DNA image cytometry of keratoacanthoma and squamous cell carcinoma.

The distinction between the keratoacanthoma (KA) and the squamous cell carcinoma (SCC) can sometimes be difficult on the basis of histologic and clinical criteria. The possible diagnostic significance of DNA ploidy initiated the present study evaluating the DNA ploidy in paraffin-embedded tissue sections of 7 KA and 15 SCC, and fresh frozen tissue touch preparations of 15 of the same cases using the CAS 200 Image Analyzer. In paraffin-embedded tissue sections the main peak DNA index was based on normal epidermis, and ranged from 1.03 to 1.59 in KA and from 1.47-2.71 in SCC. The DNA Index (DI) discriminated KA from SCC in 17 of 22 cases (p less than 0.0007). The highest DNA content of single nuclei ranged from 9.0-18.0 picograms (pg) (DI 2.9-6.03) in KA and 14.8-38.6 pg (DI 4.0-11.03) in SCC. The highest DNA content discriminated KA from SCC in 16 of 22 cases (p less than 0.003). In fresh frozen tissue touch preparations from 15 of the same lesions, there was considerable overlap in DNA indices of KA (0.534-1.39) and SCC (0.464-1.41). Abnormal DNA peaks seen in histograms from three SCC in paraffin-embedded tissue sections were lost in the touch preparation histograms, probably due to inadequate sampling. Therefore, image analysis of paraffin-embedded tissue sections is better able to distinguish KA from SCC than touch preparations.

Mohs micrographic surgery for skin cancer.

Mohs micrographic surgery is a reliable outpatient surgical method of removing skin cancer. The method includes tissue excision in thin layers, colour-coding of excised specimens, accurate orientation of excised tissue through construction of tissue maps, and microscopic examination of horizontal frozen sections. Selected basal and squamous cell carcinomas are treated most commonly by this method, however, a variety of less common tumors are also amenable to treatment. Mohs micrographic surgery offers the highest cure rates for selected malignancies while maintaining maximal preservation of normal tissue and important anatomic structures.

Gorlin's basal cell nevus syndrome.

A case report is used to illustrate the characteristics of Gorlin's syndrome and to emphasize the need for early recognition by the physician and for thorough lifetime follow-up by the patient to prevent severe sequelae.

The wound healing process.

A dramatic sequence of events accounts for the repair of cutaneous wounds, be they of a surgical or accidental nature. Although our understanding of this process is increasing at a rapid rate, unanswered questions remain. Undoubtedly, as time goes on and knowledge increases, we will gain further insight into the intricacies of the wound healing phenomenon. Physicians, particularly those who perform surgical procedures of the skin, should be familiar with the biologic precepts implicit in the wound healing process. The understanding of these principles will ultimately lead to a more rational approach to wound management, which does not run counter to a meticulously conceived script.

Liposuction of the abdomen. The basics.

As one of the most frequent regions treated by liposuction in both men and women, the abdomen presents unique learning opportunities for the liposuction surgeon. Because of anatomic variation, the upper abdomen is more fibrous than the lower abdomen, requiring a slightly different approach to achieve optimal fat removal. The periumbilical area also provides unique challenges for the operator and care must be taken to avoid leaving a ring of residual fat. Potentially excellent skin retraction in the area, combined with relatively aggressive fat removal can lead to dramatic results including, in some cases, significant contraction of a long-standing panniculus. In this article, the basic techniques and potential pitfalls of abdominal liposuction are presented in detail.

Skin cancer in the elderly.

Skin cancer is a major concern in geriatric populations. Cumulative exposure to carcinogens and age-related factors both contribute to the high prevalence of cutaneous malignancy in the elderly. Although mortality rates from skin cancer are relatively low, morbidity can be significant, particularly if lesions are neglected. Physicians can have a major impact on the course of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma by nurturing a high index of suspicion for malignancy when unexplained cutaneous lesions are encountered.

Special considerations in pediatric dermatologic surgery.

Dermatologic surgical procedures can be performed in the pediatric patient in an outpatient setting. Although the surgical techniques involved are the same as those used in adult medicine, special attention must be given to anesthesia and patients' fears when dealing with pediatric patients. In this communication, some insights relating to pediatric surgical procedures performed at Duke University Medical Center's Dermatologic Surgery Unit are presented.

Silicone, fibrel, and collagen implantation for facial lines and wrinkles.

In recent decades, cutaneous surgeons have contributed to the development of a number of implantable materials useful in the management of facial lines and wrinkles. Among these, the most effective are injectable liquid silicone, bovine collagen implant (Zyderm/Zyplast, Collagen Corporation, Palo Alto, CA) and gelatin matrix implant (Fibrel, Mentor Corporation, Goleta, CA). Each of these treatments carries its own balance of efficacy, safety, and ease of use. Clinicians are encouraged to evaluate each of these treatments in order to be able to offer a full range of injectable therapy for the aging face.

Wound healing: a review. II. Environmental factors affecting wound healing.

A variety of factors, both intrinsic and extrinsic, may influence the healing of wounds. Some of these influences are environmental in nature and subject to advantageous manipulation by the practitioner. In this article, the role of humidity, temperature, infection and oxygen tension on the process of wound healing will be discussed.

Wound healing: a review. III. Nutritional factors affecting wound healing.

Wound healing proceeds more efficiently and quickly in well-nourished individuals who are in good general health at the time that they have to undergo surgery. Per contra, individuals who are malnourished and chronically ill heal less well and are in general at greater risk of complications during and after surgery. For the latter, elective surgery may be deferred until nutritional improvement is attained, but for emergency or urgent operations, institution of measures promoting good nutrition has to be concurrent with necessitous surgery and continued postoperatively. In this paper, the importance to wound healing of proteins, carbohydrates, fats, vitamins, and trace elements and minerals is reviewed.

Wound healing: a review. IV. Systemic medications affecting wound healing.

Physicians performing dermatologic surgery should include a thorough drug history in their preoperative assessments of patients. Such information may allow for the discontinuation, if desired, of drugs that negatively influence the wound-healing process. In some instances, the surgeon may find it useful, during the perioperative period, to substitute a drug known to impede wound healing with another possessing no untoward effects. In other situations, as in the treatment of keloids, physicians may wish to introduce drugs known to reduce scar formation into the biologic environment in which wound healing ensues.

Rapid instrument sterilization.

A rapid dry heat sterilization system has been found to be an effective alternative to other popular methods for assuring instrument sterility. Unpackaged instruments can be sterilized in as little as 6 minutes. This system would be of particular value to the dermatologist who performs a minimal amount of surgery or maintains only a small inventory of surgical instruments.