Macrodactyly. Trigeminal trophic syndrome. Extramammary Paget's disease. Self-assessment examination of the American Academy of Dermatology.
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Biomedical subjects
Publications and source records attributed to P L Bailin.
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We describe a patient with both Muir-Torre syndrome and alpha 1-antitrypsin deficiency. A keratoacanthoma developed after immunosuppressive therapy for necrotizing vasculitis. To our knowledge, this is the first reported case of Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency.
Recently, magnetic resonance imaging (MRI) has been reported to be clinically useful, in selected cases, in patients with melanocytic skin lesions. This report describes good resolution, clinically useful MRI scans of squamous cell carcinoma, dermatofibroma, and primary cutaneous B-cell lymphoma. The tumor depth measured by MRI was in excellent correlation with Breslow's depth measurements, indicating that MRI is probably the radiologic technique of choice for preoperative evaluation of the extent and depth of primary and recurrent skin tumors. This report also provides the authors' recommendations for obtaining optimal MRI images of cutaneous lesions.
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In a 1984 survey, 2750 members of the American Academy of Dermatology were asked which dermatologic surgery procedures they performed and which procedures they expected to be performing in 5 years. A similar survey was completed by the American Society for Dermatologic Surgery in 1988. In this article, the results of the 1988 survey are presented and compared to that of 1984.
The skin barrier was evaluated as a function of transepidermal water loss (TEWL) and electrolyte loss. Combination electrodes for chloride and pH determinations and a potassium ion electrode were utilized. Delipidization of the skin did not impair the electrolyte barrier, but did damage the epidermal water barrier. Cellophane tape stripping of normal stratum corneum resulted in an increase in outward transepidermal potassium and chloride ion flux, an increase in skin surface pH, and an increase in TEWL. It appears that damage to the epidermal water barrier does not necessarily result in damage to the epidermal electrolyte barrier. We found the potassium electrode facile to use and believe that a combination potassium electrode would be useful for investigating and assessing the epidermal electrolyte barrier.
Advances in laser technology now permit the physician to provide an effective form of treatment for a variety of cutaneous disorders for which no previous therapy existed. Additional refinements in both laser instruments and treatment techniques are certain to have a profound impact on the treatment of skin lesions. For that reason, a complete understanding of the basic properties of lasers and how they can be utilized in various clinical settings is the goal of this article.
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This is the first literature report on magnetic resonance imaging (MRI) examination of cutaneous melanocytic or any other type of skin lesions. Good resolution, clinically useful MRI scans of a congenital nevus and a metastatic melanoma to the skin are presented. The potential usefulness of MRI technique to physicians dealing with cutaneous disease is discussed.
Cutaneous carcinoma of the auricular and periauricular region can be diagnosed early and often can be cured; however, many of these tumors become difficult to treat because of local spread and regional metastasis. Those tumors that are not treated early often require more aggressive treatment with ear canal resection, partial temporal bone resection, or even parotidectomy and radiation therapy. Mohs histographic surgery combined with conventional excision affords the best marginal control for local eradication of these tumors.
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Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.
The carbon dioxide laser in both conventional and superpulsed modes was used to treat 13 patients with chronic actinic cheilitis. The procedure was well tolerated. Focal, but not functionally restricting, scarring developed in three patients. The cosmetic result was otherwise excellent. No recurrences have been noted.
Ten patients with dermatofibrosarcoma protuberans, all of whom had been treated previously by conventional excisional surgery without success, were treated with Mohs micrographic surgery. A team approach utilizing margin control by Mohs-trained physicians and reconstruction by surgical specialists was employed. Average follow-up exceeds 3 1/2 years, with no recurrences. Microscopically controlled excision appears to be the treatment of choice for dermatofibrosarcoma protuberans.
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Many of the standard forms of therapy for large or multiple superficial basal cell carcinomas are limited by significant postoperative pain, excessive scarring, and prolonged wound healing time. Combining traditional curettage with carbon dioxide laser vaporization creates a procedure that allows excellent visualization, due to the bloodless surgical field produced by the laser, minimal nonspecific thermal damage, rapid healing, and diminished postoperative pain. In addition, the speed and ease with which this procedure can be performed allow successful treatment of many lesions in a single outpatient session. We wish to report our results using this technique for the treatment of 52 patients with 370 superficial basal cell carcinomas.
A description of the technique used in preventing inadvertent injury to the eye during periorbital or eyelid laser surgery is given.
The carbon dioxide laser can be successfully used in its two different modes of operation to treat rhinophyma in a relatively bloodless fashion. With the focused mode, layers of excess soft tissue are precisely shaved away until the approximate size and shape of the nose has been achieved. Then with the defocused mode, extremely thin layers of soft tissue can be vaporized to provide the final contouring. Minimal blood loss in most cases, rapid healing, and little postoperative pain are significant advantages of this technique.