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2.
Dermatol Surg ; 2024 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-38603804

RESUMEN

BACKGROUND: Although there is a large body of literature regarding risk stratification and outcomes for perineural invasion (PNI) in cutaneous squamous cell carcinoma (cSCC), there is a relative paucity of studies exploring the role of lymphovascular invasion (LVI) in cSCC and a lack of clear evidence-based guidelines for how to manage patients with these tumors. OBJECTIVE: This article is intended to review the available literature regarding LVI in cSCC and formulate evidence-based recommendations for clinical management. METHODS AND MATERIALS: A literature review was conducted using PubMed to find relevant articles relating to outcomes and management of primary cSCC with LVI. RESULTS: The available literature suggests that LVI is a major risk factor for poor outcomes and increased morbidity and mortality in cSCC. CONCLUSION: Lymphovascular invasion is a very high-risk feature that should place these tumors in the highest-risk category, and management of these tumors should be similar to that of squamous cell carcinoma with PNI.

4.
Cureus ; 16(2): e54426, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38510898

RESUMEN

Introduction Merkel cell carcinoma is an aggressive neuroendocrine tumor that is related to immunosuppression and the Merkel cell polyomavirus. It is more common on the head and neck and has been associated with other skin malignancies such as basal cell carcinoma, squamous cell carcinoma, and melanoma. However, there has never been a nationwide investigation that quantifies Merkel cell carcinoma's connection with these subgroups. Methods Utilizing the National Institutes of Health's All of Us open-access database, a retrospective study was conducted by filtering for Merkel cell carcinoma through the International Classification of Diseases, 9th and 10th Clinical Modification codes 209.* and C4A.*, respectively. This led to the inclusion of 41 patients in the study, with each instance compared to four control patients without merkel cell carcinoma, matched by age, race, and gender. The data's demographics and skin cancer co-morbidities were collected and evaluated with odds ratios and 95% confidence intervals using Wald's method. Results In patients with merkel cell carcinoma, a statistically significant gradient of increasing risk for developing basal cell carcinoma (Odds Ratio, 11.63; 95% Confidence Interval, 4.30-31.45; P < 0.0001), squamous cell carcinoma (Odds Ratio, 15.09; 95% Confidence Interval, 3.87-58.84; P = 0.0001), and melanoma (Odds Ratio, 27.94; 95% Confidence Interval, 3.26-239.48; P = 0.0024) was observed. The race/ethnicity demographics showed that 85.4% of the patients were white, and they were at the highest risk of developing merkel cell carcinoma. However, the study has limitations, such as the inability to identify the stage of merkel cell carcinoma among patients and the lack of consideration for other confounding variables. Conclusion The study examines the link between merkel cell carcinoma and other skin malignancies, underscoring the need for more national research to better understand the underlying causes that contribute to this link. The findings also indicate the possibility of sample bias in the All of Us database, emphasizing the need to assess the patient population's representativeness in such investigations.

9.
Dermatol Online J ; 29(6)2023 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-38478673

RESUMEN

A 74-year-old woman who presented initially with trigeminal neuralgia of the left forehead and scalp was later found to have a poorly differentiated squamous cell carcinoma (SCC) with large-nerve perineural and intraneural invasion of the left supraorbital nerve. Negative histopathologic margins were achieved in three stages of permanent fixed tissue en face processing and the final defect was repaired with a large rotation flap. Approximately one month after repair, the patient presented with new-onset diplopia and was found to have a complete left cranial nerve VI palsy suspicious for continued disease spread. MRI confirmed perineural spread along the ophthalmic branch of the trigeminal nerve through the superior orbital fissure into the cavernous sinus. She was subsequently treated with radiation therapy (66Gy in 33 fractions). The involvement of two distinct cranial nerves by perineural invasion is uncommon and has mostly been described involving branches of the trigeminal and facial nerves. This case highlights the rare presentation of perineural invasion involving both the trigeminal nerve and the abducens nerve. Anatomically, this clinical presentation can be explained by the retrograde perineural spread along the ophthalmic branch of the trigeminal nerve through the supraorbital fossa into the cavernous sinus where these two nerves are in close proximity.


