Spitz nevus: follow-up study of 8 cases of childhood starburst type and proposal for management.

Spitz nevus is an uncommon, benign melanocytic neoplasm that shares many clinical and histological features with melanoma. It presents clinical ambiguity that makes the diagnosis and management of the patient difficult. We present our experience in the management of Spitz nevus by rigorous dermoscopic long-term follow-up of 8 Spitz nevi in patients younger than 12 years. Dermoscopic images, acquired every 6 months, show evolution and modifications of these lesions. The aim of this paper is to better understand the long-term modifications of nevi with starburst pattern to avoid surgical excision of these lesions in the pediatric age group.

Textured and smooth breast implants: is there a difference in the chemical structure of silicone?: an analysis with fourier transformation infrared and attenuated total reflectance spectroscopy.

Scientific controversy concerning silicone and its biocompatibility has been ongoing for the last 10 years. This study on textured and smooth silicone breast implant shells using fourier transformation infrared spectroscopy associated with attenuated total reflectance cells aimed to identify eventual chemical modifications of silicone induced by texturization. The surfaces of 8 new implants produced by 2 well-known manufactures have been taken into consideration. A sample 1 cm2 has been harvested from the anterior and posterior sides of textured and smooth shells. Infrared spectra were then recorded, evaluated, and compared with the reference spectrum of pure silicone. Potentially reactive groups, known as silanols, were identified, in all shells, intensity increasing in textured implants (P < 0.05), whereas no silanols were detected in the spectrum of pure silicone. These results suggest that polar groups, present in manipulated silicone might influence capsula formation.

Recurrent atypical eccrine spiradenoma of the forehead.

Eccrine spiradenoma is an uncommon but well recognized benign adnexal tumour of the eccrine sweat glands. It can appear at any age, but the highest rate of incidence is observed among young adults, without any sex predilection. The commonest clinical presentation is a solitary blue-red dermal or subcutaneous cystic nodule, ranging from 0.3 to 5 cm in diameter. Malignant transformation is a rare phenomenon, presenting as a rapidly enlarging nodule within a long-standing lesion. We report a case of eccrine spiradenoma in a thirty-six-year-old man who presented with a recurrent soft-tissue neoplasm of the forehead, with cytological atypia. The differential diagnosis of this tumour, as well as its possible malignant transformation, is discussed.

Burn after breast reconstruction.

AIMS: Burns occur rarely after breast reconstruction, and results from loss of sensory and thermoregulatory skin functions. We aimed to investigate the pathophysiological processes leading to these injuries. METHOD: Cases described in the literature are reviewed and discussed. Three cases of burn complicating the outcome of two implants and one autologous breast reconstruction are newly reported. DISCUSSION: The ineffectiveness of skin thermoregulatory reflexes, caused by different surgical procedures, plays an essential role in the pathogenesis of burns to reconstructed breasts; tissue expansion and radiotherapy are also essential aetiological factors.

Poroid hidradenoma: a case report.

Poroid hidradenoma is a variant of the eccrine poroma that belongs to the group of poroid neoplasms. It presents architectural features of hidradenoma, with solid and cystic areas and tumour cells restricted to the dermis, and cytological features of poroid neoplasm such as poroid and cuticular cells. Poroid hidradenoma becomes malignant in less than 1% of cases, but its histologic characteristics may resemble those of malignant neoplasms; thus it is easily misdiagnosed. Twenty percent of poroid hidradenomas occur in the extremities. To date, very few cases of this entity have been reported in the literature. We present a case of poroid hidradenoma in a 35-year-old man with a soft-tissue lesion on his right thigh.

An increase in basal cell carcinoma among the young: an epidemiological study in a middle-south Italian population.

During the last 20 years, an increasing incidence of basal cell carcinoma (BCC) has been demonstrated by several studies. A ten-year retrospective analysis on 7,266 cases of primary BCC of the Department of Dermatology and Plastic Surgery of the University of Rome La Sapienza and the Department of Dermatology of the University of Naples "Federico If' is reported. Among a population aged over 35 years, BCC cases increased from 618 in 1994 up to 749 cases in 2003, while among the younger population (<35 years), BCC cases increased from 30 in 1994 to 47 cases in 2003. Anatomic site distribution of BCC among people aged <35 years was: head and neck=51.54%, trunk=41.40%, limbs=5.91%, others= 1.12%. On histological examination aggressive-growth BBC was recorded in 48 out of 355 cases (13.52%) among people aged <35 years and in 841 out of 6,755 cases (12.45%) among patients >35 years. In conclusion, an increasing incidence of basal cell carcinoma among young people over the past 20 years was reported. No significant difference in tumour aggressiveness between the young and the elderly patients was observed.

Adipose compartments of the upper eyelid: anatomy applied to blepharoplasty.

Many authors have indicated the presence of ectopic or accessory upper eyelid fat pads, but the effective rate of eyelid fat variations and the corresponding clinical features are still unclear. The purpose of this study was to evaluate the variability of upper lid fat and to define the anatomical landmarks of the adipose pockets of the upper lid. From January of 1998 to January of 2002, the authors investigated the upper eyelid fat compartments of 47 patients who underwent upper blepharoplasty. To support surgical findings, 11 fresh cadavers were also investigated; the anatomy of the intraorbital fat and of the upper eyelid fat compartments was reviewed. Ten patients (21.3 percent) showed an accessory fat pad in the upper lid, which was found on both sides in nine cases. In all patients, the third fat pad was situated lateral to the two classic compartments described by Castanares, behind the orbital septum. Surgical dissections demonstrated that this fat pad derived from the preaponeurotic fat. Anatomical dissections in three cadavers demonstrated an accessory fat compartment protruding under the inferior border of the lacrimal gland. This protruding fat derived from the preaponeurotic fat in all cases and might justify the clinical appearance of a bulge or fullness in the lateral third of the upper eyelid. In the authors' experience, the presence of an accessory upper eyelid fat pad was a frequent finding during blepharoplasty; it could be found and actually resected in about 21 percent of all cases. Surgical and experimental findings put this element as a lateral physiological extension of the preaponeurotic fat that can anteriorly protrude under the inferior border of the lacrimal gland toward the orbital septum. The clinical appearance may be a bulge or fullness in the upper eyelid, and its resection can better define the lateral one third of the supratarsal fold.

Metatypical basal cell carcinoma: a clinical review.

BACKGROUND: Metatypical cell carcinoma can be considered as a new entity of skin cancer, being an intermediate typology between basal cell carcinomas and squamous cell carcinomas. The behaviour of the metatypical cell carcinoma lies between these two varieties of skin cancer. It is difficult to perform a differential diagnosis based on morphological and clinical features - therefore it is only possible by accurate histology. METHODS: The authors have retrospectively analysed clinical records of 240 patients who were affected by metatypical skin cancer and who were treated by surgery, radiotherapy and chemotherapy. RESULTS: MTC affected more males than females (62.5% vs 37.5%) than males. The most affected site was the cervicofacial area, 71.7%; then the trunk, 10%; the limbs, 9.6%; the scalp 3.7%; and other regions 5%. A recurrence occurred in 24 cases (10%), mainly in head and neck area. CONCLUSION: In this manuscript, the authors have emphasised the importance of conducting a differential diagnosis, and the importance of the specific treatment for metatypical skin cancer, even though more clinical studies and long-term follow-ups are required before establishing specific guidelines.