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Biomedical subjects

R H Zax

Publications and source records attributed to R H Zax.

8 recordsLinked to original sources
PubMed1998

Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study.

BACKGROUND: We previously reported our experience using Mohs micrographic surgery (MMS) for 45 patients with lentigo maligna (LM) and lentigo maligna melanoma (LMM). The patients were treated between 1985 and 1992. In our initial publication, all of the patients were free of local disease and evidence of metastases at an average of 29.2 months after therapy. OBJECTIVE: The purpose of this study was to report long-term follow-up of our previously published data. METHODS: MMS was performed in 26 patients with LM and 19 patients with LMM using frozen sections followed by rush permanent sections. Follow-up was obtained by contacting the referring physician, examination by one of our two Mohs surgeons, or by contacting the patient or his or her family. RESULTS: After a median follow-up of 58.0 months (214.3 patient-years), there was one recurrence. This patient was a 56-year-old woman with five prior recurrences before MMS. Six patients were decreased of other causes during the study. CONCLUSIONS: MMS using frozen and rush permanent sections resulted in a 97% cure rate for LM and LMM. Because MMS minimizes the removal of normal tissue, and the cure rate exceeds that of conventional therapies, the authors recommend this technique for the treatment of LM and LMM.

Adult↗
PubMed1996

Recurrent lentigo maligna invading a skin graft successfully treated with Mohs' micrographic surgery.

Lentigo maligna (LM) is a pigmented lesion occurring on sun-exposed skin that may become lentigo maligna melanoma (LMM). The tumor can behave in an aggressive fashion, causing significant cosmetic disfigurement, often extending significantly further than the clinical margin. Complete surgical excision is the treatment of choice. We describe a 74-year-old woman with a large LM of the left cheek, upper and lower eyelids, and preauricular skin that had recurred twice. The tumor was removed using Mohs' micrographic surgery (MMS) with rush permanent sections and was found to infiltrate extensively the split-thickness skin graft that had been placed five years earlier. LM can invade and replace a skin graft. Although destructive modalities and conventional surgery are recommended by some authors, MMS offers the greatest likelihood of cure, the ability to examine nearly 100 percent of the surgical margins, and maximal tissue sparing. Complete excision of LM at its earliest recognition may prevent invasive LMM and will limit cosmetic disfigurement.

Adult↗
PubMed1994

Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs' micrographic surgery aided by rush permanent sections.

BACKGROUND: Lentigo maligna (LM) is a pigmented neoplasm on sun-exposed skin of elderly patients. LM slowly increases in size and may become lentigo maligna melanoma (LMM), a potentially fatal malignancy. Complete excision is the treatment of choice. Mohs' micrographic surgery (MMS) with frozen and permanent sections may be used for complete eradication of the lesion, while sparing as much normal tissue as possible. The authors studied the efficacy of MMS for the treatment of LM and LMM. METHODS: Between 1985 and 1992, 45 patients with LM (26) and LMM (19) were treated with MMS. The authors' technique was to use examination of frozen sections and rush permanent sections (prepared and read within 24 hours). Positive frozen sections warranted further excision. For negative or equivocal frozen sections, surgery was interrupted until the examination of permanent sections was performed. RESULTS: All 45 patients were free of local disease and evidence of metastases at an average of 29.2 months (range, 4-81 months) after therapy. CONCLUSIONS: MMS aided by rush permanent sections yielded a prolonged disease free survival for all 45 patients with LM or LMM. Because the MMS technique minimizes the removal of normal tissue, and the local cure rate in this study was superior to that reported for conventional surgery, the authors recommend this technique for the treatment of LM and LMM.

Adult↗
PubMed1993

Trichothiodystrophy and associated anomalies: a variant of SIBIDS or new symptom complex?

Trichothiodystrophy is characterized by sparse, short, sulfur-deficient hair. Numerous symptom complexes have been described in which the hair abnormality represents a constant feature. We report a boy with trichothiodystrophy, ichthyotic skin changes, onychodystrophy, chronic neutropenia, osteosclerosis, hypothyroidism, nystagmus, growth and mental retardation, and microcephaly, who developed a progressive encephalopathy with ataxia and optic atrophy at 2.5 years of age. In addition to a deficient cystine level identified on a hair sample, a disturbance in the composition of other amino acids was present. Although features were reminiscent of osteosclerosis, ichthyosis, brittle hair due to trichothiodystrophy, impaired intelligence, decreased fertility, and short stature (SIBIDS) and could represent a variant of this disorder, findings in our patient may reflect a new trichothiodystrophy symptom complex that carries a poor prognosis for survival beyond childhood.

Growth Disorders↗
PubMed1990

Cutaneous leukocytoclastic vasculitis. Serial histopathologic evaluation demonstrates the dynamic nature of the infiltrate.

Data from experimentally induced cutaneous vasculitis have suggested that the inflammatory infiltrate is dynamic. In contrast, data from humans with cutaneous vasculitis have suggested that two distinct patterns of cellular infiltrate exist, a mononuclear-predominant and a neutrophilic-predominant type. There are little data regarding the temporal evolution of spontaneously occurring cutaneous vasculitis in humans. A patient with a cutaneous leukocytoclastic vasculitis manifest as palpable purpura had four lesions encircled on the day of presentation. Biopsies of these lesions were obtained sequentially at 0, 24, 48, and 120 hours. The histopathologic specimens were graded without knowledge of the timing of the biopsy. The character of the infiltrate progressively changed from a neutrophilic-predominant to a mononuclear-predominant infiltrate supporting the theory of a dynamic process in cutaneous vasculitis. The previous reports that suggest that there are two distinct inflammatory cell types may be the result of performing the biopsy at one point in time during this transitory process.

Aged↗
PubMed1989

Leukemia cutis presenting as a scrotal ulcer.

A patient with acute nonlymphocytic leukemia developed a painful scrotal ulcer thought initially to be caused by infection. The lesion failed to heal with oral antibiotic therapy and local wound care. Histopathologic examination of a biopsy specimen revealed an infiltrate of leukemic cells. This cutaneous lesion heralded the relapse of acute myelogenous leukemia. A review of the literature indicates that acute nonlymphocytic leukemia rarely presents as an ulcer or on the genitalia, thus emphasizing the uniqueness of this case regarding morphology, and site of presentation. To our knowledge, this is the first case of leukemia cutis presenting as a scrotal ulcer. Therefore leukemia cutis should be added to the differential diagnosis of chronic genital ulcers. Also, because a variety of skin lesions may signify the relapse of leukemia, any skin lesion in a patient with leukemia should be examined by biopsy.

Aged↗
PubMed1989

Sarcoidosis.

Sarcoidosis is characterized by noncaseating granuloma that can occur in any organ of the body. The lymph nodes, lungs, skin, liver, spleen, phalangeal bones, parotid glands, and eyes are the most common sites of involvement. Although sarcoidosis rarely causes death, its course is highly variable, and its treatment can be challenging to the clinician. This article presents an updated review of the clinical manifestations of sarcoidosis as well as discussions of the diagnostic evaluation and treatment of this idiopathic disease.

Adrenal Cortex Hormones↗