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Renal cell carcinoma with cutaneous metastases.

An 86-year-old man presented with multiple papules on his face, neck, lips and ears 4 years after a left nephrectomy for renal cell carcinoma. Shave biopsies and excisions of the cutaneous lesions revealed findings consistent with metastatic renal cell carcinoma of clear cell type. The patient continued to present to the clinic over the next 3 years with similar eruptions, and biopsies continued to confirm renal cell carcinoma. During this time, metastases to the bone, lung, soft palate and posterior leg were also diagnosed. This case represents an unusual clinical presentation of metastatic renal cell carcinoma. It shows that a high index of suspicion should be maintained as cutaneous metastases can mimic other skin conditions.

Adenocarcinoma, Clear Cell↗

The bony crescent sign--a new sign of facial nerve schwannoma.

Schwannomas of the facial nerve are rare slowly growing lesions that have a predilection for the geniculate ganglion. Radiological evaluation is important in their diagnosis and in the assessment of their extent. In our series of 4 cases the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed sign of facial nerve schwannoma which appears on the basis of this small series to be strongly indicative of the presence of this tumour. Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate CT scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. Lesions occurring in the petrous area are all rare. The differential diagnosis includes cholesterol granuloma, epidermoid, carotid aneurysm and, very rarely, primary and secondary bone tumours. We describe a new sign associated with facial nerve schwannoma on CT, that of a bony crescent. Recognition of this sign makes those tumours arising in the region of the geniculate ganglion easy to diagnose prospectively.

Adolescent↗

Uses of the O-to-Z-plasty repair in dermatologic surgery.

The mechanics of repairing round and oval wounds by O to Z-plasty and some personal modifications and uses in special circumstances and locations are described. Several schematics and photographs illustrate the technique and clinical results.

Dermatologic Surgical Procedures↗

Management of temporal nerve injuries.

Transection of the temporal branch of the facial nerve results in paralysis of the frontalis muscle with subsequent inability to wrinkle the forehead. In addition there is ptosis of the eyebrow with upper visual field defects. The intent of this article is to outline an orderly, rational approach to the management of such injuries based on our experience with seven patients whose nerve was damaged during Mohs surgery for cancer ablation. Repair options include various combinations of direct brow-plasty, indirect temporal or coronal browlifts, and adjunctive upper lid blepharoplasty.

Basal Cell Carcinoma↗

Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer.

BACKGROUND: Basal cell carcinoma with mixed histology (BCC-MH) demonstrates more than one pathologic pattern of tumor. Appropriate therapy for the nonaggressive tumor subtype diagnosed from a superficial biopsy may not be adequate to treat the unsuspected aggressive tumor subtype, resulting in recurrent skin cancer. OBJECTIVE: We prospectively evaluated the incidence and characteristics of BCC-MH. METHODS: Mohs surgical sections were evaluated for BCC-MH. RESULTS: BCC-MH was observed in 43% (49/144) of cancers. Only 10% (5/49) of the biopsy reports from these cancers diagnosed BCC-MH. Most BCC-MH were previously untreated (90% [44/49] of tumors) and were located on the nose. CONCLUSION: More than 40% of basal cell carcinomas referred for removal of the residual tumor were BCC-MH. An unsuspected aggressive pathologic pattern of growth may not be detected after a superficial biopsy. Subsequently, the cancer may recur if the initial treatment for the diagnosed nonaggressive tumor subtype is inadequate for the undiscovered aggressive carcinoma. Mohs micrographic surgery is recommended for BCC-MH treatment.

Adult↗

Diffuse neonatal hemangiomatosis.

Diffuse neonatal hemangiomatosis is an often fatal disorder characterized by widespread capillary hemangiomas of the skin and visceral organs. Ultrasound and computed tomographic scans may be useful in determining the extent of visceral disease. The organs most commonly affected are the gastrointestinal tract, brain, liver, and lung. Complications include high-output cardiac failure, gastrointestinal bleeding, hydrocephalus, and consumption coagulopathy. Despite therapy with corticosteroids, the mortality rate is high.

Brain Neoplasms↗

Multiple agminate Spitz nevi.

A five-year-old boy had multiple agminate Spitz nevi arising in an area of hyperpigmentation that developed concurrently with the nevi. Multiple Spitz nevi occurring in a single group are rare, and their presence on a hyperpigmented background is extremely uncommon. Very few such cases have been described, and all of those lesions arose on a congenital hyperpigmented patch. In contrast, the nevi in our patient appeared to arise on an acquired hyperpigmented patch that was not present at birth, and histologically did not demonstrate features of a congenital nevus. Accurate diagnosis is necessary to avoid unnecessary radical therapy.

Biopsy↗

Multiple agminated Spitz nevi: report of two cases and review of the literature.

Spitz nevus is most commonly a benign solitary lesion. Multiple lesions arranged in clusters (agminated) are very rare. Malignant degeneration has not been reported. Although spontaneous involution may occur, the nevi are frequently treated by surgical excision. We describe two preschool girls with multiple agminated Spitz nevi, and review the current world literature on multiple Spitz nevi.

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