Suzanne M. Olbricht

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.

Microcystic adnexal carcinoma: report of four cases treated with Mohs' micrographic surgical technique.

Background  Microcystic adnexal carcinoma (MAC) is a rare and aggressive malignant tumor of the sweat glands. Clinically, it often presents as a firm subcutaneous nodule on the head and neck regions. On histology, MAC exhibits both pilar and sweat duct differentiation with a stroma of dense collagen. It often extends beyond the clinical margins with local spreading in the dermal, subcutaneous, and perineural tissue planes. It has a high local recurrence rate after standard excision. Recent preliminary reports have indicated more favorable cure rates with Mohs’ micrographic surgery (MMS).

Consensus for Nonmelanoma Skin Cancer Treatment, Part II: Squamous Cell Carcinoma, Including a Cost Analysis of Treatment Methods

BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in the United States. Cutaneous squamous cell carcinoma has an estimated incidence of more than 700,000 new cases per year and a 5% risk of metastasis. OBJECTIVE To provide clinicians with guidelines for the management of cSCC based on evidence from a comprehensive literature review and consensus among the authors. MATERIALS AND METHODS The authors conducted an extensive review of the medical literature on treatment methods for cSCC, taking into consideration cure rates, recurrence and metastatic rates, aesthetic and functional outcomes, and cost effectiveness of the procedures. RESULTS Surgical treatments provide the best outcomes for cSCC. Mohs micrographic surgery is a cost-effective procedure that affords the highest cure rate, maximal tissue preservation, and superior cosmetic outcomes. Nonsurgical methods may be used as a primary treatment for low-risk squamous cell carcinomas, but the cure rates are lower. CONCLUSION The cure rate remains the most important consideration in choosing the treatment method, but additional factors, such as the patients general medical condition, psychosocial circumstances, the location of the tumor and cost effectiveness of the therapy should be considered. Mohs micrographic surgery remains the preferred treatment for high-risk tumors and tumors located in cosmetically sensitive areas.

Closing surgical defects of the external ear.

Closing surgical defects of the external ear poses unique challenges because of the convoluted shape and thin tethered skin. Choice of repair is often dictated by the site of the wound. If the defect is central and anterior with intact cartilage, most defects will do well by second intention healing or grafting. If the defect involves the helical rim, reconstruction is often preferred to maintain the normal curvature of the external ear and a helical rim advancement flap with trimming of the central cartilage is often used. Defects of the posterior ear where the skin is more abundant and loose can often be closed side to side. Split earlobes may be repaired by Z-plasty. The full range of repair options should be considered in every case. Because each ear differs in shape and flexibility, creativity is warranted, rewarding both the patient and the surgeon.

Histologic Pitfalls in the Mohs Technique

The success of the Mohs procedure depends on the reliability of each step in the technique. Pitfalls in histologic preparation of the tissue specimens may occur during debulking, excising, orienting, creating the map, sectioning, inking, tissue flattening and freezing, cutting, slide fixation, staining, and mapping the tumor. Challenges are also present in interpreting the slides. Diagnostic pitfalls include floaters, inflammatory conditions resembling tumor, and perineural invasion. The technique requires time, teaching, and a sufficient quantity of cases from which to learn, as well as attention to the pitfalls that occur while processing tissue specimens and interpreting and mapping the histology.

Nodular Hidradenoma: A Report of Three Cases and Review of the Literature

background. Nodular hidradenoma is a rare adnexal tumor most likely arising from the eccrine gland. objective. We describe three cases of a nodular hidradenoma presenting as an expanding nodule on the forehead (case 1), left lower extremity (case 2), and left neck (case 3). We discuss the clinical and histologic features of this tumor and present a review of the literature. conclusions. This report highlights the salient histologic findings that distinguish nodular hidradenomas from other adnexal tumors and emphasizes the benefit of complete local excision to prevent recurrence of these tumors.

Dog Ear Island Pedicle Flap for Repair of Alar and Nasal Wall Defects

The nasal ala has a unique architecture, and its integrity must be maintained during alar reconstruction for optimal functional and cosmetic results. It is well defined and framed by the alar crease superiorly, the nasofacial sulcus and upper cutaneous lip triangle laterally, and the alar rim inferiorly. Distortion of any of these structural boundaries can produce an unnatural appearance to the ala and may prevent proper inspiration. In general, there are limited options for the reconstruction of larger defects on the ala and nasal sidewall.

Sex and leadership in academic dermatology: A nationwide survey

REFERENCES 1. Torensma B, Thomassen I, van Velzen M, In ’t Veld BA. Pain experience and perception in the obese subject systematic review (revised version). Obes Surg. 2016;26: 631-639. 2. Karayiannakis AJ, Syrigos KN, Zbar A, et al. The effect of vertical banded gastroplasty on glucose-induced beta-endorphin response. J Surg Res. 1998;80:123-128. 3. Kukkar A, Bali A, Singh N, Jaggi AS. Implications and mechanism of action of gabapentin in neuropathic pain. Arch Pharm Res. 2013;36:237-251. 4. Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: a risk factor or a risk marker? Curr Atheroscler Rep. 2016; 18:21.