Giant molluscum contagiosum presenting as lid neoplasm in an immunocompetent child.

A three-year-old boy presented to our oculoplastic clinic with complaints of painless gradually increasing right upper lid mass for the last 6 months. On examination a firm mass measuring roughly 1x1 cm was present on the upper lid. The mass was non tender with fine superficial vessels running over it. A differential diagnosis of epidermoid cyst, vascular malformation, pilomatrixoma, and juvenile xanthogranuloma was considered. The patient underwent excisional biopsy of the mass. On gross examination the mass had a brain like appearance. Histopathological examination confirmed the diagnosis of molluscum contagiosum. It is rare for molluscum contagiosum to present as a solitary lid tumor. A brain like appearance of the excised mass can provide a clue towards the diagnosis.

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.

[New surgical approaches for the treatment of anogenital HPV infections]. / Neue operative Ansätze zur Sanierung anogenitaler HPV-Infektionen.

HPV infections in the anogenital region may have very heterogeneous clinical features. Most often typical papillomatous condylomata acuminata are observed that usually present no differential diagnostic difficulty. In contrast, the clinical findings of higher grade intraepithelial dysplasias with flat papules and erythematous/ eczematous lesions are often quite inconspicuous and hardly characteristic. The goal of therapy is to prevent further progression to carcinoma, removal of bothersome tumors and avoidance of complications. Surgical methods are preferentially employed for extensive lesions, unfavorable locations and higher grade dysplasia. Options include removal with scissors or scalpel, laser therapy and electrocautery. For purely intraepithelial alterations, superficial ablative techniques are usually preferable over excision. Further developments such as argon plasma coagulation reduce the risk of unwanted deep thermal destruction with the accompanying complications. The risks for the surgeon and the surgical team during treatment should also not be neglected. With consideration of all relevant aspects, the combination of different methods may reduce the risk of complications and frequency of recurrences. Due to the high recurrence rate independent of the selected therapy, consistent follow-up after primary therapy is crucial for the long-term success.

Development of multiple pigmented viral plaques and squamous cell carcinomas in a dog infected by a novel papillomavirus.

Canine viral plaques are uncommon skin lesions that are induced by papillomaviruses (PVs). Plaques are usually of little clinical significance in dogs, although they have been reported rarely to progress to squamous cell carcinoma (SCC). Here is described a 7-year-old mixed-breed dog that developed numerous darkly pigmented plaques up to 8 cm in diameter. Multiple ulcerated nodular masses were visible within plaques on the ventrum and axilla. The dog showed no clinical evidence of immunodeficiency and appeared otherwise healthy. Over the next 2 years, five surgeries were performed to remove 23 ulcerated masses that ranged in size from 2 to 5 cm in diameter. Five masses were submitted for histology, and all were SCCs. Each was surrounded by epidermis that contained histological features consistent with those described in canine plaques. Suggestive of a PV aetiology, massive numbers of large keratohyaline granules were present throughout the thickened epidermis. Additionally, koilocytes were focally present, and one sample contained a band of keratinocytes within the superficial epidermis that contained pale cytoplasm and marginated chromatin. From two samples, DNA sequences from a previously unreported PV were amplified, and immunohistochemistry confirmed the presence of PV antigen in both. The PV DNA sequences were most similar to those of canine PVs previously associated with plaque formation. The plaques observed in this case were unusual owing to their rapid growth, large size and frequent malignant transformation. It is unknown whether this unusual behaviour was due to the specific PV detected in this case or to host factors within the dog.

Pulsed dye laser treatment for viral warts: a study of 120 patients.

A prospective, non-blinded, non-randomized study on 120 wart patients treated with pulsed dye laser was performed to evaluate the efficacy and safety of pulsed dye laser treatment for viral warts and to demonstrate the proper application and effective technique of this method. The overall clearance rate was 49.5%. The clearance rates of flat warts, periungual warts, plantar warts and common warts were 67.6%, 51.1%, 47.6% and 44.3%, respectively. Overall, the response rates of pediatric warts, recalcitrant warts and old warts were superior to those of adult warts, simple warts and non-old warts, respectively; however, those trends were not statistically significant. We concluded that pulsed dye laser treatment is a safe, tolerable and relatively effective treatment method for viral warts. Pulsed dye laser treatment may be a more efficacious method for flat warts and recalcitrant periungual warts, and it can be an effective modality for newly-developed warts. The highest clearance rate was noted at a fluence of 9.5 J/cm2 (P < or = 0.05) and it is recommended that practitioners perform pulsed dye laser treatments for viral warts at the fluences of 9.0-9.5 J/cm2. A replacement of pulsed dye laser treatment should be considered unless prominent improvement is observed after three treatment sessions.

