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Biomedical subjects

M G Dahl

Publications and source records attributed to M G Dahl.

At least 19 recordsLinked to original sources
PubMed2000

A retrospective study of outcome of Mohs' micrographic surgery for cutaneous squamous cell carcinoma using formalin fixed sections.

The surgical management of recurrent or large squamous cell carcinoma (SCC) can be challenging as tumours often extend beyond visible margins. Micrographic surgery is a potentially effective method of ensuring complete clearance of tumour. A retrospective study of all cases of SCC treated by micrographic surgery in this department between 1986 and 1996 has been done. Sixty-one patients were treated using a formalin-fixed paraffin-embedded tissue technique with a median follow-up of 4 years. In two cases there was local recurrence and in three others metastasis to local lymph nodes. The overall cure rate was 92% (56 of 61), which compares favourably with published series using chemosurgery and frozen tissue techniques. The results show that this technique of micrographic surgery is a satisfactory and cost-effective alternative to conventional frozen section techniques in the treatment of SCC. The formalin-fixed tissue method has the advantage of providing high-quality permanent histological sections using existing conventional pathology services.

Adult↗
PubMed1998

Vesicular mycosis fungoides.

Blistering is not a feature normally associated with mycosis fungoides (MF). We present a case of MF in which histopathological vesicle formation was such a prominent feature that diagnosis was delayed. The patient's disease ran an aggressive course and death occurred within one year of presentation. Tumour involvement of the tongue with MF was an unusual late feature.

Blister↗
PubMed1998

Mohs' surgery of periocular basal cell carcinoma using formalin-fixed sections and delayed closure.

Mohs' surgery of periocular basal cell carcinoma (BCC) ensures a high cure rate with maximal preservation of normal tissue. The formalin-fixed paraffin-embedded tissue technique allows Mohs' surgery to be performed using routine pathology facilities and permits the efficient use of operating room personnel and theatre time. The inevitable delay between excision and closure may potentially result in a poor functional and cosmetic outcome, particularly around the eye. We prospectively studied all patients with periocular BCC treated with this technique at our unit between 1985 and 1996. One hundred and twenty-three periocular BCCs in 120 patients were treated. Microscopic clearance was achieved in all cases. Closure was performed on average 5 days after the initial excisional stage. Closing procedures included direct closure, flaps and grafts. Significant complications affecting outcome were noted in only two patients. Eighty-eight per cent of patients assessed had a functional and cosmetic result regarded as excellent, good or adequate. Mohs' surgery of periocular BCC using formalin-fixed paraffin-embedded tissue and delayed closure results in a satisfactory functional and cosmetic outcome and offers a viable alternative to the frozen section fresh tissue technique.

Adult↗
PubMed1996

Micrographic surgery for subungual squamous cell carcinoma.

Eight patients were treated for subungual squamous cell carcinoma (4 female, 4 male; mean age 61 years). History of disease ranged from 9 months to 14 years (mean 4.7 years). Outpatient surgery under local anaesthetic was performed using Mohs micrographic surgery and formalin-fixed histological specimens. Tumour clearance was achieved after 2-6 procedures (median 3) over a mean period of 6.9 days. In all cases the wounds were allowed to heal by secondary intention and the distal phalanx was preserved. During a mean follow-up period of 3.1 years (range 0.5-6), no recurrence was seen and involved digits remained functional. Mohs micrographic surgery can provide a valuable alternative to amputation for subungual squamous cell carcinoma.

Aged↗
PubMed1996

Nail surgery: an assessment of indications and outcome.

To examine the merits of nail surgery, we studied the surgical investigation, treatment and the outcome of 78 consecutive patients with nail pathology in the context of their complaint. A diagnosis was reached in 74/78 patients. Thirty-six out of seventy-eight (46%) of patients had tumours, 17/78 (22%) had a dermatosis, 21/78 (27%) had infection or trauma and 4/78 (5%) remained undiagnosed. The presenting complaint was treated with substantial or complete resolution in 66/78 (87%) patients. Ninety-seven per cent (35/36) of those with tumours were cured, including all 5/36 with malignant and dysplastic tumours. Post-operative splitting of the nail was seen in only one patient due to secondary infection of a longitudinal nail unit biopsy. Information from this study demonstrates the diagnostic and therapeutic value of nail surgery within dermatology.

