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Biomedical subjects

Leonard H Goldberg

Publications and source records attributed to Leonard H Goldberg.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of inflammatory facial acne vulgaris with combination 595-nm pulsed-dye laser with dynamic-cooling-device and 1,450-nm diode laser.

BACKGROUND AND OBJECTIVES: The 585-nm pulsed-dye laser and the 1,450-nm diode laser have been found effective for the treatment of mild-to-moderate inflammatory facial acne. This study was designed to evaluate the efficacy and safety of the combined treatment with the 595-nm pulsed-dye laser and the 1,450-nm diode laser for inflammatory facial acne. STUDY DESIGN/MATERIALS AND METHODS: Fifteen patients with inflammatory facial acne were treated with a combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser. Patients' subjective response to treatment was evaluated regarding improvement in acne, acne scarring, oiliness, and redness of the skin. RESULTS: All patients had reductions in acne lesion counts. Mean lesion counts decreased 52% (P < 0.01), 63% (P < 0.01), and 84% (P < 0.01) after one, two, and three treatments, respectively. Patients described moderate-to-marked improvement in acne, acne scarring, and post-inflammatory erythema. Adverse effects were limited to mild, transient erythema. CONCLUSIONS: The combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser is safe and effective for the treatment of inflammatory facial acne, acne scarring, and post-inflammatory erythema.

Acne Vulgaris↗
PubMed2006

Combined linear closure and Burow's graft for a dorsal nasal defect.

An 80-year-old man with a history of nonmelanoma skin cancers of the head and neck presented for treatment of a basal cell carcinoma of the nose. Physical examination revealed a poorly defined, exophytic, ulcerated nodule of the mid-dorsal nose. Given the size, location, and ill-defined margins of the tumor, Mohs micrographic surgical excision was indicated. The tumor was excised in three stages with microscopic control. The final defect was full thickness of the dermis, sparing the underlying muscle and measuring 3.2 x 2.4 cm on the mid-dorsal, supratip, and lateral aspects of the nose (Figure 1). How would you repair this defect?

Aged, 80 and over↗
PubMed2006

Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers.

BACKGROUND: Injection of filler materials into the dermis is well tolerated, with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE: We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION: Injection necrosis in the glabellar region may be prevented by knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol.

Biocompatible Materials↗
PubMed2006

Lymphoepithelioma-like carcinoma of the skin: a report of two cases treated with complete microscopic margin control and review of the literature.

Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous neoplasm with microscopic similarities to non-cutaneous lymphoepitheliomatous malignancies, particularly undifferentiated carcinoma of the nasopharynx. It can be clinically and histologically confused with other benign and malignant tumors. If not adequately treated, recurrence and distant metastasis are probable. We present two cases of LELCS treated surgically with complete microscopic margin control (one by the Mohs method and the other with en face permanent sections) and review the literature.

Aged, 80 and over↗
PubMed2006

Fractional photothermolysis for treatment of poikiloderma of civatte.

Poikiloderma of Civatte refers to a change in the skin where there is atrophy, hyper- and hypopigmentation, and dilation of fine blood vessels (telangiectasia). These alterations often cause cosmetic disfigurement, most commonly in middle-aged or elderly women with a fair complexion. Several treatment modalities, based on the theory of selective photothermolysis, including argon lasers, KTP lasers, pulsed dye lasers, and intense pulsed light devices, have been used to treat this condition in the past. Clinical experience has shown that complete clearing is difficult to achieve. Moreover, depending on the modality used, adverse effects, such as scarring with irregular hypopigmentation, post-inflammatory hyperpigmentation, post-treatment purpura, mottled appearance, crusting, and erythema, have been reported. Multiple sessions with these treatments are usually necessary to obtain optimal clearing.

Atrophy↗
PubMed2005

In vitro sensitivity to ultraviolet B light and skin cancer risk: a case-control analysis.

