Characterizing the tissue dielectric constant of skin basal cell cancer lesions.

BACKGROUND: Measuring tissue dielectric constant (TDC) of cancer tissues to distinguish them from normal or non-cancerous tissues has been an active area of research that has targeted several different cancer types usually using in vitro specimens. The goal of this study was to determine if and to what extent TDC values measured in vivo at 300 MHz using a simple hand-held measuring device might differentiate between skin cancer lesions and non-cancerous skin. MATERIALS AND METHODS: Triplicate TDC measurements were made in 32 patients who were subsequently diagnosed with skin basal cell carcinoma (BCC) and in 14 patients subsequently diagnosed as having non-cancerous lesions. Lesion TDC values were compared to contralateral unaffected skin and between lesion types. RESULTS: A significantly lower TDC value (mean ± SD) of BCC lesions (TDCL ) vs TDC values of contralateral non-affected skin (TDCC ) was found (22.4 ± 16.2 vs 38.1 ± 15.2, P < .00001). A similar pattern was found for non-cancerous lesions with lesion TDC values less than non-affected skin (14.5 ± 9.0 vs 29.1 ± 9.0, P < .0001). However, TDC values were not statistically different between BCC lesions and non-cancerous lesions (22.4 ± 16.2 vs 14.5 ± 9.0, P = .096) and calculated TDCL /TDCC ratios between BCC lesions and non-cancerous lesions also were not significantly different (0.596 ± 0.345 vs 0.501 ± 0.261, P = .364). CONCLUSIONS: (1) Main results do not support using TDC measurements to differentiate in vivo skin cancer lesions from non-cancerous lesions. (2) TDC values strongly suggest reduced water content of both cancerous and non-cancerous lesions. (3) Lesion TDC measurements provide reference values for future studies.

Trichoblastic fibroma. A series of 10 cases with report of a new plaque variant.

BACKGROUND: Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial to complete follicular induction. We studied 10 cases of trichoblastic fibroma and reviewed their clinical and histologic features. OBSERVATIONS: All 10 tumors were located on the face. Nine of 10 patients were women. The mean age at presentation was 63.8 years (range, 35 to 81 years). Two distinct subsets of trichoblastic fibroma were identified: the nodular variant and the plaque variant. The nodular variant is well circumscribed, while the plaque variant is poorly circumscribed, has significant subclinical extension, and may represent the low-grade malignant counterpart of the classic nodular trichoblastic fibroma. Histologically, both variants demonstrate mesenchymal induction with keratin cysts, papillary mesenchymal bodies, and an inductive fibroblastic stroma. CONCLUSIONS: Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial-mesenchymal components is helpful in tumor recognition. The plaque variant trichoblastic fibroma has not been previously reported. Familiarity with this variant is important because of the potential for infiltrative growth.

Engaging ethnically diverse teens in a substance use prevention advocacy program.

Teen Activists for Community Change and Leadership Education is designed to engage high school students living in low-income neighborhoods in community advocacy efforts to transform their schools and communities so they do not reinforce use of alcohol, tobacco, and other drugs. This nine month intervention for 116 freshmen and sophomores in and near San Jose, California consisted of 30-90 minute meetings. Social cognitive constructs of sense of community, perceived self-efficacy, outcome expectancies, incentive value, policy control, and leadership competence guided the program. No changes in individual use of alcohol, tobacco, and other drugs were observed by the end of the program, but improvements in community involvement and self-perception of many of the constructs were observed.

Molecular biology and spinal disorders. A survey for the clinician.

Over the past 10 years, advances in molecular biology techniques have extended the potential for understanding spinal disorders from the microscopic (histologic) level down to the molecular level of gene expression within individual cells. These advances are initiating new avenues of research and, ultimately, novel clinical treatments. The intent of this update is to provide the spine clinician with a basic understanding of molecular biology, the type of information that may be learned from its application, and the potential for gene therapy in spine disorders.

Angiolymphoid hyperplasia with eosinophilia and nephrotic syndrome.

We report a case of angiolymphoid hyperplasia with eosinophilia (ALHE) and nephrotic syndrome. The clinical and histologic features of ALHE are described and contrasted with Kimura's disease. Both ALHE and Kimura's disease may be associated with renal disease.

Acquired digital fibrokeratoma.

Acquired digital fibrokeratomas are unusual benign tumors of fibrous tissue. A case of recurrent acquired digital fibrokeratoma with a striking clinical presentation is presented and differential diagnosis as well as treatment of these lesions are reviewed.

