Safety of liposuction: a review of 9478 cases performed by dermatologists

Complications and methods of anesthesia were reviewed in 9478 patients who had undergone liposuction surgery often in several areas. Seventy-one percent of the patients were treated under local anesthesia and the overall level of complications was extremely low. The results of the survey reflect the large number of liposuction procedures that are being performed by dermatologists with a high degree of patient safety.

Blast tattoos resulting from black powder firearms

Blast tattoos occur when fragments of gunpowder are propelled into the skin during a firearm discharge. This unusual type of injury is often associated with accidents involving replica firearms. Some of the more superficially embedded powder fragments may be removed with dermabrasion; however, deeper fragments may cause permanent tattooing. Blast injuries to the face also have the potential of causing permanent eye injury.

A histologic evaluation of the effects of skin refrigerants in an animal model

The effects of a number of commonly used skin refrigerants were studied in controlled freezing experiments on guinea pig skin. Frigiderm and Fluro Ethyl produced very little effect on the skin compared to colder preparations such as Cryosthesia -30 degrees C and Cryosthesia -60 degrees C.

Treatment of multiple facial neurofibromas with dermabrasion

Three patients with multiple facial neurofibromas were treated by dermabrasion with good cosmetic results. Wound healing was entirely normal and no complications were observed. There was no evidence of accelerated regrowth of tumors during follow-up.

Mycobacterium kansasii infection with multiple cutaneous lesions

Mycobacterium kansasii infections of the skin are rarely seen and present variable clinical and histopathologic features. Laboratory identification of the organism is essential for proper diagnosis and selection of appropriate antimycobacterial medications. Antituberculous drugs are the standard treatment; however, therapy with tetracycline or minocycline is a provocative alternative.

Repair of surgical defects

Basic skills in elliptical excision are essential for success in dermatologic surgery. Once the elliptical excision has been mastered, the practitioner should progress to variations on the ellipse. These include "curving" the incision, M-plasty, A-to-T closure, O-to-Z closure, and subcutaneous island pedicle flaps. When one of these methods will not suffice, a local flap or a full-thickness skin graft is often a good alternative.

Quantitative assessment of burn injury in porcine skin with high-frequency ultrasonic imaging

Early excision and grafting of full thickness burns has been shown to decrease morbidity and mortality. Errors made in assessing acute burn depth are common and result in prolonged hospitalization in expectant healing of full-thickness burns and in unnecessary excision and grafting of potentially regenerative partial-thickness burns. High-frequency ultrasonic imaging may be a noninvasive, convenient means of quantitating burn depth. A depth analysis system for imaging burned skin was developed using a high-frequency 18.5 MHz (nominal 25 MHz) pulse-echo ultrasound system with a longitudinal resolution of 86 mu. Five adult mini-swine (15 kg) were burned with a temperature-(190 degrees C) and pressure-controlled (236 g/cm2) burning iron. A series of burn durations (1-45 seconds) was used to inflict partial- and full-thickness burns of various depths. Ultrasonic scans of the acutely excised burns were performed across the lateral margin of the burn, including adjacent normal skin to serve as control. Direct histologic comparison was made with each scan plane. Average burn and normal skin depth measurements were made by independent observers for 34 scans and corresponding histologic sections. A significant correlation was achieved between burn depth and percent burn (burn depth/adjacent normal skin depth) as measured by ultrasound and histology (R = 0.90, t = 11.2, P less than .001).

Basal cell carcinoma with eccrine differentiation (eccrine epithelioma)

Basal cell carcinoma with eccrine differentiation is an invasive, slow-growing tumor that usually occurs on the scalp. The histopathologic findings include basaloid epithelial elements, cystic spaces, and a fibrous or myxomatous stroma. The patient described in this report demonstrated epithelial elements with marked similarity to eccrine ducts. Mohs micrographic surgery, by virtue of the large number of frozen sections that are examined, provides an ideal way to study the characteristics of this unusual tumor.

