Ken K. Lee

Biopsy techniques Diagnosis of melanoma

The biopsy of a suspicious pigmented lesion is critical to establishing a correct and complete diagnosis. It allows the dermatopathologist accurately to diagnose melanoma and to gauge maximum depth of invasion (and other histologic criterion). This, in turn, influences the extent of further necessary surgery or other adjuvant therapy. Furthermore, choosing the appropriate biopsy technique provides adequate cosmetic results, bearing in mind that the excisional technique is ideal because it removes the suspicious lesion en toto. Excisional biopsies should extend to the subcutaneous fat by means of a punch biopsy, a fusiform ellipse, or a saucerization. Incisional biopsies can be performed in certain circumstances, but should be done so with caution because sampling error may lead to missed diagnosis or inaccurate histologic criterion, such as depth.

Modified Single-Sling Myocutaneous Island Pedicle Flap: Series of 61 Reconstructions

BACKGROUND Bilevel undermining above and below the transverse nasalis muscle in the construction of a myocutaneous island pedicle flap produces a bilateral or unilateral muscular sling with exceptional vascular supply for reconstruction of defects on the distal nose. We present further modification of the single-sling myocutaneous island pedicle flap that expands its application to a wide variety of nasal defects and further defines its usefulness in nasal reconstruction. METHODS A series of 61 consecutive myocutaneous island pedicle flap reconstructions performed after Mohs surgery between March 2005 and July 2006 are presented. Flap modifications are presented, and advantages and limitations are discussed. RESULTS Flap modifications introduce additional reach and rotational mobility to the flap that permit extension of the flap to defects on the nasal tip and distal ala. CONCLUSION Modifications of the bilevel approach to the single-sling nasalis myocutaneous island pedicle flap further define its practicality in nasal reconstruction and expand its application to a variety of nasal defects.

Fusiform Elliptical Burow's Graft: A Simple and Practical Esthetic Approach for Nasal Tip Reconstruction

BACKGROUND Reconstruction of cutaneous nasal tip and supratip defects presents a common challenge in which esthetic outcomes are dependent on appropriate flap or graft selection and execution. OBSERVATION We describe the fusiform elliptical Burows graft, a modified full-thickness skin graft, for repair of moderately sized nasal tip and supratip defects. It has the advantage of being a one-stage procedure with incisions and undermining similar to a primary closure. This technique allows the defect to become smaller in size and shallower in depth while taking the shape of a fusiform ellipse confined to a single cosmetic subunit. The color and texture match of the adjacent Burows skin graft combined with its fusiform elliptical shape allow it to blend in more naturally with the nasal tip contour compared with the traditional circular-shaped Burows graft, which is typically used on the nose. CONCLUSION The fusiform elliptical Burows graft is a simple, reliable, easily reproducible, and esthetically pleasing technique for repair of defects on the nasal tip and supratip.