John D. Hendrix

Cutaneous malignancies and their management

Skin cancer is the most common malignancy occurring in humans, and the incidence of basal cell carcinoma, squamous cell carcinoma, and melanoma continues to rise. Advances in the diagnosis and treatment of skin cancer have led to more successful management of these tumors. A number of options for the treatment of skin cancer are available to the patient and physician, allowing for high cure rates and excellent functional and cosmetic outcomes.

Duplicitous growth of infiltrative basal cell carcinoma: Analysis of clinically undetected tumor extent in a paired case-control study.

BACKGROUND Many clinicians believe infiltrative basal cell carcinoma (BCC) is a more difficult tumor to eradicate than nodular BCC because the growth of infiltrative BCC is not easy to detect clinically. However, data supporting this observation are largely anecdotal. OBJECTIVE Our purpose was to show that infiltrative BCC have wider and deeper tumor extensions than nodular BCC of similar clinical size. METHODS In this retrospective study, 139 cases of infiltrative BCC excised by Mohs micrographic surgery (MMS) were matched to a control group of 139 cases of nodular BCC similarly excised. They were paired by site, size, number of recurrences, age, gender, and previous treatment type. The cases were selected and paired by computer from 1197 consecutive BCC (primary and recurrent) referred for MMS over a 5‐year period. MMS technique allowed us to quantitate the extent of tumor spread using three measurements: the number of surgical stages required for complete removal of tumor, the width of tissue required to remove subdinical extension of tumor, and the depth of defect at completion of MMS. RESULTS Analysis showed the infiltrative BCC was more difficult to detect and to eradicate than the nodular BCC. The number of surgical stages required for complete removal of tumor, the width of tissue required to remove subclinical extension of tumor, and the depth of defect at completion of MMS were all greater with infiltrative BCC when compared with nodular BCC regardless of whether cases mere primary or recurrent. These differences were all statistically significant. CONCLUSION Infiltrative BCC can be significantly more destructive than nodular BCC because tumor extension is difficult to detect clinically. Clinicians should treat infiltrative BCC with its potential for covert invasion in mind.

Dermatomyositis associated with bronchiolitis obliterans organizing pneumonia (BOOP)

Bronchiolitis obliterans organizing pneumonia (BOOP) is rarely associated with dermatomyositis and may be resistant to conventional corticosteroid therapy under this circumstance. We present a case of BOOP associated with dermatomyositis that responded to a combination of cyclophosphamide and corticosteroid therapy after corticosteroid treatments, alone, had failed. We believe this case shows it is important to recognize that facial rash in the presence of respiratory distress may represent dermatomyositis with BOOP and aggressive treatment may be necessary for resolution of pulmonary symptoms.

Skin cancer associated with ichthyosis: The MAUIE syndrome

by increased dermal innervation. J Invest Dermatol 1991;97:555-61. 12. MasseyEW.: Fleet AB. Electromyographic evaluation of notalgia paresthetica. Neurology 1981 ;31:642. 13. Cline M, Ochoa J, Torebjork HE. Chronic hyperalgesia and skin warming caused by sensitized C nociceptors. Brain 1989;112:621-7. 14. Yamitsky D, Fowler C. Quantitative thermal testing. In: Osselton JW, editor. Clinical neurophysiology. Oxford: Butterworth-Heinemann; 1995. p. 253-70. 15. Bernhard JD. Neurogenic pntritus and strange skin sensations. In: Bernhard JD, editor. Itch, mechanisms and management of pruritus. New York: McGraw-Hill; 1994. p. 185-201. 16. Layton AM, Cotterill JA. Notalgia paresthetica: report of three cases and their treatment. Clin Exp Dermatol 1991;16:197-8. 17. Wallengren J. Treatment of notalgia paresthetica with topical capsaicin. J Am Acad Dermatol 1991 ;24:286-8. 18. Wallengren J. Treatment of notalgia paresthetica with capsaicin (Zostrix). Skin Pharmacol 1989;2:229-30. 19. Bernstein JG. Handbook of drag therapy in psychiatry. 2nd ed. Littleton: Year Book Medical Publishers; 1988.