Biomedical subjects

David G Brodland

Publications and source records attributed to David G Brodland.

10 recordsLinked to original sources

PubMed2006

Melanocytes in long-standing sun-exposed skin: quantitative analysis using the MART-1 immunostain.

OBJECTIVE: To help distinguish early melanoma from normal sun-damaged skin by quantifying the density, confluence, and depth of follicular penetration of melanocytes in long-standing sun-exposed skin of the face and neck. DESIGN: Case series. SETTING: Referral center. PATIENTS: Random selection of 149 patients undergoing Mohs surgery for basal cell and squamous cell carcinomas of the face and neck. INTERVENTION: Frozen-section slides were made from long-standing sun-exposed normal skin and stained with MART-1 (melanoma antigen recognized by T cells 1 staining) immunostain. MAIN OUTCOME MEASURES: The number, confluence, and depth of penetration of melanocytes along the follicular epithelium were quantified per high-power field (original magnification x 400, equivalent to 0.5 mm of skin). Confluence was categorized by the number of adjacent melanocytes (none, 0-1; mild, 2; moderate, 3-6; and severe, >6). RESULTS: The mean number of melanocytes per high-power field was 15.6 (range, 6-29). Confluence was severe in 1.0% of the specimens, moderate in 34.0%, mild in 54.0%, and absent in 11.0%. Focal areas of increased melanocyte density occurred in 24.2% of the specimens; in these areas, the mean number of melanocytes per high-power field was 20.3 (range, 7-36) and the confluence of melanocytes was severe in 13.0%, moderate in 50.0%, and mild in 37.0%. The mean depth of follicular epithelium penetration by melanocytes was 0.38 mm. Pagetoid spread and nesting of melanocytes were not seen. Nonspecific scattered MART-1-staining dermal cells were in half of the slides. CONCLUSIONS: Melanocytes in long-standing sun-exposed skin have an increased density and a confluence that is often moderate (3-6 adjacent melanocytes), but they do not exhibit pagetoid spread or nesting. Nonspecific MART-1-staining dermal cells should not be interpreted as invasive melanoma.

Adult↗

PubMed2006

Split-thickness skin graft in nonhelical ear reconstruction.

Defects of the nonhelical ear after skin cancer extirpation can be challenging. When other reconstructive options are not optimal, split-thickness grafting is an easy and effective technique for successful aesthetic and functional restoration of the ear.

Ear Deformities, Acquired↗

PubMed2005

Auricular reconstruction.

Reconstruction strategies for the ear should address the major aesthetic goals of maintaining the helical curvature and the symmetric frontal profile. When the auditory canal is involved, maintaining its patency is a major functional goal. The anatomic location of the defect, by virtue of its topographic features and adjacent donor pools, will dictate the appropriate reconstructive option. Familiarity with these anatomically-specific options will enable the surgeon to more simply and effectively reconstruct the ear.

Ear, External↗

PubMed2005

Cutaneous head and neck melanoma treated with Mohs micrographic surgery.

BACKGROUND: Previous studies show that Mohs micrographic surgery is a viable treatment option for cutaneous melanoma. The head and neck region represents an anatomic location of historically high recurrence/metastasis rates and poor survival rates. OBJECTIVE: Our purpose was to determine the safety and efficacy of Mohs micrographic surgery for the treatment of primary cutaneous melanoma of the head and neck. METHODS: A consecutive sample of 625 patients referred for treatment of primary cutaneous melanoma of the head and neck comprised the study group. Mean follow-up for the group was 58.0 months. All melanomas were excised using Mohs micrographic surgery and surgical margin examination was performed using frozen section tissue in all cases. After stratification using updated American Joint Commission for Cancer (AJCC) Breslow thickness criteria, the Kaplan-Meier method was used to calculate 5-year local recurrence rates, metastasis rates, and disease specific survival rates. Tumors were then re-stratified by earlier Breslow thickness criteria for comparison to historical controls for local recurrence rates, metastasis rates, and disease-specific survival rates. Recommendations for predetermined excision margins were proposed and were based on the surgical margin widths that achieved complete melanoma removal in 97% of the cases in this study. RESULTS: Mohs micrographic surgery for the treatment of head and neck melanoma achieved five-year local recurrence rates, metastasis rates, and disease specific survival rates comparable to or better than historical controls after Breslow thickness stratification. The size of the surgical margin required for complete excision was significantly related to tumor thickness but not tumor size or specific location. CONCLUSION: Mohs micrographic surgery is an effective treatment modality for primary cutaneous melanoma, and may contribute to favorable outcomes especially on the head and neck where extensive sub-clinical spread is relatively common.

