Senait Dyson

Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior.

Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.

Infantile systemic hyalinosis: Case report and review of the literature.

Infantile systemic hyalinosis (ISH) is a rare, progressive autosomal recessive disease, which is usually fatal by the age of 2 years. Clinical onset typically occurs within the first few weeks of life. The disease is characterized by joint contractures, osteopenia, failure to thrive, gingival hypertrophy, diarrhea, protein-losing enteropathy, and frequent infections. Dermatologic manifestations include thickened skin, hyperpigmentation, perianal nodules, and facial papules. Histopathology shows hyaline deposits in the dermis and visceral organs. We describe a patient with ISH confirmed by clinical and histopathologic findings, as well as DNA sequence analysis, which revealed a novel homozygous T118K mutation in the CMG2 gene.

Nonmelanoma skin cancer of the head and neck II: surgical treatment and reconstruction

Surgical treatment of non-melanoma skin cancers (NMSC) is most often straight forward and can be performed as an office-based procedure by non-surgically trained professionals. However, the cases that present to an Otolaryngology practice typically will involve difficult-to-treat lesions around the face and lesions that necessitate an in depth knowledge of how to balance the need for adequate surgical margins with the reconstructive contraints imposed by aesthetic subunits of the face. This article discusses modern concepts of surgical margins for NMSC, including the Mohs micrographic surgical technique, and then reviews the most common reconstructive strategies for difficult-to-treat areas on the face. The goal of this paper is to help the general Otolaryngollogists to understand the basic principles of surgical resection and reconstruction of NMSC lesions on the face.

Langerhans cell histiocytosis mimicking malignant melanoma: a diagnostic pitfall.

Langerhans cell histiocytosis (LCH), especially with an involvement limited to the skin, is a rare entity in adults. In formulating a differential diagnosis of a solitary skin lesion, LCH is rarely considered. Morphologically, cells seen in LCH can mimic those seen in a melanocytic tumor; moreover, they both show S-100 protein reactivity with immunoperoxidase staining. A 63-year-old male presented to a dermatology clinic with a solitary hyperpigmented macule on his right calf. A biopsy specimen showed epithelioid cells within the dermis, singly and in small groups, surrounded and infiltrated by collections of histiocytes and lymphocytes. These cells were diffusely positive for S-100 and negative for Melan-A. A diagnosis of malignant melanoma, spitzoid variant, was rendered, and the patient was sent to our melanoma center for surgical treatment. On histologic examination, some of the lesional cells had reniform, vesicular nuclei with central grooves. Additional immunoperoxidase staining showed strong, diffuse positivity for CD1a, supporting the diagnosis of LCH. LCH is morphologically similar to and can be misdiagnosed as malignant melanoma. It is important to be aware of this pitfall and utilize immunohistochemical and ultrastructural analysis to achieve correct diagnosis.

Chronically painful right thumb with pustules and onycholysis

A 67-year-old woman presented with a 5-year history of a chronically tender right distal thumb with pustules and nail dystrophy. She described recurrent episodes of pain and purulent discharge of her thumb and occasionally other digits. For years, these periods of discomfort had resolved with use of topical steroids, but most recently, the eruption on her thumb had been prolonged, and treatment with azithromycin and topical steroids had not improved her condition. She had no history of other skin disorders. On examination, the right distal thumb was found to be tender to palpation. The nail bed and surrounding tissue were erythematous and oedematous, with extensive onycholysis. A well-circumscribed erythematous plaque with scale, fissures, lakes of pus and clear exudate extended beneath the lytic nail. The patient had no other skin lesions (Fig. 1).

Novel cryoprecipitate for wound healing and skin grafts in rats.

The authors sought to evaluate the ability of locally administered enhanced cryoprecipitate (eCryo) to improve the wound healing of split thickness skin grafts (STSG) and their donor sites. An STSG (5 × 5 cm) was harvested on the back of 30 rats and divided into four areas that were then treated in one of the following groups: A: ‘standard’ dressing without STSG; B: eCryo without STSG; C: eCryo with STSG coverage and D: STSG alone. Macroscopic and histological assessments (histomorphometric grading scale and cellular composition) were evaluated at days 7, 14, 21 and 28 for wound healing. All wound beds as well as STSGs healed well without any complications. Eighty per cent of the STSG showed a histological graft take of >75% after 28 days. There were no statistically significant differences of macroscopic or histological results between the groups at any time point. Preparation of eCryo is easy and effective. Its use as an adhesive for STSGs is safe and shows similar results as controls. The theoretical benefits of eCryo did not show significant differences. Possible reasons as well as important findings for future research on wound healing are discussed.

Erythematous, eczematous papules appearing in the spring

A 6-mm punch biopsy was taken. The chief histological findings were the presence of minimal papillary dermal oedema, and dense superficial and mid-dermal perivascular infiltrate. The infiltrate was composed predominately of lymphocytes (Fig. 2). The epidermis showed atrophy and focal spongiosis with associated exocytosis of lymphocytes and vacuolar degeneration of the basal layer (Fig. 3). Inflammation around adnexal structures and dermal mucin deposition were not present.

An indurated, enlarged lower lip

A 58-year-old woman presented with a 4-month history of increasing oedema, xerosis, pruritus and pain of the lower lip. She had been previously treated with a course of prednisone for several days without improvement. On physical examination, the lower lip was significantly larger than the upper lip (Fig. 1) and was indurated. Further questioning revealed that the patient had received an injection of silicone into her lower lip 15 years previously while in Vietnam.