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Keith E Schulze

Publications and source records attributed to Keith E Schulze.

16 recordsLinked to original sources
PubMed2006

Pleomorphic basal cell carcinoma: case reports and review.

Pleomorphic basal cell carcinoma is a pathologic variant of basal cell carcinoma characterized by the presence of atypical-appearing, mononuclear or multinucleated giant cells. Including our 3 patients, a total of 52 pleomorphic basal cell carcinomas have been described in 48 individuals. The tumors usually present as a nodule on the head or neck. The nuclei of the giant tumor cells are irregularly shaped, hyperchromatic, and 2 to 10 times larger than the nuclei of the surrounding cancer cells. Atypical mitoses may be present. The pathogenesis of pleomorphic basal cell carcinoma remains to be determined; however, investigations utilizing electron microscopy, immunohistochemistry, image analysis, and flow cytometry have provided additional insight regarding the features of the giant tumor cells and the etiology of this cancer. All of these tumors are aneuploid. Although these aneuploid tumors have alarming microscopic features, their clinical course is similar to that of basal cell carcinomas without pleomorphic giant tumor cells. Therefore, appropriate therapy to ensure adequate treatment of the tumor is recommended. Our patients' pleomorphic basal cell carcinomas were successfully treated by excision using the Mohs micrographic surgical technique.

Aged↗
PubMed2006

Treatment of extramammary Paget disease with topical imiquimod cream: case report and literature review.

Extramammary Paget disease is an uncommon cutaneous neoplasm that presents as erythematous plaques most frequently located in the anogenital region. Management of patients with extramammary Paget disease involves evaluation of the individual for: (1) a disease-associated, unsuspected, visceral malignancy and (2) secondary adenocarcinoma in the underlying dermis or regional lymph nodes. Several modalities, each with variable effectiveness, are available to treat the cutaneous component of the disease: electrodesiccation and curettage, laser surgery, aminolevulinic acid photodynamic therapy, radiotherapy, topical chemotherapy, and wide surgical excision. However, surgical excision using the Mohs micrographic technique is currently the modality of choice for treating the cutaneous lesions of extramammary Paget disease. Recently, a topical imidazoquinoline immunomodulator that induces cytokine production and stimulates the innate and cellular immune responses--imiquimod cream-has been used for the management of primary or relapsing extramammary Paget disease. Complete healing, without recurrence, of extramammary Paget disease in patients whose cutaneous lesions were treated topically with imiquimod 5% cream was observed. We describe a man with suprapubic extramammary Paget disease whose condition was primary and limited to his skin. Biopsy-confirmed complete resolution of his disease was observed after the topical application of imiquimod 5% cream 3 times per week (on alternate days) for 16 weeks. After reviewing the published reports of other patients with extramammary Paget disease whose disease was successfully treated with imiquimod cream, we suggest that topical imiquimod 5% cream-at least 3 times per week (with 1-2 d of nontreatment in between) for a minimum of 8 to 16 weeks--be considered as an initial treatment for primary cutaneous extramammary Paget disease. Surgical excision or an alternative therapeutic modality is recommended for patients whose extramammary Paget disease persists or recurs after treatment with topical imiquimod.

Administration, Topical↗
PubMed2006

Articaine: an effective adjunctive local anesthetic for painless surgery at the depth of the muscular fascia.

BACKGROUND: Articaine is a unique amide anesthetic that contains a thiophene ring and an additional ester group. The rapid diffusion and enhanced tissue-penetrating properties of articaine enable its use for infiltrative anesthesia. OBJECTIVE: To describe the effective use of articaine as an adjuvant local anesthetic for surgical excisions requiring dissection at the level of the muscular fascia. METHODS AND MATERIALS: We discuss the successful adjunctive use of articaine to provide effective infiltrative anesthesia of muscular fascia. We review the composition, the pharmacologic properties, and the safety profile of articaine. RESULTS: Adjuvant local anesthesia using articaine results in painless surgery at the level of the muscular fascia without any perioperative complications. CONCLUSION: Articaine is not only well tolerated but also rapidly effective for anesthesia in the fascial plane of the trunk and extremities. We recommend it be considered as an adjunctive local anesthetic for consistently painless cutaneous surgery near the muscular fascia.

Adjuvants, Anesthesia↗
PubMed2006

Periungual basal cell carcinoma: case report and literature review.