Adult↗

PubMed2005

Paramedian forehead flap reconstruction for nasal defects.

BACKGROUND: The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects. OBJECTIVE: Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results. METHODS: The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed. RESULTS: Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss. CONCLUSION: With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.

Forehead↗

PubMed2004

Extramammary Paget's disease: surgical treatment with Mohs micrographic surgery.

BACKGROUND: Extramammary Paget's disease (EMPD) is an uncommon tumor that has a high rate of recurrence after conventional surgical treatments. OBJECTIVE: Our purpose was to establish the efficacy of Mohs micrographic surgery (MMS) in the treatment of EMPD, and to make treatment recommendations with regard to surgical margins. We also attempted to summarize the published recurrence rates of EMPD after standard surgical management. METHODS: In a retrospective chart review, pertinent demographic data, tumor data, treatment characteristics, and follow-up data were tabulated. A search of the literature for recurrence rates after MMS and non-MMS surgical treatment modalities was performed. RESULTS: The recurrence rate after treatment with MMS was 16% for primary EMPD and 50% for recurrent EMPD. The 5-year tumor-free rates (Kaplan-Meier analysis) were 80% for primary tumors and 56% for recurrent tumors. Using MMS, the salvage rate (and, hence, overall cure rate) was 100%. Margins of 5 cm were required to clear 97% of the tumors. The recurrence rate after non-MMS (from the literature) is 33% to 60%. CONCLUSION: MMS is effective, and superior to standard surgical management in the treatment of EMPD. We recommend a 5-cm margin of normal skin if MMS cannot be offered.

Aged↗

PubMed2004

Immunostaining melanoma frozen sections: the 1-hour protocol.

BACKGROUND: There is significant debate over the use of frozen section processing in Mohs micrographic surgery (MMS) for melanoma. Opponents argue that individual melanocytes are too subtle to view consistently on frozen sections. On the other hand, proponents state that (1) melanocytes are visible on well-prepared frozen sections and (2) MMS using frozen sections for evaluation of melanoma surgical margins achieves comparable recurrence rates when compared with MMS using paraffin-embedded, permanent sections. OBJECTIVE: To introduce a new immunohistochemical (IHC) staining protocol that consistently produces melanoma frozen section slides in 1 hour that are easily evaluated during MMS. METHODS: We adapted a polymer-based IHC staining protocol to use with MMS frozen sections for the evaluation of melanoma surgical margins. RESULTS: When used with antibody directed against MART-1 for frozen section evaluation of melanoma, the section staining is reproducible and specific for melanocytes. CONCLUSIONS: In contrast to current IHC protocols that are time consuming (2 to 2.5 hours), we present a new frozen section protocol that takes approximately 1 hour to perform. This technique benefits patients, histotechnicians, and surgeons.

Adult↗

PubMed2002

Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery.