Atypical keloids after dermabrasion of patients taking isotretinoin

Six patients underwent dermabrasion while on or having recently completed isotretinoin (Accutane) therapy. All patients developed keloids in atypical locations; the keloids eventually responded to topical or intralesional steroid therapy. Retinoids have a modulatory effect on connective tissue metabolism, including suppression of collagenase, which may enhance keloid formation. Dermabrasion should be delayed in those patients taking or recently on isotretinoin therapy.

Invasion of parotid gland by basal cell carcinoma: implications for therapy

A review of 1,146 cases of basal cell carcinoma of the head and neck revealed that twelve (1.05%) involved the parotid gland by direct extension. The male to female ratio was 5:1 and the average age was 70.1 years. Tumor size, site of origin, and duration prior to treatment were factors influencing secondary parotid involvement by these neoplasms. Mohs micrographic surgery was found to be an effective method of treatment with a high cure rate.

Large keratoacanthomas in difficult locations treated with intralesional 5-fluorouracil

Keratoacanthoma is a benign tumor; however, it may cause massive destruction of normal tissue during its rapid growth phase. Intralesional 5-fluorouracil (5-FU) has been shown to be an effective treatment for keratoacanthoma. We have successfully treated five patients with large keratoacanthomas in difficult locations. There have been no recurrences during follow-up periods ranging from 18 to 45 months. Intralesional 5-FU may be ineffective for keratoacanthomas that are not rapidly proliferating.

Variables affecting the results of xenogenic collagen implantation in an animal model

A number of variables that can affect the results of xenogenic collagen implantation were studied by means of the pig model. Zyderm Collagen Implant was analyzed biochemically and was used to study the following variables: injection volume, collagen concentration, injection intervals, and needle gauge. The results of the study revealed the following: Injection volumes of 0.125 to 0.25 ml given at the same site resulted in the appearance of large "pools" of Zyderm Collagen Implant in the subcutaneous fat. However, injection volumes of 0.0625 to 0.1 ml given at the same site resulted in all of the implant's being retained in the dermis. There was no appreciable difference in the results achieved with two different concentrations of implant. Serial reinjections of 0.1 ml at 1-week intervals revealed increased amounts of implant material in the dermis. The use of a 30-gauge needle allowed more superficial placement than was possible with a 27-gauge needle.

Complications of dermabrasion resulting from excessively cold skin refrigeration

Three patients developed complications following dermabrasion with a new potent skin refrigerant mixture. Freezing can usually be performed more rapidly with such mixtures, but the risk of complications may be greater.

Skin Cancer in Professional and Amateur Female Golfers

In brief: Fifty-one female professional golfers and 142 female amateur golfers were evaluated for skin cancer and skin cancer risk. The professionals were considerably younger than the amateurs (average of 28.4 vs 54.5 years) and received five times as much sun exposure as the amateurs. Four of the professionals had already developed basal cell carcinoma (BCC). Their average age was 25.5 years. Eleven amateurs also developed BCC, but their average age was 51.4 years. This study suggests that skin cancer can develop at earlier ages when sun exposure has been heavy. The likelihood of developing a skin I cancer also was related to eye and hair color.

Congenital smooth muscle hamartoma masquerading as congenital pigmented nevus

Smooth muscle hamartomas are rare benign tumors of the skin, characterized by proliferation of large interlacing bundles of nonstriated muscle within the reticular dermis. The lesions may masquerade as one of several clinical entities. In this report, we describe two patients with congenital smooth muscle hamartomas masquerading as congenital pigmented nevi. Review of the literature indicates that these cases represent the ninth and tenth reported cases of congenital smooth muscle hamartoma. Our second case represents the largest lesion reported to date.

Acne, retinoids, and dermabrasion

A group of nine patients with severe nodulocystic acne vulgaris were treated with oral 13-cis-retinoic acid and their acne cleared. During or after retinoid therapy, all patients underwent full-face dermabrasion. Postoperative healing was normal, and no significant complications were seen.