Decreased skin cancer after cessation of therapy with transplant-associated immunosuppressants.

BACKGROUND: Immunosuppression for solid organ transplantation is associated with increased incidence of internal and cutaneous malignant tumors, among which skin cancer is the most common. OBJECTIVE: To determine the effects on cutaneous carcinogenesis when stopping therapy with immunosuppressive medications. OBSERVATIONS: We followed the clinical course of 6 solid organ transplant recipients after therapy with immunosuppressant medications was stopped because of allograft failure or unacceptable cutaneous carcinogenesis. Generally, we found that stopping therapy with immunosuppressive medications resulted in deceleration of cutaneous carcinogenesis, resolution of cutaneous verrucae vulgaris, and qualitative improvements in skin condition. Four patients experienced marked improvement; 2 did not. CONCLUSIONS: Cessation of transplant-associated therapy with immunosuppressive medications for patients in whom cutaneous carcinomas developed after transplantation may lead to deceleration of cutaneous carcinogenesis, decreased verrucae, and improved skin quality within 1 to 2 years. Because of the natural variation in skin cancer development and the small number of cases in this series, definitive conclusions require further study.

Eyebrow transplantation.

BACKGROUND: Reconstruction of the eyebrow has historically been accomplished with temporal scalp pedicle flap formation or free composite scalp grafts. These two techniques may be associated with substantial morbidity and a false, overly dense eyebrow appearance. Hair transplantation of the eyebrows has been described with excellent results, but is relatively underreported in the literature. OBJECTIVE: To determine whether modern techniques of micrograft hair transplantation can suitably re-create an aesthetic eyebrow in a case of iatrogenic eyebrow alopecia. METHODS: A 33-year-old woman with iatrogenic eyebrow alopecia underwent four sessions of eyebrow micrograft hair transplantation to re-create both eyebrows. RESULTS: Suitable aesthetic eyebrows were re-created in a symmetric fashion with proper hair orientation. The process was time consuming and tedious, but highly effective. CONCLUSION: Eyebrow transplantation is a suitable alternative to pedicle flap formation and composite scalp grafting. It is a straightforward procedure that can be performed in the office under local anesthesia with minimal attendant morbidity. The result may be superior to that seen with more involved eyebrow replacement procedures.

Risk of synchronous and metachronous second nonmelanoma skin cancer when referred for Mohs micrographic surgery.

BACKGROUND: Patients with basal cell carcinoma and cutaneous squamous cell carcinoma are at substantial risk for the onset of a second nonmelanoma skin cancer (NMSC). OBJECTIVE: Our purpose was to determine the incidence of multiple (synchronous) NMSC at presentation to an academic Mohs micrographic surgery referral center and to note the incidence of second lesions occurring in a metachronous fashion. METHODS: A retrospective study was conducted of 456 consecutive patients who presented for Mohs surgery over a 2-year period. Patients were assessed at initial visits for the presence of multiple NMSCs and were subsequently examined over 2 years for the onset of new NMSCs. RESULTS: More than 39% of patients initially referred for Mohs surgery with a basal cell or squamous cell carcinoma either presented with multiple primary lesions or experienced a subsequent NMSC within 2 years. These tumors were divided almost equally between multiple primary NMSC at presentation and subsequent (metachronous) tumors. CONCLUSION: Patients referred for Mohs surgery in an academic setting are a select group at extremely high risk of additional NMSCs at or shortly after presentation for the index lesion.

Bilateral primary mucinous carcinoma of the eyelid treated with Mohs surgery.

BACKGROUND: Primary mucinous carcinoma is an uncommon malignant cutaneous tumor which arises most commonly on the eyelid. While rarely causing death, recurrence following primary excision is common and widespread metastasis may occur. OBJECTIVE: We report the first case of bilateral primary mucinous carcinoma of the eyelid. METHODS: A lesion of the left lower eyelid had been resected three times previously with positive conventional margins. Both this lesion and a second primary lesion of the contralateral lower lid were removed with Mohs microscopically controlled excision without recurrence for more than 2 years. CONCLUSION: Multiple lesions of mucinous carcinoma of the eyelid do not necessarily connote metastasis. Mohs microscopically controlled excision may be a suitable form of therapy for primary mucinous carcinoma of the eyelid.

Squamous cell cancer: a practical approach.

Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer and is treated frequently by dermatologists. For many years, the level of knowledge regarding treatment of SCC has taken a backseat to the treatment of basal cell carcinoma and malignant melanoma. As dermatologists become more surgically proficient and assume a leading role in the surgical care for cutaneous carcinoma, a thorough knowledge of the appropriate management of SCC is of paramount importance. In particular, it is essential to recognize that, unlike basal cell carcinoma, certain SCC have a significant metastatic potential and require more comprehensive care. This review targets the etiology, pathogenesis, clinical presentation, histopathology, and treatment of SCC. Particular attention is focused on providing appropriate care for SCC and recognizing and arranging appropriate management for high risk SCC.

Does bacteremia occur during flexible sigmoidoscopy?

Up to 10% of patients may have bacteremia after rigid sigmoidoscopy. The aim of our study was to determine the frequency of bacteremia accompanying flexible sigmoidoscopy. Blood samples for aerobic and anaerobic cultures were obtained before, during, and after flexible sigmoidoscopy in 100 patients who were examined a mean distance of 49.5 cm, range 15-60 cm, after a bowel preparation of two Fleet enemas. In one patient, a transient bacteremia with Streptococcus intermedius was documented and was attended by no associated clinical manifestations. This organism has been previously isolated from patients with endocarditis, peritonitis, emphysema, and hepatic and appendiceal abscesses. There was no association in our study with bacteremia and such factors as length of bowel examined and duration of procedure, the presence of bowel pathology, performance of endoscopic biopsies, liver disease, and portal hypertension or poor bowel preparation. We conclude that the extremely low incidence of significant bacteremia with flexible sigmoidoscopy may be related to the smaller diameter of the instrument and provides further support for the routine use of flexible rather than rigid sigmoidoscopy.

Cerebrospinal fluid GABA and cyclic nucleotides in alcoholics with and without seizures.

Cerebrospinal fluid levels of gamma-aminobutyric acid (GABA) and cyclic nucleotides were measured in alcoholic and control patients. Alcoholics without seizures had higher GABA levels than either alcoholics with seizures or controls. Levels of cyclic AMP and cyclic GMP in cerebrospinal fluid of controls and alcoholics with and without seizures were not significantly different.