Adolescent↗
PubMed1987

PUVA-induced blisters, complement deposition, and damage to the dermoepidermal junction.

We followed the course of 56 patients receiving psoralen plus long-wave ultraviolet light (PUVA) therapy. Nonhemorrhagic blisters developed on clinically normal skin on the limbs of seven patients. Seeming to be related to friction and trauma, the blisters form as a result of damage to the basal and suprabasal layers. Perilesional skin specimens from all blistered patients contained granular deposits of C3 at the dermoepidermal junction, around the upper dermal blood vessels, or at both sites. The average time for initiation and complete formation of suction blisters was measured in 51 patients at different stages during the course of PUVA treatment. Blister separation was in the lamina lucida, with the pemphigoid antigen in the roof while the blister floor contained the lamina densa, laminin, and type IV collagen. This impaired dermoepidermal adhesion was a general phenomenon that occurred in all PUVA-treated patients. The mechanism remains to be determined.

Adult↗
PubMed1986

Excision of skin tumours without wound closure.

Sixty-two patients with 67 large or poorly defined skin tumours predominantly on the head and neck (58 basal cell carcinomas) were treated by excision of the lesion and allowing the defect created to heal by second intention. Histological control of the adequacy of excision was monitored using routine vertical sections of formalin-fixed tissue. Further re-excisions were performed in 17 patients in whom tumour extended up to or within 1 high power field (approximately 0.44 mm) of the excision margin. The formalin-fixed specimens ranged from 6-60 (mean 21) mm in diameter and 2-12 (mean 5) mm in depth. After one excision the time to complete re-epithelialization was directly proportional to the surface area (r = 0.73) and ranged from 13 to 60 days (mean 33 days). Measurements of the movements of fixed reference points tattooed at the wound edges in six patients showed that movement of surrounding tissue into the defect accounted for 39-62% (mean 45%) of the reduction in surface area of the defect during healing. Post-operative complications were rare and the cosmetic results were considered good or excellent in 48 patients, fair in nine and poor, i.e. requiring corrective surgery, in three patients. Poor results were due to distortions of free margins, e.g. lower eyelid and nasal margin. The major benefit of this technique is the ease with which further excisions can be performed when histologically indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Two patterns of skin ulceration induced by methotrexate in patients with psoriasis.

Two patterns of skin ulceration occurred in patients receiving weekly methotrexate for psoriasis. In type I ulceration, psoriatic plaques became painful and eroded shortly after starting methotrexate (MTX) (median, 10 days). Type II ulcers occurred in clinically uninvolved skin affected by other pathology--stasis dermatitis in two and adjacent to an anal fistula in one and had a variable relationship to the duration of methotrexate treatment. Type I ulcers developed at methotrexate doses between 12.5 and 25 (median, 20) mg/wk and healed rapidly (median, 10 days) after dose reduction or withdrawal. Type II ulcers developed at methotrexate doses of 7.5 to 20 (median, 10) mg/wk and took a median of 9 weeks to heal. Type I ulceration may be confused with an exacerbation of psoriasis, and the MTX dose mistakenly increased rather than reduced. Type II ulcers can mimic stasis ulcers and may be overlooked as evidence of MTX toxicity.

Adult↗
PubMed1979

Lesions induced by trauma in pemphigoid.

Three patients are described with pemphigoid (two with typical adult type and one with juvenile pemphigoid) in whom bullous lesions had clearly been induced by the trauma of scratching. In two patients this phenomenon occurred during the first few weeks of systemic corticosteroid treatment at a time when other lesions were resolving or had completely healed. Although lesions induced by trauma are not usually of great clinical importance, epidermolysis bullosa acquisita may represent a variant of pemphigoid in which trauma-induced lesions predominate. Induction of pemphigoid lesions by trauma may prove a useful method of studying early immunopathological events.

Aged↗