Judith U. Ostertag

Congenital naevi treated with erbium:YAG laser (Derma K) resurfacing in neonates: clinical results and review of the literature

Background  Giant congenital melanocytic naevi (CMN) are often disfiguring, potentially malignant pigmented lesions present at birth. Their management is based on two main considerations: attempt to minimize the risk of malignancy and to obtain an acceptable cosmetic result. In the past various approaches have been used to treat these naevi.

Treatment of basal cell carcinomas in patients with nevoid basal cell carcinoma syndrome

Background  Nevoid basal cell carcinoma syndrome (NBCCS) is characterized by the development of multiple basal cell carcinomas (BCCs). A major problem for these patients is the enormous amount of BCCs which can invade in the deep underlying structures, especially in the face. Different treatment modalities are used in these patients; surgical excision, Mohs micrographic surgery, cryotherapy, photodynamic therapy, ablative laser therapy and topical 5% imiquimod. There is no evidence based advice how to treat a NBCCS patient.

Superficial Hemangioma: Pulsed Dye Laser Versus Wait-and-See

Background and Objectives Childhood hemangioma is the most common soft tissue tumor of infancy, occurring in 10% of children younger than 1 year old. Ten percent of these infantile hemangiomas involute yearly without intervention. Treatment with the pulsed dye laser (PDL) is the criterion standard for treating vascular lesions. It is well established as the most effective, safest treatment for port‐wine stains. Previous studies of the use of PDL treatment in superficial hemangioma showed inconsistent results. Main objectives were to compare the efficacy and adverse effects of PDL treatment with those of observation in the treatment of superficial hemangiomas. Parental quality of life was also assessed. Materials and Methods This was a prospective, randomized, controlled trial in which we enrolled 22 infants aged 1.5 to 5 months old with early hemangiomas with a maximum diameter of 5 cm. We assigned the infants to PDL treatment (n = 11) or observation (n = 11), and followed up until the age of 1 year. Patients in the intervention group were treated using a 595‐nm PDL (VBEAM, Candela Corp., Wayland, MA) with a 7‐mm spot diameter, 30/10 to 40/10‐ms epidermal cooling, a 7‐ to 15‐J/cm2 fluence range, and a pulse duration of 0.45 to 40.0 ms. During follow‐up, color measurements were made (Colori meter; Minolta, Tokyo, Japan), and surface area and echo depth of the hemangioma were determined. Results No significant differences were seen between the groups at time of inclusion or at the age of 1 year in echo depth (p = .66) or surface area (p = .62). Results were significant for color difference (p = .03) between PDL treatment and observation. Cosmetic outcome judged by an independent panel consisting of a dermatologist, physician assistant, dermatology resident, dermatology nurse, and plastic surgery resident was significantly better in the PDL treatment group (46%) than in the observation group (18%) (p = .006). Conclusions Pulsed dye laser is only to be considered as an alternative treatment up to the age of 6 months, at which time parents and physicians consider cosmetic outcome to be a relevant factor, but laser therapy plays a major role in the treatment of residual lesions at older ages.

Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: A prospective randomized controlled study

Background  Imiquimod 5% cream can reduce or clear superficial and small nodular basal cell carcinoma (BCC). It could be used as a pretreatment of Mohs micrographic surgery (MMS) to decrease defect size.

The incidence of skin cancer in dermatology

It is known that the incidence of skin cancer is rising rapidly worldwide, but no reliable figures on multiple nonmelanoma skin cancer (NMSC) are available.

