Biomedical subjects
H W Randle
Publications and source records attributed to H W Randle.
Giant basal cell carcinoma and cigarette smoking.
Several recent studies have linked cigarette smoking to an increased risk of squamous cell skin cancer, but previous studies have found no correlation between smoking and basal cell carcinoma. This article is a retrospective chart review of 200 patients who had Mohs' surgery for basal cell carcinoma at the Mayo Clinic in Rochester, Minnesota, between 1986 and 1990. In patients with tumors less than or equal to 1.0 cm, 30% were smokers. In patients with tumors 1.1 to 2.0 cm, 42% were smokers. In patients with tumors 2.1 to 4.9 cm, 56% were smokers; and in patients with tumors greater than or equal to 5.0 cm, 50% were smokers. Cigarette smoking is associated with an increased prevalence of basal cell carcinomas larger than 1.0 cm in diameter.
Serial excision of a large facial skin cancer.
BACKGROUND: In the management of large facial neoplasms, the dermatologic surgeon must consider local factors affecting the success of closures. OBJECTIVE: Large facial neoplasms can be removed serially with Mohs micrographic surgery. Serial excision facilitates recruitment of adjacent normal skin for replacement of lesional skin, minimizing the risks of necrosis. METHODS: A large morpheaform basal cell carcinoma was excised serially. The initial defect was closed with an O to L advancement flap. The final excision and repair 2 months later consisted of a combination of primary closure with marsupialization and pursestring closure. A full-thickness skin graft was used to close the final defect. RESULTS: The patient had optimal cosmesis at 2-year follow-up. CONCLUSION: Large facial neoplasms can be excised serially. This technique, performed in the setting of Mohs micrographic surgery, takes advantage of "mechanical and biologic creep," resulting in excellent cosmesis and function.
Linear basal cell carcinoma: report of seventeen cases and review of the presentation and treatment.
BACKGROUND: Linear basal cell carcinoma was first described as a distinct clinical morphologic variant in 1985. Subsequently, twelve cases were reported. OBJECTIVE: To review and identify cases of linear basal cell carcinoma in our institutions and determine optimal treatment based on review of our cases and those in the literature. METHODS: Primary basal cell carcinomas treated at the three campuses of Mayo Clinic and the University of Montreal were reviewed retrospectively, as were the twelve cases in the literature. RESULTS: Seventeen cases of linear basal cell carcinoma were identified. The age and sex ratios were similar to those of patients with standard basal cell carcinomas. Based on the review of the few reported cases of linear basal cell carcinoma (29), the percentage of aggressive histologic subtypes (38%) was increased compared with that in a general population. The average number of Mohs layers required for treatment was higher than that reported for standard basal cell carcinoma, an indication of increased subclinical spread. CONCLUSION: Linear basal cell carcinoma is an uncommonly recognized morphologic variant. Based on the small number of cases, these tumors have more aggressive histologic subtypes. Because of the possibility for increased subclinical spread, Mohs micrographic surgery can be considered for treatment. Further studies are needed to confirm these findings.
Calcifying basal cell carcinomas.
BACKGROUND: Dystrophic calcification refers to calcium deposition occurring in association with local tissue injury or abnormality. Little is known about dystrophic calcification occurring in malignant cutaneous neoplasms. OBJECTIVE: The purpose of this study was to determine the frequency and pattern of dystrophic calcification occurring in basal cell carcinomas and squamous cell carcinomas. METHODS: Consecutive cases (200) of basal cell carcinoma and squamous cell carcinoma were reviewed for evidence of dystrophic calcification. Histologic subtype, location of calcification, and tumor site were noted. RESULTS: Of 200 basal cell carcinomas, 41 (21%) showed evidence of dystrophic calcification, compared with 6 (3%) squamous cell carcinomas. Calcifying basal cell carcinomas were more likely to have a more aggressive histologic subtype and to be located on the trunk. CONCLUSION: Skin calcium binding protein may be responsible for the calcium deposition and account for the discrepancy seen between the frequency of calcification occurring in basal cell carcinomas and squamous cell carcinomas. As with other tumors with follicular differentiation, calcium deposits were located in keratin-filled cysts. This pattern of dystrophic calcification may be a marker of follicular differentiation.
Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: a clinical, histopathologic, and immunopathologic study of eight patients.
BACKGROUND: Unusual papulovesicular lesions resembling arthropod bites have been described in patients with chronic lymphocytic leukemia (CLL). OBJECTIVE: Our purpose was to describe and characterize further the clinical, histopathologic, and immunopathologic features of these lesions. METHODS: Eight patients were identified retrospectively who had CLL and characteristic skin lesions. Clinical and histologic features were recorded. Skin biopsy specimens were analyzed immunohistochemically for eosinophil granule major basic protein, eosinophil-derived neurotoxin, neutrophil elastase, and mast cell tryptase. RESULTS: The clinical features, including the lesional distribution, suggested arthropod bites, although most patients could not recall having been bitten. Mixed T- and B-cell lymphoid cell infiltrates were present within lesions, along with prominent eosinophil infiltration and eosinophil granule protein deposition. CONCLUSION: Exuberant papulovesicular lesions develop in patients with CLL apparently as an exaggerated response to arthropod bites. Prominent eosinophil infiltration and degranulation within these lesions likely contribute to the severity of symptoms.
