Rapid application of split-thickness skin grafts.
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Biomedical subjects
Publications and source records attributed to F C Koranda.
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A case of recurrent basal-cell carcinoma at the mandibular ramus presented clinically with a subdermal nodule. The patient had previously been treated with aggressive curettage and electrodesiccation which had penetrated through the dermis. The authors postulate that either incomplete extirpation of the neoplasm with the curet or iatrogenic deep implantation of the tumor during the procedure may have led to the presentation of the recurrence as a subdermal nodule.
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The antimalarials, chloroquine, hydroxychloroquine, and quinacrine, are used primarily for malaria; but they can be beneficial for cutaneous lupus erythematosus (LE), polymorphous light eruption, solar urticaria, and porphyria cutanea tarda. Antimalarials bind to deoxyribonucleic acid (DNA) which prevents DNA and ribonucleic acid (RNA) polymerase reactions and DNA heat inactivation; and they inhibit the LE cell phenomenon, antinuclear antibody reactions, and suppress lymphocyte transformation. By competing with calcium ion, they stabilize membranes and have an anesthetic effect. Their anti-inflammatory potential is due to their inhibition of hydrolytic enzymes, stabilization of lysosomes, interference with prostaglandin synthesis, blocking of chemotaxis, and antagonism of histamine responses. The antimalarials have no sunscreening properties. The most common toxic effects are cutaneous pigmentation, nausea, vomiting, diarrhea, mild ileus, and cycloplegia. There has been a reluctance to use chloroquine and hydroxychloroquine because of the possibility of retinopathy. However, if the "safe" daily dose limit of chloroquine, 2 mg per pound of body weight, and of hydroxychloroquine, 3.5 mg per pound of body weight, is followed, the chance of retinopathy is slight. Quinacrine does not cause retinopathy, but it has more cutaneous side effects than the other two agents.
The basal cell carcinomas of the nevoid basal cell carcinoma syndrome present a serious challenge in therapy because of the large number of cancers that eventually develop and because a notable proportion of them are highly aggressive neoplasms. Microscopically controlled surgery provides a means to ensure eradication of both the highly malignant and the more benign-behaving neoplasms. Since microscopic control obviates the need to remove an extra margin of normal tissue, elimination of the tumors is accomplished with conservation of the greatest possible amount of normal tissues. These conclusions are based on a study of 30 patients with nevoid basal cell carcinoma syndrome who were treated in chemosurgery clinics during the past 30 years.
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