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Biomedical subjects

Pearon G Lang

Publications and source records attributed to Pearon G Lang.

13 recordsLinked to original sources
PubMed2006

Aggressive squamous carcinomas of the scalp.

BACKGROUND: Squamous cell carcinomas of the scalp sometimes exhibit unusually aggressive behavior. OBJECTIVE: To describe a series of 11 cases of extraordinarily aggressive squamous cell carcinomas of the scalp. METHODS: These cases were selected based on a number of criteria including their tendency to recur after Mohs surgery, their propensity to develop satellite lesions, their tendency to invade bone, and their tendency to metastasize to regional nodes and systemically. A chart review was performed for each patient. RESULTS: Five of 11 patients have succumbed to their disease. Of note is that the patients all had significant long-standing alopecia or thinning of their hair with marked actinic damage. Initial biopsies of the tumors revealed them to be either moderate or well-differentiated. Four of 11 patients developed satellite lesions and experienced recurrences despite obtaining clear margins with Mohs micrographic surgery. CONCLUSION: Squamous cell carcinomas of the scalp may metastasize and cause death. Thus, early diagnosis and treatment of these neoplasms is mandatory. In the setting of satellitosis, it is believed that it is best to perform a wide excision with margin control followed by split-thickness grafting and postoperative irradiation. The employment of radiation therapy, however, should be done with appropriate caution owing to the significant risk of osteoradionecrosis.

Biopsy↗
PubMed2005

Basal cell carcinomas with unusual histologic patterns.

Uncommon histologic variants of basal cell carcinoma (BCC) can present a diagnostic challenge. In this case series, we describe 3 patients with unusual BCCs encountered in a dermatologic surgical unit over a 1-year period from September 2003 to September 2004. The formalin-fixed, paraffin-embedded histologic specimens were initially examined microscopically after staining with hematoxylin and eosin. Additional stains, including diastase periodic acid-Schiff, colloidal iron, carcinoembryonic antigen, and cytokeratin-20, were subsequently performed as appropriate. Of the 3 lesions, one exhibited apocrine differentiation and two demonstrated a trabecular growth pattern. Although BCCs demonstrating apocrine differentiation have previously been described, a trabecular growth pattern, to our knowledge, has not been previously reported for BCC.

Aged↗
PubMed2004

The role of Mohs' micrographic surgery in the management of skin cancer and a perspective on the management of the surgical defect.

In the past 30 years, MMS has become recognized as the treatment of choice for certain uncommon cutaneous neoplasms and for certain variants of BCC, squamous cell carcinoma, and melanoma. It offers an extremely high cure rate and maximally preserves healthy tissue, which often allows for preservation of function as well as an optimal cosmetic outcome. Because it is performed in an office setting under local anesthesia, MMS is a very cost-effective procedure and often extends operability to patients who are poor candidates for general anesthesia. In the past 30 years, MMS has evolved in a number of ways. The fixed tissue technique is uncommonly employed today. This makes the procedure less painful and faster and allows for immediate reconstruction. In addition, because statistics have demonstrated the reliability of MMS, it has become less necessary to delay definitive reconstruction or use temporizing measures. With experience and training, more Mohs' surgeons have become adept at repairing the surgical defects they create; nevertheless, at times, it is necessary for the Mohs' surgeon to call on his or her colleagues to reconstruct the Mohs' defect or to assist in ridding patients of their cancer. At times, a multidisciplinary approach may provide the best care for patients. It also encourages collegiality and this has led to increasing respect for MMS by other surgical disciplines in the past 30 years.

Facial Neoplasms↗
PubMed2004

Extensive angiosarcoma on chronically sun-damaged skin.

Cutaneous angiosarcoma of the face and scalp is a rare malignant vascular tumor that most often occurs in the white elderly males. No clear etiologic factors have been associated with the development of this aggressive neoplasm. Due to delay in diagnosis, inability to adequately define clinical and surgical margins, and its high local recurrence and metastatic rates, angiosarcomas generally have a poor prognosis. Histologic evaluation of angiosarcoma can be somewhat difficult due to the varying patterns of differentiation. We present a case of angiosarcoma arising on chronically sun-damaged skin and review the histopathology and prognostic factors important in this malignancy.

Aged↗
PubMed2003

Delayed full-thickness skin grafts revisited.

BACKGROUND: There are many options for the management of surgical defects after Mohs micrographic surgery (MMS). For patients with complex defects who are not candidates for immediate grafting or who lack appropriate donor skin for a flap or who do not desire to undergo a major flap procedure, delayed full-thickness skin grafting (FTSG) may be an option. OBJECTIVE: To determine the role and usefulness of delayed FTSG in the management of Mohs surgical defects. METHODS: The records of 70 patients, seen over a 5-year period, who had their Mohs surgical defects repaired with a FTSG or who were scheduled for a delayed FTSG, were reviewed, along with their accompanying photographs (when available). The outcome of immediate and delayed FTSG was compared in terms of (1) graft loss, (2) epidermal sloughing, (3) thickening and/or irregularity, (4) contour correction, (5) hypopigmentation/hyperpigmentation, (6) persistent erythema, and (7) need for surgical revision. RESULTS: Twenty-seven patients underwent immediate FTSG, and 20 patients underwent delayed FTSG on an average 3.6 weeks after Mohs surgery. Twenty patients, originally scheduled for a delayed FTSG, were allowed to heal by second intention, with a very satisfactory cosmetic result in most instances. When patients undergoing immediate FTSG were compared with those undergoing delayed FTSG, there was essentially no difference in the two groups, as judged by the parameters cited previously here. CONCLUSION: Delayed skin grafting is often a viable option for patients undergoing Mohs surgery who are not candidates for immediate FTSG or who lack appropriate donor skin for a flap or who do not desire a major flap repair. It also has the added advantage in that as these patients are monitored in preparation for delayed grafting, it quite often becomes obvious that a significant proportion (more than 50%) can be allowed to heal by second intention with a satisfactory cosmetic result.

