Reconstruction of Large Facial Defects after Delayed Mohs Surgery for Skin Cancer

The face is a common localization for skin malignancies. Mohs surgery or delayed Mohs surgery are considered the gold standard of treatment despite new drug developments.We analyzed our patient files over a three-year period. Only large facial defects ≥3 cm in diameter after complete tumor removal were considered. Twenty patients (9 men and 11 women) were found, with a mean age of 83.6 years. The following tumor entities were responsible for large defects: basal and squamous cell carcinoma, melanoma, Merkel cell carcinoma, atypical fibroxanthoma, and cutaneous angiosarcoma. Surgery was performed in all cases using regional or local anesthesia. Defect repair was done using linear sutures (n=1), skin grafts (n=1), and flaps (n=18). The various types of repair are illustrated in this review, advantages and limitations of each type of repair are discussed. Patient satisfaction was high. Complications or adverse events were rare. The need for repair of large facial defects after tumor surgery is not uncommon. Careful planning and the use of a number of techniques allows a tailored approach for each patient.</p

Bilateral periorbital ecchymosis following ablative laser removal of xanthelasma palpebrarum

Periocular ecchymosis is a rare finding with various, sometimes life-threatening pathologies. We report the case of a 48-year-old woman who presented with bilateral periocular ecchymosis after laser removal of xanthelasma palpebrarum. Her medical history was unremarkable. Amyloidosis could be excluded by histopathology. We suggest that periocular ecchymosis is a rare adverse event after minor (laser) surgery of the eyelids and discuss the possible pathogenesis and differential diagnoses.  </p

Muir-Torre syndrome - Treatment with isotretinoin and interferon alpha-2a can prevent tumour development

Muir-Torre syndrome is a genodermatosis in which multiple internal malignancies are associated with cutaneous sebaceous tumours and kerato-acanthomas. A 57-year-old man presented with multiple sebaceous tumours, kerato-acanthomas, verrucous carcinoma of the nose, renal cell and transitional cell carcinomas of the left kidney, adenoma of the colon and a positive family history of colon carcinoma. He was treated with interferon (IFN-alpha Pa) s.c. 3 x 10(6) U three times a week along with 50 mg isotretinoin daily as well as topical isotretinoin gel. During a follow-up of 29 months, only 1 sebaceous skin tumour developed and was removed, whereas more than 30 such skin tumours had been surgically removed during the last 3 years. No evidence of internal tumour development or recurrence was found. The combination of IFN with retinoids seems to be of promise to prevent tumour development in Muir-Torre syndrome. Copyright (C) 2000 S. Karger AG, Basel

Plexiform Neurofibroma Without Neurofibromatosis Type 1

Plexiform neurofibroma (PNF) is a particular subtype of benign nerve sheath tumors with a reticular growth pattern not respecting tissue borders and involving several nerve branches or fascicles. It is most commonly reported in patients with neurofibromatosis type-1 (NF-1) and represents in up to 30% of NF- 1 patients (1,2). Other possible associations include schwannomatosis, multiple cutaneous schwannomas syndrome, and rarely neurofibromatosis type-2 (NF-2) (3)

Condyloma-like squamous cell carcinoma of the vulva: report of two midline cases

Shyam B Verma,1 Uwe Wollina21Nirvana Clinic, Vadodara, Gujarat, India; 2Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanyAbstract: Vulvar cancer is uncommon and may be confused with genital condylomata. We report two cases of middle-aged women presenting with exophytic vulvar tumors of the midline for which diagnosis of a vulvar squamous cell carcinoma was confirmed by histopathology. Risk factors, staging, and treatment options are discussed.Keywords: condyloma, human papillomavirus (HPV), squamous cell carcinoma, surgery, vulv

Looking through the cracks of diabetic candidal balanoposthitis!

India is becoming an epicentre of type II diabetes mellitus with a crude prevalence rate of about 9%. Candida balanoposthitis is a known feature of diabetes mellitus especially in Indian males who are predominantly uncircumcised. In this country, diabetes is often diagnosed for the first time by dermatologists. Diabetes is much more frequently the cause of candida balanoposthitis than sexual intercourse in India. Fissuring along with balanoposthitis was found to be more common in sexually active males. The biomechanical basis of fissuring and the effect of diabetes in this phenomenon are explained. The issue of circumcision is debated under various aspects

A Sheep in Wolf’s Clothing: Lobular Pyogenic Granuloma Masquerading Nodular Amelanotic Melanoma

BACKGROUND: Tumor masquerading is a common phenomenon seen in clinical dermatology. While amelanotic melanoma is known to simulate pyogenic granuloma, a benign vascular tumour, the contrary has been reported exceptionally scarce. CASE PRESENTATION: We present a 52-year-old woman with a slow-growing lesion on her right flank, which developed over 12 months. On examination, we observed a large exophytic, easily bleeding tumour on the right flank, that resembled amelanotic malignant melanoma. Histologic analysis after complete excision of the lesion confirmed a pyogenic granuloma of the lobular capillary hemangioma subtype. In the present case masquerading of the lesion went to the better site after histologic investigations despite the delay of diagnosis caused by the patients. CONCLUSION: Nevertheless, the diagnosis of uncertain lesions needs a rapid histologic analysis to gain the best possible prognosis for the patient