Alar rotation flap for small defects of the ala.

BACKGROUND: Surgical defects of the alar lobule can be difficult to repair with aesthetically pleasing results. Full-thickness skin grafts are often smoother than the sebaceous skin of the ala. Random patterned flaps from the cheek or proximal nose usually bridge and obliterate the supra-alar crease and may cause nasal valve malfunction. OBJECTIVE: We describe and illustrate a technique to repair subtotal alar lobule defects within the cosmetic unit of the alar lobule. METHODS: Twenty-three consecutive alar lobule rotation flaps for repair of Mohs surgical defects were reviewed by patient examination and interview. RESULTS: Twenty-one of 23 patients were contacted. Patients rated cosmetic results as excellent (18), good (2), or fair (1), and no patients graded their results as poor. Six patients reported "a little" breathing difficulty in the postoperative period that resolved within 6 months. Anesthesia reported by 11 of 21 patients resolved within 5 years in 8 of 9 patients available for follow-up. CONCLUSION: Rotation of the ala combined with cheek advancement is a cosmetically pleasing and functional method to repair deep defects of the ala.

Temporal artery biopsy in a dermatologic surgery practice.

BACKGROUND: A positive temporal artery biopsy (TAB) is essential to the diagnosis of temporal arteritis. Both this relatively common disease and its prolonged treatment with corticosteroids are associated with serious sequelae. Therefore, accurate and timely diagnosis is critical. The dermatologic surgery literature lacks a description of this straightforward surgical technique, as TABs are most often performed by ophthalmologists. OBJECTIVE: As a service to our rheumatology department we began performing TABs on a same-day on-call basis in July 1996. METHODS: We have performed 45 TABs in a 22-month period using a simple, safe, time-efficient technique. We review the surgical anatomy and danger zone of the temporal region and potential complications. We describe the biopsy technique which aims at safely obtaining a greater than 2 cm segment of a peripheral branch of the superficial temporal artery (STA), identified preoperatively by doppler ultrasonography. RESULTS: The procedure was performed on the day requested in all cases. Intraoperative time ranged from 20 to 40 minutes. TAB established the diagnosis of temporal arteritis in 8 of 44 biopsies (18%) and in 7 of 35 patients (20%), including 1 of 9 patients in whom we performed bilateral TAB. One patient was diagnosed with small-vessel polyarteritis nodosa by TAB. The mean formalin-fixed length of the arterial specimen was 2.2 cm. The length did not vary between positive and negative specimens. There were no complications and the cosmetic results were excellent. CONCLUSION: TAB is a quick, safe, straightforward, and gratifying office procedure which dermatologic surgeons are very qualified to perform.

The chondrocutaneous helical rim advancement flap of Antia and Buch.

BACKGROUND: The cutaneous surgeon commonly encounters defects of the helix, as 2-4% of all skin cancers occur at this site. OBJECTIVE: We report our experience with 47 patients using the chondrocutaneous helical rim advancement flap of Antia and Buch. METHODS: Incisions are made from the defect inferiorly into the lobule and, when necessary, superiorly along the helical sulcus into the helical crus. The postauricular skin is extensively undermined to allow maximal movement of the resulting broadbased, well-vascularized flap(s). RESULTS: We experienced very favorable results using this technique with our patients. No necrosis due to ischemia occurred in any of our cases. Hematomas formed postoperatively in two patients, but healing proceeded uneventfully after removal of coagulated blood. CONCLUSION: This technique is an excellent method of repairing many defects of the helical rim. Its advantages include technical simplicity, little risk of tip necrosis, patient convenience, and superior cosmesis.

Actinic keratosis. A premalignant skin lesion.

The actinic keratotic lesion appearing on the sun-exposed skin of the middle-aged and elderly is a common premalignant lesion that infrequently becomes squamous cell carcinoma. Generally, superficially destructive measures provide adequate therapy for this epidermal dysplastic growth. Because of the rare threat of squamous cell carcinoma, a therapeutic dilemma results. If the physician detects any signs of malignancy, such as palpability, induration, or bleeding, a biopsy is mandatory for confirmation.

Calcinosis cutis associated with syringomas: a transepidermal elimination disorder in a patient with Down syndrome.

Several cutaneous disorders have been associated with Down syndrome. An increased frequency of syringomas and of elastosis perforans serpinginosa, a transepidermal elimination disorder, have been described. We report the first case of the simultaneous occurrence of transepidermal elimination of calcium associated with syringomas in a patient with Down syndrome who had lesions clinically suggestive of milia.

Idiopathic pigmented purpuric eruption with palmar-plantar involvement.

A case of generalized idiopathic pigmented purpuric eruption with distinctive and rare palmar-plantar involvement is presented. The clinical and histopathologic features, differential diagnosis, and nosology of the idiopathic pigmented purpuric eruptions are presented.

Fusarium as a pathogen. A case report of Fusarium sepsis and review of the literature.

Fusarium species are known to the dermatologist as cutaneous contaminants. Rarely they occur as pathogens. We report a case of disseminated Fusarium moniliforme in a 44-year-old patient with acute lymphocytic leukemia. We also review the previous reports of human Fusarium infections. The mycologic characteristics of Fusarium, including its nosologic and morphologic characteristics and its response to medications, are discussed.

Atrophia maculosa varioliformis cutis.

We describe a case of atrophia maculosa varioliformis cutis (AMVC), a rare form of idiopathic facial macular atrophy. A biopsy revealed only a depression in the epidermis, probably caused by loss of dermal collagen. Because AMVC may be confused with scarring, and factitial disease may be suggested, it is important that this condition be recognized by the physician.

Hyperpigmentation in megaloblastic anemia.

Generalized hyperpigmentation developed over 2 years in a 65-year-old woman. A diagnosis of pernicious anemia was made, and treatment with vitamin B12 led to complete reversion of her hyperpigmentation to normal. Literature pertinent to hyperpigmentation and its association with megaloblastic anemias is reviewed and several possible mechanisms are mentioned.