OBJECTIVE: To assess the efficacy of intraincisional clindamycin therapy as an alternative to nafcillin treatment in decreasing the risk of postoperative wound infections in dermatologic surgery. DESIGN: Prospective, double-blinded, randomized, placebo-controlled trial conducted over a 7-month period. SETTING: Three private practice Mohs micrographic surgery referral centers. PATIENTS: A total of 1030 consecutive patients who underwent Mohs micrographic surgery with subsequent reconstruction. INTERVENTIONS: Prior to reconstruction, patients were randomly assigned to receive either intraincisional buffered lidocaine with epinephrine containing clindamycin or buffered lidocaine with epinephrine without clindamycin. Nurses and physicians who scored the wound at follow-up were blinded to the treatment conditions. MAIN OUTCOME MEASURES: Surgical wounds evaluated at the time of suture removal were scored according to a standardized assessment based on erythema, edema, and the presence of purulent discharge. Wounds scored 4 or higher were considered to be infected. Bacterial cultures obtained when indicated were also compared. RESULTS: Of the 1172 surgical wounds included in the study, 29 had wound scores of 4 or higher, 6 in the study group and 23 in the control group (P =.001, Fisher exact test). Of these 29, 18 had culture-positive infections. Four of these occurred in the study group, and 14 occurred in the control group (P =.02, Fisher exact test). CONCLUSIONS: The results of this study further support the efficacy of single-dose preoperative intraincisional antibiotic treatment for dermatologic surgery. With the relatively high prevalence of patient-reported penicillin allergies, buffered lidocaine containing clindamycin offers an inexpensive, safe, convenient, and effective alternative.

Adult↗

PubMed2002

Atrophic dermatofibroma: a case report and review of the literature.

BACKGROUND: Atrophic dermatofibroma is an uncommon variant of dermatofibroma. It lacks the classic clinical features of a dermatofibroma and is often misdiagnosed. OBJECTIVE: To describe the clinical and histologic features of atrophic dermatofibroma. METHODS: Case report and review of the literature. RESULTS: A 45-year-old white woman was found to have a 7 mm x 5 mm atrophic, depressed lesion in the right axilla. A clinical diagnosis of anetoderma was made and the lesion was excised with minimal margins. Histopathologic examination revealed findings consistent with dermatofibroma. However, focal CD34 staining and involvement of superficial subcutaneous tissue raised concern regarding an early dermatofibrosarcoma protuberans developing in a dermatofibroma. The patient underwent Mohs micrographic surgery (MMS) for definitive treatment. The final diagnosis is thought to be atrophic dermatofibroma. Reported cases in the English language literature are reviewed and the clinical and histopathologic findings are described. CONCLUSION: Atrophic dermatofibroma is a well-described, yet uncommon, variant of dermatofibroma. It is often clinically misdiagnosed, and histopathologic evaluation can be misleading. The clinician and pathologist should consider this diagnosis in the evaluation of atrophic, depressed lesions.

Antigens, CD34↗

PubMed2002

Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation.

BACKGROUND: Optimal treatment of primary Merkel cell carcinoma (MCC) is unknown. High local recurrence rates after excision alone compel some physicians to advocate postoperative radiation therapy to improve local control. OBJECTIVE: We wondered whether marginal recurrence and survival rates differed between patients with primary MCC treated with Mohs surgery alone and those treated with Mohs surgery and adjuvant postoperative radiation. METHODS: A collaborative retrospective study was performed; the study group consisted of 45 patients with stage I MCC who were histologically and clinically free of disease after Mohs excision. Twenty patients subsequently received elective postoperative radiation to the primary site, and 25 patients had no adjuvant radiation therapy. RESULTS: One marginal recurrence (4%) and 3 in-transit metastases were observed in the Mohs surgery alone group, whereas none were observed in the Mohs surgery and radiation group. The proportion of patients with these events was not significantly different between treatment groups. Overall survival, relapse-free survival, and disease-free survival were not significantly different between treatment groups. CONCLUSION: Adjuvant radiation appears unessential to secure local control of primary MCC lesions completely excised with Mohs micrographic surgery. Adjuvant radiation is recommended for patients unable to have complete excision or if complete histologic margin control is unavailable and should be considered for patients with large or recurrent tumors.

Aged↗