Asunto(s)
Enfermedades del Nervio Abducens , Carcinoma de Células Escamosas , Neoplasias Cutáneas , Femenino , Humanos , Anciano , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Nervio Trigémino/patología , Enfermedades del Nervio Abducens/etiología , Enfermedades del Nervio Abducens/patología , Nervio Facial/patología
10.
Cutis ; 109(5): 272-276, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35856762

RESUMEN

The COVID-19 pandemic has impacted the practice of Mohs micrographic surgery (MMS). We sought to determine the characteristics of skin cancers treated by MMS during the pandemic compared with prepandemic controls. A retrospective chart review was conducted. Tumors included were all treated in accordance with best practice guidelines set forth by state- and national-level professional governing bodies. Bivariate and multivariate analyses were performed to compare outcome variables. Changes in tumor characteristics during the pandemic are of clinical significance, potentially affecting extent of reconstructive surgery, cost, operating time, and future tumor characteristics.


Asunto(s)
COVID-19 , Neoplasias Cutáneas , COVID-19/epidemiología , Humanos , Cirugía de Mohs , Pandemias , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía
13.
Cutis ; 108(2): 100-101, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34735320

RESUMEN

Spitting sutures are a common complication of dermatologic surgery following closure of a cutaneous defect using buried sutures. This development can be distressing and uncomfortable for patients and may lead to further complications, such as surgical-site infection and abscess. Presented here is a straightforward and reliable algorithm to guide management of spitting sutures and their complications.


Asunto(s)
Técnicas de Sutura , Suturas , Absceso , Algoritmos , Humanos , Infección de la Herida Quirúrgica
15.
Cutis ; 107(3): 144-148, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33956606

RESUMEN

Reconstruction of defects involving the upper lip can be challenging. The purpose of this review was to analyze the anatomy and function of the upper lip and provide an approach for reconstruction of upper lip defects. The primary role of the upper lip is coverage of dentition and animation, whereas the lower lip is critical for oral competence, speech, and eating. The orbicularis oris (OO) and several other muscles contribute to upper lip function. There are various insertion points for animation muscles, including the upper lip dermis, OO, and modiolus. Special attention should be paid to the philtrum, Cupid's bow, and vermilion border during reconstruction. Advantages and disadvantages of the Abbe, Estlander, and Karapandzic flaps are presented. Knowledge of mechanics, indications, and properties of local flaps while considering unique characteristics of upper lip anatomy and function are crucial for optimal aesthetic and functional outcomes.


Asunto(s)
Neoplasias de los Labios , Procedimientos de Cirugía Plástica , Músculos Faciales , Humanos , Labio/cirugía , Neoplasias de los Labios/cirugía , Colgajos Quirúrgicos
16.
Dermatol Online J ; 27(2)2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33818979

RESUMEN

The fields of dermatology and psychiatry have overlap in the patient populations and diseases they treat. However, there are not currently fellowship opportunities for dermatologists or psychiatrists specifically interested in gaining expertise in psychodermatology. We discuss the logistics of a one-year psychodermatology fellowship, open to residents after completing either dermatology or psychiatry residencies, and the potential benefits that it could bring to both dermatology and psychiatry training programs across the county.


Asunto(s)
Dermatología/educación , Becas , Psiquiatría/educación , Humanos
17.
Int J Dermatol ; 60(12): e480-e485, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33739460

RESUMEN

Dermatologists are faced with an aging population, accompanied by an increase in the incidence of skin cancer, especially nonmelanoma skin cancer. With this increase in cutaneous malignancy comes an increase in the number of dermatologic procedures being performed. A common concern of dermatologists and dermatology patients is the attenuation and management of pain associated with dermatologic procedures. Fortunately, there are several techniques that may be used in the preoperative, intraoperative, and postoperative periods to manage patient anxiety, minimize injection pain, and safely and effectively treat postoperative pain.


Asunto(s)
Dermatología , Neoplasias Cutáneas , Anciano , Procedimientos Quirúrgicos Dermatologicos , Humanos , Manejo del Dolor , Dolor Postoperatorio/etiología , Neoplasias Cutáneas/cirugía
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