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PubMed2002

[Indications for medical lasers in dermatology].

FOUR CATEGORIES OF LASERS ARE USED IN DERMATOLOGY: These are vascular, depigmentation, depilatory or resurfacing or vaporization lasers. Today, there are more potential or suggested indications than good methodological studies that confirm these indications. Nevertheless, there are indisputable indications for these lasers. VASCULAR LASERS: They are indicated in the treatment of capillary nevus in adults and children and, with pulsed dye lasers, infants can be treated within the first weeks of life. Another indication for vascular lasers is treatment of Stage II rosacea, i.e., at the stage of telangiectasic erythrosis or couperose. Other indications include radiodermatitis, ulcerated hemangioma and erythrosis of the neck. DEPILATORY LASERS: Treatment of patients with pale phototype and dark hairs appears possible. However, around 4 to 6 sessions are required to obtain significant lasting hair removal. DEPIGMENTATION LASERS: The best indications are the removal of tattoos, Ota's nevus and, to a lesser degree, liver spots and Becker's nevus. Melasma and chloasma are not indications or exeresis of nevo-cellular nevi using this technique, since no histological control is possible. PULSED VAPORIZATION LASERS (CO2 OR ERBIUM LASER): They permit dermabrasion in the treatment of verrucous harmatoma, extensive benign superficial dermo-epidermal lesions and the esthetic treatment of non-muscular wrinkles, i.e., excepting wrinkles of the forehead and nasal sulcus. Continuous CO2 lasers destroy small dermo-epidermal lesions. They are particularly indicated for profuse lesions, in which there is a risk of hemorrhage or when direct contact should be avoided because of potential HIV infection. CONCLUSION: There are many potential indications, but a consensus has only been reached on those mentioned. The others remain to be confirmed.

Adult↗

PubMed2003

[Surgical treatment of malignant lip tumors. Personal experience].

The malignant tumours of the lip account for nearly 1-2% of the cervicofacial neoplasms. These lesions are frequently spinous cell carcinomas and basal cell carcinomas (25% of all oral cancers). The spinous cell carcinoma is mainly located in the lower lip, the basal cell carcinoma is more common in the upper lip. The incidence of lip cancer in males is much high than in females. The etiopathogenesis of these lesions is connected with exposure to sun, smoking, genetics predisposition (mutation of the p53 suppressor factor) and with the evolution of precancerous lesions (radiodermatitis, chronic cheilitis, xeroderma pigmentosum). Some Authors emphasized the viral etiopathogenesis: HPV16, HPV24, HSV1, HSV2. The treatment of lip carcinoma is surgical: excision and reconstruction. The numerous reconstructive techniques are mostly the cutaneous local sliding flaps and the rotation flaps. The lip reconstruction require a remarkable diligence for preserve, as much possible, the shape and functions of lip. The Authors report their experience about the surgical treatment of 19 patients with lip carcinoma (16 spinous cell carcinomas, 3 basal cell carcinomas) and describe the main surgical reconstructive techniques to preserve the feeding, phonation and mimic expression.

Aged↗

PubMed2006

Radiation port wart: a distinct cutaneous lesion after radiotherapy.

UNLABELLED: LABELED BACKGROUND: Radiotherapy may cause common cutaneous side effects such as acute and chronic radiodermatitis and also rare skin conditions. CASE REPORT: A 42-year-old woman who received radiotherapy for invasive breast carcinoma developed multiple, scaly, rough papules and nodules restricted to treatment fields six months after completion of the treatment. A relapse of the breast cancer and/or seborrheic keratosis was ruled out by histological confirmation of verruca vulgaris. CONCLUSION: We report the first case of verruca vulgaris associated with radiation treatment. Radiotherapists and dermatologists should be aware of this possibility and be able to differentiate it from other skin lesions associated with irradiation.

Adult↗

PubMed1990

[The chemical peel].

