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Biomedical subjects

J A Zitelli

Publications and source records attributed to J A Zitelli.

At least 19 recordsLinked to original sources
PubMed1992

New primary nonmelanoma skin cancer in patients with a history of squamous cell carcinoma of the skin. Implications and recommendations for follow-up.

BACKGROUND: Rational follow-up guidelines for skin cancer patients should be based on the risk of three separate events: cancer recurrence, cancer metastasis, and the development of subsequent skin cancers. However, currently no guidelines exist for follow-up of patients with squamous cell carcinoma of the skin (SCC), which take into account all three of these risks. OBJECTIVE: The purpose of this study is to establish rational minimum guidelines for follow-up of patients with SCC. To do this, we first must determine the risk of SCC patients for the development of subsequent skin cancers. Combining these data with previously published data on SCC recurrence and SCC metastasis, we then propose guidelines for follow-up of patients with SCC. METHODS: We followed up 101 SCC patients on a yearly basis for 5 years after treatment and recorded the date and site of subsequent nonmelanoma skin cancers (NMSCs). RESULTS: Thirty percent of SCC patients developed additional SCCs and 52% developed subsequent NMSCs within 5 years of therapy for their first SCC. Patients showing the highest risk of subsequent NMSC were those presenting with multiple SCC, SCC greater than 1 cm in diameter, SCC requiring more than 1 Mohs surgery layer to remove, or SCC occurring on the scalp, ear, nose, or extremities. One hundred percent of subsequent NMSCs were detected by the fourth year of follow-up; 54% of these occurred within the first year of follow-up. CONCLUSION: After combining our data with previously published studies of SCC recurrence and metastasis, we recommend that all patients with SCC be followed up for at least 4 years after treatment. Moreover, because most subsequent NMSCs, SCC recurrences, and SCC metastases developed early in the follow-up period, we recommend that patients be reexamined at least every 3 months during the first year of follow-up and every 6 months thereafter. It must be stressed that these are meant as minimum follow-up guidelines.

Carcinoma, Squamous Cell↗
PubMed1992

Mechanisms of metastasis.

The role of dermatologists in the diagnosis and treatment of skin cancer continues to increase. Consequently, they will more frequently be involved in the diagnosis, treatment, and management of patients with metastatic or potentially metastatic tumors. Squamous cell carcinomas and malignant melanomas are frequently seen in dermatologic practices and have the capability to metastasize. Metastases are the result of a complex process that is characterized by a sequence of steps, each of which requires acquisition by the malignant cell of key biologic properties. The metastatic sequence can be conceptualized as detachment from the primary tumor followed by invasion, intravasation into a vessel, circulation, stasis within a vessel, extravasation, invasion of the recipient tissue bed, and ultimately proliferation. The basic steps of the metastatic sequence are described as well as how these steps and other tumor cell adaptations can affect the clinical patterns of metastasis. Finally, practical applications of the understanding of these principles of metastasis are discussed.

Cell Aggregation↗
PubMed1992

Surgical margins for excision of primary cutaneous squamous cell carcinoma.

BACKGROUND: No guidelines for the margin of resection of cutaneous squamous cell carcinoma have been based on data measuring subclinical tumor extension, as have been formulated for basal cell carcinoma. OBJECTIVE AND METHODS: Guidelines for appropriate margins of excision of primary cutaneous squamous cell carcinoma were formulated on the basis of a prospective study of subclinical microscopic tumor extension. RESULTS: Four millimeter margins were adequate for most squamous cell carcinomas. However, certain tumor characteristics were associated with a greater risk of subclinical tumor extension and included size of 2 cm or larger, histologic grade 2 or higher, invasion of the subcutaneous tissue, and location in high-risk areas. CONCLUSION: Minimal margins of excision of 4 mm around the clinical borders of the squamous cell carcinoma are proposed for all but the high-risk tumors, in which at least a 6 mm margin is recommended.

Aged↗
PubMed1991

The reliability of frozen sections in the evaluation of surgical margins for melanoma.

As the width of surgical margins declines, histologic evaluation of the margins is needed to assess the completeness of excision of a malignant melanoma. We studied 221 specimens in 59 patients and compared the interpretations of frozen and paraffin sections from the same block. Frozen sections had a sensitivity of 100% in detecting melanoma when present and a specificity of 90%.

False Positive Reactions↗
PubMed1991

Syringoid eccrine carcinoma.

Eccrine carcinomas are locally aggressive and have an infiltrative growth pattern. They have a variable clinical appearance and a diversity of histologic findings that often make the diagnosis difficult. The histologic findings, together with immunoperoxidase and enzyme histochemical studies, usually allow differentiation between eccrine carcinomas, other cutaneous neoplasms, and visceral adenocarcinomas with skin metastases. Provided there is no evidence of distant metastases, surgical excision is the treatment of choice. We report a case of syringoid eccrine carcinoma that was treated with Mohs micrographic surgery.

Adenocarcinoma↗
PubMed1991

A regional approach to reconstruction of the upper lip.

Treatment of upper lip wounds by second intention, full-thickness skin grafts, and local flaps is discussed. The location, size, depth, and type of closure for each defect in 200 cases involving defects of the upper lip are reviewed. The percentages of wounds treated by each modality were 20, 6, 74% for second intention, grafts, and local flaps, respectively. Of wound treatment by local flaps, 80% used advancement flaps, 10% used transposition flaps, and 10% used island-pedicle flaps. Advancement flaps, island-pedicle flaps, possible complications, and post-operative care are reviewed.

Humans↗
PubMed1991

Reconstruction of the nose with local flaps.

