Biomedical subjects
Kishwer S Nehal
Publications and source records attributed to Kishwer S Nehal.
Innovative laboratory techniques to facilitate processing of large Mohs cases.
BACKGROUND: Processing multiple tissue sections in large Mohs cases is time consuming and labor intensive. OBJECTIVE: To present innovative laboratory techniques to facilitate processing of large Mohs cases. METHODS: A method for processing a large dermatofibrosarcoma protuberans Mohs case is outlined. RESULTS: Modifications in tissue processing and equipment employed in a large Mohs case are presented. CONCLUSION: Innovative modifications to the standard Mohs laboratory technique can facilitate processing of large Mohs cases, resulting in high-quality, rapid frozen sections while optimizing efficiency.
Clinical application of dynamic telepathology in Mohs surgery.
BACKGROUND: Telepathology is an expanding technology in multiple fields for remote pathology diagnosis and consultation. The use of telepathology in Mohs surgery has been very limited. OBJECTIVE: To describe the clinical experience of using a telepathology system for intraoperative consultations on difficult frozen sections during Mohs surgery. MATERIALS AND METHODS: Intraoperative consultation with a dermatopathologist was obtained using a dynamic telepathology system for all questions arising on frozen sections during Mohs surgery for nonmelanoma skin cancers during a 2-year period. RESULTS: The most common reason for consultation was to distinguish basal cell carcinoma from a benign histologic simulant on Mohs frozen sections. Other uses included determining tumor histology and distinguishing inflammation from residual tumor. CONCLUSION: Dynamic telepathology is a useful and convenient adjunct in the Mohs surgery practice for intraoperative consultations on difficult frozen sections.
Multiple subclinical syringomatous proliferations encountered during Mohs surgery for basal cell carcinoma.
BACKGROUND: Examination of Mohs surgery frozen sections may lead to discovery of incidental benign neoplasms such as syringomas. OBJECTIVE: An unusual occurrence of numerous subclinical syringomatous proliferations discovered during Mohs surgery for a basal cell carcinoma that posed a diagnostic and management dilemma is reported. METHODS: Clinical records and histologic sections are examined. RESULT: Multiple syringomatous proliferations were noted around a basal cell carcinoma during Mohs surgery. A few foci were atypical appearing and focally extending into the deep dermis causing a diagnostic dilemma. All atypical syringomatous proliferations were excised. Evaluation of final Mohs margins by permanent sections and biopsies of normal-appearing facial skin showed multiple benign syringomas. CONCLUSION: Although solitary subclinical syringomas have been described in association with basal cell carcinomas, the occurrence of multiple syringomas and syringomatous proliferations has not been previously reported. Dermatologists should be aware of the existence of this phenomenon and consider permanent section evaluation to better determine nature of unusual incidental tumors identified in frozen sections during Mohs surgery.
Use of ex vivo confocal scanning laser microscopy during Mohs surgery for nonmelanoma skin cancers.
BACKGROUND: Ex vivo confocal scanning laser microscopy offers rapid optical reflectance imaging of excised tissue without conventional frozen histopathology that can potentially expedite Mohs surgery. OBJECTIVE: The objective was to determine the feasibility of using ex vivo confocal scanning laser microscopy during Mohs surgery for detecting residual basal cell carcinoma and squamous cell carcinoma. METHODS: One-hundred fifteen Stage I Mohs surgery excisions (92 basal cell carcinoma, 23 squamous cell carcinoma) were imaged with acetowhitening and confocal scanning laser microscopy and compared to conventional Mohs frozen histologic sections for normal and tumor features. RESULTS: Large aggregates of residual tumor such as nodular basal cell carcinoma were easily detected by ex vivo confocal scanning laser microscopy, whereas smaller tumor foci were not consistently identified. Confocal morphology of tumor subtypes is described. CONCLUSION: Ex vivo confocal scanning laser microscopy can potentially expedite Mohs surgery in rapidly detecting large nodular basal cell carcinomas without conventional frozen histopathology. Further improvements in instrumentation and image quality are necessary to allow broader application and acceptance of this novel technology in Mohs surgery.
