Peter B. Odland

Detection of Human Papillomavirus DNA in Cutaneous Squamous Cell Carcinoma among Immunocompetent Individuals

The presence of certain types of human papillomavirus (HPV) is a known risk factor for the development of anogenital squamous cell carcinomas (SCCs). A similar association has been hypothesized for cutaneous SCCs, although, to our knowledge, no studies to date have combined sensitive HPV DNA detection techniques with epidemiologic data controlling for known risk factors to explore the association. We designed a case-control study examining HPV prevalence using highly sensitive PCR-detection assays in tissue samples from 85 immunocompetent patients with histologically confirmed SCCs and 95 age-matched individuals without a prior history of skin cancer. A standardized interview was administered to all study subjects to collect information pertaining to potential confounding variables. The overall detection rate of HPV DNA was high in case lesions (54%) and perilesions (50%) and in both sun-exposed normal tissue (59%) and non-sun-exposed normal tissue (49%) from controls. In comparing case tissue to control tissue, there was no differential detection of HPV DNA across various HPV species. However, HPV DNA from beta-papillomavirus species 2 was more likely to be identified in tumors than in adjacent healthy tissue among cases (paired analysis, odds ratio=4.0, confidence interval=1.3-12.0). The high prevalence of HPV DNA detected among controls suggests that HPV DNA is widely distributed among the general population. However, the differential detection of HPV beta-papillomavirus species in tumors among cases suggests that certain HPV types may be involved in the progression of cutaneous SCCs.

Immunohistochemical characterization of dermatofibrosarcoma protuberans with practical applications for diagnosis and treatment

Dermatofibrosarcoma protuberans (DFSP) is a rare, clinically challenging, soft tissue tumor. The main histologic differential of DFSP is usually a dermatofibroma. In 1990, the first report appeared demonstrating that cells of DFSP express the human progenitor antigen CD34 on their surface. Since then, there have been increasing reports of the usefulness of immunohistochemical staining with CD34 to differentiate DFSP from dermatofibroma and other soft tissue tumors. This literature is reviewed with special emphasis on the insights studies have provided into the histogenesis of DFSP. The literature demonstrating the practical applications of CD34 staining in the diagnosis and treatment of DFSP is also discussed.

Dermatofibrosarcoma protuberans (DFSP) : Growth characteristics based on tumor modeling and a review of cases treated with Mohs micrographic surgery

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare cutaneous tumor that is clinically challenging since it is locally highly invasive and aggressive, although it rarely metastasizes. Traditionally, wide and deep local surgical excision has been regarded as the treatment of choice for DFSP. However, even 3-cm-wide local excision margins have resulted in a local recurrence rate of 11%. In recent years, reports of DFSPs successfully treated with Mohs micrographic surgery have been appearing in the literature. The DFSP literature is reviewed here, including worldwide experience reported to date in the use of Mohs surgery to excise DFSPs. Using this margin control technique, the recurrence rate is shown to be 2.4%, much lower than the best previously reported recurrence rate of 11% when wide local excision was used. Three-dimensional reconstructions of DFSPs, based on Mohs micrographic surgical technique, are also presented. These illustrations provide new insight into the growth characteristics of these tumors and why Mohs micrographic surgery is emerging as the treatment of choice for DFSP.

Evidence that the p75 neurotrophin receptor mediates perineural spread of desmoplastic melanoma