UNLABELLED: BACKGROUND Basal cell carcinoma, the most common malignancy in humans, rarely occurs on the nail unit and may be frequently misdiagnosed clinically. OBJECTIVES To present a case of basal cell carcinoma of the nail unit successfully treated with the mohs technique and to review the literature regarding this unique presentation of this tumor. MATERIALS AND METHODS: Case report and review of the English literature of nail unit basal cell carcinoma. RESULTS In addition to the currently described patient, 17 other patients with nail unit basal cell carcinoma have been reported. The tumor occurred approximately 3 times more often on the fingers then on the toes and had a slight predilection to occur in men. Ulceration, noted in more than one-half of patients, was the most common presentation of nail unit basal cell carcinoma. Mohs micrographic surgery. Often with second intention healing, was successfully employed in 39% of patients. CONCLUSIONS Basal cell carcinoma infrequently involves the nail unit and often presents as ulceration. Adequate biopsy of the lesion is essential in making a timely diagnosis. Mohs micrographic surgery with second intension healing is an effective treatment that may offer excellent cosmetic and functional results.

Aged, 80 and over↗
PubMed2006

Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer.

BACKGROUND: Basal cell carcinoma with mixed histology (BCC-MH) demonstrates more than one pathologic pattern of tumor. Appropriate therapy for the nonaggressive tumor subtype diagnosed from a superficial biopsy may not be adequate to treat the unsuspected aggressive tumor subtype, resulting in recurrent skin cancer. OBJECTIVE: We prospectively evaluated the incidence and characteristics of BCC-MH. METHODS: Mohs surgical sections were evaluated for BCC-MH. RESULTS: BCC-MH was observed in 43% (49/144) of cancers. Only 10% (5/49) of the biopsy reports from these cancers diagnosed BCC-MH. Most BCC-MH were previously untreated (90% [44/49] of tumors) and were located on the nose. CONCLUSION: More than 40% of basal cell carcinomas referred for removal of the residual tumor were BCC-MH. An unsuspected aggressive pathologic pattern of growth may not be detected after a superficial biopsy. Subsequently, the cancer may recur if the initial treatment for the diagnosed nonaggressive tumor subtype is inadequate for the undiscovered aggressive carcinoma. Mohs micrographic surgery is recommended for BCC-MH treatment.

Adult↗
PubMed2006

Ectopic sebaceous gland: a developmental anomaly.

We report the case of a 21-year-old white male with an ectopic sebaceous gland and duct located within the bulb of an anagen hair follicle. This is an incidental finding in one of two biopsies from his chin, performed as part of the workup for a recalcitrant perioral acneiform eruption. The embryogenesis and development of sebaceous glands in human scalp hair follicles are reviewed. To our knowledge, this is the first report of such a developmental anomaly.

Adult↗
PubMed2005

Cutaneous carcinoma with mixed histology: a potential etiology for skin cancer recurrence and an indication for Mohs microscopically controlled surgical excision.

Cutaneous carcinomas with mixed histology describe nonmelanoma skin cancers which have more than one histologic subtype. These include basal cell carcinomas with concurrent aggressive growth patterns (such as sclerosing, infiltrating, micronodular, keratinizing, and tumors with perineural involvement) and nonaggressive growth patterns (such as superficial, nodular, and follicular) and squamous cell carcinomas with concurrent poorly differentiated and well-differentiated components. One mechanism of recurrence of nonmelanoma skin cancer may very well result from the inadequate initial treatment of cutaneous tumors with mixed histology. If the aggressive histologic subtype of the original tumor is initially not suspected based upon the pathology observed from a superficial biopsy specimen, the clinician may initiate therapy that would be appropriate for the less aggressive variant that was diagnosed. Subsequently, the more aggressive tumor may persist and eventually manifest as a clinical recurrence of the cancer. This is particularly important when there is perineural tumor involvement. We describe two patients whose skin cancers had more than one histologic subtype to demonstrate the histologic features of cutaneous malignancies with more than one pathologic pattern and to emphasize how inaccurate a single diagnostic biopsy can be. We also suggest that clinicians consider Mohs surgical excision of nonmelanoma skin cancers since this technique incorporates microscopically controlled removal of the tumor with complete pathologic evaluation of all surgical margins for any residual cancer.

Aged↗
PubMed2005

Familial median canaliform nail dystrophy.