BACKGROUND: Mutagen sensitivity, measured as mutagen-induced chromatid breaks per cell in primary lymphocytes in vitro, has been used to study susceptibility to various epithelial cancers. Patients with xeroderma pigmentosum are highly sensitive to ultraviolet (UV) light due to inherited defects in DNA repair and have a 1000-fold higher risk of UV-induced skin cancer than the general population. However, an association between UV-induced chromosomal aberrations and risk of skin cancer in the general population has not been established. METHODS: We assessed in vitro UVB-induced chromatid breaks in a hospital-based case-control study. The study included 469 patients with skin cancer (231 with nonmelanoma skin cancer [NMSC] and 238 with cutaneous malignant melanoma [CMM]) and 329 cancer-free control subjects. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two-sided. RESULTS: Compared with the frequency of UVB-induced chromatid breaks per cell in control subjects (mean = 0.28 breaks per cell, 95% CI = 0.27 to 0.30), that in NMSC patients (basal cell carcinoma [BCC], n = 143, mean = 0.36 breaks per cell, 95% CI = 0.33 to 0.39 and squamous cell carcinoma [SCC], n = 88, mean = 0.35 breaks per cell, 95% CI = 0.32 to 0.38) was higher (P = .001 and P < .001, respectively), but that in CMM case patients (mean = 0.30 breaks per cell, 95% CI = 0.28 to 0.33) was not (P = .22). A frequency of chromatid breaks per cell above the median of control subjects was associated with nearly threefold increased risks for BCC (OR = 2.78, 95% CI = 1.79 to 4.30) and SCC (OR = 2.62, 95% CI = 1.50 to 4.60), but not with an increased risk of CMM. A dose-response relationship was evident between mutagen sensitivity and risk for both BCC (Ptrend < .001) and SCC (Ptrend < .001). Multiplicative interactions between mutagen sensitivity and sun exposure variables on risk, particularly for sunburn in BCC and hair color, tanning ability, and family history of skin cancer in SCC, were seen for NMSC but not CMM. CONCLUSIONS: UVB-induced mutagen sensitivity may play a role in susceptibility to NMSC but not to CMM.

Adult↗
PubMed2005

Island pedicle flap.

The island pedicle flap uses an island of skin that is detached from its epidermal and dermal attachments while retaining its vascular supply from an underlying pedicle to repair a cutaneous defect. Proper design of this flap requires familiarity with the anatomic and vascular basis of the flap and with technical aspects of flap mobility. Transposition, tunneling, interpolation, myocutaneous, and transcartilage variants of the island pedicle flap are discussed. This flap is most useful for defects on the upper cutaneous lip and eyebrow, but its use on the nose, ears, and periorbital area are indispensable for the repair of select defects.

Face↗
PubMed2005

A rare case of fatal primary cutaneous mucinous carcinoma of the scalp with multiple in-transit and pulmonary metastases.

BACKGROUND: Primary cutaneous mucinous carcinoma is a rare neoplasm derived from the sweat glands. It is usually located in the head and neck region, with the eyelids being the most common site of presentation. Recurrence following primary excision is common but metastasis is rare. CASE REPORT: We report a patient presenting with rapidly progressive cutaneous mucinous carcinoma on the right parietal scalp. Systemic work-up failed to reveal an occult primary source. The tumor was treated with Mohs micrographic surgery with clear margins. However, within two months, the patient developed new lesions on the scalp both adjacent to and separate from the original previously excised area, as well as metastasis to the right parotid gland. The patient received adjuvant radiation therapy both to the scalp lesions and to the parotid gland with apparent control of locoregional disease. However, two weeks after completing radiation therapy, the patient was found to have developed pulmonary metastases and died soon thereafter. CONCLUSION: Primary mucinous carcinoma arising in the skin is rare and usually follows an indolent course. We report the rare occurrence of a mucinous carcinoma of the scalp that developed multiple cutaneous tumors caused by in-transit metastases, as well as parotid gland metastases and eventual fatal pulmonary metastases.

Adenocarcinoma, Mucinous↗
PubMed2005

Analysis of 197 female scalp tumors treated with Mohs micrographic surgery.

BACKGROUND: There has been no previously published study on skin cancers on the scalp of women. OBJECTIVES: To better elucidate the characteristics of skin cancers that develop on the female scalp. METHODS: A retrospective review of 13,885 biopsy-proven skin cancers treated by Mohs micrographic surgery was performed. We identified 197 tumors on the scalp of women. Demographic features and tumor characteristics were compiled and analyzed. RESULTS: The average age of women with scalp tumors was 61.8 +/- 16.9, which was significantly lower than that of men with scalp tumors. The age followed a bimodal distribution with peaks in the fifth and eighth decades. Overall, 77% of female scalp tumors were basal cell carcinomas (BCCs), 17% were squamous cell carcinomas (SCCs), and 6% were a variety of other tumors. This contrasts with men in whom 53% of tumors were squamous cell carcinomas. Basal cell carcinomas were significantly more common in women under age 50. CONCLUSION: Skin cancers of the female scalp tend to be basal cell carcinomas, many of which occur at a relatively young age as compared to other skin cancers. The exact role of ultraviolet radiation in the development of some of these tumors is unclear.

