Victor J. Marks

Calcinosis cutis associated with syringomas: a transepidermal elimination disorder in a patient with Down syndrome.

Several cutaneous disorders have been associated with Down syndrome. An increased frequency of syringomas and of elastosis perforans serpinginosa, a transepidermal elimination disorder, have been described. We report the first case of the simultaneous occurrence of transepidermal elimination of calcium associated with syringomas in a patient with Down syndrome who had lesions clinically suggestive of milia.

Hyperpigmentation in megaloblastic anemia

Generalized hyperpigmentation developed over 2 years in a 65-year-old woman. A diagnosis of pernicious anemia was made, and treatment with vitamin B12 led to complete reversion of her hyperpigmentation to normal. Literature pertinent to hyperpigmentation and its association with megaloblastic anemias is reviewed and several possible mechanisms are mentioned.

The Chondrocutaneous Helical Rim Advancement Flap of Antia and Buch

background The cutaneous surgeon commonly encounters defects of the helix, as 2–4% of all skin cancers occur at this site. objective We report our experience with 47 patients using the chondrocutaneous helical rim advancement flap of Antia and Buch. methods Incisions are made from the defect inferiorly into the lobule and, when necessary, superiorly along the helical sulcus into the helical crus. The postauricular skin is extensively undermined to allow maximal movement of the resulting broad‐based, well‐vascularized flap(s). results We experienced very favorable results using this technique with our patients. No necrosis due to ischemia occurred in any of our cases. Hematomas formed postoperatively in two patients, but healing proceeded uneventfully after removal of coagulated blood. conclusion This technique is an excellent method of repairing many defects of the helical rim. Its advantages include technical simplicity, little risk of tip necrosis, patient convenience, and superior cosmesis.

Alar Rotation Flap for Small Defects of the Ala

Background. Surgical defects of the alar lobule can be difficult to repair with aesthetically pleasing results. Full‐thickness skin grafts are often smoother than the sebaceous skin of the ala. Random patterned flaps from the cheek or proximal nose usually bridge and obliterate the supra‐alar crease and may cause nasal valve malfunction. Objective. We describe and illustrate a technique to repair subtotal alar lobule defects within the cosmetic unit of the alar lobule. Methods. Twenty‐three consecutive alar lobule rotation flaps for repair of Mohs surgical defects were reviewed by patient examination and interview. Results. Twenty‐one of 23 patients were contacted. Patients rated cosmetic results as excellent (18), good (2), or fair (1), and no patients graded their results as poor. Six patients reported “a little” breathing difficulty in the postoperative period that resolved within 6 months. Anesthesia reported by 11 of 21 patients resolved within 5 years in 8 of 9 patients available for follow‐up. Conclusion. Rotation of the ala combined with cheek advancement is a cosmetically pleasing and functional method to repair deep defects of the ala.

Academics or Private Practice? The Future of Dermatologic Surgery Education

BACKGROUND The career choices of Mohs fellows have important implications for ensuring the quality of dermatologic surgery training during residency. No published data examine the career choices of fellows in Mohs micrographic surgery. OBJECTIVE To determine the number of Mohs fellows entering academics and to examine the influence of fellowship characteristics, scholarly activities, and personal background on career decision. METHODS A voluntary survey was distributed by mail in June 2004 to all Mohs fellows-in-training during 2003–2004. RESULTS Twenty-nine percent (12 of 42) of the fellows chose jobs in an academic or university setting. The practice setting of the fellowship, personal factors, and scholarly activities prior to fellowship did not correlate with career decision. By contrast, increased scholarly activities during fellowship and an interest in teaching did correlate with the choice to enter academics. CONCLUSIONS A significant percentage of Mohs fellows pursued academics. Increased academic productivity during the fellowship and an interest in teaching correlated with the decision to pursue an academic career. Fellowship directors interested in encouraging academic careers may find these data useful to structure their curricula and to mentor fellows inquiring about academic careers.

Subcutaneous forehead nodules: attention to the button osteoma and frontalis-associated lipoma.

Historical descriptions of forehead nodules date to coins from 57 to 37 BC. Bearing the images of the kings of Parthia, some of these show monarchs with what would have been 1- to 1.5-cm forehead nodules.1 Other portrait-capturing images since then, such as paintings and sculptures, have shown indiv

Complications of tissue ischemia in dermatologic surgery

Ischemic complications in cutaneous surgery can be devastating. Tissue ischemia can result from improper technique or closure design (i.e., increased tension), inadequate hemostasis, or infection, all of which result in decreased blood supply to the surgical site. Knowledge of patient characteristics that affect blood supply to the surgical site, including comorbid conditions, medications and behaviors (i.e., tobacco and alcohol use), is essential. Also, a thorough understanding of cutaneous anatomy, principles of surgical design, coupled with meticulous technique will minimize the likelihood of ischemic complications. Prompt recognition of hematoma, infection and impending ischemia/necrosis, and proper treatment of such complications, can minimize poor outcomes.

Excision of a Peristomal Basal Cell Carcinoma Using Mohs Micrographic Surgery

Although basal cell carcinoma (BCC) usually arises on sun-exposed areas such as the head and neck, it has been reported in unusual sites including the anus, areola, axilla, buttock, penis, scrotum, 5 hand, and male nipple. A review of the literature revealed only one previously reported case of BCC arising in association with a colostomy. Herein, we report the second case of a peristomal BCC. However, Mohs micrographic surgery (MMS) was used instead of wide excision, as in the first reported case.

Circumscribed Acral Hypokeratosis: Successful Treatment of a Potentially Premalignant Condition

C ircumscribed acral hypokeratosis (CAH) is a rare benign dermatosis of unknown origin first described in 2002. This uncommon dermatosis is seen predominantly on the palms of adult women with a mean age of 65 years. Lesions have a predilection for the thenar or hypothenar eminence of the predominant palm and less frequently on the soles. Typically, the lesions are solitary, but multiple lesions have been reported. Circumscribed acral hypokeratosis has characteristic clinicopathologic features and runs a chronic course. Histologically, the lesions show a classic abrupt decrease in the thickness of the stratum corneum, forming a sharp stair between normal and involved acral skin. The lack of epidermal atypia or cornoid lamellae clearly differentiates CAH from its clinical mimics, Bowen disease and porokeratosis. Circumscribed acral hypokeratosis is generally considered a benign condition, but Kanitakis et al recently reported a case of CAH that underwent premalignant transformation and hypothesized that the absence of the horny layer rendered the underlying keratinocytes susceptible to photocarcinogenesis. This report emphasized the need for close follow-up and suggested that treatment of CAH lesions may be useful to prevent malignant transformation. We describe herein a patient who experienced a sustained complete clinical response after treatment with liquid nitrogen cryotherapy.

Primary Cutaneous Lymphoepithelioma‐Like Carcinoma Treated Using Mohs Micrographic Surgery and Zinc Chloride Fixative

Lymphoepithelioma arises from the nasopharyngeal region and histologically consists of malignant undifferentiated non-keratinizing epithelium associated with a dense lymphoid infiltrate. Lymphoepithelioma-like carcinoma (LEC) is a neoplasm with similar histologic features at extranasal sites, where primary cutaneous localization is uncommon. The neoplasm has a small tendency for local relapse and infrequently metastasizes. Herein, we describe a case of primary LEC of the skin treated with Mohs micrographic surgery (MMS) and further highlight the first reported use of zinc chloride fixative as an adjuvant therapy for clearance of this tumor.