Katrin Schweinzer

Surgical treatment of rhinophyma: experience from a German cohort of 70 patients

BackgroundRhinophyma is a deforming soft tissue hyperplasia of the nose and surgical removal represents the treatment of choice. Comprehensive data on surgical therapy and the impact of rhinophyma on patient quality of life are lacking.ObjectivesPatients who received surgery for rhinophyma between 2006 and 2015 were retrospectively evaluated for postoperative complications, clinical outcome, recurrence of rhinophyma, and the impact of rhinophyma on daily life.Materials & MethodsA total of 143 patients were treated with superficial tumour decortication by scalpel under tumescent anaesthesia. Outcomes were determined by clinical review, clinical files, and a patient questionnaire.ResultsOf 143 patients, 70 answered the questionnaire and were included in this study with a mean follow-up time of 54 months. Cosmetic results were evaluated as very good or good in 77% of patients. The majority of patients (87%) were very satisfied or satisfied with the postoperative result. Surgical treatment of rhinophyma improved patients’ quality of life in 67% of patients. Recurrence of rhinophyma was detected in 38% of patients.ConclusionSurgery is an effective therapy for rhinophyma with excellent outcome.

Lymph node dissection for melanoma using tumescence local anaesthesia: an observational study

BackgroundThe possibility that tumescence local anaesthesia (TLA) may lead to dissemination of tumour cells in lymph nodes is presently unclear.ObjectivesTo evaluate whether infiltration by TLA influences metastatic spread and survival probability, compared to general anaesthesia (GA), based on lymph node dissection in melanoma patients.Patients & methodsIn total, 281 patients (GA: 162; TLA: 119) with cutaneous melanoma and clinically or histologically-confirmed metastases in regional lymph nodes were included. All patients underwent complete lymph node dissection.ResultsMedian follow-up was 70 months. The rate of lymph node recurrence at the dissection site was 25.3% in the GA group and 17.6% in the TLA group (p = 0.082). No significant difference was found concerning 10-year melanoma-specific survival (GA: 56.2%, TLA: 67.4%; p = 0.09), disease-free survival (GA: 72.8 %, TLA: 81.1%; p = 0.095), or lymph node-free survival (GA: 72.8%, TLA: 81.1%; p = 0.095). Distant metastases-free survival appeared to be slightly reduced in the TLA group (GA: 49.9%, TLA: 64.0%; p = 0.025).ConclusionsNo differences were identified between the GA and TLA groups regarding prognostic outcome for overall survival or disease-free survival.

Multiple nodular papules and tumors of the head and face

Multiple tumors on the scalp, the temples, and in the preauricular region were removed by en-bloc resections and sent for histopathological evaluation. One of the tumors located in the nasolabial fold showed follicular differentiation and islets of small basaloid, palisading basophilic cells and multiple small keratin pearls at the center of the lesion. A second tumor (from the preauricular region) was made up of multiple basophilic nodules – surrounded by a fi brous capsule – of slightly basophilic cells with large nuclei at the center as well as smaller peripheral cells with hyperchromatic nuclei (Figure 2 a). Multiple nodular papules and tumors of the head and face Case for Diagnosis

Serpiginous Lesions in an Infant

A 1-year-old infant presented at our department with a 6-week history of skin lesions, starting 1 month after a holiday trip to Sri Lanka. There the boy ingested some sand at a beach, where local dogs were present. The physical examination showed irregular and serpiginous erythematous papules and stripes at the right lower leg (A), the perianal region (B), and the left cheek crossing the mouth and the oral mucosa. The clinical picture is characteristic for cutaneous Larva migrans. Reports on infected oral mucosa are rare. We treated our patient with topical albendazol 10%, which resulted in complete healing. Visual Dermatology 748887 CMSXXX10.1177/1203475417748887Journal of Cutaneous Medicine and SurgeryMaier et al. other2017

An unexpected result following sentinel lymph node biopsy for desmoplastic cutaneous squamous cell carcinoma

