Treatment of maxillofacial congenital melanocytic nevus with percutaneous radiofrequency thermal ablation: A case series study.

When congenital melanocytic nevus (CMN) is in the maxillofacial region, a safer, more effective and fewer side-effects treatment is needed for patients with high requirement for appearance. The objective of this study was to investigate the effectiveness of radiofrequency thermal ablation (RFA) for CMN in the maxillofacial region. We reviewed 21 patients treated with RFA for CMN followed by a blinded retrospective analysis of serial photographs taken during the course of their therapy. Questionnaires were used to evaluate perceived therapeutic response and complications of this treatment. Most CMNs stopped growing, faded in color and became smaller. Reduction in size of 90% to 100% was obtained in two patients (10%), 75% to 90% in six patients (29%), 50% to 75% in two patients (10%), <50% in eight patients (38%), and three had no reduction (13%). Clear effect of clinical response score was obtained in two patients (10%), excellent in four patients (19%), good in 14 patients (67%), and fair in one patient (4%). No serious complication, severe hypertrophic scarring, and evidence of recurrence was observed in any case. Percutaneous RFA, as a minimally invasive and safe treatment, may provide an alternative treatment for maxillofacial CMN.

Nódulo proliferativo en nevus melanocítico congénito gigante / Proliferative nodule in giant congenital melanocytic nevus

El nevus melanocítico gigante es una entidad poco frecuente. En los primeros meses o años de vida, pueden aparecer nódulos dérmicos pequeños o grandes, muy pigmentados, que pueden crecer rápidamente o incluso ulcerarse. Esto obliga a realizar diagnóstico diferencial con el melanoma. Se presenta el caso de una paciente de 3 años de edad, con gran lesión pigmentada en pierna izquierda, con nódulos de rápido crecimiento, compatibles con nódulo proliferativo.

Giant melanocytic nevi are rare. In the fi rst few months or even years of life, they may develop small or large dermic nodules, very pigmented, with rapid growth o even ulcer formation. This forces the diff erential diagnosis with melanoma. We present a case of a 3 year old female patient, with a large pigmented lesion on the left leg, with nodules compatible with proliferative nodules.

Excision biopsy in a patient with suspected local anaesthetic allergy: use of 0.9% saline with benzyl alcohol as local anaesthesia.

Dermatologists may see patients with actual or suspected local anaesthetic (LA) allergy who require an urgent dermatological procedure to be performed without time for formal allergy testing. We report a case of shave biopsy and subsequent excision biopsy of an atypical naevus performed using tumescent analgesia with 0.9% saline containing benzyl alcohol preservative. The tumescence itself and the benzyl alcohol present in the 0.9% saline solution provided sufficient analgesia for excision. This technique may be an option for managing urgent procedures in patients suspected or known to have allergy to LA.

Effectiveness of skin cancer screening for individuals age 14 to 34 years.

BACKGROUND: Approximately 15 % of all cases of melanoma are diagnosed before age 35 years. In Germany, individuals ≥ 35 years are eligible for the national skin cancer screening program. The effectiveness of a population-based skin cancer screening in general and in particular for young adults is unclear. OBJECTIVES: Assessment of the effectiveness of a skin cancer screening program and of risk factors for detection of a melanoma/atypical nevus in the setting of a screening for the age group 14 to 34 years. METHODS: A total of 12,187 individuals age 14 to 34 years were screened in Saxony for skin cancer by a dermatologist in the program "Haut-Check 14-34 Jahre" of the AOK PLUS, a large German health insurance, between January and July 2009. Demographic, clinical and histopathological data and UV-exposure data were collected from each participant. Multivariate logistic regression models were used to assess risk factors for the detection of a (histopathologically confirmed) melanoma or atypical nevus. RESULTS: 2.8 % of the eligible individuals participated in the skin cancer screening program with women being more likely to do so. In 1 072 individuals (8.8 %) screening included at least one excision of a skin lesion leading to the diagnosis of melanoma in two participants, melanoma in situ in four persons, and atypical nevus in 641 persons. Use of tanning beds, higher age, number of nevi, and previous cutaneous excision were independent risk factors for the detection of a melanoma or atypical nevus. CONCLUSIONS: In 5.5 % of all cases skin cancer screening resulted in the excision of a malignant or atypical melanocytic lesion. It remains unclear what proportion of these cases would have been detected in routine care. The rate of excisions per newly diagnosed melanoma was 179 : 1. Further investigations are necessary to explore the reasons for this low diagnostic specificity. This study highlights the possibilities and limitations of routine data to evaluate screening programs and indicates the need to collect additional information on healthcare utilization behaviour.

