Naturopathic Self-Treatment of an Atypical Fibroxanthoma: Lessons for Dermatologic Surgery.

BACKGROUND: Alternative therapies are favored by some patients. In skin cancer, this may be to try to avoid surgery out of fear for the procedure and its functional or cosmetic consequences. Frequently, use of these therapies is not curative and can cause harm. Our objective is to detail a case where black salve was used as a natural remedy for an atypical fibroxanthoma and resulted in a severe burn. We highlight the challenges of communicating effective treatment options for those who have strong beliefs concerning natural remedies after a cancer diagnosis. CASE REPORT: A 78-year-old man was referred for excision of a small atypical fibroxanthoma of the scalp. He had reservations about conventional treatments, he initially declined surgery. Later, he was found to have a severe burn over the site of the biopsy-proven AFX, extending to 20% of his scalp. He was found to have been applying black salve. Hospital admission and multiple stages of scalp reconstruction with Head and Neck Surgery were required. CONCLUSION: For patients who desire to use alternative medicine, communication is all important. Integrative approaches to use traditional therapy while reconciling patient beliefs in natural medicine can improved oncologic, functional, and psychosocial outcomes. J Drugs Dermatol. 2018;17(6):683-685.

Double endoscopic technique for operative dilation of esophageal strictures resistant to conventional therapy.

Esophageal strictures are a common problem causing significant morbidity for affected patients. Most can be treated safely and successfully with esophageal dilation. We have treated two patients with post-radiation esophageal strictures so tight that standard dilation technique failed even with an aggressive approach. We utilized a technique for operative dilation of these strictures using both antegrade and retrograde endoscopes. This approach for refractory esophageal strictures has only twice been previously reported. In both patients, a gastrostomy was placed and an endoscope was subsequently passed from the stomach retrograde up to the level of the stricture. Another endoscope was passed from above down to the proximal portion of the stricture. Illuminating the stricture, using fluoroscopy, carefully passing a wire, and grasping and pulling the wire with forceps from the opposite endoscope allowed for safe passage through the stricture. Savary dilators were utilized to effectively dilate the strictures. A method for protection of the lumen for subsequent dilations by passing a small catheter through the stricture was also developed. This technique offers an option for patients with otherwise untreatable strictures, with the major advantage of visualization from above and below.

Loss of reflex tearing: an expected consequence of juvenile nasopharyngeal angiofibroma.

OBJECTIVE: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN AND SETTING: A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia. RESULTS: One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA. CONCLUSION: The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery. SIGNIFICANCE: The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM RATING: C.

Sclerosing cervicitis: report of a skull base lesion with literature review.

BACKGROUND: Invasive fibrosclerotic lesions of the head and neck outside of the thyroid and orbit are extremely rare. To date 13 cases of sclerosing cervicitis have been described in the literature. METHODS: We present a case of a sclerosing inflammatory lesion encountered at the skull base in a 49-year-old woman. RESULTS: After surgical excision and pathologic examination, this lesion was identified as sclerosing cervicitis. CONCLUSIONS: This case report contributes to an awareness of a rare lesion of the head and neck that presents clinical and treatment challenges for surgeons managing these patients.