Sentinel lymph node biopsy (SLNB) is a procedure used in the diagnostic workup of advanced malignancies including cutaneous squamous cell carcinoma (cSCC) [1–4]. The risk of metastasis depends on various factors such as tumor thickness, tumor diameter, recurrence, perineural invasion, immunosuppression, and tumor site [2, 3, 5]. As lymphatic spread is a major route of metastasis in cSCC, SLNB is employed as an additional diagnostic method in high-risk cSCC, theoretically allowing for exact staging of the regional lymphatic basin [6]. However, the role of SLNB in cSCC and its value in clinical settings is still subject to controversial debate. Compared to melanoma of the head/neck region, fewer positive sentinel lymph nodes have been found in cSCC, although both tumor entities are capable of lymphatic spread and characterized by proliferation of intratumoral lymphatic vessels [6–9]. This discrepancy might be due to different mechanisms of metastatic spread in melanoma and cSCC as well as staged surgical procedures performed in advanced cSCC. Moreover, extensive inflammatory stromal reactions observed in cSCC are associated with reduced detectability of sentinel nodes [10]. Besides lymphatic dissemination, cSCC can metastasize by direct extension. There have even been reports of cSCC showing metastatic spread to lower cervical lymph node stations, without involvement of lymph nodes further upstream (skip metastasis) [11]. An important source of error is the accidental excision of a non-sentinel lymph node, resulting in a false-negative SLNB. The anatomy of the head/neck region, where the majority of cSCCs are found, results in complex lymphatic drainage. Furthermore, the short distance between primary tumor sites and sentinel lymph nodes may possibly interfere with the detection by radionuclide labeling. SLNB is frequently designed as a staged procedure following excision of the primary tumor and wound closure with a local flap, which changes the original lymphatic drainage pattern. In a systematic review by Ahmed et al., false-negative rates were reported to be 4.7 %; in a retrospective analysis by Krediet et al. 6 %. [2, 12]. Emphasizing the awareness of false-negative sentinel lymph nodes, we present the case of an 81-year-old patient with a desmoplastic squamous cell carcinoma (dSCC) of the temple region (tumor thickness > 5 mm; T2N1M0, stage III). Re-excision of the primary tumor using microscopically controlled surgery and SLNB were performed in a single-stage procedure. SLNB was basically successful as a radionuclide-labeled lymph node was detected in the regional lymphatic basin. While that node was found to be tumor-free on pathological examination, histopathology of the re-excised tissue showed a lymph node at a distance of less than 5 mm from the primary tumor; further immunohistochemical studies revealed this particular lymph node to contain a micrometastasis (Figure 1). This rare case of an “unintentionally” detected SLNB illustrates that lymph nodes considered to be “sentinel lymph nodes” may be false-negative due to the complex lymphatic drainage pattern of the head/neck region as well as due to surgery-related factors. Given that a relevant number of patients experience a fatal outcome, further research in this field is required to ascertain the reliability of SLNB in cSCC and dSCC.

Uncommon ulcers in a patient with diabetes

A 52-year-old man presented at our hospital with digital ulcers on both hands, some of them showing secondary impetiginization (Figures 1, 2 ). He reported tension and stiffness in all fi ngers and diffi culty clenching his fi st. These changes were reported to have been present for over a year. He noticed worsening of the symptoms during winter, especially at work as the driver of a snowplow. The patient did not report any other symptoms such as Raynaud’s phenomenon, dyspnea, fever or fatigue. Type 2 diabetes was diagnosed many years Uncommon ulcers in a patient with diabetes Case for Diagnosis

Fumaric acid: a possible new therapy for macular edema?

IntroductionCauses of macular edema are multifactorial, but inflammation, vascular factors and mechanical traction are of major importance. Therapeutic options of macular edema depend on the underlying cause. Intravitreal administration of inhibitors of vascular endothelial growth factor leads to inhibition of retinal neovascularization and subsequent edema.ObjectiveFumaric acid esters are successfully used in dermatology for years according to their antiangiogenic and anti-inflammatory effects.ResultFor the very first time, we describe a successful therapeutic attempt for macular edema, controlled by optical coherence tomography using fumaric acid esters followed up for 60 months.