Guidelines of care for alopecia areata.
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Biomedical subjects
Publications and source records attributed to R I Ceilley.
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Removal of the nail matrix is indicated in a variety of recalcitrant conditions in which the growth of the nail plate causes mechanical problems such as recurrent onychocryptosis or pain due to pinching or pressure. Before performing a matricectomy, the physician must consider the use of nonsurgical methods and the possible contraindications to surgery. Once the decision for matricectomy is made, the physician should then utilize the modality with the least morbidity and greatest convenience for the patient. A wide repertoire of methods of matricectomy is available for use; all methods, when performed properly, have similar high rates of cure.
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The nose is one of the most common sites of malignancy on the face, probably because of its unique position of exposure to environmental damage. By far the most common type of nasal tumor is basal cell carcinoma. Squamous cell carcinoma is less common but considerably more aggressive, with a tendency to fast growth and metastasis. Tumors of either type are more likely to invade easily and resist treatment if they are in certain "danger zones." Nasal skin cancer in general has a relatively good prognosis, regardless of the type of treatment selected, ie, surgery, radiotherapy, cryotherapy, or electrodesiccation and curretage. However, tumors that are not eradicated have a long history of recurrences before proving fatal. When ablative surgery is performed, some type of reconstructive procedure is usually necessary.
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Freezing with liquid nitrogen in the conventional manner of cryosurgery followed immediately by injection of a suspension of a fluorinated adrenocorticosteroid is an effective way of treating keloids and hypertrophic scars. Details of the method are given.
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A method for reconstruction of a sideburn is described in detail. Rotated flaps provide coverage with hair at once in a single surgical procedure.
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Three basal- and four squamous-cell carcinomas in seven patients with chronic lymphocytic leukemia or chronic lymphocytic lymphoma recurred repeatedly after conventional treatment, and grew to large sizes. The squamous-cell carcinomas metastasized in all four of the patients so afflicted. Absolute numbers of circulating T lymphocytes were normal in the seven patients, but they had cutaneous anergy to intradermal tests with common antigens and to dinitrochlorobenzene. The following recommendations for management of cutaneous carcinomas in patients with malignant lymphomatoses are made: 1) closer surveillance than for patients with cutaneous cancers but without malignant lymphomatoses, 2) early treatment of actinic keratoses to prevent possible transformation to malignancy, and 3) microscopically controlled excision of basal- or squamous-cell carcinomas larger than 1 cm in diameter.
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