Carmen Campanelli

Porokeratosis ptychotropica: A clinically distinct variant of porokeratosis

Porokeratosis represents a spectrum of clinical disease. Multiple variants have been described including porokeratosis ptychotropica, a rare subtype. The clinical presentation of porokeratosis ptychotropica frequently resembles an inflammatory perianal disease. We report a patient with porokeratosis ptychotropica with coexistent disseminated superficial actinic porokeratosis. We review the current literature on porokeratosis ptychotropica including the clinical presentation, histopathology, cause, and pathogenesis of this rare variant of porokeratosis.

Keratoacanthoma of the Head and Neck with Perineural Invasion: Incidental Finding or Cause for Concern?

Keratoacanthoma (KA) is generally regarded as a less aggressive variant of cutaneous squamous cell carcinoma (SCC) that has a low propensity to recur or metastasize. This characteristic benign behavior reportedly holds true in cases of KA of the head and neck even when they exhibit perineural invasion (PNI) on histologic examination. There is a paucity of data regarding KA with PNI, but the evidence that exists suggests that PNI is an incidental finding that does not affect patient outcome. For this reason, many dermatologic surgeons do not alter their treatment plan when PNI is encountered in the treatment of KA of the head and neck, whereas they would probably recommend radiation therapy or more aggressive surgery for SCCs that exhibit similar histologic findings.

Suprascapular Nerve Injury During Mohs Surgery and Review of the Surgical Anatomy of the Nervous Structures of the Supraclavicular Triangle

Accurate anatomic knowledge of the nervous structures of the neck is essential to the dermatologic surgeon to avoid serious adverse outcomes postoperatively, including but not limited to injury to the brachial plexus and paresis of the hemidiaphragm. Detailed descriptions of the surgical anatomy of the supraclavicular triangle (SCT) are scarce, and reports of nervous injuries during cutaneous surgery are absent from dermatologic textbooks and journal literature. The primary objective of this article is to provide a brief review of the nervous anatomy of the SCT region.

Basal Cell and Squamous Cell Carcinoma Occurring within a Field of Multiple Tumors of the Follicular Infundibulum

A 69-year-old Caucasian man with severe actinic damage and a history of multiple basal cell and squamous cell carcinomas was referred for Mohs micrographic surgery. Clinical examination revealed an ill-defined, pearly, ulcerated plaque on the right cheek, as well as two smaller ulcerated papules. Severe actinic damage with lentigines, atrophic white scar-like macules, and telangiectasia were present over the face and neck (Figure 1). A frozen section from the center of the largest tumor on the right cheek confirmed nodular basal cell carcinoma. Mohs margins were significant for a proliferation of anastomosing bands of basaloid cells with horn cyst formation emanating from the epidermis. In other portions of the specimen, aggregates of basaloid cells with peripheral palisading were present, with focal retraction from surrounding stroma. Similar findings were evident in sections from a second stage. Repair was delayed, and several skin biopsies were taken from skin adjacent to the original lesion, contralateral cheek, and neck. All specimens were formalin fixed for permanent sections. Histological features of tumor of the follicular infundibulum were present in all specimens (Figure 2). One margin contained findings of superficial basal cell carcinoma and tumor of the follicular infundibulum (TFI) (Figure 3). Discussion

A single-stage alternative approach to reconstruction of the lateral nose requiring subsurface support.

A 78-year-old white woman presented with an infiltrative basal cell carcinoma on the right alar crease. After five stages of Mohs surgery, the final defect measured 2.0 1.8 cm, extending from the alar crease onto the right cheek (Figure 1). Although the alar rim was preserved, the defect was to a depth of the submucosa, and the structural support of the ala nostril was severely compromised (Figure 2). How would you reconstruct this defect?