PubMed Health⌕ Search

Biomedical subjects

Désirée Ratner

Publications and source records attributed to Désirée Ratner.

At least 19 recordsLinked to original sources
PubMed2006

Aggressive basal cell carcinoma with invasion of the parotid gland, facial nerve, and temporal bone.

Aggressive variants of basal cell carcinoma (BCC), such as infiltrating, morpheaform, and basosquamous types, are associated with invasion of underlying tissues and are often difficult to treat.1 BCCs located in embryonic fusion planes, such as the periauricular region, are thought to exhibit deep extension and, subsequently, high recurrence rates, although this theory has been challenged and remains controversial.2-4 Despite the known features of aggressive BCC, parotid gland invasion and temporal bone and facial nerve involvement are rarely reported occurrences. We describe two patients with morpheaform BCC in the periauricular region demonstrating direct invasion of the parotid gland and concomitant facial nerve involvement. These patients require complex surgical management, as highlighted in this report.

Aged↗
PubMed2006

Economic impact of preoperative curettage before Mohs micrographic surgery for basal cell carcinoma.

BACKGROUND: The role of curettage before Mohs micrographic surgery for basal cell carcinoma (BCC) remains controversial. Preoperative curettage may allow the surgeon to better delineate the subclinical extensions of high-risk BCCs, thereby enabling a more precise first-stage excision around tumor-containing tissue. OBJECTIVE: To assess the economic impact of preoperative curettage for high-risk BCCs treated with Mohs micrographic surgery on patients, providers, and insurers. METHODS: Given the enormous variability in practice styles, it was estimated that the time required to complete a second stage of Mohs surgery was 25, 50, or 75% of that required to complete the first stage. New York City Medicare and Standard reimbursement rates were used to approximate the cost of an additional stage of Mohs surgery for high-risk BCCs. RESULTS: Assuming that preoperative curettage increases operative efficiency by reducing the number of required Mohs stages from 2 to 1, the time saved can be quantified. Thus, if the Mohs surgeon estimates that the time required to remove a second stage is 75% of that of the first stage, the time savings with preoperative curettage equals 75% of the duration of a one-stage Mohs surgery. Similarly, when a second stage requires 50 or 25% of the time needed to complete the first stage, the time saved equals 50 or 25% of the duration of a one-stage Mohs surgery. Reducing the number of stages from 2 to 1 saves insurers and privately paying patients approximately $250 and $500, respectively. CONCLUSIONS: Whether preoperative curettage can offer a more precise first-stage excision without compromising tissue conservation remains a subject of debate. Preoperative curettage may reduce the number of Mohs surgical stages required for tumor clearance, potentially shortening patient encounters and allowing surgeons to treat additional patients, while decreasing costs for patients and insurers.

Basal Cell Carcinoma↗
PubMed2005

Composite and free cartilage grafting.

The nasal ala and helical rim of the ear are common sites for the development of skin neoplasms. Removal of skin cancers from these aesthetically delicate areas may leave defects that free skin grafts alone may not adequately repair. The contractural forces of scarring within and around the skin graft during healing may produce elevation or notching of the rim and may lead to functional compromise. The use of a composite graft or the inclusion of a free cartilage graft in conjunction with a skin graft or flap repair can provide structural support, which may help to prevent undesirable outcomes. This article focuses on the use of composite or free cartilage grafts harvested from the ear to repair nasal alar or helical rim defects within a single surgical session. Preoperative considerations, surgical technique, and postsurgical complications are discussed.

Cartilage↗
PubMed2005

Introduction to flap movement: reconstruction of five similar nasal defects using different flaps.

BACKGROUND: There are several options for closure of a given surgical defect after tumor extirpation is confirmed. Flap reconstruction is one of these options. OBJECTIVE: The purpose of this article is to introduce the three basic types of flap movement: advancement, rotation, and transposition. METHODS: Five similar defects located on the nasal sidewall were repaired, each using a different flap design. RESULTS: The optimal flap design for a given defect on a particular patient is based on the answers to a series of questions: Where is the available tissue reservoir? How can tissue be mobilized from the reservoir to cover the defect? How do the resulting tension vectors affect critical structures? Where are the final incision lines? CONCLUSION: Many factors must be evaluated before determining a method of reconstruction. Flap reconstruction requires a thorough understanding of anatomy and tissue movement.

Aged↗
PubMed2003

Skin grafting.

