ABSTRACT
BACKGROUND: Patients with the atypical mole syndrome have multiple dysplastic nevi that appear to be randomly distributed on certain preferred anatomical sites such as the upper back. These dysplastic nevi are thought to be acquired melanocytic nevi that begin appearing at puberty. To our knowledge, the presence of agminated atypical (dysplastic) nevi has not been reported. OBSERVATION: We describe a patient with the atypical mole syndrome who has more than 100 melanocytic nevi, many of which are clinically atypical and one of which proved to be a melanoma. Among his many melanocytic nevi is a cluster of approximately 50 nevi that are distributed in an area measuring 5 x 3 cm. The histopathologic features of these nevi are consistent with the diagnosis of "dysplastic nevus." CONCLUSIONS: To our knowledge, agminated atypical (dysplastic) nevi have not been described previously. The presence of agminated atypical (dysplastic) nevi in a patient with the atypical mole syndrome can be theorized to arise because of loss of heterozygosity.
Subject(s)
Dysplastic Nevus Syndrome/pathology , Adult , Biopsy , Diagnosis, Differential , Dysplastic Nevus Syndrome/classification , Humans , Male , Terminology as TopicABSTRACT
BACKGROUND: Sebaceous carcinoma is an aggressive neoplasm that commonly arises from the meibomian glands of the eyelids and other sebaceous glands of the ocular adnexa. Historic data indicate a nearly 30% local recurrence rate with standard surgical excision. Excision by means of Mohs micrographic surgery may be more efficacious. However, reports documenting the effectiveness of this technique for the treatment of eyelid sebaceous carcinoma have been limited to a few cases. OBJECTIVE: We report our experience in the treatment of ocular sebaceous carcinoma with the Mohs fresh tissue technique. METHODS: Eighteen patients with a diagnosis of sebaceous carcinoma of the eyelid who underwent resection by means of the Mohs fresh tissue technique during the years 1988-1998 were reviewed. RESULTS: Sixteen of the 18 patients were free of disease after an average follow-up of 37 months (11.1% recurrence rate). One patient who experienced local recurrence also had metastatic disease of the parotid lymph nodes (5.6% metastatic rate). The recurrence and metastasis were noted 9 months after excision. The other patient experienced a local recurrence 19 months postoperatively. Both patients exhibited pagetoid spread and involvement of both the upper and lower eyelid at the time of Mohs excision. CONCLUSION: Mohs surgery offers excellent results when used as the primary treatment modality for sebaceous carcinoma of the eyelid. When compared with historic series of standard surgical excision, Mohs micrographic surgery has a significantly lower recurrence rate and metastatic rate.
Subject(s)
Adenocarcinoma, Sebaceous/surgery , Eyelid Neoplasms/surgery , Mohs Surgery/methods , Adenocarcinoma, Sebaceous/pathology , Aged , Eyelid Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Graftskin, a bilayered living skin construct, is an effective therapeutic option in the management of chronic venous ulcerations and simple acute surgical excisions. However, it is not routinely used in the management of complicated surgical wound defects. OBJECTIVE: To determine the effectiveness of graftskin as a therapeutic modality in difficult surgical defects. METHODS: Two patients with complex surgical wound defects after Mohs micrographic surgery underwent a single application of graftskin. The engineered skin was fenestrated and sutured in place. The wounds were examined on a weekly basis. One hundred percent healing was defined as complete reepithelialization (wound coverage). RESULTS: Graftskin was well tolerated by these patients and resulted in complete wound healing within 9 weeks of application. CONCLUSION: Graftskin is an excellent alternative for difficult surgical wounds not amenable to other therapies. Graftskin results in a shortened healing time and decreased morbidity. It should be considered for wounds in which healing by secondary intention is preferably avoided.
Subject(s)
Mohs Surgery , Skin Neoplasms/surgery , Skin, Artificial , Aged , Aged, 80 and over , Biomedical Engineering , Ear Neoplasms/surgery , Ear, External/surgery , Female , Humans , Leg/surgery , MaleABSTRACT
Induction therapy with all-trans -retinoic acid has been shown to improve the outcome of patients with acute promyelocytic leukemia, although some side effects occur. Dry skin and lips are among the most common cutaneous side effects. We report a case of scrotal ulcerations induced by all-trans -retinoic acid in an American patient; to our knowledge this is the first such case reported.
