A "skin helix" flap to correct circular skin loss on the nasal ala.

The surgical treatment of circular skin defects localized on the nasal ala is always extremely challenging. Such lesions can be repaired by using full-thickness skin graft or skin flaps, normally with poor aesthetic outcomes. Skin grafts do not achieve satisfactory aesthetic results because of the unnatural look of the transplanted skin. If a skin flap is chosen, the choice of which one to employ among the many available must be made very carefully in order to obtain the best possible aesthetic outcome. This article describes the clinical case of a localized tumor on the nasal right ala that was surgically removed and satisfactorily treated by employing a "skin helix flap."

Horizontal advancement flap for lateral dorsal nasal defects.

BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps.

Intralesional granulocyte-monocyte colony-stimulating factor followed by subcutaneous interleukin-2 in metastatic melanoma: a pilot study in elderly patients.

AIM AND BACKGROUND: Recent data in the literature indicate that antigen-presenting cells (APC) are inactive in tumour tissue because of local immunosuppression. Tumour-infiltrating lymphocyte (TIL) signal activation transducing mechanisms are also seriously impaired. Administration of granulocyte macrophage-colony stimulating factor (GM-CSF) may lead to APC recovery and interleukin (IL)-2 may restore local TIL activation. Moreover, IL-2 increases the systemic lymphocyte population, an event that seems to correlate with a better prognosis. STUDY DESIGN: The present phase I-II study was carried out to examine whether intralesional injection of GM-CSF followed by subcutaneous IL-2 would induce a clinical response in advanced, pretreated elderly melanoma patients. METHODS: Sixteen patients over 60 years of age received intralesional GM-CSF (150 ng per lesion on day 1), generally divided between the two largest cutaneous lesions, followed by perilesional subcutaneous IL-2 (3,000,000 IU) for 5 days (days 3-7 inclusive) every 3 weeks. RESULTS: Four clinical responses [two partial (PR) and two minimal (MR)] (25%), which also involved lesions that had not been directly treated, and nine cases of stable disease were observed. The response duration for PR and MR was 9, 4, 4 and 2.5 + months, respectively. Stable disease (56%) recorded in the nine patients was short-term (3-6 months). Three patients rapidly progressed after two, two and one therapy cycles, respectively. The patient who reached the best PR had a fairly high absolute lymphocyte count (1600-2400/mm3). The second one, who reached complete remission after subsequent locoregional chemotherapy and hyperthermia, however, had a low absolute lymphocyte count that had doubled by the end of treatment. Blood lymphocyte values in the other patients were too varied to allow any correlation with clinical response. Therapy was well tolerated and only mild fever was observed, with the exception of one patient who had grade 3 fever, with muscle pain and arthralgia. CONCLUSIONS: Considering the very low toxicity observed, this treatment might be indicated in elderly patients for whom systemic therapy is no longer a viable option. Improved scheduling and timing could result from further studies.

Chronic bullous disease of childhood following Epstein-Barr virus seroconversion: a case report.

We report the case of a 3-year-old boy with classical chronic bullous disease of childhood (CBDC) arising after recent Epstein-Barr virus seroconversion following infectious mononucleosis. The patient also had small red cells and decreased levels of circulating IgA. He received combined treatment with dapsone and prednisone with good results. Our report is the first of CBDC preceded by Epstein-Barr virus seroconversion. The virus may have had an initial immunopathogenic role in the genesis of the bullous eruption.

An epidemic of infantile papular acrodermatitis (Gianotti-Crosti syndrome) due to Epstein-Barr virus.

Five out of twelve 13- to 15-month-old children, attending the same class of a crèche in Forlì (Italy), presented infantile papular acrodermatitis (Gianotti-Crosti syndrome), associated with lymphocytosis and evidence for a recent Epstein-Barr virus infection. This cluster may be due to two facts: (1) the long and close contacts among the patients and (2) the concurrent immunization with a combined diphtheria-tetanus-pertussis-poliomyelitis vaccine from 2 to 6 weeks previously.