Richard A. Krathen

Cutaneous metastasis: A meta-analysis of data

Background Previous studies of the incidence and the most common causes of cutaneous metastasis have not led to a consensus. We compiled data from many retrospective studies and from patient data registries and autopsies to increase the total number of cases available for a larger analysis of this subject. This study was conducted to gain a better understanding of the true incidence of cutaneous metastasis, the tumors most commonly involved in this presentation, and the locations of such lesions. Methods A meta-analysis of cutaneous metastases from patient tumor registries and autopsic studies was performed. Results The overall incidence of cutaneous metastasis is 5.3%. The most common tumor to metastasize to the skin is breast cancer. The chest is the most common site of cutaneous metastasis. Every practitioner should be highly suspicious of acute-onset, persistent, firm papulonodules, especially when they develop on the chest. Conclusion This meta-analysis greatly increases the total number of cases available for the analysis of cutaneous metastases and provides a better overall view of this topic than was previously possible.

Island Pedicle Flap for Alar Defects

Island pedicle flaps used to repair nasal defects have been well described. In 1983, Rybka described a supratip nasal defect repair for defects up to 1.25 cm using a laterally based myocutaneous island pedicle flap. This flap depended on branches of the angular artery that supply the nasalis muscle. This flap was described as a ‘‘traditional’’ or ‘‘classic’’ island pedicle flap, in which the blood supply is directly below the island of moving skin. Constantine used a similar technique for defects up to 1.5 cm. Wee and colleagues, in 1990, refined the nasal myocutaneous reconstruction using Z-plasty, early dermabrasion, and placement of a bolster. All of these flaps describe repair of defects located superior to the alar groove with a classic island pedicle.

Disseminated superficial actinic porokeratosis in black skin.

A 54-year-old black-American woman with a history of rheumatoid arthritis treated with methotrexate for 2 years presented with a 1.5-month history of occasional pruritic lesions which abruptly appeared on the legs and later involved the trunk. The patient reported that the lesions were initially scaly and left a dark mark behind as the scale diminished. There was no family history of similar lesions. On physical examination, there were numerous 4–6-mm hyperpigmented macules with an elevated thread-like keratotic border and a minimally atrophic center on the bilateral lower extremities (Fig. 1). A shave biopsy was performed. Histology showed columns of porokeratosis at both edges with dyskeratosis underneath. The central portion was minimally atrophic with attenuation of the rete ridge pattern and scattered dermal melanophages (Fig. 2).

Obtaining thin and complete Mohs layers using the methylene blue staining technique.

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