Faculty Bibliography

OBJECTIVE: To determine whether differences of angles between the alar rim and the long axis of the secondary defect in a Zitelli bilobed flap affect alar displacement in a fresh cadaver model. METHODS: In fresh cadaver heads, identical, unilateral 1-cm circular defects were created at the superior alar margin. Three different laterally based bilobed flap templates for reconstruction were used. One template, used on 3 cadavers, had an angle of 60 degrees between the alar rim and the long axis of the secondary defect. Another template, used on 3 cadavers, had an angle of 90 degrees . The last template had an angle of 135 degrees and was used on 2 cadavers. Photographs were taken before the repair and after with the camera and cadaver heads in the same spatial relationship to each other. RESULTS: In the 3 cadavers that had repair using an angle of 60 degrees , all cadavers experienced alar retraction, with a mean displacement of 1.3 mm. This was not a statistically significant change (P = .07). In the defects that had repair using an angle of 90 degrees , there was also no significant alar displacement (P = .72). In the 2 cadavers that underwent repair using an angle of 135 degrees , both ala underwent depression by 1.0 mm. When the differences achieved between the different angles were compared, there was a significant difference in measured distortion between the cadavers that had 90 degrees and 60 degrees vector placement (P = .02). There were no measurable changes to the contralateral maximal nostril distance. CONCLUSIONS: Vector alignment can have an impact on nostril displacement. In bilobed flaps, the axis of the secondary defect may play an important role. This study suggests that secondary defects aligned perpendicular to the nostril have the least amount of alar distortion

BACKGROUND: Complete surgical excision for lentigo maligna (LM) and LM melanoma (LMM) in the head and neck region may be challenging because of potential significant subclinical extension. OBJECTIVE: We sought to review clinical and histologic features of LM and LMM and determine surgical margin necessary for complete excision. METHODS: We conducted a retrospective study of 117 LM and LMM cases treated with a staged margin-controlled excision technique with rush paraffin-embedded sections. RESULTS: The mean total surgical margin required for excision of LM was 7.1 mm and was 10.3 mm for LMM. Of the tumors diagnosed as LM on initial biopsy specimen, 16% were found to have unsuspected invasion. Total surgical margin was associated with initial clinical lesion diameter. LIMITATIONS: Retrospective and single-institution experience are limitations. CONCLUSION: This study corroborates that the standard excision margins for LM and LMM are often inadequate and occult invasive melanoma occurs in LM. An excision technique with permanent sections using a team of dermatopathology and surgery that carefully examines the central tumor and the surgical margins is reliable for the treatment of LM and LMM

A 54-year-old woman presented with subcutaneous nodules and a prior diagnosis of multiple, cutaneous granular-cell tumors. The first case of granular cell tumor was reported in 1854. It remains a rare tumor, which is most commonly seen in women. One-half are usually located in the head and neck region, mostly on the tongue. Approximately one third are cutaneous and 25 percent of the cases occur as multiple lesions

BACKGROUND: The objectives of this study were to (1) identify the number of published articles related to skin cancer in The New York Times newspaper from 1980-2004; (2) assess the content of the articles related to skin cancer, and (3) examine the trends in media coverage of skin cancer over time. METHODS: We performed a content analysis on articles related to skin cancer appearing in The New York Times during January 1, 1980, through December 31, 2004, using the ProQuest online content repository database and key words skin cancer. We conducted an advanced focus search of all 'skin cancer' articles using key words 'melanoma,' 'squamous cell carcinoma,' 'basal cell carcinoma,' 'sunscreen,' 'tanning,' 'sunbathing,' and 'tanning salon'. RESULTS: We identified 874 published articles relating to skin cancer. Melanoma was the primary subject of the 874 articles, with 29% of the articles focusing on some aspect of melanoma. Coverage of other major subjects included sunscreen (11%), tanning (9%), basal cell carcinoma (7%), squamous cell carcinoma (3%), sunbathing (2%), and tanning salon (2%). The remaining 37% of articles contained some mention of skin cancer, but skin cancer was not the main topic nor were any of the focus terms. Over the 25-year period we examined, there was a slight upward trend in the number of skin-cancer-related articles, although we observed year-to-year variation. CONCLUSIONS: Understanding how the print media portrays skin cancer issues provides valuable feedback for federal agencies and cancer organizations and may ultimately help promote skin cancer prevention and education

A 13-year-old boy presented with a lifelong history of tightly-adherent, brown, polygonal scales that covered the extensor surfaces of the extremities, lateral aspects of the trunk, and neck. The clinical presentation and the history of a similar skin condition in the patient's male maternal relatives helped establish the diagnosis of X-linked recessive ichthyosis (XLI). Systemic manifestations of the steroid sulfatase (STS) deficiency underlying XLI include cryptorchidism, asymptomatic corneal opacities, and maternal failure to progress during labor. Most cases of XLI are caused by deletions of the STS gene, and contiguous gene syndromes may occur when the deletions extend to neighboring genes on the distal short arm of the X chromosome

A 46-year-old man presented with a history of a congenital pigment disorder. On physical examination hypopigmented and depigmented patches were present on the mid-forehead, anterior chest, and extremities. He also had loss of pigment of the medial eyebrows and a white forelock. The patient has a family history of a similar congenital pigment disorder, the pattern of which is indicative of the autosomal dominant disorder piebaldism

Actinic keratoses (AKs) represent the second most common reason to visit a dermatologist in the United States and their therapy has become a major portion of most dermatologists' practice. An ever-increasing array of therapeutic options exist for the therapy of actinic keratoses, offering physicians and patients a greater number of choices than ever before. Patient expectations and needs seem to be changing at the same time, thus effecting therapeutic decision-making. While destructive therapies with resultant wounds, time for wound healing, and possible hypopigmentation or scarring were acceptable in the past, many patients from the baby-boom generation are now developing AKs and have little tolerance for any time for wound healing or any cosmetic changes. This paper will raise some fundamental questions regarding AKs and their management