Symmetric facial macules in an Asian woman.

Hori nevus, also known as acquired bilateral nevus of Ota-like macules, is a form of dermal melanocytosis found most commonly in women of East Asian heritage. It presents as discrete brown macules on the bilateral cheeks which later coalesce into confluent grey-brown macules and small patches. Herein, we report a classic case of Hori nevus and discuss the histologic findings and differential diagnosis. We also review the proposed pathophysiology, genetic considerations, and treatment options.

Comprehensive Treatment of Facial Deformity Due to Radiotherapy in Rhabdomyosarcoma Patients: Distraction Osteogenesis and Free Flaps Surgical Technique.

Radiotherapy is essential for achieving and maintaining local control in head and neck rhabdomyosarcoma patients. However, radiotherapy may cause outgrowth disturbances of facial bone and soft tissue, resulting in facial asymmetry.Several studies have shown that the management of irradiated bones still remains challenging. The possibility of obtaining functional and aesthetic results when managing facial deformities due to radiation therapy with distraction osteogenesis combined with free flaps reconstruction is not common and not well documented in recent literature.In this report, we present the long-term results of distraction osteogenesis and soft tissue reconstruction via microvascular free flap to correct the facial hypoplasia of a young patient who underwent radiation therapy for rhabdomyosarcoma.This is the first presentation of 26 years long-term results in a patient who also underwent free flaps reconstruction as ancillary surgery for esthetic good results.

Successful and safe use of Q-switched lasers in the treatment of nevus of Ota in children with phototypes IV-VI.

OBJECTIVE: Nevus of Ota represents congenital dermal melanocytosis in a trigeminal distribution, most commonly occurring in Asian individuals and other individuals with skin of color. Evidence suggests early treatment is beneficial. Multiple reports have shown efficacy and safety of Q-switched laser treatment in adults. There is little data on children and in non-Asian skin types. This series was done to demonstrate safe and effective use of Q-switched laser therapy in children of multiple skin types. STUDY DESIGN: Retrospective case series. METHODS: This was a chart review of patients under 18 years old who presented to our practice from 2002 to 2015 with a clinical diagnosis of nevus of Ota who were treated with Q-switched lasers (694 and 1,064 nm). Patients were treated without the use of general anesthesia or sedation, and corneal shields were used in appropriate cases. Percentage of improvement as well as side effects were rated by five physicians independently. Improvement, when present, was rated in quartiles (1-25%, 26-50%, 51-75%, and 76-100% improvement). RESULTS: Twenty-four children were included. The average age at the start of treatment was 3.9 years old (range of 3 months to 12.4 years), and patients had Fitzpatrick skin types IV through VI. The mean number of treatments was 9.3. Assessment revealed excellent response (76-100% improvement) in 70% of patients and good to excellent response (51-100% improvement) in 86%. Two patients (8%) had post-inflammatory hyperpigmentation, one of whom also had focal hypopigmentation. CONCLUSION: Treatment of nevus of Ota with Q-switched lasers in children with skin of color, without general anesthesia or sedation, is safe and effective. Early intervention should be encouraged for better efficacy and to prevent psychosocial distress in later childhood and adulthood. Lasers Surg. Med. 50:56-60, 2018. © 2017 Wiley Periodicals, Inc.

Orbitofacial dermatofibrosarcoma protuberans with intranasal extension.

A 25-year-old Chinese woman presented with recurrent painless swelling over the left medial canthus region for 3 months and intranasal mass for an indeterminate duration. Initial incision biopsy of the mass was reported as nodular fasciitis but the lesion recurred 3 weeks later. Intraoperative findings during repeat biopsy showed a mass extending from the deep dermal tissue into the anterior orbit and polyp-like nasal mass. Histopathology findings were that of dermatofibrosarcoma protuberans (DFSP). The mass recurred 4 months later without orbital or intranasal recurrence. Wide excision biopsy under frozen section guidance was attempted however; clear surgical margins could not be achieved despite extensive resection. She was subsequently referred for adjuvant radiotherapy. We report an exceptionally rare case of local recurrence of DFSP in an unusual anatomic location. This case was surgically challenging in achieving negative margins, and thus neoadjuvant therapy may improve overall outcome to prevent local relapse.

B-Cell Lymphoma in a Patient With a History of Foreign Body Injection.

Dermal filler injection has been one of the most evolving areas of interest in the field of esthetic plastic surgery. This procedure is sometimes preferred to surgery due to shorter procedure and patient recovery times, and because it is suitable for a wide range of applications. Dermal filler injection is considered to be relatively safe, but various late complications such as infection and foreign body granuloma sometimes occur. Postprocedure development of lymphoma also occurs, but is extremely rare. The authors diagnosed extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue that developed after a filler injection procedure was performed on a patient's face. This 72-year-old female first presented with a palpable mass on her left cheek that developed after a probable silicone injection. An magnetic resonance imaging (MRI) scan and excisional biopsy confirmed the presence of the lymphoma. Complete remission occurred after radiotherapy. This rare case of lymphoma in a patient with a history of foreign body injection indicated that practitioners must be aware that long-standing chronic inflammation resulting from dermal filler injections can trigger lymphoma development.