Knowledge of the indications, techniques, donor site considerations, and complications of all types of skin grafting is invaluable for the dermatologic surgeon who performs soft tissue reconstruction on a regular basis. With proper defect assessment, reconstructive planning, and attention to detail pre-, intra-, and postoperatively, optimal cosmetic and functional results using skin grafting techniques can be achieved.

Cartilage↗
PubMed2003

Human papillomavirus type 2 in a squamous cell carcinoma of the finger.

BACKGROUND: Human papillomavirus (HPV) type 2 is generally considered to be a benign viral infection associated with common warts. Other HPV types have been associated with the development of squamous cell carcinomas (SCCs). OBJECTIVE: To describe a case of HPV type 2 identified in a SCC of the finger in an immunocompetent patient. To our knowledge, this is the first such case reported in the literature. METHODS: This is a case report and review of the literature. RESULTS: Mohs micrographic surgery performed in two stages effectively removed the tumor. CONCLUSION: HPV type 2 may play a role in the development of cutaneous SCC. Further epidemiologic and molecular studies of HPV and SCCs will be helpful in determining the role of HPV type 2 in cutaneous oncogenesis.

Aged↗
PubMed2003

The efficacy of curettage in delineating margins of basal cell carcinoma before Mohs micrographic surgery.

BACKGROUND: Curettage may be helpful as a preliminary step to outline the gross subclinical extensions of high-risk basal cell carcinomas (BCCs) before the first stage of Mohs micrographic surgery. Although many Mohs surgeons use curettage in the Mohs surgical setting, no prospective studies have as yet been performed that demonstrate the efficacy of curettage in delineating tumor margins before Mohs surgery. OBJECTIVE: To document the efficacy of curettage in delineating BCC margins before Mohs micrographic surgery. METHODS: This was a prospective evaluation of 599 patients with biopsy-proven BCCs treated with Mohs surgery. The preoperative dimensions of each tumor, the curetted dimensions before the first surgical stage, the proposed excisional margins before each surgical stage, and the final defect dimensions after each surgical stage were measured. The maximum curetted margin around each tumor was calculated and compared with typical Mohs excisional margins of 1, 2, 3, and 4 mm. A hypothetical 1-, 2-, 3-, or 4-mm excisional margin was added to the preoperative X and Y dimensions of each tumor, and the actual final defect sizes were compared with the hypothetical final defect sizes to determine whether an additional surgical stage would have been needed had curettage not been performed. The amount of tissue stretch occurring after specimen removal was calculated to determine whether tissue stretch falsely elevated the number of instances in which an additional surgical stage would have been needed had curettage not been performed. RESULTS: The curetted margin around the observed extent of each tumor exceeded 1 mm in 87.6% of cases, 2 mm in 47.1% of cases, 3 mm in 19.7% of cases, and 4 mm in 5.7% of cases. The mean curetted margin was 1.7 mm. Taking a 1-mm margin in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.2% of cases, whereas taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 93.0%, 88.1%, and 49.4% of cases, respectively. After calculating and eliminating the effects of tissue stretch, it was found that a 1-mm excisional margin taken in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.0% of the cases. Taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 87.5%, 57.9%, and 29.5% of cases, respectively. CONCLUSION: Careful debulking and palpation with the curette significantly reduce the number of Mohs surgical stages required for BCC clearance. Even after taking the effects of tissue stretch into consideration, a significant proportion of tumors would still require an additional stage for tumor clearance without aggressive presurgical curettage.

Adult↗
PubMedDate not supplied

Keratoacanthoma.

Explore the source record for details and available documents.

Aged↗
PubMedDate not supplied

Microcystic adnexal carcinoma.

A 71-year-old woman presented with a firm flesh-colored plaque with overlying whitish discoloration that had been present on her left cheek for at least 15 years (Figure 1). The lesion measured 1.6 x 1.1 cm in diameter. The patient had a history of radiation treatment for acne. What is your diagnosis? What should be the course of management?

Aged↗
PubMedDate not supplied

Diagnosis and management of atypical fibroxanthoma.

A 90-year-old Caucasian man with a history of basal cell carcinoma and squamous cell carcinoma presented with a friable erythematous nodule on his scalp that had been present for several months. The lesion measured 1.4 x 1.8 cm. What is your diagnosis? How would you proceed?

Aged, 80 and over↗