and the art of cutaneous resurfacing is identifying the cutaneous defect and selecting the appropriate tool or tools to realize the optimal clinical results.