Mohs micrographic surgery for the treatment of difficult skin cancers.

Most skin cancers can be managed effectively using standard therapeutic methods. However, specific subsets of skin cancers--including tumors that are recurrent, large, or aggressive, along with tumors located at sites of functional and cosmetic concern--provide a significant therapeutic challenge. Mohs micrographic surgery offers the greatest potential cor cure of difficult tumors, while providing for maximal preservation of healthy tissue. This paper describes the history of Mohs surgery, the technique, and the indications for its use.

Autografting and PUVA. A combination therapy for vitiligo.

A novel approach to the management of vitiligo is described using a combination of epidermal autografts transplanted into the depigmented areas and psoralen-ultraviolet-A (PUVA) therapy. Epidermal autografts can be obtained rapidly and in large numbers using a device that combines the synergistic effects of suction and heat on the skin. Subsequent exposure to PUVA therapy promotes spread of pigmentation out of the grafts resulting in even and complete pigmentation. In certain situations, the combination therapy appears to offer the potential for avoiding the disadvantages of both of the two treatments when they are used alone. This article presents our preliminary work in the development of the methodology for this combined approach.

The biochemistry and development of adipose tissue and the pathophysiology of obesity as it relates to liposuction surgery.

It is clear that central obesity is a strong predictor of multiple health risks. It appears likely that much of the influence for the preferential deposition of fat in these various stores is related to sex hormones, although other factors clearly play a role, including genetic, environmental, nutritional, and other factors. Whereas a great deal has been discovered about these relationships in the past 10 years, further study is necessary to clarify them and determine what role dietary and surgical interventions may play in the prevention and reversal of those risk factors.

Upper lip repair--the subcutaneous island pedicle flap.

The repair of medium-sized defects involving the lateral cutaneous upper lip offers significant reconstruction challenges. The triangular subcutaneous island pedicle flap is described for repair of such defects. Anatomic and technical considerations will be presented as well as the advantages of this flap over other reconstructive alternatives.

Special ablative and reconstructive techniques for cutaneous cancers.

Although the Mohs technique is most often applied to moderate and large lesions, with appropriate modifications it can also be applied to massive lesions. Reconstructive procedures after resection of large defects are also discussed.