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Biomedical subjects

Ming H Jih

Publications and source records attributed to Ming H Jih.

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

The 1450-nm diode laser for facial inflammatory acne vulgaris: dose-response and 12-month follow-up study.

BACKGROUND: The 1450-nm diode laser has been known to thermally alter sebaceous glands and has been found to be effective for the treatment of inflammatory facial acne. OBJECTIVE: Our aim was to evaluate the dose response of a 1450-nm diode laser for treatment of facial acne, sebum production, and acne scarring utilizing two laser fluences and to determine long-term remission after laser treatment. METHODS: Twenty patients (Fitzpatrick skin phototypes II-VI) received 3 treatments using the 1450 nm diode laser (3-4 week intervals). Split face comparisons were performed by randomizing patients to one of two fluences (14 or 16 J/cm(2)) on the right or left side of the face. Clinical photographs, lesion counts, and sebum measurements were obtained at baseline and after each treatment. Investigators' and patients' subjective evaluations of response to treatment were assessed. RESULTS: Percentage reductions in mean acne lesion counts from baseline were 42.9% (14 J/cm(2)) and 33.9% (16 J/cm(2)) after one treatment and 75.1% (14 J/cm(2)) and 70.6% (16 J/cm(2)) after 3 treatments. There was persistent reduction of 76.1% (14 J/cm(2)) and 70.5% (16 J/cm(2)) at the 12-month follow-up (P < .01). Both objective and subjective improvements in acne scarring and sebum production were noted. Treatment-related pain was well tolerated, and adverse effects were limited to transient erythema and edema at treatment sites. LIMITATIONS: This was a small study and comparison was limited to two laser fluences. CONCLUSION: The 1450-nm diode laser reduced inflammatory facial acne lesions even in Fitzpatrick skin phototypes IV-VI with minimal side effects. Significant improvement in acne lesion counts were noted after the first treatment and was maintained 12 months after the third treatment, indicating significant long-term clinical remission after laser treatment.

Acne Vulgaris↗
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

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↗
PubMed2005

Curettage prior to Mohs' micrographic surgery for previously biopsied nonmelanoma skin cancers: what are we curetting? Retrospective, prospective, and comparative study.

BACKGROUND: Curettage prior to excision and Mohs' micrographic surgery for nonmelanoma skin cancer is performed based on the assumption that the curette will remove softer, more friable tumor-infiltrated dermis and leave structurally intact normal skin. This assumption, however, has not been objectively examined in the dermatologic surgery literature. OBJECTIVE: We performed a study to examine the ability of curettage to selectively remove and delineate nonmelanoma skin cancer prior to Mohs' micrographic surgery. METHODS: The study included 150 previously biopsied basal cell and squamous cell carcinomas less than 1.5 cm in size. We conducted (1) a retrospective study of 50 tumors curetted prior to Mohs' surgery by a surgeon who routinely curettes preoperatively; (2) a prospective study in which a surgeon who routinely does not curette preoperatively curetted 50 tumors prior to Mohs' surgery; and (3) a comparative historical group of 50 noncuretted tumors treated with Mohs' surgery by the latter surgeon. All curetted tissue was evaluated histologically. RESULTS: Only 50% of the curetted tissue demonstrated the presence of tumor in the curettings, but in 76% of these, the curette left residual tumor at the surgical margins. Of the other 50% in which the curette removed only non-cancer-containing skin, 34% had tumor present at the surgical margin. Overall, the curette removed tumor, leaving no residual tumor at the surgical margins in only 12% of lesions. Comparison with historical noncuretted tumors operated on by the same surgeon showed that curettage did not affect the mean number of stages or the proportion of tumors requiring more than one stage for histologic clearance. CONCLUSION: Although curettage may be helpful in debulking friable skin prior to Mohs' micrographic surgery, it does not reliably delineate the extent of a tumor.

Biopsy↗
PubMed2004

Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study.

