The subtleties of Mohs surgery.
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Dermatologic Surgical Procedures↗
Biomedical subjects
G B Winton
Publications and source records attributed to G B Winton.
The transverse anatomy of androgenic alopecia.
Twenty-five biopsy specimens from the balding frontal scalp of five patients were studied. Processing included vertical and transverse (horizontal) sectioning, toluidine blue and hematoxylin and eosin staining, and fixed and frozen sectioning. Findings included decreased hair density, increased numbers of vellus hairs, and alteration of the normal follicular architecture. Transverse frozen sectioning with toluidine blue staining appeared to be a rapid and reliable tool for studying androgenic alopecia.
Alopecia Areata↗
Skin diseases aggravated by pregnancy.
During pregnancy, immunologic, endocrine, metabolic, and vascular changes occur that make the pregnant woman susceptible to aggravation of certain skin diseases. These diseases can be organized into five broad categories: infections, diseases of altered immunity, metabolic diseases, connective tissue disorders, and miscellaneous conditions. A discussion of how each of these diseases is altered by pregnancy and how treatment may differ during gestation is presented.
Acquired Immunodeficiency Syndrome↗
Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma).
Microcystic adnexal carcinoma (MAC) is a recently described malignant neoplasm of the adnexal structures of skin that shows a marked propensity for early infiltrative and locally aggressive growth. Its banal clinical appearance may lead to a delay in diagnosing the tumor by biopsy, and its multifaceted histologic features may lead to an incorrect tissue diagnosis. Confusion with benign tumors and less aggressive malignancies can lead to inadequate initial treatment and extensive recurrences. We describe three cases of microcystic adnexal carcinoma and review the clinical and histologic features, treatment, and prognosis of this neoplasm.
Adenocarcinoma↗
A synthetic skin substitute as a temporary dressing in Mohs surgery.
Epigard (Synthes, Paoli, PA), a synthetic skin substitute, is useful in the temporary covering of surgical wounds. The dressing adheres to the wound bed, provides hemostasis, and aids neovascularization. When removed after 2-3 days, the surgeon has a wound ready to accept a graft.
Aged↗
Surgical pearls.
This article contains a potpurri of surgically related stratagems, alternative techniques, and philosophies. These surgical pearls have been selected for their simplicity, usefulness, and applicability.
Biopsy, Needle↗
Basal cell carcinomas arising in chronic lymphedema.
A unique case is presented of basal cell carcinomas arising in chronic lymphedema of the lower extremity. The lesions were successfully treated with the CO2 laser.
Aged↗
Anesthesia for dermatologic surgery.
The increased scope and complexity of dermatologic surgery has led to a need for greater skill in the preoperative administration of local and regional anesthesia. This article reviews the mechanism of action of local anesthetic agents, their pharmacologic properties and adverse reactions, and describes accepted techniques for safely and effectively establishing local and regional anesthesia for skin surgery. The presentation is limited to those techniques of greatest use to the office practitioner.
Anesthetics, Local↗
Acute pseudomonas infection of the external ear (malignant external otitis).
Pseudomonas aeruginosa commonly causes low-grade infections of the external auditory canal. If these infections are inadequately treated, they can progress into a severe form of external otitis called malignant external otitis (MEO). MEO usually occurs in elderly diabetic patients and demands immediate diagnosis and medical therapy in order to prevent systemic invasion, neurologic sequelae, and even death. We present two cases of acute pseudomonas infections of the ear, neither of which progressed to MEO due to early implementation of antibiotic therapy.
Acute Disease↗
Dermabrasion of the scalp as a treatment for actinic damage.
Dermabrasion of the scalp was safely and effectively performed on five patients as a treatment for actinic damage. This surgical modality can be an important part of the management of solar keratoses of the scalp in patients with alopecia.
Aged↗
Use of rotation flaps to repair small surgical defects on the ala nasi.
A simple rotation flap is recommended for closure of a set of surgical defects of the ala nasi which lie above the alar crease and are up to 1.5 cm in diameter.
Basal Cell Carcinoma↗
Clinical evaluation of a nonadhering wound dressing.
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Adhesiveness↗
Wound dressings for dermatologic surgery.
Cutaneous surgery requires more than technical skill. A thorough understanding of instrumentation, suture material, sterile technic, and wound dressings is also imperative. This article will organize, primarily by pictorial essay, the often-neglected subject of surgical dressings. The principals and theory of dressings, the materials available to construct them, and the specific technics for tailoring them to difficult anatomic sites will be presented.
Bandages↗
Dermatoses of pregnancy.
Pregnancy is a period of profound endocrine and metabolic changes which are tolerated by the body for a relatively short time. During gestation both physiologic and pathologic changes can occur in the skin, nails, and hair shafts which should be recognized and appropriately managed by the dermatologist. These changes can conveniently be placed into five broad categories: (1) physiologic changes in skin and appendages caused principally by the hormonal milieu, (2) cutaneous tumors affected by pregnancy, (3) diseases specifically associated with pregnancy, (4) genital infections of perinatal importance, and (5) other dermatologic diseases influenced by pregnancy. A discussion of each of these topics reveals the vast spectrum of dermatologic disease seen in pregnancy and underscores the important role of the dermatologist in the care of pregnant patients.
Autoimmune Diseases↗
Contact urticaria.
Contact urticaria is an immediate wheal response generated by a wide variety of contactants in susceptible individuals. These contactants can be divided into three categories based on their mechanism of action: nonimmunologic, allergic, and unknown. The list of known illicitors of CU is growing rapidly, and the syndrome is being recognized more often. CU to certain preservatives in foods and pharmaceuticals may get increased attention in the future because of such widespread exposure to them both through contact and systemic absorption. A range of systemic reaction patterns can be seen in allergic CU, in some of the physical urticarias, and in exposure to ammonium persulfate. The danger of such systemic reactions should be borne in mind when performing rechallenge patch testing in the office.
Allergens↗