The use of prophylactic Nunchaku stents to reduce the risk of nasolacrimal duct obstruction in patients with midfacial tumours undergoing radiotherapy.

The treatment of midfacial tumours with radiotherapy, chemotherapy and radio-iodine can cause nasolacrimal duct fibrosis resulting in epiphora. Nasolacrimal patency can be maintained by stenting. We report our experience of prophylatic Nunchaku stent insertion in 5 patients prior to midfacial radiotherapy. Four out of 5 patients (80%) had patent nasolacrimal ducts without any symptoms of epiphora following removal of the stents. One patient was initially asymptomatic with patent nasolacrimal duct, but subsequently developed epiphora. Nunchaku stents may provide a simple and effective way of preventing epiphora, obviate the need for nasal retrieval that is required for other nasolacrimal stents, and reduce the risk of requiring further lacrimal surgery.

[Merkel cell carcinoma of the facial skin. Cases presentation and general rules of treatment].

Merkel cell carcinoma is an aggressive, malignant, neuroendocrine tumor of the skin. The aim of the study is to present the clinical pictures, methods and results of treatment of MCC in the Clinic of Maxillofacial Surgery in Rzeszow in years 2003-2010. Changes were located on the skin of the face of four patients. All patients were treated surgically, the primary change was removed. Recurrence after surgical treatment was observed in all patients. The observations confirmed the data from the literature about the incidence of MCC over 75 years of age, aggressiveness and difficulties in treatment of this disease.

A randomized, split-face clinical trial of Q-switched alexandrite laser versus Q-switched Nd:YAG laser in the treatment of bilateral nevus of Ota.

Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.

Asymptomatic and infiltrated plaque on the left cheek.

Centrofollicular B Cell lymphomas constitute 25% of non-Hodgkin lymphomas that originate in the skin. They are the second in frequency of those lymphomas with extranodal location after gastrointestinal B lymphomas. The primary cutaneous centrofollicular lymphoma is characterized by the neoplastic proliferation of centrocytes and centroblasts confined to the skin. The prognosis is considered excellent with low probability of extracutaneous dissemination. We present a patient recently diagnosed in our unit with a good response to radiotherapy and complete resolution of the tumor with mild atrophy of the site.

A case report of primary cutaneous marginal zone lymphoma treated with intralesional steroids.

IMPORTANCE: Primary cutaneous marginal zone lymphoma (PCMZL) is a low-grade malignant B-cell lymphoma that appears in the skin without any extracutaneous manifestations. Therapeutic mainstays for PCMZL have primarily included radiotherapy and surgery. Intralesional steroids have been found to resolve the lesions caused by PCMZL, but there is a dearth of literature regarding this therapy indicating that this is not a commonly favored treatment option. OBSERVATIONS: We present a case of 60-year-old woman who presented with PCMZL on her right eyebrow. Three years later, after two courses of radiation and one relapse, the patient presented with new lesions on both arms, consistent once again with PCMZL. At this time, therapy with nine rounds of intralesional triamcinolone was attempted. After each round of triamcinolone, gradual improvement of the lesions was noted until complete resolution occurred. CONCLUSIONS AND RELEVANCE: This case reminds practitioners that intralesional corticosteroids can be effectively and safely used to treat localized PCMZL. Intralesional steroids are less invasive, cheaper, and easier to administer than the majority of other recommended therapies for PCMZL. Thus, although they are often overlooked, intralesional corticosteroids should be more often considered when developing a treatment plan for localized PCMZL.

Merkel cell carcinoma.

A 92-year-old man presented for evaluation with a 1-month history of a rapidly growing asymptomatic pink nodule on his forearm. Biopsy results of the lesion demonstrated pathology consistent with Merkel cell carcinoma (MCC). Immunohistochemical studies displayed positive cytoplasmic staining for cytokeratin AE1/AE3, positive dot-like perinuclear staining for cytokeratin-20, diffuse cytoplasmic staining for neuron specific enolase, and no significant staining for S-100. Subsequent positron emission tomography did not reveal evidence of metastatic disease. Wide excision of the lesion was performed along with a sentinel node biopsy of his left axilla. The sentinel nodes were negative for MCC. Adjuvant radiation treatment of the tumor site was provided because the pathologist noted MCC within 2 mm of the deep margin.

125I brachytherapy alone for recurrent or locally advanced adenoid cystic carcinoma of the oral and maxillofacial region.