OBJECTIVES: To quantitatively assess improvement in acne scarring after a series of nonablative laser treatments and to determine efficacy at 1-, 3-, and 6-month follow-up after treatment. DESIGN: Before-after trial of consecutively selected patients. SETTING: Private practice at the Laser and Skin Surgery Center of New York, New York. PATIENTS: Eleven patients with mild to moderate atrophic acne scarring were treated. INTERVENTIONS: A 3-dimensional optical profiling imaging system was used to assess skin topography before, during, and after treatment. Patients were treated with a 1064-nm Q-switched Nd:YAG laser and reassessed after 3 treatment sessions and at 1, 3, and 6 months after the fifth treatment session. MAIN OUTCOME MEASURES: The skin roughness analysis was quantified at baseline and at each follow-up interval. Pain, erythema, and petechiae formation were assessed on 3-point scales. RESULTS: At midtreatment (1 month after the third treatment session), an 8.9% improvement in roughness analysis was seen. This improvement increased to 23.3%, 31.6%, and 39.2% at 1, 3, and 6 months after the fifth treatment, respectively. Patients reported mild to moderate pain with treatment. The only adverse effects noted were transient erythema and mild pinpoint petechiae. CONCLUSIONS: Treatment with the nonablative 1064-nm Q-switched Nd:YAG laser results in significant quantitative improvements in skin topography in patients with mild to moderate atrophic acne scars. Continued incremental improvements were noted at 1-, 3-, and 6-month follow-up, indicating ongoing dermal collagen remodeling after the treatment.

Acne Vulgaris↗
PubMed2004

60-minute application of S-Caine Peel prior to 1,064 nm long-pulsed Nd:YAG laser treatment of leg veins.

BACKGROUND AND OBJECTIVES: Advancements in laser treatment of leg veins necessitate concurrent investigations in topical anesthesia to minimize treatment-related pain. To evaluate the efficacy of the S-Caine Peel for providing topical anesthesia after a 60-minute application. STUDY DESIGN/PATIENTS AND METHODS: A randomized, double-blinded, placebo-controlled trial was performed in two centers. Sixty patients received S-Caine Peel and placebo vehicle on different treatment sites for 60 minutes prior to laser treatment of leg veins using a 1,064 nm long-pulsed Nd:YAG laser. Patients rated their level of pain using a visual analog scale. Adequacy of anesthesia and expressed pain at each site were rated by the investigator. RESULTS: The mean visual analog scale (VAS) was 27 mm for active sites compared to 43 mm for placebo (P < 0.001). Improved pain relief was noted for 67% of active versus 30% of placebo sites (P < 0.001). Anesthesia was judged adequate by the investigator for 55% of active compared with 12% of placebo sites (P < 0.001). CONCLUSIONS: The S-Caine Peel is safe and effective when applied for 60 minutes prior to laser therapy of leg veins.

Adult↗
PubMed2004

Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study.

BACKGROUND: The 1450-nm diode laser has been found to damage sebaceous glands selectively and to be effective for the treatment of inflammatory acne on the back. OBJECTIVE: To evaluate the efficacy and safety of the 1450-nm diode laser in the treatment of inflammatory facial acne vulgaris. METHODS: Nineteen patients with inflammatory facial acne were treated with the 1450-nm diode laser at 4- to 6-week intervals. There was no control group. Clinical photographs and lesion counts were obtained at baseline and after each treatment. Subjective evaluation of response to treatment and pain was assessed using a questionnaire. RESULTS: All patients had a reduction in acne lesions. Lesion counts decreased 37% after one treatment (p<0.01), 58% after two treatments (p<0.01), and 83% after three treatments (p<0.01). Treatment-related pain was well tolerated, and adverse effects were limited to transient erythema and edema at treatment sites. CONCLUSION: This is the first published report documenting the safety and efficacy of laser treatment for inflammatory facial acne. In our study, clinical improvement was seen in all patients and was generally dramatic, even in those refractory to previous treatment with oral isotretinoin. Topical anesthetics should be used to minimize pain associated with treatment.

Acne Vulgaris↗
PubMed2004

Nonphysician practice of dermatologic surgery: the Texas perspective.

BACKGROUND: Increases in complications resulting from the nonphysician practice of dermatologic procedures have been reported nationally. This investigation was initiated owing to growing concern regarding the nonphysician practice of medicine in Texas. OBJECTIVE: The objective was to survey dermatologists in Texas to determine the number of patients seeking corrective treatment owing to complications from dermatologic procedures performed by nonphysicians. METHODS: A total of 488 dermatologists in Texas were surveyed and seven patients who experienced complications were interviewed by phone. RESULTS: Nearly 53% of responding physicians noted increased complications resulting from nonphysician practice of medicine. Approximately 33% of responding physicians reported that complications were known to have occurred in the absence of an on-site supervising physician. CONCLUSION: The increase in the number of complications owing to nonphysician practice of medicine in Texas mirrors the increases that have been reported nationally. The serious complications reported underscore the need for improved awareness and regulatory changes by state boards of medicine.

Clinical Competence↗