BACKGROUND The desmoplastic variant of melanoma has a striking propensity for neurotropism. This neurotropism may reflect Schwannian differentiation. The migration of Schwann cells along embryonic nerves is reportedly regulated by the 75 kd neurotrophin receptor (p75NTR) and one of its cognate ligands, nerve growth factor (NGF). OBJECTIVE The purpose of this study was to test the hypothesis that the mechanism of perineural spread in desmoplastic melanomas is analogous to that of neurotropism in Schwann cells, which apparently depends on expression of p75 neurotrophin receptor and its ligands. METHODS Immunolabeling of p75NTR in histologic sections of spindle cell and desmoplastic melanomas was compared and contrasted with that of epithelioid melanomas. RESULTS The histologic material consisted of spindle cell melanoma specimens from 11 patients, of which seven exhibited features of desmoplastic melanoma. All spindle cell melanoma specimens expressed the p75NTR in at least 10% of the cells, and most expressed p75NTR in more than 50% of cells. In contrast, 10 of 11 control melanomas of conventional epithelioid phenotype expressed lower levels of p75NTR (0% to 10% of cells). CONCLUSION There is a strong correlation between expression of p75NTR and the desmoplastic phenotype, supporting the hypothesis that the propensity of these melanomas for neurotropism involves p75NTR and its ligands. Immunolabeling for p75NTR may be a useful marker for the neurotropic phenotype, as well as for detecting perineural spread in histologic sections of melanomas.

Nevi and migration within the United States and Canada: a population-based cross-sectional study

A survey to ascertain factors associated with benign melanocytic nevi or moles was conducted among randomly-selected White adults (aged 18 to 50 years) in Washington State (United States). Participants of the telephone interview in 1990–91 were questioned about lifetime places of residence and constitutional factors. Subjects counted raised nevi on their arms at the end of the survey. Logistic regression was used to examine the risk for two or more nevi compared with no nevi. Individuals who resided in warmer areas and lower latitudes than Washington State were at higher risk of having multiple nevi. This association held for residence at birth, during childhood, adolescence, and over lifetime: an odds ratio (OR) of 2.3 (95 percent confidence interval =1.2–4.3) for lifetime average daily maximum temperature of ≥64°F compared with 58.9°F, and similar ORs of 2.1 for adolescence and 1.8 for childhood. These associations remained significant after adjusting for potential confounding effects of constitutional factors and for childhood sunburns as a potential mechanism. Risk of multiple nevi was reduced for both early age at migration and longer duration of stay in Washington. These data are consistent with the importance of childhood and adolescent sun exposure in the etiology of nevi, but also suggest an effect of lifetime sun exposure.

Combination Full- and Split-Thickness Skin Grafts for Superficial Auricular Wounds

&NA; The authors have indicated no significant interest with commercial supporters.

Repair of the Philtrum: An Illustrative Case Series:

Background: Distortion of the philtrum, which lends considerable symmetry to the midface, leads to a poor esthetic outcome. Objective: This case series describes reconstructive approaches to six philtral defects after Mohs micrographic surgery. Reconstructive approaches including advancement flaps, full-thickness skin grafts, and second-intention healing are illustrated. Postoperative complications included graft hypertrophy, irregularity of the graft surface, graft color mismatch, tenderness, and slight eclabium, which improved with dermabrasion or intralesional triamcinolone. Conclusion: The reasonable success of full-thickness skin grafts demonstrated here provides an additional approach to philtral repairs, especially when combined with traditional advancement flaps.

Bilobed flap variations

Summary Bilobed flaps are useful to reconstruct defects in the lower half of the nose. Using this three-circle technique, one is sure to a create flap which is appropriate in size and rotation for the given defect because its design is dictated by the location of donor tissue. The overall configuration of the three-circle bilobed flap is similar to previous descriptions. However, the design is conceptually different because one is able to choose from a variety of flaps with a gradation of rotation or advancement characteristics.

Healing by secondary intention

Healing by secondary intention is a time-honored alternative to primary reconstruction of cutaneous wounds. In fact, there are situations in which this may be the preferred approach. An understanding of wound healing is fundamental to making surgical decisions regarding repair of any wound, particularly those in which healing is allowed to occur by secondary intention (or granulation). Preoperative patient education is important. It serves to allay the anxiety and concerns patients tend to have regarding an open wound, to insure that there will be adequate wound care to effect an uneventful and timely course of healing, and to preoperatively identify those patients who for several reasons may not be good candidates for secondary intention healing. Although granulation is a reasonable alternative for managing cutaneous wounds of the head and neck, selection of appropriate location and size reliably produces results that are both functionally and cosmetically acceptable. Perhaps the most attractive aspect of secondary intention healing is that virtually any time during the healing process, one has the option to surgically reconstruct the residual defect.