Successful treatment of nevus comedonicus with the use of the Erbium Yag laser

1 Anhalt GJ, Kim S-C, Stanley JR et al. Paraneoplastic pemphigus. An autoimmune mucocutaneous disease associated with neoplasia. N Engl J Med 1990; 323: 1729–1735. 2 Robinson ND, Hashimoto T, Amagai M, Chan LS. Continuing medical education: the new pemphigus variants. J Am Acad Dermatol 1999; 40: 649–671. 3 Oursler JR, Labib RS, Ariss-Abdo L, Burke T, O’Keefe EJ, Anhalt GJ. Human autoantibodies against desmoplakins in paraneoplastic pemphigus. J Clin Invest 1992; 89: 1775–1782. 4 Hashimoto T, Amagai M, Watanabe K et al. Characterization of paraneoplastic pemphigus autoantigens by immunoblot analysis. J Invest Dermatol 1995; 104: 829–834. 5 Kiyokawa C, Ruhrberg C, Nie Z et al. Envoplakin and periplakin are components of the paraneoplastic pemphigus antigen complex. J Invest Dermatol 1998; 111: 1236–1238. 6 Komai A, Amagai M, Ishii K et al. The clinical transition between pemphigus foliaceus and pemphigus vulgaris correlates well with the changes in autoantibody profile assessed by an enzyme-linked immunosorbent assay. Br J Dermatol 2001; 144: 1177–1182. 7 Ng PP, Thng ST. Three cases of transition from pemphigus vulgaris to pemphigus foliaceus confirmed by desmoglein ELISA. Dermatology 2005; 210: 319–321.

Laser-mediated Photodynamic Therapy: An Alternative Treatment for Actinic Keratosis?

Photodynamic therapy (PDT) with light emitting diode (LED) illumination is a frequently used treatment modality for actinic keratosis (AK) with excellent cosmetic outcome. A major disadvantage, however, is the high pain score. Pulsed dye laser (PDL) illumination has been suggested, but the long-term efficacy of this treatment is unknown. In this split-face study we prospectively treated 61 patients with AK, with both LED-PDT and PDL-PDT. The mean change in the number of lesions between the end of follow-up and start of therapy was -4.25 (95% confidence interval (95% CI) -5.07; -3.43) for LED-PDT and -3.88 (95% CI -4,76; -2.99) for PDL-PDT, with a non-significant difference (p = 0.258) of -0.46 (95% CI -1.28; 0.35). The percentage decrease from baseline in the total number of AK was 55.8% and 47.8%, respectively, at 12-month follow-up. Visual analogue scale pain score was lower after PDL (mean 2.64) compared with LED illumination (mean 6.47). These findings indicate that PDL-PDT is an effective alternative illumination source fo.

Bilateral linear temporoparietal scleroderma en coup de sabre

Zusammenfassung. Die bilaterale lineare Sklerodermie en coup de sabre ist eine extrem seltene Form der lokalisierten bandförmigen Sklerodermie. Der Fall einer 35jährigen Patientin mit bilateraler linearer temporoparietaler Sklerodermie en coup de sabre wird vorgestellt. Die möglicherweise auftretenden Begleitsymptome und serologischen Befunde bei linearer Sklerodermie werden kurz erläutert.Abstract. Bilateral linear frontoparietal scleroderma en coup de sabre is an extremely rare form of localized linear scleroderma. In this paper the case of a 35-year-old woman with bilateral linear temporoparietal en coup de sabre is presented. The manifestations that can be associated with linear scleroderma and the serologic abnormalities it envolves are briefly discussed.

Rapid Lump Examination as a New Aid to Speedup Mohs Micrographic Surgery: A Pilot Study.

BACKGROUND Although most cases of basal cell carcinoma (BCC) are curable, facial and recurrent BCCs require time consuming and labor-intensive Mohs micrographic surgery (MMS) to ensure complete removal with optimal cosmetic results. To handle the skin cancer epidemic, there is an urgent need to speedup MMS. Recently, rapid lump examination (RLE) has been shown to enable quick histologic examination, but its usefulness within MMS is unknown. OBJECTIVE To evaluate the accuracy of RLE for the detection of residual BCC during MMS. MATERIALS AND METHODS Twenty-two BCCs of various subtypes were evaluated by means of RLE and standard fresh frozen section (FFS) examination. For RLE, the freshly excised tissue was stained with toluidine blue and imaged with a stereomicroscope before being subdivided into sections suitable for processing into FFS. Fresh frozen sections were stained with hemotoxylin and eosin and evaluated with light microscopy. RESULTS Using FFS examination as the gold standard for the detection of residual BCC, RLE had a sensitivity, specificity, positive predictive value, and negative predictive value of 83.8%, 94.0%, 83.8%, and 94.0%, respectively. CONCLUSION As RLE enables quick 3-dimensional visualization of surgical margins for the detection of residual BCC, it holds the potential to speedup histologic examination during MMS.