Richard G. Bennett

Squamous Cell Carcinoma Arising in a Nevus Sebaceous of Jadassohn in a 9‐Year‐Old Girl: Treatment Using Mohs Micrographic Surgery with Literature Review

Jadassohn first described nevus sebaceous of Jadassohn (NSJ), a localized skin malformation, in 1895. Mehregan and Pinkus outlined three clinical stages of NSJ development. During the first stage, in infancy and childhood, the NSJ usually appears as a smooth, alopecic, orange-yellowish skin thickening. A second stage occurs in puberty, when the NSJ thickens and contains verrucous papules, plaques, or both. A third stage may occur in adulthood characterized by development of benign and malignant tumors in the original nevus.

Simultaneous subungual melanoma in situ of both thumbs

been reported. Granulation tissue in palbebral conjunctivae during retinoid therapy has never been described in the literature and although the temporal association between acitretin use and development of granulation tissue in our case is suggestive of etiology, a case report is not sufficient to prove it. The patient had a pustule on his nose that might suggest a diagnosis of rosacea. If the patient had rosacea, the granulation tissue could be secondary to a combination of ophthalmic rosacea complicated by the oral retinoid. However, because the patient had no other signs or symptoms of rosacea, we propose that the single pustule represented a folliculitis. The excess granulation tissue reported with retinoids usually appears after 3 to 12 weeks of therapy, but there are reports in which the reaction appeared 6 months after beginning therapy, and even after the withdraw of the drug because of the long elimination half-life of etretinate. In our patient, the lesions developed 12 weeks after starting the therapy, in accordance with literature on the subject. The reaction may resolve spontaneously after the discontinuation of therapy or after reduction of the dose, suggesting that the reaction is adose-dependent effect. In our patient, the lesions spontaneously resolved 40 days after withdrawal of the drug.

Intraoral Extraction of Cheek Skin Cyst

Background When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. Objective To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. Method An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. Result The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. Conclusion A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin.

Instrumentation for cosmetic surgery

Abstract Dermatologists have always been concerned with aesthetics, especially as it relates to the skin and body contours. The role of the dermatologist has involved primarily medical treatments of surface aesthetic defects, such as the development and refinement of skin care products, collagen and silicone (for implantation), and chemoexfoliation agents. During the past few decades, surgical techniques have become more widely used for the correction of aesthetic defects, and dermatologists have contributed to the development of such techniques. This chapter will review instrumentation used in cosmetic surgery procedures, including hair transplantation and scalp reduction, liposuction and lipoinjection, and dermabrasion. A discussion of the carbon dioxide, argon, and other types of lasers is beyond the scope of this chapter. A complete review of instruments routinely used for cosmetic surgery, including their proper care and maintenance, appears elsewhere. 1

Adamantinoid basal cell carcinoma: a predictor of more aggressive clinical behavior.

We were pleased to see the article by Berk and colleagues on adamantinoid basal cell carcinoma (BCC). We agree with their main points that this subtype of BCC has been overlooked in the literature and that it usually requires a larger excision for clearance by Mohs micrographic surgery (MMS) than is appreciated clinically, but we felt that the method of their study was fraught with error. In their methods section, the authors compare a group of 44 adamantinoid BCCs with a control group of 445 BCCs, all of which presented sequentially for MMS. Thus, the control group must have consisted not only of nodular BCCs, but also of infiltrative and morphealike BCCs. The latter two subtypes, as the authors acknowledge, are aggressive BCC subtypes. Furthermore, in our Mohs practice, not only are these aggressive BCC subtypes common, 24% of the time the first stage of MMS shows no tumor. Thus, in the control group, the subtypes of the “unseen” BCCs were not known, nor were the percentage of aggressive subtypes stated. Perhaps the authors were only controlling against nodular BCCs, but this is not mentioned in the article and would be improbable anyway because the control group was a sequential cohort. Furthermore, any subtyping of the control group would have needed to have been done at the time of MMS, as was the case in the adamantinoid BCC group. If there was no well-defined control group of non-aggressive or aggressive BCCs, we believe it is difficult to draw meaningful conclusions from their data shown in Table 1.

Mohs Surgery for Periungual and Subungual Skin Cancer

Mohs surgery for a malignancy in the periungual and subungual location is advantageous because it is a tissue-sparing technique that preserves maximum function and normal appearance. Traditional surgical treatment for such tumors is wide local excision and closure; in some cases, amputation of the digit is considered. The amount of tissue removed with these standard surgical treatments may be quite debilitating for the patient. Often, Mohs surgery will preserve a significant amount of nail matrix so that an almost normal-appearing nail regrows.