Cutaneous lymphangiectasis: treatment with sclerotherapy.
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Giant skin cancers.
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High-risk nonmelanoma skin cancers.
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Mohs surgery vs wide excision for atypical fibroxanthoma: follow-up.
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A comparison of Mohs micrographic surgery and wide excision for the treatment of atypical fibroxanthoma.
BACKGROUND: Atypical fibroxanthoma (AFX) is an uncommon spindle cell neoplasm occurring most often in actinically damaged skin of elderly patients. This tumor has invasive potential, may recur locally after excision, and rarely metastasizes. To conserve tissue and improve the likelihood of cure, Mohs micrographic surgery (MMS) has been used for treatment. OBJECTIVE: We review and discuss the Mayo Clinic experience treating AFX with MMS and retrospectively compare the clinical outcome with that in a similar cohort of patients treated with wide local excision (WE). METHODS: The medical records of 45 patients were reviewed at three Mayo Clinic practices. Follow-up data were available for 44 patients: 19 treated with MMS and 25 with WE. RESULTS: In patients treated with MMS, there were no recurrences after a mean follow-up of 29.6 months. There were three first recurrences in 25 patients (12%) treated with WE after a mean follow-up of 73.6 months. One patient had a single local recurrence, and two patients each had two local recurrences. Parotid node metastasis eventually developed in one of the patients with two local recurrences, so that the regional metastatic rate in this series was 4% (1 in 25 patients). CONCLUSION: Microscopic control of the surgical margins with MMS in the treatment of AFX results in a lower recurrence rate than that with WE and conserves normal tissue.
Suntanning: differences in perceptions throughout history.
In ancient times, the sun was venerated as a source of life in some cultures. Scientifically, the relationship between vitamin D and sunlight and the deficiency of vitamin D in patients with rickets were ultimately discovered. In 1903, Niels Finsen was awarded the Nobel Prize in medicine or physiology for his "Finsen light therapy" for infectious diseases, especially lupus vulgaris. In the 1930s and 1940s, the medical profession promoted sunbathing as beneficial for children. From these bases, the popularity of suntanning emerged, promoted by the availability of more leisure time and, eventually, the development of sunlamps and commercial tanning salons. Although the precise role of ultraviolet light in the pathogenesis of melanoma is uncertain, a melanoma epidemic began to be noticed in the 1970s. During the past 15 years, campaigns have attempted to educate the public about the potential dangers of suntanning and exposure to ultraviolet light. Whether the melanoma epidemic can be reversed remains to be seen.
Giant basal cell carcinoma.
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Basal cell carcinoma. Identification and treatment of the high-risk patient.
BACKGROUND: Some cutaneous basal cell carcinomas have a significant potential to recur, disfigure, and metastasize. OBJECTIVES AND METHODS: The identification and selection of treatment of these high risk carcinomas is based on a review of studies of recurrence, giant size, metastasis, and mortality. RESULTS: Basal cell carcinomas with any of the following: long duration, location in the mid face or ear, larger than 2 cm, with aggressive histologic subtype, previous treatment, neglected, or a history of radiation exposure, should be considered "high risk." CONCLUSION: For basal cell carcinomas with this high risk profile, complete excision by margin control or total destruction should be considered.
Dermabrasion of the hyperkeratotic foot.
BACKGROUND: Keratoderma is a common problem. Its treatment is difficult and may be associated with systemic side effects. OBJECTIVE AND METHOD: To describe the use of dermabrasion for hyperkeratotic conditions of the palms and soles. RESULTS: Dermabrasion of keratoderma is an easy, quick, and safe method that brings immediate relief to patients, allows improved penetration of topical medications, and facilitates the control of the underlying disease with simple measures. CONCLUSIONS: Dermabrasion should be considered among the treatment options for keratoderma.
Hypertrophic discoid lupus erythematosus resembling squamous cell carcinoma.
BACKGROUND: Hypertrophic discoid lupus erythematosus (HDLE) may resemble cutaneous squamous cell carcinoma (SCC) histologically. OBJECTIVE: The histologic features that help to differentiate HDLE from SCC are reviewed. METHODS: Two patients are described with HDLE. RESULTS: Both patients were treated initially with Mohs surgery for "biopsy-proven" SCC. Subsequent biopsies confirmed the diagnosis of HDLE and the patients responded well to appropriate therapy. No significant complications occurred in either patient. CONCLUSION: Lesions of HDLE may imitate SCC. Strategies are suggested to avoid surgical procedures based on an incorrect biopsy report.
Natural history of squamous cell carcinoma of the skin: case report.
Squamous cell carcinoma is a malignant proliferation of the epidermal keratinocyte. With early recognition and treatment, most of these tumors have a favorable prognosis. If the lesions are left untreated, however, the results may prove fatal. We describe a case of long-standing neglect of cutaneous squamous cell carcinoma leading to widely metastatic disease in a 69-year-old man.
Reducing the pain of local anesthesia.
The administration of local anesthetic agents before cutaneous surgery usually results in discomfort. This paper reviews techniques and pharmaceutical agents that will minimize pain during this preoperative procedure.