Unusual presentation of human giant orf (ecthyma contagiosum).

Giant orf is a zoonotic infection that is endemic in sheep and goats. It may be transmitted to humans by direct contact with infected animals or contaminated objects and is typically found on the hands. We report the case of a sheep farmer with facial orf that proliferated dramatically with the formation of satellite lesions after curettage.

[Laser use in various fields of surgery]. / Lazer't v niakoi oblasti na khirurgiiata.

A total of 236 patients presenting various pathological conditions are operated in the Department of General and Operative Surgery of the Medical University--Sofia over the period 1993 through 1998, using laser radiation--CO2-laser in 216 cases, ans Nd-YAG laser--in 20 cases. Both focused and unfocussed laser beam is applied. The superiorities of laser surgery in definite diseases and the results thus far obtained are analyzed.

Pulsed dye laser treatment of warts: an update.

BACKGROUND: Warts are a therapeutic challenge. New studies indicate that pulsed dye laser therapy may be effective, with clearance rates of 72 to 93%. OBJECTIVE: To determine clearance rate in pulsed dye laser treatment of warts and compare our rate to those of other published studies. METHODS: Thirty-three patients with 96 warts received pulsed dye laser treatment for recalcitrant plantar, digital, peri- and subungual, and body warts. RESULTS: Forty-eight percent of patients had complete wart clearance; 45% partially cleared. Sixty-nine percent of those who cleared remained wart-free for an average of 11 months. Mean fluence was 9.4 J/cm2, with an average of 3.4 treatments. Body and palmar warts responded best, digital and peri- and subungual next, and plantar lesions worst. No significant side effects were observed. CONCLUSION: Pulsed dye laser is an effective treatment option for recalcitrant warts with an excellent side effect profile. However, our response rates were not as high as those previously reported, and we feel that further studies would be useful.

Argon laser therapy of benign tumors of the eyelid.

PURPOSE: To report the therapy of benign eyelid tumors with an argon laser as an alternative to surgery. METHODS: Forty-one patients with 47 benign tumors of the eyelid were included in this study. In all patients, the eyelid tumor was eliminated by argon laser. In 24 cases the lower eyelid and in 23 cases the upper eyelid was involved, including the lid margin in 17 cases. Laser spot size ranged from 150 to 500 microm. Argon laser power density varied between 4.1 and 61.1 W/mm2. Spots were counted between 40 and 1204. Twenty-seven of 41 patients treated were followed up; the mean follow-up period was 5.8 months (range, 3 to 24 months). Postoperatively, histologic confirmation was obtained in 42 cases of the 47 treated tumors. RESULTS: All patients were satisfied regarding the laser therapy and the cosmetic result. Remarkably, the wounds were dry after argon laser therapy. No infections of the wounds occurred; wounds were epithelialized after 2 to 3 weeks by a normal-appearing epithelium. The area of argon laser treatment was less pigmented than the surrounding skin and showed no obvious remarkable notches. As a complication, one patient developed a viral conjunctivitis. No relapses occurred during follow-up. CONCLUSIONS: Argon laser therapy of benign eyelid tumors may result in very satisfactory wound healing. Taking the short follow-up and the limited number of cases into account, it seems to be a useful alternative to traditional surgery, especially for tumors positioned close to the lacrimal papillae.

[The CO2 laser treatment of extensive skin changes to the vulva caused by the human papillomavirus (HPV) and refractory to other types of therapy]. / Lechenie s CO2-lazer na obshirni kozhni izmeneniia po vulvata, prichineni ot choveshkiia papilomen virus (HPV) i nepoddali se na drug vid terapiia.

The authors describe three cases of large vulvar lesions caused by HPV. One patient has condylomata covering entirely the labia majora and minora, the clitoris, the perineum and the perianal area. The lesions made the structures of the vulva hard to distinguish. She was treated with podophyllin, Solcoderm and diathermy without effect. After 2 applications of Laser vaporisation 40 days apart she was completely cured. The other patient had two big squamous papillomata 3.5 by 3.5 cm and 0.5 cm thick situated on both sides of commissura posterior. She was also treated unsuccessfully with Podophyllin, Solcoderm and surgical excision. She was completely cured by a single-stage CO2-laser treatment. The third patient had condylomata acuminata of the labia minora and majora, fossa navicularis, the perineum and the perianal area. No other treatment had been attempted before. After two sessions of laser vaporisation she was cured, too.