Microcystic adnexal carcinoma: a case series treated with mohs micrographic surgery and identification of patients in whom paraffin sections may be preferable.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare cutaneous tumor characterized by aggressive local infiltration, including a high propensity for perineural invasion (PNI). OBJECTIVES: To report our experience in treating MAC using Mohs micrographic surgery (MMS) with frozen sections and to identify patients in whom that technique may have limitations. MATERIALS & METHODS: A review of records between 1992 and 2008. RESULTS: Nine patients with MAC were identified. All tumors were located on the face. PNI was noted in the diagnostic biopsies of two patients with periocular MAC, in both of whom tumor persisted after MMS. The mean duration of follow-up was 5.4 years. CONCLUSIONS: MMS with frozen sections is reliable for treating primary MAC in which PNI is not present on a diagnostic biopsy. Previous surgery and PNI were associated with greater risk of persistence in periocular MAC. In these patients, it may be appropriate to consider MMS with paraffin-embedded sections, possibly as a layer after apparent clearance on frozen sections. Further excision of orbital contents should be considered in periocular MAC that infiltrate the deep orbital fat or are noted to have PNI.

Complications of laser dermatologic surgery.

BACKGROUND AND OBJECTIVE: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. METHODS: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. RESULTS: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. CONCLUSION: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.

Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a light source, compared with pulsed dye laser alone: a pilot study.

BACKGROUND AND OBJECTIVES: Laser-induced photo thermal damage has been combined with photodynamic therapy (PDT) using a systemic photosensitiser to treat vascular lesions. The efficacy of PDT using systemic 5-aminolaevulinic acid (5-ALA) as the photosensitiser and pulsed dye laser (PDL) as the light source in port wine stains (PWS) is unknown. STUDY DESIGNS/MATERIALS AND METHODS: We conducted an internally controlled pilot study comparing the efficacy of PDT using PDL as a light source, to PDL alone in the treatment of PWS. RESULTS: The PWS improved slightly in all patients but no significant difference was found between the three treatment arms in terms of lesional lightening or incidence and severity of side effects. CONCLUSIONS: There was no evidence of increased efficacy of PDT using PDL as a light source compared to PDL alone. There was also no significant difference in adverse events. Further studies using different treatment regimens over longer periods of time may be warranted.

CO(2) laser therapy of vulval lymphangiectasia and lymphangioma circumscriptum.

BACKGROUND: Lymphangiectasia is a disorder of superficial lymphatics resulting from obstruction of previously normal deep lymphatics, while lymphangioma circumscriptum describes a deep dermal and subcutaneous lymphatic malformation with secondary superficial ectatic changes. Previous case reports have suggested the effectiveness of CO2 laser treatment. OBJECTIVE: To assess CO2 laser therapy for vulval involvement by these lymphatic disorders. METHODS: A retrospective case review at St. John's Institute of Dermatology from 1996 to 1999 identified three women with vulval lymphangiectasia and two with vulval lymphangioma circumscriptum treated with the CO2 laser. RESULTS: Patient tolerance of the procedure was good. Healing was complete within 1 month and occurred without change in skin texture. All patients reported considerable improvement in symptoms (mean follow-up 22 months, median 24 months, range 10-33 months). Focal recurrence and an area of localized persistence were noted in the two patients with lymphangioma circumscriptum. CONCLUSION: CO2 laser therapy of vulval lymphangiectasia and lymphangioma circumscription is effective and well-tolerated; the latter may possibly be more resistant to treatment than the former.