R. Stan Taylor

Constitutive absence and interferon-γ-induced expression of adhesion molecules in basal cell carcinoma

Adhesion of lymphocytes to target cells via certain cell surface molecules is important in cytotoxic T lymphocyte-mediated immune reactions. The binding of lymphocyte function-associated (LFA) antigens 1 and 2, with their respective ligands, intercellular adhesion molecule-1 (ICAM-1) and LFA-3, which are expressed on the surface of nonlymphoid cells, has been shown to be critical for lymphocyte adhesion. To determine whether basal cell carcinomas (BCCs) can escape immunodetection as a result of the inability of cytotoxic T lymphocytes to bind tumor cells, the expression of adhesion molecules on numerous BCCs, before and after exposure to interferon-gamma (IFN-gamma), was examined. Ninety-three percent of 30 freshly excised invasive BCCs did not express ICAM-1 and 73% of 11 BCCs did not express LFA-3. However, the normal-appearing basal keratinocytes in epidermis overlying nests of BCC, did express ICAM-1, particularly when a marked LFA-1+ and LFA-2+ dermal lymphocytic infiltrate was present. After BCC tissue was incubated in vitro with IFN-gamma the expression of ICAM-1 was induced on 85% of tumors studied. Thus tumor cells did not possess an absolute inability to express adhesion molecules; rather the constitutive absence of such molecules may be due to insufficient in vivo cytokine levels necessary to induce expression or a barrier preventing cytokines from reaching and interacting with tumor cells. We conclude that the absence of ICAM-1 and LFA-3 adhesion molecules is a mechanism by which BCCs can avoid immunosurveillance.

Chondrocutaneous advancement flap for reconstruction of helical rim defects in dermatologic surgery

The helical rim is often affected with cutaneous malignancies and requires special attention in the repair, owing to the complex cartilaginous contour, preservation of the aesthetic contour and restoration of its supportive function for eyeglasses and hearing aids. We review the surgical technique of chondrocutaneous advancement flap described by Antia and Buch as one of the most cosmetically appealing and versatile approaches for the repair of small defects of the ear helix.

Mohs Micrographic Surgery of the Eyelid: An Overview of Anatomy, Pathophysiology, and Reconstruction Options

Background Mohs micrographic surgery (MMS) is the ideal treatment for skin cancer removal. The advantages of MMS in the eyelid area include its high cure rate, tissue‐sparing effects, and overall cost effectiveness. Objective To review eyelid anatomy, detail ocular tumors that are amenable to MMS, and examine the surgical repair options commonly used in this area. Materials and methods A review of the literature on MMS of the eyelid was performed with specific reference to ocular anatomy, eyelid malignancy types, and surgical reconstruction. Conclusion Eyelid function is critical for the maintenance of ocular health and vision. MMS is an ideal skin cancer treatment for the delicate structure of the eyelid, where maximal tissue preservation is critical. There are a plethora of reconstruction options to consider after MMS has been performed in this area. The choice of repair and surgical outcome depend, in part, on the surgeons knowledge of eyelid anatomy and his or her ability to assess the repair requirements of the post‐MMS defect. Dermatologic surgeons can effectively work with other specialists to help ensure that their patients receive a cure with restored ocular function and optimal cosmesis.

Mohs Micrographic Surgery for Penoscrotal Malignancy

Mohs micrographic surgery (MMS) has been shown to reduce recurrence rates when used to excise many different mucocutaneous neoplasms, especially of the head and neck. The low recurrence rates are due to careful microscopic evaluation of the horizontal and vertical surgical margins. This article discusses the utility and limitations of MMS in controlling neoplasia of the male genitalia. Specific penoscrotal neoplasias discussed in this article include invasive and in situ squamous cell carcinoma, basal cell carcinoma, extramammary Paget disease, and granular cell tumor.

A Novel 2-Hour Method for Rapid Preparation of Permanent Paraffin Sections When Treating Melanoma In Situ with Mohs Micrographic Surgery

BACKGROUND Distinguishing sun-induced melanocyte atypia from residual melanoma in situ (MIS) can be challenging, particularly when working with frozen sections. Immunostains such as melanoma-associated antigen recognized by T cells (MART-1) can assist, but paraffin sections provide an optimal means of analyzing melanocyte morphology. OBJECTIVE To verify the effectiveness of a 2-hour paraffin processing technique that uses microwave technology in the preparation of MIS sections. METHODS Twelve MIS debulk specimens were divided into 4 pieces with each piece processed 1 of 4 ways: our 2-hour paraffin technique with hematoxylin and eosin (H&E), conventional 24-hour paraffin processing with H&E, frozen sections with H&E, and frozen sections with MART-1 immunostaining. A Mohs surgeon and a dermatopathologist compared all specimens in a blinded fashion using a 3-point ranking scale to assess ease of visualizing normal melanocytes, ease of visualizing abnormal melanocytes, and overall ability to adequately visualize epidermal and dermal structures. RESULTS A nonparametric signed rank test indicated no significant differences between our microwave technique and conventional paraffin processing in all 3 criteria (p=.29, .63, .75, respectively). Our microwave technique was significantly better than frozen H&E sections for all 3 criteria (p=.046, .004, .005, respectively). CONCLUSION This rapid microwave tissue processing technique is comparable with conventional paraffin section processing.

Solid Organ Transplant Recipients Presenting for Mohs Micrographic Surgery: A Retrospective Case–Control Study

BACKGROUND Solid organ transplant recipients (SOTR) have a high risk of cutaneous malignancy. Mohs micrographic surgery (MMS) is recommended for the treatment of skin cancers in this group. The characteristics of the tumors in SOTR presenting for MMS are not well documented. OBJECTIVE To describe the characteristics of tumors in SOTR presenting to a single institution over an 11‐year period and compare them with tumors of non‐SOTR who have also undergone MMS. METHODS A database query captured patients with a current organ transplant who underwent MMS. These patients (cases) were matched to controls who also underwent MMS. Statistical models were used to identify tumor and operative characteristics significantly associated with SOTR compared with matching controls. RESULTS Ninety‐two SOTR underwent MMS for 432 skin cancers; 163 controls had 269 skin cancers. Squamous cell carcinoma (SCC) was the most common tumor in SOTR, with a reversal of the usual ratio of basal cell carcinoma to SCC. Mean tumor and defect sizes were similar in SOTR and controls. Cardiac transplants were the predominant transplant. CONCLUSIONS SOTR referred for MMS have disproportionately more and different types of skin cancers than controls.

Expandable Desiccated Ear Wicks Aid in Skin Graft Reconstruction of the External Auditory Canal After Mohs Micrographic Surgery

Reconstruction of the external auditory canal and conchal bowl after Mohs micrographic surgery is a challenge for the surgeon. The concavity of these structures predispose fulland splitthickness skin grafts to ‘‘tenting’’ and failure of the graft to intimately appose to the recipient site. Bolster dressings composed of foam or cotton wrapped in petrolatum gauze are typically used to compress a skin graft into the recipient site and enhance a graft’s eventual survival during the wound healing phases of imbibition and neovascularization. Bolster dressings also minimize the likelihood of tenting and hematoma formation beneath a graft, which can compromise its survival.