Metastatic umbilical carcinoma: the Sister Joseph's nodule.

Metastatic umbilical carcinoma has been referred to by generations of physicians as Sister Joseph's nodule. Though not common, this characteristic lesion is important to recognize and properly evaluate. We present a case of an eighty-two-year-old woman with a Sister Joseph's nodule due to an unknown primary carcinoma, and we review the diagnostic and prognostic features of umbilical metastases.

High-energy pulsed light source hair removal device used to evaluate the onset of action of a new topical anesthetic.

BACKGROUND: Topical anesthetic agents are widely used to mitigate the pain associated with laser and high-energy pulsed light source hair removal. OBJECTIVE: To evaluate the relative efficacy and onset of action of a new topical anesthetic agent, ELA-Max cream (lidocaine 4%), relative to a widely used agent, EMLA cream (lidocaine 2.5%/prilocaine 2.5%). METHODS: ELA-Max and EMLA were applied to the forearms of 10 unblinded test subjects. The EMLA-treated sites were occluded for 1.5 hours prior to testing. The ELA-Max-treated sites were unoccluded and the cream was applied immediately prior to testing. Pulses from an Epilight high-energy pulsed light source were then administered 1.5 hours after occlusion with EMLA and in 5-minute intervals after application of ELA-Max. Pain scores were recorded on a visual analog scale (VAS). RESULTS: Six of 10 patients reported some anesthetic effect from ELA-Max after 5 minutes of unoccluded skin contact. Seven of 10 subjects reported maximal pain control 20 minutes after application of unoccluded ELA-Max, roughly equivalent to EMLA after 1.5 hours of occlusion. CONCLUSION: ELA-Max is an effective topical anesthetic agent comparable to EMLA under occlusion. It appears to be faster acting than EMLA, and along with its effectiveness without occlusion, may be an easier agent to use.

Differential expression of factor XIIIa and CD34 in cutaneous mesenchymal tumors.

The histogenetic relationship amongst various dendritic cells of the dermis which may express markers including factor XIIIa (FXIIIa) or CD34 remains unclear. In this study we utilized a sensitive indirect immunoperoxidase staining technique to identify CD34 and FXIIIa, as well the monocyte/macrophage markers KP-1 and MAC 387 expression in a variety of cutaneous dermal tumors of mesenchymal origin to see if differential expression of CD34 vs FXIIIa exists. Tumors studied included dermatofibroma (DF) (N = 10), keloid (N = 9), atypical fibroxanthoma (AFX) (N = 3), and dermatofibrosarcoma protuberans (DFSP) (N = 7). DF were all composed of FXIIIa+ spindle-shaped and stellate tumor cells (mean score = 4.9 or > or = 75% FXIIIa+) as previously reported, but these cells rarely (< 10%) expressed CD34. Six of 7 DFSP were found to be > 75% CD34+ and FXIIIa negative, while one DFSP was negative for both CD34 and FXIIIa. In all DFSP, there were trapped FXIIIa+ cells which were distinct from the spindle-shaped tumor cells. AFX showed sparse populations of FXIIIa+ cells in the stroma (mean score = 1.33 or 10-25% positive), which were distinct from the atypical giant cells characteristic of these tumors. Keloid similarly contained trapped FXIIIa+ cells (mean score = 0.44 or < 5% positive) that were distinct from the spindle-shaped fibroblasts of the tumor mass. Dendritic and spindle-shaped cells within these tumors were consistently both KP-1 and Mac-387 negative, while all lesions studied were characterized by scattered round, histiocytic cells which were KP-1+ and/or Mac-387+ irrespective of tumor cell type.(ABSTRACT TRUNCATED AT 250 WORDS)

Minocycline hyperpigmentation: model for in situ phagocytic activity of factor XIIIa positive dermal dendrocytes.

Pigmentary disorders resulting from the prolonged use of the semisynthetic tetracycline derivative antibiotic, minocycline, are rare but well recognized sequelae of ingestion of this drug. We present two cases of women with bullous pemphigoid who developed blue-black pigmentation in areas of scarring on the legs after oral minocycline therapy. On histologic examination, the deposited pigment was localized within dendritic cells limited to the upper dermis. Immunohistochemical analysis revealed these cells to be factor XIIIa positive dermal dendrocytes which was confirmed by transmission electron microscopy. We believe these cases demonstrate, in-situ, the phagocytic capabilities of this recently described cell population.