Deborah F. MacFarlane

Quantifying soft tissue loss in the aging male face using magnetic resonance imaging

BACKGROUND Quantitative data on soft tissue aging of the face are scarce, particularly in men. OBJECTIVE Magnetic resonance imaging (MRI) was used to quantify and compare facial soft tissue loss in men. MATERIALS AND METHODS Two thousand thirty-seven MRIs were screened and 30 male subjects were divided into young, middle, and old-aged groups. A blinded radiologist measured temporal, infraorbital, and medial and lateral cheek areas. RESULTS The mean thickness of the subcutaneous tissue in the temporal area was 12.5, 10.9, and 9.6 mm in the young, middle, and older age groups, respectively (p < .001). A 40% reduction in the skin thickness was seen in the infraorbital areas. Finally, a decrease of 1.5 and 2.7 mm in medial cheeks (p < .001), and 0.9 and 1.6 mm (p = .03) in lateral cheeks were measured in middle and old age groups. CONCLUSION A steady and significant decline in the soft tissue thickness was noted at all measured sites in men over time. These findings are in contrast to our recently study in women showing dramatic loss of soft tissue between the ages of 30 and 60 with no significant differences between the middle and old-aged groups. These results have implications for volume correction and maintenance of a youthful appearance in the aging male face.

Primary and metastatic malignant tumors of the scalp: an update.

In recent years there have been a number of interesting advances in several topics relating to the diagnosis and treatment of cutaneous lesions with particular applicability to primary and metastatic malignancies of the scalp. In this article we provide a general update of advances in this field, and cover the more salient points relating to a variety of malignant tumors that have been reported to appear on the scalp as primary or metastatic lesions.A search and review of the literature on PubMed was made to identify and discuss relevant points relating to diagnosis and treatment of primary and metastatic tumors of the scalp.We describe the anatomy of the scalp, epidemiology of scalp tumors, theories of field cancerization and field therapy, photodynamic therapy, excisional surgical techniques and reconstruction, lymphoscintigraphy, chemoprevention, as well as details relating to atypical fibroxanthoma, Brooke-Spiegler syndrome, nevus sebaceus, cutaneous lymphoma, and metastatic disease.There is a very broad differential diagnosis for scalp nodules, which includes many different benign and malignant diseases, and treatment should be tailored accordingly. Given the potential for poor prognosis with some of the more aggressive malignancies that can be found in this anatomic area, the importance of a thorough physical examination cannot be emphasized enough, and early detection is critical to provide patients with the best chance for a favorable outcome.

Cross-species identification of genomic drivers of squamous cell carcinoma development across preneoplastic intermediates

Cutaneous squamous cell carcinoma (cuSCC) comprises 15–20% of all skin cancers, accounting for over 700,000 cases in USA annually. Most cuSCC arise in association with a distinct precancerous lesion, the actinic keratosis (AK). To identify potential targets for molecularly targeted chemoprevention, here we perform integrated cross-species genomic analysis of cuSCC development through the preneoplastic AK stage using matched human samples and a solar ultraviolet radiation-driven Hairless mouse model. We identify the major transcriptional drivers of this progression sequence, showing that the key genomic changes in cuSCC development occur in the normal skin to AK transition. Our data validate the use of this ultraviolet radiation-driven mouse cuSCC model for cross-species analysis and demonstrate that cuSCC bears deep molecular similarities to multiple carcinogen-driven SCCs from diverse sites, suggesting that cuSCC may serve as an effective, accessible model for multiple SCC types and that common treatment and prevention strategies may be feasible.

Patient safety in procedural dermatology: Part II. Safety related to cosmetic procedures

Cosmetic procedures are growing in popularity and are associated with unique risks. Considering potential complications and prioritizing patient safety will help practitioners improve outcomes of elective procedures. In part II of this continuing medical education article, we provide a comprehensive review of patient safety in cosmetic procedures, including medical and legal issues surrounding the supervision and training of physician extenders.

The role of imaging in the management of patients with nonmelanoma skin cancer: When is imaging necessary?

&NA; When treating aggressive skin cancers, pre‐ and postoperative imaging provides important information for treatment planning and multidisciplinary cooperation of care. It is important for dermatologists to recognize the clinical scenarios where imaging is indicated in the management of skin cancer. We here address the most common indications for imaging in cutaneous oncology and how to best utilize the modalities available.

The role of imaging in the management of patients with nonmelanoma skin cancer: Diagnostic modalities and applications

While uncomplicated cases of nonmelanoma skin cancer can be treated with surgery, destruction, or topical therapy alone, advanced or neglected cases require more complex management decisions. Dermatologists and dermatologic surgeons should be familiar with the imaging techniques relevant to cutaneous oncology and their value in different clinical scenarios. Herein we review imaging modalities used in management of nonmelanoma skin cancer.

Full-thickness skin grafts may not need tie-over bolster dressings

Traditionally performed after full-thickness skin grafts (FTSGs), tie-over bolsters are thought to act as secured pressure dressings, protecting the graft from external mechanical forces and hematoma or seroma formation. The theory is that graft healing is optimized by applying enough pressure to prevent graft movement and fluid collection while still allowing nutrition, but tie-over bolster dressings can be a source of patient complaint, and we have found little evidence in the literature showing that they are strictly necessary.

Cryoimmunotherapy: superficial basal cell cancer and squamous cell carcinoma in situ treated with liquid nitrogen followed by imiquimod.

tients showed inflammatory lesions that waned after MEL treatment (P .003), and 5 patients had hyperkeratotic lesions that subsequently disappeared (P .02). Three of 13 patients’ areas of disease showed decreased infiltration during the study. Six patients reported scalp pain before or during the study, but none by the end (P .008). While 10 of 13 patients reported itching at baseline or during the study, none indicated pruritus by the end of the study (P .001). An increased growth of hair after 4 to 8 weeks was observed in 3 patients, with stable remission in 2. In 1 patient with canities, repigmentation of hair appeared.

A Schema Using Fixed Anatomic Landmarks for Biopsy Site Identification on the Head and Neck

Surgical removal of partially regressed BCCs raises another question regarding recurrence. In a mouse model, BCCs regressed with transgenic inactivation of the hedgehog pathway, but a small subset of nonproliferative cells was able to form tumors after transgene reactivation of the pathway. Resistance might also develop in which the tumors develop transgene independence. In patients treated with vismodegib, it is unknown whether the partially regressed portion will recur if the drug is stopped or if resistance to drug develops. Histologically normal-appearing cells may still harbor hedgehog pathway mutations and result in recurrence because of drug withdrawal or resistance. The histologic findings described are in BCNS patients and may not be applicable to those who do not harbor the Patched 1 gene mutation. Further studies will provide insight into how treatment with drug may affect subsequent surgical treatment.

Imaging of Head and Neck Skin Cancer

It is important for clinicians to understand and to take advantage of new imaging techniques available for the management of skin cancers. There is little written in either skin cancer or radiology texts on the topic of imaging in head and neck skin cancers. This chapter is an attempt to find a common ground between the disciplines of surgery and radiology so that each may communicate more effectively with the other, thereby benefiting patient care and health-care costs.