The authors describe the chemical peeling or desquamation method, which more precisely consists of cutaneous exfoliation designed to promote young-looking skin. They are not concerned with the value of exfoliation as a method to prevent skin cancer, the effect of which has been studied by many authors, namely in relation to acnitic (senile) keratosis, radiodermatitis, leukoplasia, scleroderma pigmentosum, epithelioma.

Chemexfoliation↗

PubMed1988

[Basal cell carcinomas of the scalp. Review of 77 patients with 81 tumors].

Out of 3,000 consecutive basal cell carcinoma 81 (2.7%) were located on the scalp of 77 patients (41 males, 36 females). The age at diagnosis was 50.8 +/- 14 years. Seventy five patients had a single lesion, one had 2 and another 4. Significant etiological factors were organoid nevi (11), syringocystadenoma papilliferum (1), androgenic alopecia (5), wound scar (1) and radiodermatitis (1). Out of 29 patients who answered a specific enquiry 10 admitted to having been treated by X-ray epilation for tinea capitis in childhood and 4 to have taken arsenic containing medicines. The evolution of the tumors varied from several months to more than 10 years. They were mostly nodular, pigmented and, less commonly, ulcerated with a pearly border, pendunculated or sclerosing in type. Histologically they were mainly solid or adenoid, with 2 sclerosing and 1 keratotic in type. In two cases there was underlying bone involvement. Treatment was by conventional surgery (54), Mohs' surgery (24) and cryotherapy (3). Four lesions recurred but the follow-up was below 5 years in most cases. We cannot confirm the impression of a more aggressive behaviour often suggested in the literature.

Adolescent↗

PubMed1987

Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders.

Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers of varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. A whole host of chronic cutaneous infections can lead to malignancy occasionally; these include lupus vulgaris, lymphogranuloma veverum, granuloma inguinale, leprosy, actinomycosis, and candidiasis. BCC more than SCC is known to complicate smallpox vaccination sites. Certain erosive and/or scarring dermatoses other than those mentioned above can be unusually affected by secondary malignancy. Discoid lupus erythematosus lesions often subjected to the carcinogenic effects of sunlight can degenerate into SCC in patients with either light or dark skin. In acrodermatis chronica atrophicans, a condition not often seen in the United States, the involved skin, particularly of the lower extremities, is susceptible to SCC, lymphoma, and BCC. Epidermolysis bullosa, especially the recessive dystrophic variant, can be complicated by SCC on affected mucous membrane and acral skin.(ABSTRACT TRUNCATED AT 400 WORDS)

Burns↗

PubMed1971

Dermatologic radiotherapy--R.I.P.

A questionnaire returned by nearly 3,000 dermatologists indicates that about 75 percent of them have discontinued completely the use of x-ray therapy in acne. An additional 11 percent use it in less than 10 percent of their patients who have this disease."Hazards" constituted the greatest deterrent to the use of ionizing radiation. Yet the assumption that it can cause skin cancers, in the absence of radiodermatitis, is not proved and its importance as an additive energy to solar radiation is considered to be limited. About one-third of the respondents expressed belief that better treatments were available for this condition. An equal number were concerned with public resistance to this therapeutic agent, which, however, seems to be more apparent than real. Probably the major roadblock was posed by the dermatologic training centers where teaching was withheld despite a rule of the American Board of Dermatology favoring it. Other factors mentioned with some frequency included ineffectiveness of radiotherapy, lack of equipment, and fiscal and medicolegal considerations. This study indicates that dermatologic radiation therapy is passing into oblivion.

Acne Vulgaris↗

PubMed1966

Planing for precancerous skin. A ten-year evaluation.

A 10-year follow-up of 10 patients with precancerous cutaneous alterations that could be expected to recur (actinic keratoses, radiodermatitis, leukoplakia) revealed that dermabrasion gave excellent results in four cases and at least some benefit in four others. While planing is not a panacea for the premalignant skin, this study suggests that it is of prophylactic value in the control of this condition in a reasonable proportion of cases.

Dermabrasion↗

PubMed1984

[Pseudoscleroderma and sclerodermiform states].

