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Biomedical subjects

H T Greenway

Publications and source records attributed to H T Greenway.

13 recordsLinked to original sources

Mohs micrographic excision of sebaceous carcinoma of the eyelids.

BACKGROUND: Sebaceous carcinoma of the eyelid is a difficult tumor to manage because of diagnostic difficulties and pagetoid-type spread in the conjunctivae. OBJECTIVE: We report our experience with eight patients using the Mohs technique of excision with reconstruction. METHODS: Six cases were managed with paraffin-embedded hematoxylin and eosin sections. One case was managed by frozen histologic sections and one was managed with frozen section processing followed by paraffin-embedded section review. RESULTS: The correct pathologic diagnosis was made initially in only 50% of the cases. Eighty-eight percent of the cases revealed intraepithelial neoplasm. There has been one recurrence with metastatic disease. The average follow-up period has been 56.8 months. CONCLUSIONS: We advocate early recognition and excision with the Mohs technique with paraffin-embedded sections followed by reconstruction. The use of paraffin-embedded histologic sections helps with interpretation of intraepithelial and pagetoid tumor spread.

Adenocarcinoma, Sebaceous

Interferon.

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Basal Cell Carcinoma

The effect of intralesional 5-fluorouracil therapeutic implant (MPI 5003) for treatment of basal cell carcinoma.

BACKGROUND: Basal cell carcinomas (BCCs) are usually treated with ablative procedures. A nonsurgical treatment alternative would be of value in selected patients. OBJECTIVE: We evaluated the safety and efficacy of a new preparation for intralesional sustained-release chemotherapy with MPI 5003, 5-Fluorouracil Therapeutic Implant, for treatment of BCCs. METHODS: Two doses of intralesional MPI 5003 (0.25 and 0.5 ml) were compared in a double-blind study of 20 patients with biopsy-proven BCC. One BCC per patient was treated weekly for up to 6 weeks and followed up monthly for 3 months until excisional biopsy for histologic examination. Before excision the cosmetic appearance of the test site was graded. RESULTS: Eighty percent of 10 BCCs treated with 0.5 ml of MPI 5003 had histologically confirmed cures as compared with 60% of 10 tumors treated with the lower dose (0.25 ml). Cosmetic assessments before excision were typically good to excellent. No systemic side effects occurred. CONCLUSION: Results indicate the potential of MPI 5003 for targeted local chemotherapy for BCC.

Adult

Treatment of cutaneous squamous cell carcinomas by intralesional interferon alfa-2b therapy.

BACKGROUND AND DESIGN: Intralesional recombinant interferon alfa-2b has been shown to be effective in the treatment of actinic keratoses and basal cell carcinomas. This open-label study was designed to evaluate the effectiveness and cosmetic result of this therapy on actinically induced, primary cutaneous squamous cell carcinomas. Thirty-six squamous cell carcinomas (28 invasive lesions and 8 in situ lesions) ranging in size from 0.5 to 2.0 cm in the longest dimension were treated with interferon alfa-2b 1.5 million units injected intralesionally three times per week for 3 weeks. Eighteen weeks following therapy, the treatment sites were excised and examined for histologic evidence of remaining tumor. RESULTS: Thirty-three (97.1%) of 34 evaluable lesions revealed an absence of squamous cell carcinoma histologically after therapy, although three biopsy specimens (8.8%) obtained after treatment showed actinic keratoses, for an overall complete response rate of 88.2%. The lesion not eliminated after treatment was an invasive squamous cell carcinoma. The investigators and patients independently judged 93.9% of cases to have a very good or excellent cosmetic result. Adverse reactions were limited to those influenzalike symptoms well recognized to occur with interferon therapy and these were well tolerated. Only one patient discontinued therapy due to side effects. CONCLUSIONS: This trial demonstrates that intralesional interferon is effective in the treatment of small sun-induced squamous cell carcinomas with well-tolerated side effects and a highly acceptable cosmetic result.

Adult

Mohs Micrographic Surgery for skin cancer.

Mohs Micrographic Surgery is a technique offering superior treatment for skin cancer with cure rates of 99% for primary and 94.4% for recurrent BCC, greater than 94% for SCC. As developed by Dr Frederic Mohs, the technique originally involved application of a chemical fixative. Mohs' fresh tissue technique is now usual, with immediate horizontal frozen sectioning of the entire margins of excised tissue, mapping and microscopic identification of remaining tumour, then repeat excisions, mapping and examination until a tumour-free plane is demonstrated throughout. This provides maximal conservation of uninvolved tissue structures, and allows more confident repair of a cancer-free surgical defect. Mohs Micrographic Surgery is becoming more widely available in Australasia; concurrently, indications for the technique are widening, as are the research interests, training opportunities, and professional organization of Mohs Practitioners. Very high, and increasing, incidence and prevalence of skin cancer in Australasia, and factors tending to contribute to this, suggest that Mohs Micrographic Surgery has an expanding role to play in Australasia.

Basal Cell Carcinoma

The Carmalt straight splinter forceps: a versatile economical instrument.

The inexpensive Carmalt straight splinter forceps has many uses including removal and placement of wound closure adhesive strips, suture removal, isolating small blood vessels for electrosurgical destruction, and holding suture ends prior to cutting. It can also be used to assist in suturing.

Equipment Design

Intralesional interferon therapy for basal cell carcinoma.

In a clinical trial of 172 patients at four medical centers, interferon alfa-2b (1.5 x 10(6) IU) or a placebo was injected directly into biopsy-proved noduloulcerative or superficial basal cell carcinomas three times weekly for 3 weeks, for a cumulative dose of 13.5 million IU. Efficacy of treatment was determined at 16 to 20 weeks by examination of biopsy specimens that demonstrated cure of lesions in 86% of interferon-treated patients and in only 29% of placebo-treated patients. During the treatment course and follow-up, an initial inflammatory response was observed at the treatment sites, followed by diminished erythema, improvement in overall appearance, and a decrease in size of lesions. Side effects of treatment, mainly flu-like symptoms, were usually mild and transient and occurred more commonly in the interferon-treated group. Only three patients, all in the interferon-treated group, discontinued therapy because of side effects. One year after initiation of therapy, 81% of interferon recipients and 20% of those given the placebo remained tumor free. Noduloulcerative and superficial lesions were equally responsive to treatment with interferon. For some patients with noduloulcerative or superficial basal cell carcinomas, intralesional interferon alfa-2b may be an alternative, effective treatment.

Basal Cell Carcinoma

Treatment of basal cell carcinoma with intralesional interferon.

Eight patients with basal cell carcinomas were treated with recombinant alpha-2 interferon. Each patient had a biopsy-proved basal cell carcinoma of the nodular or superficial type that was injected intralesionally three times a week for 3 weeks (9 total injections) with 1.5 X 10(6) IU (0.15 ml) of alpha-2 interferon per injection (total dose, 13.5 X 10(6) IU). Excisional biopsy 2 months after completion of therapy revealed no evidence of basal cell carcinoma in any patient. Minimal side effects were observed. In these eight patients alpha-2 interferon was therefore an effective and safe modality of treatment. The encouraging results of this pilot study suggest that additional evaluation of interferon in the treatment of basal cell carcinoma is warranted.

Basal Cell Carcinoma