The author presents the results of a study of 200 patients with surgical defects of the nose following excision of skin malignancies. The location, size, depth, and quality of the adjacent skin, the reconstruction choice, and the cosmetic result were recorded. Healing by second intention was most useful for wounds in concave areas. Full-thickness skin grafts were used for defects too large for local flaps, or for defects on the nasal tip or alar surface. Local flaps were the most useful choice for nasal reconstruction. Transposition flaps, in particular, were most useful for each cosmetic sub unit of the nose.

Humans↗
PubMed1990

TIPS for a better ellipse.

The ellipse or fusiform closure is the simplest and most common type of excisional surgery and repair. Textbooks and review articles repeat similar traditional principles for excision and closure. In this article four additional ideas are reviewed to improve the final cosmetic result of the ellipse.

Dermatologic Surgical Procedures↗
PubMed1990

Systemic isotretinoin: effects on dermal wound healing in a rabbit ear model in vivo.

Clinical observations have suggested that wound healing may be altered in patients treated with systemic isotretinoin. In this study, we examined the effects of systemic isotretinoin on dermal wound healing and connective tissue metabolism in a rabbit ear model. Forty 6-mm punch-biopsy wounds were created in the ears of two control rabbits as well as two experimental animals fed isotretinoin, 4 mg/kg per day. Clinical inspection and histologic examination revealed no difference between the control and isotretinoin-treated rabbits in terms of the time required for complete wound healing or the appearance of the final scar. The tissue removed from the wound site at days 0, 7, 14, and 21 after wounding was subjected to analysis of a collagen production and collagen gene expression. Collagen production, determined by the synthesis of [3H]hydroxyproline after incubation of tissue slices with [3H]proline in vitro or by the measurement of the steady-state levels of types I and III procollagen mRNAs, was not significantly different between the two groups. The results indicate that systemic administration of isotretinoin does not affect collagen synthesis in the rabbit ear model of wound healing.

Animals↗
PubMed1990

The nasolabial flap as a single-stage procedure.

The nasolabial flap is a useful reconstructive technique for the repair of defects on the nose. An improved technique used in 32 patients is presented, which allows use of this procedure as a single-stage rather than the more commonly seen two-stage procedure. The alterations include the following: (1) the excision of a Burow's triangle superior edge of the defect toward the inner canthus; (2) the use of a periosteal or suspension suture to minimize tenting across the concave junction of the nose and cheek; (3) wide undermining of the skin surrounding the defect to create a stabilizing platelike scar; (4) significant thinning of the donor flap; and (5) adjust the size of the flap to recreate the original preincisional skin tension on the flap after suturing. None of the 32 patients presented required a second-stage procedure to correct trapdoor defects or to recreate natural folds or creases.

Follow-Up Studies↗
PubMed1989

Human papillomavirus type 16 DNA in periungual squamous cell carcinomas.

Ten squamous cell carcinomas (in situ or invasive) of the fingernail region were analyzed for the presence of DNA sequences homologous to human papillomavirus (HPV) by dot blot hybridization. In most patients, the lesions were verrucae of long-term duration that were refractory to conventional treatment methods. Eight of the lesions contained HPV DNA sequences, and in six of these the sequences were related to HPV 16 as deduced from low-stringency nucleic acid hybridization followed by low- and high-stringency washes. Furthermore, the restriction endonuclease digestion pattern of DNA isolated from four of these lesions was diagnostic of episomal HPV 16. The high-frequency association of HPV 16 with periungual squamous cell carcinoma is similar to that reported for HPV 16 with squamous cell carcinomas on mucous membranes at other sites, notably the genital tract. Our findings suggest that HPV 16 may play an important role in the development of squamous cell carcinomas of the finger, most notably those lesions that are chronic and located in the periungual area.

Adult↗
PubMed1989

Melanoma update.

Explore the source record for details and available documents.

Humans↗
PubMed1989

Buried vertical mattress suture.

The buried vertical mattress suture combines the advantages of the vertical mattress suture and the buried intradermal suture. It provides prolonged wound support and eversion, while leaving no permanent suture marks on the skin.

Dermatologic Surgical Procedures↗
PubMed1989

Topical tretinoin and epithelial wound healing.

The effects of topical tretinoin on epithelial wound healing were studied using a porcine model. Eight animals were treated with 0.05% tretinoin cream daily for ten days prior to partial-thickness skin wounding. Daily tretinoin treatment was continued after wounding on two of eight animals. Treatment with topical tretinoin before wounding accelerated epithelial wound healing in partial-thickness wounds. Continued tretinoin treatment on the wounds themselves retarded reepithelialization. Biopsy specimens of wounds with continued tretinoin treatment revealed persistent inflammation and fibroplasia in the dermis. The healing epithelium itself displayed areas of spongiosis and intracytoplasmic pale eosinophilic periodic acid-Schiff-positive, diastase-resistant globules. These globules did not stain with alcian blue. These epidermal alterations may be a direct effect of tretinoin or may be secondary to the underlying inflammation. While the dermal inflammation associated with continued tretinoin treatment appears to retard reepithelialization, epithelial cell alterations may also play a role.

Administration, Topical↗
PubMed1989

Tips for wound closure. Pearls for minimizing dog-ears and applications of periosteal sutures.

Pearls for minimizing dog-ears and applications of periosteal sutures are shared by the author. The discussion begins with the less common methods of minimizing dog-ears and includes how to plan the incision, excision techniques, and undermining techniques. Next, the author describes how to use periosteal sutures to simplify some reconstructions and to improve cosmetic results.

Face↗