Adolescent↗
PubMed2005

Surgical repair of temple defects after Mohs micrographic surgery.

BACKGROUND: It is typically recommended that linear surgical closures follow a relaxed skin tension line (RSTL). In the temple, these lines generally run parallel to the orbital rim. However, closures parallel to RSTLs are not feasible for many medium and large surgical defects because of anatomic constraints. OBJECTIVES: We sought to describe our method of repairing temple defects and assess the cosmetic outcome of temple defects repaired perpendicular to the RSTLs. METHODS: We performed a two-phase study of temple closures. In the first phase, a retrospective analysis was performed to assess the defect size and type of closure used for 99 consecutive temple defects. In the second phase, 27 of 86 patients who previously underwent linear surgical repairs in the temple that were designed perpendicular to the RSTLs were evaluated 12 to 24 months postoperatively to assess the cosmetic outcome. Results In the first phase of the study, there was an inverse correlation between the width of the postoperative defect and the ability to close the defect parallel to the RSTLs. The percentage of defects that could be repaired parallel to the RSTLs for defects up to 1 cm in width, 1.1 to 2 cm in width, and greater than 2 cm in width was 46%, 28%, and 8%, respectively. In the second phase of the study, 27 patients with temple defects repaired perpendicular to the RSTLs were evaluated an average of 1.7 years after operation. Most scars (83%) were clinically invisible or barely visible. There were no cases with residual standing cones (dog-ears) or hypertrophic scars. CONCLUSION: The vast majority of temple defects can be repaired in a linear fashion. Smaller defects (width < 1 cm) can be repaired parallel to the RSTL. Those that are larger (width 1-3 cm) or more medially located can be repaired perpendicular to the RSTL, using loose cheek skin for the closure. Very large defects (width > 3-5 cm) or those with limited cheek mobility may require flaps or skin grafts for closure.

Cosmetic Techniques↗
PubMed2005

Accuracy of serial transverse cross-sections in detecting residual basal cell carcinoma at the surgical margins of an elliptical excision specimen.

BACKGROUND: There has been no published study estimating the proportion of positive surgical margins that is missed when serial transverse cross-sectioning (bread-loafing) is used to histologically evaluate the surgical margins. OBJECTIVE: Our purpose was to estimate the accuracy of serial transverse cross-sectioning (bread-loafing) at 4-mm intervals in detecting the presence of residual tumor at the margins of well-defined facial basal cell carcinomas excised as an ellipse with 2-mm surgical margins. METHODS: Forty-two small (<1 cm), well-defined, primary, nonmorpheaform facial basal cell carcinomas that had been excised as an ellipse with 2-mm margins and that had positive surgical margins utilizing en-face Mohs sections were included. After longitudinal bisection of each ellipse, frozen sections were prepared encompassing the entire surgical margin. Transparencies with parallel lines spaced at 4-mm intervals were superimposed on the histologic slides with the lines perpendicular to the epidermal surface. Areas in which the lines intersected tumor at the surgical margin were noted. The percentage of tumors that would be detected by serial cross sections was calculated on the basis of the percentage of these parallel lines that intersected tumor. RESULTS: The 42 tumors had a total of 50 positive surgical margins. Overall, the cross-sectional lines intersected tumor 44% of the time (95% confidence interval, 37%-51%). Only 5 (10%) of the residual tumors at the surgical margins exceeded 4 mm in their longitudinal dimension. In the 9 sections containing tumor in the deep margin, tumor intersected the lines 39% of the time. CONCLUSION: Bread-loafing at 4-mm intervals of elliptical excision specimens from facial basal cell carcinomas excised with 2-mm surgical margins is only 44% sensitive in detecting residual tumor at the surgical margins. We recommend complete histologic margin control by using en face tissue orientation (Mohs technique) to identify residual tumor and reduce the risk of tumor recurrence after elliptical excision of facial basal cell carcinomas.

Basal Cell Carcinoma↗
PubMed2005

Diffuse epidermal and periadnexal squamous cell carcinoma in situ: a report of 13 patients.