Early excision of congenital melanocytic nevi under tumescent anesthesia and skin expansion by intracutaneous double butterfly sutures.

BACKGROUND: Excision of large congenital melanocytic nevi is recommended because of the risk of malignant transformation and for aesthetic reasons. Our treatment concept includes 1) excision in one or more steps preferably before the age of one year, 2) skin expansion through high-tension wound closure with intracutaneous double butterfly sutures and 3) performing surgery with tumescent or general anesthesia. PATIENTS AND METHODS: A retrospective survey was conducted among all parents with children treated for congenital melanocytic nevi in 2004 or 2005 with a maximum age of 6.0 years. The parents were asked to evaluate the trauma associated with their child's surgery and the aesthetic result. RESULTS: Fifty-nine families were contacted, of whom 51 replied. Forty-two parents assessed surgery-associated trauma as light or very light. Thirty-nine parents rated the aesthetic results as good to very good. Severe complications did not occur. CONCLUSION: The proposed surgical concept is a safe procedure with good aesthetic results and low surgery-associated trauma for the child.

Noncoherent-intense-pulsed light for the treatment of relapsing hairy intradermal melanocytic nevus after shave excision.

BACKGROUND AND OBJECTIVE: Few reports about melanocytic lesions treatment by means of noncoherent-intense-pulsed light (NCIPL) have been published. Here we evaluate the clinical results of a relapsing hairy intradermal melanocytic nevus treated with a noncoherent-intense-pulsed light source. STUDY DESIGN/MATERIALS AND METHODS: A facial repigmented hairy intradermal melanocytic nevus that relapsed after shave excision, received four treatment sessions of a noncoherent-intense-pulsed light source (EpiLight, ESC Medical Systems Ltd, Israel) with the following parameters: 755 nm, a fluence energy of 40-42.5 J/cm(2), triple mode, a pulse width of 3.8 ms, and a delay of 20 ms, at 4-week intervals. RESULTS: Complete pigment clearance and hair removal was obtained. We have neither observed repigmentation nor hair regrowth after a 6 month-follow-up. No side effects were documented. CONCLUSIONS: Noncoherent-intense-pulse light is an effective treatment for hairy-pigmented melanocytic nevus.

Skin surgery under local anesthesia leads to stress-induced alterations of psychological, physical, and immune functions.

BACKGROUND: Although excision of nevi under local anesthesia is a frequent and harmless operation, it apparently causes increased stress in many patients. However, thus far no studies have focused on the question of whether there are measurable effects on psychological, physiological, and immunological parameters. OBJECTIVE: To assess the perioperative stress reactions of patients undergoing skin surgery under local anesthesia for nevocellular nevi. METHODS: Fifty consecutive patients with pigmented nevi were examined at five points of measurement: 1 week and 30 minutes before the operation, during the operation, 30 minutes and 1 week after the operation. Somatic parameters included blood pressure, pulse, respiratory rate, and the level of pain. Lymphocyte subpopulations, white blood cell count, and cortisol in saliva were determined. Anxiety and general psychological distress were evaluated with validated questionnaires. RESULTS: There was a significant increase in anxiety at the time of surgery. In parallel, the physiological parameters as well as the CD56+ lymphocytes changed significantly. Preoperation anxiety and intraoperation pain were significantly higher in women (P <.001), but did not depend on age. CONCLUSION: There appears to be an interaction between physiological and emotional components in the operative stress reaction under local anesthesia. In patients with skin cancer, the perioperative stress may lead to transient impairment of immune function.

Treatment of nevus spilus with the Q-switched ruby laser.

BACKGROUND: Q-switched lasers have shown to be effective in the removal of unwanted cutaneous pigmentation. Benign cutaneous pigmented lesions represent a heterogeneous group. Nevus spilus is a relatively uncommon pigmented lesion characterized by dark, hyperpigmented dots scattered over a tan-colored macule. OBJECTIVE: A cohort of patients with nevus spilus was studied to determine the effects of Q-switched ruby and Q-switched Nd:YAG laser treatment on clearance of pigment and to evaluate potential side effects. METHODS: Six patients with nevus spilus were treated with the Q-switched ruby laser (QSR). In addition, three lesions received a test treatment with the Q-switched Nd:YAG (QSYAG) laser at 532 or 1064 nm. The results of treatment were documented during follow up visits. RESULTS: Most lesions showed a near-complete or complete response to laser treatment. In one case partial hyperpigmentation occurred after treatment and in one case no follow-up could be obtained. In the three cases that received both QSR and QSYAG laser treatment, the QSR laser was shown to be the most effective in removing pigment. CONCLUSION: Nevus spilus can be treated effectively with the Q-switched ruby laser.

