Daniel S. Behroozan

Fractional photothermolysis for the treatment of surgical scars: A case report

Background. Surgical scars are a challenging condition to treat. Fractional photothermolysis provides a promising new modality for treatment. Case report. A 55‐year‐old white female patient with a surgical scar on the chin was treated with fractional photothermolysis (1550 nm FraxelTM SR laser). A single treatment session was performed at pulse energy of 8 mJ (MTZ) and a final density of 2000 MTZ/cm2. The treatment response was assessed by comparing pre‐ and 2‐week post‐treatment clinical photography. Results. A greater than 75% clinical improvement of scarring was achieved at 2 weeks after a single treatment based on independent physician assessment. No significant adverse effects were noted. The improvement was persistent at 1‐month follow‐up. Conclusion. Fractional photothermolysis offers a new, effective, and safe modality for the treatment of surgical scars.

Delayed Infections Following Full‐Face CO2 Laser Resurfacing and Occlusive Dressing Use

Background. Carbon dioxide (CO2) laser resurfacing has become an increasingly popular procedure for the treatment of facial rhytides and solar damage. Yet despite ongoing advancements in laser technology, CO2 laser resurfacing is still a risk‐laden procedure that may lead to complications such as infection. Occlusive dressings increase the healing rate and decrease pain intensity in patients who receive full face laser resurfacing. It has been said that the use of occlusive dressings in postresurfacing patients may increase the risk of infection, which typically presents 2–10 days after the procedure. Objective. The purpose of this article is to report the incidence of infection following full‐face CO2 laser resurfacing of 354 patients who were treated with occlusive dressings. In addition, factors which may have contributed to the delayed onset in three of the four infections are discussed. Methods. Three hundred fifty‐four patients received full‐face CO2 laser resurfacing. Either a continuous wave CO2 laser with a computer‐generated scanner (396 &mgr;sec dwell time, 18 W) or a pulsed CO2 laser (500 mJ pulse energy, 90 &mgr;sec pulse duration) were used in all cases of resurfacing. Postoperatively all patients were treated with occlusive dressings and empiric oral cephalexin. Postoperatively patients were monitored at weekly intervals during the first month and then at 3 and 6 months. Results. Of the 354 patients who received full‐face laser resurfacing, there were 4 cases of culture‐proven infection, which translates to an infection rate of 1.13%. Three of the four infections developed 3–5 weeks after the procedure. Conclusion. This study reports an infection rate of 1.13% following full‐face CO2 laser resurfacing and occlusive dressing use in 354 patients. Because infection may develop many weeks after the procedure, patients should be educated to maintain proper wound care hygiene and to avoid “double dipping” of wound care products until wounds are completely healed.

Combined Linear Closure and Burow's Graft for a Dorsal Nasal Defect

An 80-year-old man with a history of nonmelanoma skin cancers of the head and neck presented for treatment of a basal cell carcinoma of the nose. Physical examination revealed a poorly defined, exophytic, ulcerated nodule of the mid-dorsal nose. Given the size, location, and ill-defined margins of the tumor, Mohs micrographic surgical excision was indicated. The tumor was excised in three stages with microscopic control. The final defect was full thickness of the dermis, sparing the underlying muscle and measuring 3.2 x 2.4 cm on the mid-dorsal, supratip, and lateral aspects of the nose (Figure 1). How would you repair this defect?

Co-existing basal cell carcinoma and blue nevus in an African-American woman

A 67‐year‐old African‐American woman presented with an enlarging darkly pigmented plaque on her scalp. Histopathologic examination revealed a basal cell carcinoma juxtaposed to a blue nevus. Interestingly, the most common types of cutaneous collision tumors include melanocytic nevus and basal cell carcinoma. Whether these combinations are simply because of chance or may have a pathophysiologic mechanism is contentious. This is the first documented case of a basal cell carcinoma co‐existing alone with a blue nevus.

Combined Linear Closure and Burow's Graft for a Dorsal Nasal Defect: COMBINED CLOSURE AND BUROW'S GRAFT FOR NASAL DEFECT

An 80-year-old man with a history of nonmelanoma skin cancers of the head and neck presented for treatment of a basal cell carcinoma of the nose. Physical examination revealed a poorly defined, exophytic, ulcerated nodule of the mid-dorsal nose. Given the size, location, and ill-defined margins of the tumor, Mohs micrographic surgical excision was indicated. The tumor was excised in three stages with microscopic control. The final defect was full thickness of the dermis, sparing the underlying muscle and measuring 3.2 x 2.4 cm on the mid-dorsal, supratip, and lateral aspects of the nose (Figure 1). How would you repair this defect?

eruptive Squamous Cell Carcinomas Associated with Braf-inhibitor Therapy in a Patient with Metastatic Melanoma

Melanoma in its advanced stage is one of the most deadly solid tumors, with median survival of between 6 and 10 months. Over the past 30 years, there has been little or no improvement in survival for these patients. Systemic therapy with immunotherapy and chemotherapy benefits only 10–15% of patients with metastatic disease, and even fewer experience durable benefits that affect survival. Approximately 50% of metastatic melanomas express a mutated BRAF gene, and the use of BRAF inhibitors to treat patients who have this mutated gene has resulted in clinical response rates higher than 50%. The development of effective specific BRAF inhibitors in melanoma marked the beginning of an attempt to target unique molecular features demonstrated by subsets of patients with melanoma.

Plasma Cell Balanitis Presenting in a Patient with a History of Syphilis

Plasma cell balanitis (PCB), also knows as Zoon balanitis, is a benign asymptomatic but chronic and erosive inflammatory condition of the glans penis and prepuce that generally affects uncircumcised men in later years. Clinical presentation involves a single, shiny, well defined reddish patch. We describe the first case of PCB ever reported in a patient with a previous history of syphilis, and include a review of the current literature. A 57-year-old Hispanic man with a remote history of syphilis presented with a 6-month nonhealing, granulating ulcer of the foreskin and glans penis that had been repeatedly mistaken for syphilis and treated unsuccessfully with circumcision 3 weeks previously. Biopsy of the glans penis demonstrated sections with denuded chronic granulation tissue showing a fibrotic stroma with numerous blood vessels and a mixed inflammatory infiltrate including scattered plasma cells. It is important to differentiate PCB from a syphilitic chancre in a patient presenting with a nonhealing penile lesion. This case report demonstrates that these entities may be seen in the same patient at different times.

Double rotation flap to repair two cheek defects in close proximity.

© 2005 by the American Society for Dermatologic Surgery, Inc. • Published by BC Decker Inc ISSN: 1076–0512 • Dermatol Surg 2005;31:1717–1719. A 65-YEAR-OLD man was referred for Mohs micrographic surgery of two basal cell carcinomas on the left cheek. Both the superior and the inferior sites were free of tumor after two stages. The superior basal cell carcinoma resulted in a defect measuring 2.2 1.1 cm. The inferior basal cell carcinoma left a resultant defect of 2.4 1.1 cm (Figure 1). How would you reconstruct this surgical defect?

Skin Manifestations of Internal Disease

As the largest organ in the body, the skin may reveal the first manifestations of internal disease. The astute clinician can often use dermatologic findings to diagnose an underlying systemic disease. This chapter outlines some of the most important skin manifestations of internal disease. Common yet clinically important systemic diseases will be reviewed, and their most notable skin findings will be delineated.