Central Forehead Reconstruction with a Simple Primary Vertical Linear Closure.

OBJECTIVE: Following Mohs surgery, medium-to-large defects on the central forehead can often be complicated to surgically reconstruct. In this paper, the authors discuss possible central forehead reconstructions and report their successful experience employing a simple primary vertical linear closure with a special technique to demarcate forehead rhytides rather than performing an overly complicated flap or graft. CASE REPORT: The patient was a 57-year-old man who presented with a broad superficial basal cell carcinoma that required treatment with Mohs surgery. For the resulting defect, the authors elected to perform a complex linear repair taking advantage of substantial side-to-side laxity in the supraperiosteal plane and carefully labeling and matching each forehead rhytide across the defect as the wound was sutured. CONCLUSION: The findings of this case demonstrate that medium-to-large wounds of the central forehead can be aesthetically repaired with a simple primary vertical linear closure. Carefully mapping and labeling horizontal forehead rhytides with a sterile surgical marking pen prior to anesthesia ensures accurate approximation during wound closure.

Fractional ablative laser skin resurfacing: a review.

Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing.

A review of sutures and other skin closure materials.

More than ever, dermatologic surgeons are faced with a multitude of suture and other closure materials when evaluating a surgical wound. Given there is no single material that is ideal for all situations, the physician must decide which material is best suited for that particular closure. This review seeks to summarize the major properties of common suture materials as well as other closure materials including adhesive tapes, glues and staples.

Secondary syphilis resembling erythema multiforme.

BACKGROUND: Secondary syphilis, which typically begins 4-10 weeks after initial exposure to Treponema pallidum, manifests with a range of cutaneous patterns. One unusual variation features oval, targetoid plaques that may resemble erythema multiforme (EM). METHODS: We describe a 23-year-old woman with an EM-like eruption, a mucous patch, and a prominent alopecia somewhat moth-eaten in appearance. She had positive rapid plasma reagin and fluorescent treponemal antibody absorption (FTA-ABS) tests, and a skin biopsy revealed swollen endothelial cells with a superficial perivascular infiltrate containing plasma cells. Response to intramuscular penicillin therapy was consistent with the empiric diagnosis of secondary syphilis. CONCLUSIONS: One should consider secondary syphilis in the differential diagnosis of an eruption resembling EM.

Minocycline-induced skin pigmentation: an update.

Minocycline is a commonly used antibiotic for long-term treatment of acne vulgaris. A well-documented and cosmetically dis-pleasing side effect is skin pigmentation. Three distinct types occur: Type I, blue-black/grey pigment on the face in areas of scarring or inflammation associated with acne; type II, blue-grey pigment on normal skin on the shins and forearms; type III, diffuse muddy-brown discoloration in areas of sun exposure. Types I and II stain for iron and melanin extracellularly and within macrophages in the dermis. Type III shows nonspecific increased melanin in basal keratinocytes and dermal melanophages staining for melanin only. The etiology of this pigmentation is unknown, but may be related to polymerized reactive metabolites, insoluble chelation products, and lengthy treatment durations of minocycline compared to other tetracyclines. Types I and II tend to resolve slowly over time, whereas type III persists indefinitely. Treatment involves early recognition, discontinuation of the drug, sun protection, and laser for persistent pigmentation.

Myopericytoma: report of two cases associated with trauma.

Myopericytoma is a rare, recently described tumor demonstrating a hemangiopericytoma-like vascular pattern. We present two cases of myopericytoma associated with trauma: a 64-year-old man who developed several nodules on his nose four months after sustaining multiple abrasions to his forehead and nose, and a 72-year-old woman with a solitary growth in the alveolar ridge of unknown duration. Biopsy specimens of the lesions in both cases demonstrated a striking concentric perivascular proliferation of bland spindle-shaped pericytic cells characteristic of myopericytoma. Despite sharing morphologic features with angioleiomyoma, myofibroma and glomus tumor, myopericytoma is thought to represent a distinct perivascular myoid neoplasm of skin and soft tissues. The tumor is characterized by a radial and perivascular arrangement of ovoid, spindled to round neoplastic cells that are immunoreactive to alpha-smooth muscle actin, often for h-caldesmon as well as smooth muscle myosin-heavy chain, and usually negative for desmin antibodies. Most cases of myopericytoma are benign, however, local recurrence and malignancy have recently been reported, Myopericytoma can be multifocal involving a single or multiple anatomic regions, and tends to occur in dermal and superficial soft tissues of adults primarily on the extremities. Our cases are unusual examples of myopericytoma manifesting as multiple nodules on the nose, and a solitary growth on the buccal mucosa after trauma.

Subcutaneous fat necrosis of the newborn with eosinophilic granules.

Subcutaneous fat necrosis (SFN) of the newborn is a variant of lobular panniculitis characterized by focal areas of fat necrosis and a granulomatous infiltrate composed of lymphocytes, histiocytes and multinucleated giant cells. Lipocytes and histiocytes contain needle-shaped clefts in a radial arrangement. Needle-shaped clefts may also be seen within the cytoplasm of multinucleated giant cells.(1-3) We present an unusual example of SFN showing multinucleated giant cells laced with eosinophilic granules. These eosinophilic granules are believed to be released from surrounding degranulating eosinophils.

Localized argyria after exposure to aerosolized solder.

GOAL: To understand localized argyria to better manage patients with the condition OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss how localized and generalized argyria differ. 2. Describe how to diagnose argyria. 3. Identify treatment options for argyria.

Multicentric reticulohistiocytosis.

Multicentric reticulohistiocytosis is a rare granulomatous disease of unknown etiology, characterized by cutaneous nodules and destructive arthritis. Skin lesions can cause significant deformity, and approximately half of affected patients develop a severe disabling arthritis. The disease is often associated with malignancy; however, the paraneoplastic nature of multicentric reticulohistiocytosis is not established. The diagnosis is confirmed by the presence of oncocytic ("ground-glass") histiocytes and multinucleated giant cells on histopathology of the cutaneous nodules and the synovial membrane.