Humans↗
PubMed2002

Prognostic factors for metastasis in squamous cell carcinoma of the skin.

BACKGROUND: Squamous cell carcinoma (SCC) of the skin exhibits a significant propensity to metastasize. A number of variables have been reported to influence the tendency of SCC to metastasize. Because of the increasing incidence of skin cancer, it is becoming increasingly important to identify those neoplasms which are biologically more aggressive. We report 25 cases of metastatic SCC and compare them to 175 cases of nonmetastasizing SCC treated during the same period. OBJECTIVE: To characterize tumors with the greatest tendency to metastasize. METHODS: A tumor registry from the Dermatologic Surgery Unit at the Medical University of South Carolina was accessed to obtain records on 200 patients diagnosed with invasive SCC managed by Mohs surgery from 1988 to 1998. A retrospective analysis was conducted. The characteristics of patients with metastatic SCC and those with nonmetastatic SCC were compared using the chi-squared test and Fisher's exact test. RESULTS: Of 200 tumors, 25 (12.5%) metastasized. Size, Clark's level, degree of differentiation, the presence of small tumor nests, infiltrative tumor strands, single-cell infiltration, perineural invasion, acantholysis, and recurrence all correlated strongly with metastasis. Location, ulceration, inflammation, and Breslow depth did not correlate with the development of metastasis. CONCLUSION: Patients with tumors that exhibit certain clinical and histologic features are more likely to metastasize and need close follow-up to detect recurrence and metastasis early, allowing for appropriate life-saving intervention. Sentinel lymph node biopsy should be considered in patients with high-risk SCC.

Carcinoma, Squamous Cell↗
PubMed2002

Current concepts in the management of patients with melanoma.

Melanoma is a significant health problem. Despite public education and free cancer screenings, the incidence and mortality of melanoma continues to rise; however, many currently diagnosed melanomas are thin lesions, suggesting that education and awareness is having an impact. In addition, there are still subsets of patients who need increased surveillance in order to increase their survival. Although large congenital nevi may be precursors of melanoma, small and medium congenital nevi have an insignificant risk for melanoma development. Large congenital nevi, which are axial in location, appear to be more likely to develop melanoma and are associated with melanocytosis and melanoma of the CNS, both of which portend a poor prognosis. Recently, the recommended margins of excision have become more conservative so that many of the surgical defects can be closed primarily. Lymphoscintigraphy and sentinel node biopsy have replaced elective node dissections, thus decreasing the morbidity associated with the surgical management of melanoma. Although controversy still exists as to whether or not sentinel lymph node biopsy alters a patient's prognosis, it has been shown to be a powerful prognostic indicator. Although most melanomas are managed by routine surgical excision, other modalities are sometimes employed. For example, cryosurgery or radiation therapy may be indicated in the frail, elderly individual with a large facial lentigo maligna. Mohs surgery is the treatment of choice for head and neck melanomas and those located in areas where maximum preservation of tissue is required and for desmoplastic and acral lentiginous melanomas. Much more work remains in the area of adjuvant therapy, chemotherapy, and immunotherapy. Dacarbazine remains the drug of choice in disseminated melanoma, but remissions are usually short lived. Interleukin and biochemotherapy has yielded good results but the percentage benefiting is small. Although high dose interferon increases disease-free and overall survival in some patients, it remains a controversial drug which is not easily tolerated. In the new staging system for melanoma, ulceration is second only to Breslow's thickness. In transit (satellite) lesions have also been included in this new system. The new system also recognizes that patients with only microscopic metastatic nodal disease fare better than patients with clinically enlarged metastatic nodes and that it is the number of nodes involved with metastases, not their size, that determines the patient's prognosis. Except for lesions <1mm thick, the Clark's level of invasion has been de-emphasized.

Antineoplastic Agents↗
PubMedDate not supplied

Occurrence of subclinical tumor in excised facial subunits.

OBJECTIVE: To determine the incidence of subclinical tumor in excised facial subunits in patients undergoing reconstruction after Mohs surgery. DESIGN: The study group comprised 45 patients who had their Mohs defects repaired by a facial plastic surgeon at a tertiary care center (university hospital). In the group, there were 74 biopsy-proved cutaneous neoplasms of the face. The median age of the group was 67 years. Nineteen patients (42%) had multiple tumors. There were 63 basal cell carcinomas (85%) and 11 squamous cell carcinomas (15%). Forty-seven tumors (64%) were primary and 27 (36%) were recurrent. Reconstruction of the defects was based on the principle of aesthetic subunits. Excised subunits were examined by the Mohs surgeon. Further excisions were performed, as necessary, if tumor was present in the subunit. RESULTS: Five patients (11%) had subclinical basal cell carcinomas in their excised facial subunits. Four patients underwent further resections. CONCLUSIONS: In patients with severe sun damage, recurrent tumors, and a history of skin cancer, clinically normal tissue excised during the reconstruction of their Mohs defects may contain subclinical tumor. Consequently, when these "high-risk" patients undergo reconstruction, excised facial subunits should be submitted for pathologic examination.

Adult↗
PubMedDate not supplied

Management of actinic keratoses.

Actinic keratoses are quite common. Since they represent the initial stage in the evolution of squamous cell carcinoma, recognition and treatment are important. Recently, new treatment modalities have become available including immune modulators, photodynamic therapy, and topical nonsteroidal anti-inflammatory agents.

Adjuvants, Immunologic↗