[A case of Cogan-Reese syndrome (iris nevus syndrome)]. / Przypadek zespolu Cogana-Reese'a ("znamienia" teczówki).

A case of 37 years old woman with a classic form of Cogan-Reese iris naevus syndrome is presented. Closure angle glaucoma, being a part of syndrome, with glaucomatous disc damage was initially treated with drugs (betaxolol, trusopt) without effective IOP decrease. A surgery was performed (goniotrepanatio by Fronimopoulos modified by Palmberg, but without iridectomy), 5 fluorouracil subconjunctival injections were given to the patient postoperatively for 5 days. We received a good IOP control on the level of 12 mm Hg. The visual acuity was 1.0 after surgical procedure. We wanted to present this case because of its rarity and a typical surgical procedure (without applying iridectomy).

Lasers in dermatology.

The use of dermatologic laser therapy is rapidly expanding. Thirty years of experience has produced advances in the technology, techniques, and therapeutic efficacy of dermatologic lasers. The original lasers have been improved and modified, and new types of lasers have expanded the dermatologist's therapeutic repertoire. Extensive research has provided a greater understanding of the skin's clinical and histologic response to laser treatment. This has allowed dermatologists to expand their therapeutic options and techniques and to improve clinical outcome.

Successful treatment of dark-colored epidermal nevus with ruby laser.

The pulsed ruby laser has a selective thermolytic effect. Recently, it has been available for the treatment of superficial pigmented disorders. We studied 5 cases of epidermal nevus treated with the pulsed ruby laser. In comparison with the usual methods including electrocautery, cryotherapy and skin abrasion, ruby laser therapy is an excellent tool due to technological ease and rapid improvement. Depigmentation after treatment in 2 cases was the only side effect of this therapy. Bose cases had a dark pigmentation of the skin. Despite of the risk of discoloration, the ruby laser is one of the most effective tools for therapy of pigmented epidermal nevus.

The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study.

BACKGROUND: The Q-switched ruby laser (QSRL) (694 nm) has been used successfully in the removal of tattoos and a variety of cutaneous pigmented lesions. The frequency-doubled Q-switched neodymium:yttrium-aluminum-garnet laser (QSNd:YAG) (1064 and 532 nm) has also been shown to be effective in the treatment of tattoos, however, little has been published regarding the QSNd:YAG laser in the removal of cutaneous pigmented lesions. OBJECTIVE: The purpose of this study is to compare the efficacy and side effect profile of the QSRL and the frequency-doubled QSNd:YAG lasers in the removal of cutaneous pigmented lesions, including lentigines, café-au-lait macules, nevus of Ota, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, and melasma. METHODS: Twenty patients with pigmented lesions were treated with the QSRL and the frequency-doubled QSNd:YAG lasers. Clinical lightening of the lesion was assessed 1 month after a single treatment. Side effects and patient satisfaction were also evaluated. RESULTS: A minimum of 30% lightening was achieved in all patients after only one treatment with either the QSRL or the frequency-doubled QSNd:YAG laser. The QSRL seems to provide a slightly better treatment response than the QSNd:YAG laser. Neither laser caused scarring or textural change of the skin. Most patients found the QSRL to be more painful during treatment, but the QSNd:YAG laser caused more postoperative discomfort. CONCLUSION: Both the QSRL and the frequency-doubled QSND:YAG laser are safe and effective methods of treatment of epidermal and dermal pigmented lesions.

A prospective study of 134 consecutive patients requiring diagnosis, excision and repair of a facial cutaneous lesion.

A prospective study of 134 patients undergoing excision of a facial lesion was undertaken. Considerable clinical diagnostic difficulty was experienced, with 21% of clinical diagnoses being incorrect. A tendency towards a clinical over-diagnosis of basal cell carcinoma was noted and whilst this is not unreasonable, a number of benign lesions inevitably were diagnosed as malignant with unnecessary sacrifice of tissue. Incisional biopsy of lesions should be considered when sited close to important anatomical structures to enable accurate diagnosis prior to definitive surgery. Although a few definite indications for a particular reconstructive technique exist (Table 1), a choice is more often available. Repair of the excisional defect with a local flap as opposed to a skin graft resulted in a reduced length of hospital admission with fewer postoperative complications and better final cosmesis. As a consequence, a local flap is recommended as the method of repair where direct closure is not feasible.

Little tips with big rewards.

We all would like to reduce the pain of injecting a local anesthetic, to simplify the treatment of xanthelasma palpebrarum and chondrodermatitis nodularis; and to improve methods of shave excision of nevi and cosmetic extirpation of large seborrheic keratoses. Here are some tips that might help.