Interpolation flaps.

Interpolation flaps provide an excellent method for reconstruction of large or deep defects where adjacent local tissue cannot supply sufficient donor tissue for repair. These flaps use tissue imported from nonadjacent sites with an inherent blood supply (vascular pedicle) to support the flap while attached to the recipient defect until neovascularization has been ensured between the flap and recipient bed. Hence, they can supply the thickness or bulk needed for large or deep defects and can survive on exposed bone or cartilage. The main disadvantage of these flaps is that they require two stages to complete because the delayed second stage releases the pedicle after inosculation and neovascularization render the tissue independent of the pedicle. This article describes three major interpolation flaps useful in repair of the nose and ear. The forehead, melolabial, and postauricular interpolation flaps are excellent methods that will add to the dermatologic surgeon's reconstructive armamentarium for the repair of large or deep defects.

Combination topical therapy for conjunctival primary acquired melanosis with atypia and periocular lentigo maligna.

PURPOSE: To report the case of a patient who initially presented with primary acquired melanosis (PAM) without atypia of the conjunctiva and later developed lentigo maligna of the eyelids and PAM with atypia of the conjunctiva. We illustrate the utility of combination topical therapy with adjunctive cryotherapy to treat extensive eyelid and conjunctival lesions. METHODS: Case report with a review of the current literature. RESULTS: Combination of imiquimod 5% cream (Aldara, 3M Pharmaceuticals) and cryotherapy for periorbital lentigo maligna with topical interferon-α2b for conjunctival PAM with atypia led to clinical resolution of pigmented lesions for 21 months. CONCLUSIONS: In our experience, combination topical therapy provides an effective alternative to surgery with superior cosmetic and functional outcomes.

A simple technique for repair of Cupid's bow.

BACKGROUND: Reconstruction of the upper lip is among the most challenging problems faced by Mohs surgeons. Cupid's bow, with its marked variability among individuals, can be particularly difficult to recreate. Numerous complex reconstructive methods have been described in the literature. The authors present a novel technique for aesthetic reconstruction of Cupid's bow. METHODS: Retrospective case reviews of defects resulting from Mohs excision located at or near Cupid's bow are given. Repair was performed using our modified mucosal advancement flap technique. RESULTS: Acceptable or very good cosmesis was attained in all cases. CONCLUSION: The use of our simple modification of the mucosal advancement flap allows aesthetic reconstruction of Cupid's bow in select cases. Selection criteria for defects amenable to this technique are presented.

Metastatic basal cell carcinoma.

BACKGROUND: Basal cell carcinoma is the most common malignancy of humans. Although it is axiomatic that this tumor does not evolve into metastatic disease, such events rarely occur, and this possibility should not be overlooked. OBJECTIVES: The reader should better understand the sequence of events that resulted in metastatic disease and how these events are emblematic of the rare cases of basal cell carcinoma that systemically spread. METHODS: We present a case report of basal cell carcinoma that underwent distant metastasis. A short review of the literature is included. RESULTS: Although basal cell carcinoma is commonly considered a regional tumor with virtually no propensity for distant spread, this case reveals that metastatic disease does occur and with devastating results. CONCLUSION: Metastatic disease in basal cell carcinoma is a very rare but catastrophic consequence of this very common skin malignancy.