Transposition island pedicle flaps in the reconstruction of nasal and perinasal defects.

Nasal and perinasal defects provide the dermatologic surgeon a challenge. It is necessary that the dermatologic surgeon assess each defect and patient individually for optimal repair. Many reconstructive options exist. This report demonstrates the technique of the transposition island pedicle flap which may be useful for reconstruction of post-Mohs surgery defects on or near the nose.

Lentigo maligna with spread onto oral mucosa.

BACKGROUND: Lentigo maligna (LM) is a form of melanoma in situ most often seen in white patients on sun-exposed areas, primarily the head and neck. Spread of LM onto the conjunctiva has been reported. There have been no reports of LM extending onto oral mucosa. OBSERVATIONS: We report 4 cases of LM in white women with contiguous spread from perioral areas to oral mucosa. The locations of the primary lesions were the vermilion of the lip, vermilion and perioral skin, cheek, and cutaneous aspect of the lip. Three cases showed focal histopathologic evidence of invasion during the course of the disease. The lesions ran a prolonged course characterized by repeated recurrences after surgery. Three of the cases required a complicated reconstruction after surgical excision. Mohs surgery with rush permanent (paraffin-embedded) sections resulted in a long remission in 2 cases, while in 1 patient, treatment with carbon dioxide laser was unsuccessful. CONCLUSIONS: In a perioral distribution, LM can spread onto oral mucosa. This clinical presentation may cause significant long-term morbidity, as indicated by a high recurrence rate and/or progression to invasive melanoma. The oral mucosa should be examined in patients with atypical pigmented perioral lesions.

Coccygodynia: treatment.

This article presents a retrospective review of the treatment of coccygodynia. The past 5 years of conservative treatment for coccygodynia were reviewed, including local injection. The results were evaluated. Retrospectively, the past 20 years of surgical treatment for coccygodynia were reviewed and the clinical results were evaluated. Twenty-four patients were treated with local injection and 15 patients were treated with coccygectomy. Local injection was successful in 78% of patients. Coccygectomy was successful in 87% of patients. The results of conservative treatment with local injection for coccygodynia appear to be successful. However, no other historical literature exists to compare these results. The results of coccygectomy for coccygodynia were also highly successful, and the success rate compares favorably to previous historical data in the literature.

Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts.

BACKGROUND: Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds. OBJECTIVE: To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon. METHODS: Comprehensive review of the literature. RESULTS: A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth. CONCLUSION: Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting.

Plantar Warts.

In brief Plantar warts can be difficult to brief treat. Many eventually resolve without treatment, but patients may want therapies that will quickly return them to pain-free activity. And though seemingly countless remedies have been concocted, no cure exists. Treatment options include chemical, immunologic, and surgical techniques. Physicians must take care to select therapy that does not cause discomfort, loss of function, or long-term problems.

Pitted Keratolysis.

In brief Pitted keratolysis usually presents no diagnostic difficulties because of its distinctive clinical appearance and odor. Participating in a sport that makes the feet hot and sweaty often contributes to this dermatologic condition. Sometimes simple measures such as proper foot drying and ventilating procedures are enough to clear the infection. The next line of treatment involves the use of topical agents such as erythromycin 2% solution.

Clearing Up Fungal Infections of the Nail Plate.

In brief Active people often seek medical care for discoloration and deterioration of toenails or fingernails. The problem may be a fungal infection of the nail (onychomycosis). Microscopic examination often shows strong evidence of onychomycosis, but a fungal culture will confirm the diagnosis. Antifungal medication alone or with conservative avulsion may resolve the fungal infection. If not, surgical nail removal may be needed for resistant cases.

Interdigital pilonidal sinus in a dog groomer.

Pilonidal sinus is an acquired condition that usually develops in the sacrococcygeal area or other hair-bearing areas. It has also been described as an occupational disease, especially when present interdigitally. We describe the case of a 47-year-old dog groomer with interdigital pilonidal sinus and briefly review the postulated pathogenesis, clinical characteristics, differential diagnosis, and treatment.