BACKGROUND: Diffuse epidermal and periadnexal squamous cell carcinoma in situ (DEPS) is a condition in which large areas of skin are affected by atypical keratinocytes that grow beneath the epidermis and encase adnexal epithelia. Normal differentiation of the overlying epidermis and adnexal epithelium is seen. OBJECTIVE: Our aim was to describe the clinical features of DEPS. METHODS: We undertook a retrospective case series of 13 patients with DEPS. RESULTS: All 13 patients were fair-skinned men older than 50 years with a history of significant sun exposure. The lesions were present on the scalp, face, and neck. Histologic examination showed a growth of atypical keratinocytes in the lower epidermis with encasement of adnexal structures by atypical neoplastic keratinocytes. In the 52 cumulative patient-years of follow-up, we treated 80 invasive squamous cell and 48 basal cell carcinomas in these patients. Despite improvement of DEPS with aggressive topical and destructive therapy, multifocal recurrence would typically develop within a few months. CONCLUSION: DEPS is characterized by diffuse involvement of chronically sun-exposed skin with atypical keratinocytes that grow along the inferior portion of the basal layer of the epidermis and around adnexal structures. The treatment of DEPS is challenging because of its widespread nature and deeper periadnexal involvement. DEPS is also associated with the development of invasive squamous cell and basal cell carcinomas.

Aged↗
PubMed2005

The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings.

BACKGROUND: There has been significant interest in the safety of office-based surgery. OBJECTIVE: Our purpose was to compare the safety of Mohs micrographic surgery and related surgical repairs performed in office- and hospital-based settings. METHODS: The study included 3937 consecutive patients undergoing Mohs surgery. Surgery was performed at either an outpatient office or a hospital-based setting. RESULTS: Mohs surgery was performed on 1540 patients in the hospital and 2397 patients underwent surgery in the office. The mean patient age was 66 years, and 61% were men. Ninety-three percent of lesions were basal cell or squamous cell carcinomas, and 86% were located on the head and neck. The average tumor measured 1.1 x 1.0 cm, required 1.7 stages of Mohs surgery, and resulted in a defect measuring 2.4 x 1.8 cm. Linear closures, flaps, grafts, and second-intention healing were utilized in 69%, 14%, 6%, and 11% of defects, respectively. There were no differences in patient or tumor characteristics or the types of closures used at the two operating facilities. The only serious surgical complication was gastrointestinal hemorrhage due to naproxen prescribed postoperatively for auricular chondritis in one patient. CONCLUSION: Mohs micrographic surgery and repair of associated defects can be safely performed in either an office- or hospital-based setting.

Aged↗
PubMed2005

Efficacy of narrow-margin excision of well-demarcated primary facial basal cell carcinomas.

BACKGROUND: A 4-mm surgical margin of clinically normal skin is the current standard for elliptical excision of basal cell carcinomas (BCCs). However, a 4-mm surgical margin is often not feasible on the face because of cosmetic and functional concerns. As such, facial excisions of BCCs are typically performed with the appropriate margin determined by the surgeon based on clinical features of the tumor. OBJECTIVE: We designed a study to test the efficacy of narrow-margin elliptical excisions for the treatment of small, well-demarcated facial BCCs. METHODS: A total of 134 primary, small (<1 cm), well-demarcated, facial nodular BCCs were excised as an ellipse with 1-, 2-, or 3-mm margins around the visible border of the tumor. The margin used was decided by the dermatologic surgeon based on cosmetic, anatomic, and functional factors, with the goal of clearing the tumor in a single excision. Using the Mohs technique for elliptical specimens, frozen sections were prepared and examined microscopically to provide complete histologic margin control. RESULTS: In all, 134 facial BCCs were included in the study. On average, the tumors measured 0.6 x 0.5 cm. Of these, 27 (20.1%) had positive margins, requiring additional excision. Excisions with 1-, 2-, and 3-mm margins were associated with positive margins in 16%, 24%, and 13% of tumors, respectively. There was no statistically significant difference in the occurrence of positive margins based on tumor size, anatomic location, or the measured margin used. CONCLUSION: Narrow margins (1-3 mm) are inadequate for the excision of small, well-demarcated, primary nodular BCCs of the face. To avoid repetitive operations and the risk of recurrence in anatomically sensitive areas, these tumors should be treated with standard wide margins (eg, 4 mm), or have Mohs micrographic surgery for histologic margin control.

Basal Cell Carcinoma↗