BACKGROUND AND PURPOSE: This retrospective study was to evaluate the local control and survival of (125)I brachytherapy for recurrent and/or locally advanced adenoid cystic carcinoma (ACC) of the oral and maxillofacial region. PATIENTS AND METHODS: A total of 38 patients with recurrent and/or locally advanced ACC of the oral and maxillofacial region received (125)I brachytherapy alone from 2001-2010. Twenty-nine were recurrent cases following previous surgery and radiation therapy. The other 9 cases involved primary tumors. Overall, 12 tumors were located in the major salivary glands, 12 in the minor salivary glands, and 14 in the paranasal region, the nasal cavity or the skull base. The prescribed dose was 100-160 Gy. RESULTS: Patients were followed for 12-122 months (median 51 months). The 2-, 5-, and 10-year local tumor control rates were 86.3, 59, and 31.5 %, respectively. The 2-, 5-, and 10-year overall survival rates were 92.1, 65 and 34.1 %, respectively. Tumors > 6 cm had significantly lower local control and survival rates. No severe complications were observed during follow-up. CONCLUSION: (125)I brachytherapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent ACC.

Low-dose high-dose-rate brachytherapy in the treatment of facial lesions of cutaneous T-cell lymphoma.

BACKGROUND: The use of many of the standard skin-directed mycosis fungoides (MF) therapies on facial skin may be limited by site-specific increased risks of side effects, excessive inflammation, and ocular toxicity. OBJECTIVE: Our study aimed to describe the levels of erythema, scale, and induration of facial lesions in MF before and after low-dose high-dose-rate surface applicator brachytherapy and to examine the overall clinical response to brachytherapy. METHODS: A total of 23 facial MF lesions in 10 patients were treated with high-dose-rate brachytherapy doses of 4 Gy per session for a total of 2 fractions at our multidisciplinary cutaneous oncology clinic between August 17, 2009, and March 12, 2012. RESULTS: In all 23 lesions, dramatic clinical improvement was observed. Patients were followed up for a median of 6.3 months. No recurrences were reported in the follow-up period. LIMITATIONS: Long-term follow-up is lacking. Reassessment of all included patients at annual intervals for a period of at least 5 years is the authors' goal. CONCLUSION: Low-dose high-dose-rate brachytherapy using custom-made surface molds is a highly efficacious therapy in the treatment of facial lesions in MF.

Malignant chondroid syringoma of the face with bone invasion.

Malignant chondroid syringoma is a very rare type of malignant sweat gland tumor. Diagnosis is based on pathologic features but is complicated by the low frequency of this tumor. The authors report a new case of malignant chondroid syringoma, initially misdiagnosed as basal cell carcinoma, that exhibited very aggressive local behavior and was located on the face, a rare site for this tumor. The authors describe its histopathologic appearance and highlight the importance of including adenoid cystic carcinoma in the differential diagnosis.

Optimal care for eyelid contraction after radiotherapy: case report and literature review.

Radiotherapy represents a major problem in facial surgery. Orbital and periorbital radiation therapy causes a contraction of the soft tissues. Scarring with ectropion is the most severe complication, with shrinking of the anterior lamella, skin dystrophy, muscle atrophy, and alteration of the remaining soft tissues. Goals for reconstruction include correction of distorted orbitofacial tissues and the restoration of orbital structures. The management of these patients is not standardized. We suggest systematically using a combined approach of surgery and lipofilling to restore the orbital deformity and dystrophy, respectively. For this purpose, we present the case of a 65-year-old woman with asymmetry of the orbital regions and severe lower eyelid cicatricial ectropion due to multiple radiation treatments in childhood for an extensive cavernous hemangioma of the right side of the face. We performed a reconstructive procedure using a tarsal strip technique in association with contralateral upper eyelid graft to correct the extensive retraction of the right lower eyelid and lid asymmetry. Subsequently, the patient underwent lipofilling to correct the post-radiotherapy dystrophy. Skin texture, softness, and elasticity greatly improved with further symmetrization. The combined treatment with surgery and lipofilling can significantly improve the functional and cosmetic outcome of shortened and dystrophic eyelids with a successful result with regard to post-radiotherapy retraction.

[Oral acitretin and topical imiquimod as neoadjuvant treatment for giant basal cell carcinoma]. / Tratamiento neoadyuvante con acitretino oral e imiquimod tópico en el carcinoma basocelular gigante.

Giant basal cell carcinoma (BCC) is defined as a tumor with a diameter of 5 cm or more. Surgery, the treatment of choice for any type of BCC, can cause considerable anatomical damage in large tumors. In 2 patients with giant BCC we therefore provided neoadjuvant treatment with a combination of oral acitretin and topical 5% imiquimod. Acitretin is a systemic retinoid used for primary prevention of nonmelanoma skin cancer. Imiquimod is an immunomodulator whose approved indications include treatment of nonfacial superficial BCC less than 2 cm in diameter. Previous studies have demonstrated a synergic anticancer effect of both drugs in vitro and in vivo. This combination produced a marked reduction in tumor mass in our patients. Later we were able to provide definitive treatment, which achieved complete remission of the tumors.