Paolo Boggio

Selective release of cytokines, chemokines, and growth factors by minced skin in vitro supports the effectiveness of autologous minced micrografts technique for chronic ulcer repair.

A new effective surgical procedure to repair chronic ulcers called minced micrografts technique has been recently reported. The technique consists in spreading a finely minced skin sample upon the wound bed. In this study, we investigate the in vitro release of cytokines (interleukin‐6, tumor necrosis factor‐α, interleukin‐1α, and granulocyte‐colony stimulating factor), chemokines (monocyte chemoattractant protein‐1 and growth‐related oncogene‐α), and growth factors (platelet‐derived growth factor, basic fibroblast growth factor, vascular endothelial growth factor, hepatocyte growth factor, and nerve growth factor) by minced (referred to as the minced sample) vs. not minced (referred to as the whole sample) human skin biopsy samples from the same donor. Factor release in the culture medium at different time points was detected using a multiplexed protein assay. The minced sample, which could behave like the skin fragments used in vivo in the autologous minced micrografts technique, expressed higher levels of tumor necrosis factor‐α, interleukin‐1α, platelet‐derived growth factor, and basic fibroblast growth factor, and lower levels of interleukin‐6, monocyte chemoattractant protein‐1, growth related oncogene‐α, and vascular endothelial growth factor compared with the whole sample. In conclusion, mincing of healthy skin may allow appropriate regulation of the inflammatory phase of wound healing and could induce overexpression of some growth factors, which facilitates the proliferative phase of healing.

Eosinophilic granules in subcutaneous fat necrosis of the newborn: what do they mean?

To the Editor, We have read with great interest the article entitled Subcutaneous fat necrosis of the newborn with eosinophilic granules’ published in issue number 34, 2007, of the Journal of Cutaneous Pathology’. In the article the Authors describe a particular histological picture whereby normal adipocytes have been replaced by multinucleated giant cells containing eosinophilic granules. They hypothesized that this finding may have resulted from the release of eosinophilic substances from surrounding eosinophils. We would like to report a similar case that we saw about 10 months ago. A newborn, with a history of difficult delivery followed by transient brain hypoxia who was placed in a hypothermic environment to prevent organ damage because of the secondary hyperperfusion, developed erythematous and violaceous nodules on the neck and back (Fig. 1). Biopsy of a back lesion showed that the normal subcutaneous fat was the site of massive fat necrosis with a heavy inflammatory and foreign body type giant cells infiltrate (Fig. 2). Many of the remaining fat cells, as well as the giant cells contained needleshaped clefts on light microscopy, often lying in a radial arrangement and in some of them eosinophilic granules were present (Fig. 3). No calcium deposits were found. The newborn had no hypercalcemia, nor seizures or other complications described in literature, either at the onset or after 6 months when the lesions had clinically completely resolved. The origin of these granules is still unknown, Tajirian et al. calling for more research to explain their possible pathogenetic role in this condition. For Tajirian et al., the presence of eosinophilic granules in the lesions may point to some commonality between SCFN and other entities such as eosinophilic cellulitis, Churg-Strauss syndrome, etc. In many cases, these affections are accompanied by eosinophilia. This, however, was not observed in our case but it would be interesting to know if the newborn described in Tajirian’s article had

Basal Cell Carcinoma of the Nipple in a Male Patient: A Particular Case Report.

Basal cell carcinoma (BCC) is a common skin cancer worldwide. However, BCC of the nipple and areola complex is rare. Men are more affected than women. Most of the cases were treated with simple excision. We report a case of BCC of the right nipple–areola complex in a 75‐year‐old man, treated with Mohs surgery and simple mastectomy.

Reconstruction of scalp defects with exposed bone after surgical treatment of basal cell carcinoma: the use of a bilayer matrix wound dressing.

Treatment of scalp defects after tumor resection or traumatic events is a challenging problem. Large defects with loss of soft tissue down to the bone require complex reconstructive options, including tissue expansion, local and distal scalp flaps, and free split thickness skin graft. Nonetheless, these techniques are often disfiguring and are limited by the relatively poor elasticity and vascularity of scalp tissues after recurrent resection or previous irradiation. Moreover, comorbid conditions among elderly patients often limit anesthetic tolerance and the use of distant flaps. We report a case of a 75‐year‐old woman with large tissue loss and bone exposure after Mohs micrographic surgery of basal cell carcinoma of the scalp which was successfully rebuilt through the use of a skin substitute. We describe the uncommon use of a bilayer matrix wound dressing as a single procedure option for the management of full‐thickness scalp defects with bone exposure.

Stewart–Treves Syndrome of the Breast after Quadrantectomy for Breast Carcinoma

multiple nodules. Also, some case reports have demonstrated an association of a breast mass and lung nodules at the time of diagnosis as in the present case. The radiological appearance has been described by some authors as an ill-defined irregular mass or focal asymmetric density on a mammogram that is suspicious for carcinoma and as an irregular hypoechoic nodular mass or mass with parenchymal mixed echogenicity, consistent with mastitis or abscess on ultrasound examination. However, none of these cases was associated with a tumor mass and included pleomorphic microcalcifications. This is the first case in the published literature in which microcalcifications are present within a suspect breast mass on mammography. Wegener’s granulomatosis of the breast needs to be reconsidered in the differential diagnosis of a single breast mass associated with microcalcifications and multiple associated lung nodules, especially in patients in which the clinical history is unknown or in patients diagnosed by using a small tissue fragment from a core biopsy, as in this case. Several inflammatory entities need to be excluded before making the diagnosis of Wegener’s granulomatosis of the breast, but especially, in cases of a breast mass associated with microcalcifications on mammography, an invasive and/or in situ carcinoma has to be excluded through microscopic examination. This emphasizes the importance of clinical features and clinic-pathologic correlations in establishing the diagnosis.

“Opposite semilunar” variant of Burow triangle in rotation and advancement flaps.

AbstractThe Burow triangle is an expedient suitably conceived either to facilitate sliding of the flap and avoid folds due to differences in skin distension or to correct coaptation of 2 cutting edges with a different length. In some cases, the triangle cannot be drawn in the right position either because of a particular anatomic site, for example, in proximity to commissures and openings, or because it is contraindicated to avoid unwelcome scar lines. In these cases, a semilunar ablation opposite to the direction of Burow triangle could be a valuable alternative. We report 3 cases where the opposite semilunar variant of Burow triangle was used in critical areas of the face.

Full-thickness triangular advancement flap for the closure of lateral upper lip defects.

A 50-year-old woman was admitted to the Department of Dermatology for a basal cell carcinoma involving more than one-third of the left upper lip. Clinically, the preoperative size of the lesion was approximately 2 2 cm. The lesion had an irregularly shaped patch appearance, with a crusted surface delimited by smooth, translucent, and slightly raised erythematous borders (Figure 1). When taking into account also the considerable subcutaneous and muscle infiltration as a palpable area, the diameter of the lesion reached 2.5 cm.