Pseudo-scleroderma should not be confused with true scleroderma, the prognosis of which is unpredictable and often serious. Progressive acrosclerosis must be differentiated from Raynaud's disease, congenital or hereditary disorders of unknown aetiology: Werner's syndrome, acrogeria and progeria; Rothmund-Thomson's syndrome, Steinert's disease, phenylketonuria, disorders of glycogen metabolism; metabolic disorders: mutilating acropathies, scleromyxoedema, porphyria cutanea tarda; occupational and iatrogenic disorders: acroosteolysis, toxic epidermic syndrome (Spain), scleroderma-like change induced by bleomycin, chronic graft-versus-host disease; and leprosy. Acute diffuse scleroderma should not be confused with Buschke's scleroedema, sclerema neonatorum, systemic amyloidosis and scleroderma-like changes in hypothyroidism. Linear pseudo-scleroderma is suggested by the following scleroderma-like conditions: facial hemiatrophy, acrodermatitis atrophicans, melorheostosis, pseudo-scleroderma after corticosteroid injection, and cutaneous lesions in carcinoid syndrome. Scleroderma in plaque must be differentiated from hypodermitis sclerotisans, panatrophy and localized lipoatrophies, hypodermitis after vitamin K injection, basal cell carcinoma, necrobiosis lipoidica, vitiligo, chronic radiodermatitis, cutaneous lymphatic invasion. Scleroderma-like changes after drug injection (vitamin B12, progestin), anetoderma barely resemble morphea guttata.

Adipose Tissue↗

PubMed1983

[The individual irradiation mask--a means for improving focussing accuracy].

Individual masks have been applied for about one year at the Radiotherapeutic Hospital of Erlangen in order to treat tumors situated in the head and neck region, the superior aperture of the thorax and the brain as well as tumors situated in the posterior cranial fossa showing a tendency to form metastases within the spine (medulloblastoma and ependymoblastoma). The advantages of this method are the reproducible position of the patient, the facilitation of exact focussing and the absence of marks on the patient's skin. The disadvantages are the increase of radiodermatitis and increased expenditure of cost and work. However, the advantages are preponderant, so the irradiation mask is routinely applied in our hospital.

Brain Neoplasms↗

PubMed1980

[Surgical treatment of basal-cell epitheliomas of the scalp and ear (author's transl)].

Basal-cell epitheliomas of the scalp are frequently observed on pre-existing chronic lesions: radiodermatitis or Jadassohn's sebaceous naevus. In cases where no irradiation has been given, basal-cell epitheliomas of the scalp should be treated by simple surgical excision. When irradiation has been applied, deep invasion must be recognized as an insufficient excision can often be fatal.

Basal Cell Carcinoma↗

PubMed1995

[Reevaluation of precancerous lesions of the skin].

Precancerous skin lesions are categorized into three groups; (1) carcinoma in situ, (2) hereditary precancerous lesions, and (3) non-hereditary precancerous lesions. Carcinoma in situ includes Bowen's disease, actinic keratosis and leukoplakia as squamous cell carcinoma in situ, Paget's disease as adenocarcinoma in situ, and melanoma in situ. Hereditary precancerous lesions include xeroderma pigmentosum, epidermodysplasia verruciformis and porokeratosis. The mechanisms of carcinogenesis in these diseases are investigated intensively. Chronic radiodermatitis and other scars are treated as non-hereditary precancerous lesions.

Humans↗

PubMed1997

Postirradiation angiosarcoma.

We describe a patient with angiosarcoma of the scalp arising in an area of radiodermatitis caused by X-ray epilation therapy for scalp ringworm as a child. Radiotherapy has been well documented as a causative factor in the formation of cutaneous malignancies, most notably basal cell and squamous cell carcinoma, but only rarely angiosarcoma. This is now the first reported case of angiosarcoma arising after X-ray epilation therapy for scalp ringworm, and we postulate a causative link between the two events.

Aged↗

PubMed1964