Median canaliform nail dystrophy typically appears as a central nail groove, beginning at or distal to the proximal nail fold, from which small lateral fissures may be found. Although the onset of this nail dystrophy has occasionally been associated with either prior local trauma or the initiation of treatment with isotretinoin, the etiology of this condition remains elusive for most affected individuals. We describe a man with median canaliform nail dystrophy whose brother and mother had the same nail dystrophy, review the other reported cases, and discuss the differential diagnosis of this nail disorder.

Aged↗
PubMed2004

Mohs micrographic surgery in a patient with a deep brain stimulator: a review of the literature on implantable electrical devices.

BACKGROUND: Implantable electrical devices are becoming increasingly common in the patient population presenting for Mohs micrographic surgery. In addition to understanding the potential intraoperative complications with implantable cardioverter-defibrillators and pacemakers, the Mohs surgeon needs to be aware of the relatively new treatment of movement disorders using implanted deep brain stimulators. OBJECTIVE: We present only the second reported case of Mohs surgery in a patient with a deep brain stimulator. In an attempt to help minimize adverse events during a procedure, we review the more commonly encountered electrical devices as well as the newer deep brain stimulators. We provide guidelines for the avoidance of electromagnetic interference during an electrosurgical procedure. METHODS: This 76-year-old patient with Parkinson's disease and an implanted deep brain stimulator underwent Mohs surgery for excision of a squamous cell carcinoma on the ear. In an attempt to minimize electromagnetic interference with his implanted device, hemostasis was obtained with the aid of a battery-operated heat-generating handheld electrocautery device. RESULTS: The patient tolerated the procedure well without complications or reports of discomfort. CONCLUSION: Patients with implanted electrical devices are subject to electromagnetic interference during an electrosurgical procedure. Care must be taken in this expanding patient population during a Mohs surgical procedure.

Aged↗
PubMedDate not supplied

Intralesional methotrexate for keratoacanthoma of the nose.

A 56-year-old woman developed a nodule on her nose. A shave biopsy of the enlarging lesion was performed after 2 weeks and showed a keratoacanthoma. During the subsequent 4 weeks, the lesion continued to grow rapidly, and she was referred for excision of the lesion using the Mohs microscopically controlled technique. A tender 10x12 mm (120 mm2) erythematous nodule with a keratin-filled central umbilication was present on her left nasal ala (Figure 1). Treatment options were discussed. The left nasal ala was locally anesthetized with 1% lidocaine with 1:100,000 epinephrine and the keratoacanthoma was circumferentially infiltrated with 10 mg of methotrexate (0.8 mL of 12.5 mg/mL methotrexate) using a 30-gauge needle. The total amount of methotrexate injected was divided among several injection sites: the peripheral shoulder of the lesion (such that there was blanching of the entire rim) and under the center of the lesion at a depth clinically judged to be the deepest area of involvement. Within the next 7 days, the tumor began to decrease in size and ulcerate centrally. Examination 2 weeks after the initial injection showed a 71% reduction in the area of the tumor, which now measured 35 mm2 (7.0x5.0 mm). The tumor was injected in a similar manner as before with 5 mg of methotrexate. After another 2 weeks, the tumor had continued to shrink. It was flat without nodularity and measured 12 mm2 (4.0x3.0 mm); the tumor area was 66% less than 2 weeks earlier and 90% less than its original size. The residual tumor was again injected with 4.5 mg of methotrexate. There was complete clinical involution of the tumor when the patient returned for evaluation 6 weeks after her initial injection of methotrexate (Figure 2). A biopsy of the lesional area to confirm histologic resolution of the keratoacanthoma was not performed since there was no visible residual tumor. Periodic follow-up examination has been performed and there has been no subsequent recurrence of the keratoacanthoma.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Pancytopenia after a single intradermal infiltration of methotrexate.

Methotrexate-related hematologic toxicity may include leukopenia, thrombocytopenia, megaloblastic anemia, and pancytopenia. We report a woman with hypertensive renal disease who was receiving hemodialysis and developed pancytopenia following a single intradermal infiltration of 25 mg of methotrexate. Caution should be exercised when considering the use of either systemic or intralesional methotrexate therapy in patients with risk factors that have been implicated in the development of adverse hematologic side effects: renal dysfunction, possible drug interactions, and advanced age.

Adult↗