Duane C. Whitaker

Malignant eccrine spiradenoma. A clinicopathologic study.

UNLABELLEDnMalignant eccrine spiradenomas (MES) are exceedingly rare and their immunohistochemical and ultrastructural features have not been fully characterized. We studied two cases, one of them immunohistochemically and electron microscopically. Patient 1 had a 25-year history of multiple exophytic tumors involving the scalp, the skin of the face, and the torso. Of the lesions removed, ten were spiradenomas, two with malignant changes, and three were cylindromas. The malignant areas showed loss of tubular and nesting patterns, lack of two cell populations, and contained anaplastic cells with high mitotic rate. The immunohistochemical findings were consistent with eccrine differentiation. Patient 2 had a cystlike mass of long duration in the right groin. Histologically, the mass consisted of nodules of benign eccrine spiradenomas adjacent to a ductal-cystic mass lined by anaplastic cells, but areas of squamous and glandular differentiation were also present.nnnCONCLUSIONSn(a) Case 1 is probably the first reported MES associated with multiple spiradenomas and cylindromas. (b) Cytodifferentiation in MES is variable, sometimes with almost complete loss of eccrine differentiation. (c) Identification of adjacent spiradenomas may be required for definite diagnosis of MES. (d) Clinical history of longstanding lesions with recent fast growth warrants tissue diagnosis.

Vulvar lymphangioma circumscriptum: A rare complication of therapy for squamous cell carcinoma of the cervix

The clinical and pathological features of a case of multifocal lymphangioma circumscriptum of the vulva are reported in a patient with chronic lymphedema of a lower extremity. Ten years previously the patient had been treated for squamous cell carcinoma of the cervix. Although lymphangioma circumscriptum is an extremely rare complication of altered lymphatic drainage, the presence of multiple noninflammatory vesicular appearing lesions in this setting should suggest the correct diagnosis.

POSTSURGICAL WOUND MANAGEMENT

Successful outcomes in cutaneous surgery depend on a variety of factors, including preoperative assessment of the patients health and expectations, intraoperative skill and attention to detail, and managing the postoperative period. Once the procedure is complete, careful selection of dressings, provision of adequate analgesia, judicious management of complications and monitoring the phases of early maturation while providing patient education improve the likelihood of long-term patient and physician satisfaction.

Injectability and Tissue Compatibility of Poly-(N-Vinyl-2-Pyrrolidone) in the Skin of Rats: A Pilot Study

Background. Filling substances have been used in dermatologic surgery for decades, but an ideal agent has yet to be discovered. Poly‐(N‐vinyl‐2‐pyrrolidone) is a hydrogel that has been used in medical settings for more than 50 years, but not as a cutaneous filling agent. Objective. We investigated the intracutaneous injectability and tissue compatibility of this hydrogel in a rat model. Particular attention was paid to ease of injection through small needles, volume retention of the implant, clinical course, and histocompatibility. Methods. The shaved backs of 12 anesthetized Sprague–Dawley rats were injected with the sterilized hydrogel and the rats closely observed. The rats were sacrificed in groups of four at 2, 4, and 12 weeks after implantation. Implant size was measured, volume calculated, and biopsies taken at each time interval. Results. Poly‐(N‐vinyl‐2‐pyrrolidone) is easily injected through 30‐gauge needles. All rats tolerated the implants well clinically. Histopathology revealed well‐circumscribed implants with pseudoencapsulation, neoangiogenesis, and mixed inflammatory cells predominating at the periphery. Volume calculations revealed an average of 33% reduction at 4 weeks and 35% reduction at 12 weeks. Conclusion. Poly‐(N‐vinyl‐2‐pyrrolidone) is easy to inject intracutaneously and is well tolerated in the rat model. Short‐term volume retention is good. Histopathology suggests a subclinical inflammatory reaction expected with implantation of a synthetic substance into the skin. Additional studies are necessary to investigate the continued persistence of the hydrogel and its long‐term effects on surrounding tissue.

Guiding sutures to promote optimal contraction of a large surgical defect prior to delayed grafting.

BACKGROUND Large surgical defects on the face are often challenging to repair. OBJECTIVE To describe a method to reduce wound area and promote wound contraction. MATERIALS AND METHODS Case report. Mohs excision of a neglected basal cell carcinoma on the cheek left a large defect of 54 cm2. Delayed grafting was selected for the repair due to the size of the wound and the presence of multiple foci of perineural, muscle and parotid invasion. Two 4–0 polyglactin guiding sutures were placed across the inferior half of the wound; the superior half of the wound was allowed to granulate. RESULTS At the time of split-thickness skin grafting 17 days later, the entire wound was 42% smaller than the original defect. The superior half of the wound was reduced by 29%, attributable to granulation. The inferior half of the wound was reduced by 55%, attributable to granulation and the contractile effect of guiding sutures. CONCLUSIONS The placement of guiding sutures across large defects is a quick and simple technique that promotes optimal wound contraction with substantial reduction in the size of a wound, improving the final surgical result.