Subject(s)
Antineoplastic Agents/adverse effects , Leukemia, Promyelocytic, Acute/drug therapy , Scrotum , Tretinoin/adverse effects , Ulcer/chemically induced , Genital Diseases, Male/chemically induced , Humans , Male , Middle AgedABSTRACT
The association between HIV infection and porphyria cutanea tarda (PCT) is not well established. Since almost all HIV-infected patients with PCT previously described in the literature had additional risk factors for PCT, it is still unclear if HIV infection and not a cofactor such as hepatitis C virus is the trigger for PCT in this population. We describe a patient with AIDS and hepatitis C who developed bullous lesions due to PCT. The cutaneous lesions persisted for 18 months and resolved after he was placed on highly active antiretroviral therapy for HIV. No other therapeutic interventions were undertaken, while exposure to other known precipitants remained unchanged. During follow-up, skin lesions reappeared when the patient discontinued antiretroviral therapy, but PCT lesions again resolved after he restarted highly active antiretroviral therapy and HIV infection was controlled. This case supports the hypothesis that a direct causative relationship exists between HIV and the development of PCT.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Antiviral Agents/therapeutic use , Hepatitis C/complications , Porphyria Cutanea Tarda/complications , Adult , Drug Therapy, Combination , Humans , MaleABSTRACT
BACKGROUND: Recently, the Pigmented Lesion Group at the University of Pennsylvania described a 4-variable model for predicting 10-year survival for patients with primary cutaneous melanoma. The variables are tumor thickness, anatomic site of the lesion, age, and gender. The objective of the current study was to test the validity of this model, employing the large data base of the New York University Melanoma Cooperative Group. METHODS: The predicted probabilities of 10-year survival for 780 patients with primary cutaneous melanoma were determined by multivariate logistic regression, using the 4 variables. RESULTS: The overall 10-year survival rate of the current study group was 78.4%. Of the four variables, tumor thickness, anatomic site of the lesion, and age were found to be independent predictors of survival. Although survival was better for women, gender was not a statistically significant factor in predicting 10-year survival when entered into the multivariate logistic regression model. In the current study, the probability of 10-year survival of patients with melanomas < 0.76 mm ranged from 93-99%, depending on the age and primary site. Age and site had more impact on the prognosis of intermediate and thick melanomas than on thin melanomas. Thus, for melanomas 0.76-1.69 mm, 1.70-3.60 mm, and thicker than 3.60 mm, the probabilities of survival ranged from 70-94%, 39-82%, and 23-68%, respectively. CONCLUSIONS: The wider ranges in survival rates for thicker melanomas, depending on the other variables, emphasize the importance of including variables in addition to tumor thickness in a prognostic model. Using a large data base from a medical center, the current study supports the prognostic multivariate model of the Pigmented Lesions Group of the University of Pennsylvania; however, the authors of the current study did not find gender to be statistically significant in this multivariate model.
Subject(s)
Melanoma/mortality , Skin Neoplasms/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Melanoma/diagnosis , Middle Aged , Predictive Value of Tests , Prognosis , Sex Factors , Skin Neoplasms/diagnosis , Survival AnalysisABSTRACT
BACKGROUND AND DESIGN: Patients with large congenital melanocytic nevi have been described to have an increased risk for the development of malignant melanoma (MM). Ninety-two patients with large congenital melanocytic nevi were followed up prospectively for the development of MM. Matched individuals from the general population served as control subjects. RESULTS: Ninety-two patients (median age, 3 years) were followed up prospectively for an average of 5.4 years. In three patients (3%), MM developed in extracutaneous sites. The cumulative 5-year life-table risk for the development of MM was calculated to be 4.5% (95% confidence interval, 0% to 9.3%). In individuals in the general US population, matched for age, sex, and length of follow-up to the 92 study patients, 0.013 would be expected to develop MM. The standardized morbidity ratio (adjusted relative risk) was calculated to be 239, which was highly significant (P < .001). CONCLUSIONS: Patients with large congenital melanocytic nevi are at a significantly increased risk for the development of MM and should be kept under continuous surveillance for the development of cutaneous as well as noncutaneous primary MM.