Management of cutaneous human papillomavirus infection: surgery.

Surgical management is typically required when the clinician encounters an increased quantity of warts, large surface areas of affected, or when malignant transformation is suspected. Basic surgical techniques, such as cryosurgery, electrosurgery and surgical excision, are successful and relatively quick methods for removing warts and uncomplicated cutaneous malignancies. Mohs micrographic surgery is an amenable option when cutaneous malignancies are located in high-risk areas such as periocular or perinasal regions, lips, ears, digits and genitalia, tend to be larger in size, are recurrent, possess aggressive histological features, such as moderate-to-poor differentiation, or demonstrate perineural invasion. Situations involving a larger tumor burden, or requiring complicated surgical reconstruction in the operating room, may necessitate the assistance of plastic and reconstructive surgery. Herein, we describe treatment modalities employed in the surgical management of cutaneous human papillomavirus infection and include surgical teaching cases.

Imaging of Mohs micrographic surgery sections using full-field optical coherence tomography: a pilot study.

BACKGROUND: Full-field optical coherence tomography (FF-OCT) is a new noninvasive imaging technique that can see down to the cellular level without tissue preparation or contrast agents. OBJECTIVE: To use FF-OCT to image Mohs micrographic surgery specimens and verify the ability of a dermatopathologist to identify or exclude malignancy. MATERIALS AND METHODS: Two Mohs surgeons supplied 18 Mohs sections from 11 patients. Each section was scanned using the FF-OCT, and a dermatopathologist blinded to the diagnosis examined the images for malignancy. The FF-OCT images were then compared with the intraoperative hematoxylin and eosin (H&E)-stained frozen sections for concordance. RESULTS: All 9 FF-OCT images interpreted as negative for malignancy were in agreement with the H&E frozen sections. Six of the remaining FF-OCT images were correctly interpreted as positive for malignancy, and three were deferred because malignancy could not be confirmed or excluded. CONCLUSION: Malignancy in Mohs sections can correctly be identified or excluded using FF-OCT. Although not ready for clinical use in its current state, FF-OCT has the potential to be incorporated into the Mohs workflow in the future.

Subungual squamous cell carcinoma after organ transplantation.

It is accepted that immunosuppressant therapy after organ transplantation is associated with an increase risk of neoplasm. Subungual squamous cell carcinoma of the toe is a rare condition and has not previously been reported, to our knowledge, in patients undergoing immunosuppressant therapy. The objective of this case study is to report the clinical and histopathologic findings and the multidisciplinary treatment approach for a case of subungual squamous cell carcinoma of the toe in an organ transplant recipient undergoing immunosuppressant drug therapy.

Perifolliculitis capitis abscedens et suffodiens in an 18-year-old Aboriginal Canadian patient: case report and review of the literature.

BACKGROUND: Perifolliculitis capitis abscedens et suffodiens (PCAS) is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. This condition often presents in males of African American origin. OBJECTIVE: This article describes the clinical presentation, diagnosis, and treatment of an Aboriginal Canadian male suffering from PCAS. A literature review on the etiology, pathology, differential diagnosis, and management is also discussed. CONCLUSION: Careful analysis of the pathology and clinical presentation can aid in the timely diagnosis and management of this challenging condition. The clinician dealing with patients suffering from PCAS has several treatment options available to help successfully manage patients with straightforward or recalcitrant disease.

Delayed cutaneous wound healing in mice lacking solute carrier 11a1 (formerly Nramp1): correlation with decreased expression of secretory leukocyte protease inhibitor.

Control of macrophage functions by natural resistance-associated macrophage protein 1 (NRAMP1) has proven to be important for murine resistance to several intracellular pathogens, including Mycobacterium bovis BCG and Salmonella typhimurium, although the exact molecular mechanism of its action remains unknown. We identified secretory leukocyte protease inhibitor (SLPI) as a novel candidate gene whose expression is dependent on Nramp1 gene expression using B10A.Nramp1+/+ and B10A.Nramp1-/- macrophage cell lines in vitro, as well as mice bearing the resistance alleles (wild type (WT)) of the Nramp1 and mice with an ablated Nramp1 gene (knockout (KO)). We established that B10A.Nramp1+/+ cells spontaneously expressed a 10-fold higher level of SLPI messenger RNA (mRNA) compared to B10A.Nramp1-/- expression. Similarly, protein secretion was detected only in supernatants from B10A.Nramp1+/+ macrophages. Induction of SLPI in excisional cutaneous wounds and, most importantly, in macrophages infiltrating these wounds was significantly higher in Nramp1 WT mice compared to KO mice. These differences in SLPI expression in vivo correlated with a significant delay in the kinetics of wound healing in Nramp1 KO mice compared to WT controls. Taken together, these results suggest for the first time that Nramp1 controls macrophage SLPI mRNA and protein expression, and can also have an important effect on the kinetics of wound healing.