Multiple infundibulocystic basal cell carcinomas: case report of unique unilateral presentation.
BACKGROUND: Basal cell carcinoma shows a wide spectrum of clinical and histologic appearances. A distinct tumor variant with follicular infundibulocystic differentiation is recognized, and there are only a few reports on its clinical presentation and management. OBJECTIVE: To report a case of multiple infundibulocystic basal cell carcinomas with a unique unilateral presentation. METHODS: A clinical history was obtained. Photographs were taken, and punch biopsies were performed. RESULTS: An 83-year-old Caucasian female presented with multiple unilateral, asymptomatic, skin-colored, dome-shaped papules around the right mouth for 11 years without apparent change. Punch biopsies revealed findings typical of infundibulocystic basal cell carcinoma. CONCLUSIONS: A patient with clinically indolent multiple unilateral infundibulocystic basal cell carcinomas is described. Given the location of these multiple lesions, standard treatment modalities for basal cell carcinomas would have significant cosmetic and functional implications. A management approach with clinical follow-up and surgical intervention only for changing lesions is discussed.
Erythromelalgia precipitated by acral erythema in the setting of thrombocytopenia.
Erythromelalgia is a rare syndrome that is characterized by episodic attacks of burning pain in the distal extremities, which last from minutes to days and are precipitated by exercise, warmth, or limb dependency. There is a primary or idiopathic form and a secondary form that occur with myeloproliferative or other diseases. All previous reports about erythromelalgia that is the result of a myeloproliferative process have documented associated thrombocytosis. We describe a 40-year-old woman with myelodysplastic syndrome who experienced erythromelalgia in the setting of acral erythema and thrombocytopenia, first induced by chemotherapy and recurring after a radiation- and chemotherapy-based myeloablative regimen that was administered before a T-cell-depleted allogeneic bone marrow transplantation.
Use of dynamic telepathology in Mohs surgery: a feasibility study.
BACKGROUND: Telepathology is an emerging technology for remote pathology consultation and diagnosis. OBJECTIVE: To assess the diagnostic accuracy and utility of a dynamic telepathology system in the setting of Mohs surgery. METHODS: Using a dynamic telepathology system, a single dermatopathologist at a remote site assessed the following cases: (1) 50 fixed-tissue slides of basal and squamous cell carcinomas for pathologic diagnosis; (2) 40 frozen-section slides from Mohs surgery for the presence or absence of tumor; (3) 20 frozen-section slides from Mohs surgery for intraoperative consultation with the Mohs surgeon. All 110 slides were then randomly reviewed by the same dermatopathologist by conventional light microscopy. Telepathology and conventional light microscopy diagnoses were then compared. RESULTS: There was complete agreement between telepathology and conventional light microscopy diagnoses. CONCLUSION: Dynamic telepathology is a convenient, useful, and accurate system for remote diagnosis and consultation in the setting of Mohs surgery.
Intralesional corticosteroid treatment of multiple eruptive keratoacanthomas: case report and review of a controversial therapy.
BACKGROUND: Use of intralesional corticosteroids in the management of keratoacanthomas has been reported in older literature. Yet this therapy is no longer a commonly considered treatment option. OBJECTIVE: To report management of a therapeutically challenging patient with multiple eruptive keratoacanthomas with intralesional corticosteriod treatment to revive awareness of this treatment option. METHODS: A 55-year-old female with frequent episodes of multiple eruptive keratoacanthomas was treated with intralesional corticosteroids and methotrexate. RESULTS: Intralesional corticosteroids successfully treated eruptive keratoacanthomas with complete regression and minimal scarring within 2-4 weeks. CONCLUSION: Despite its limitations, intralesional corticosteroids may have a role in the treatment of select keratoacanthomas.
Current concepts in the management of actinic keratosis.
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