Faculty Bibliography

BACKGROUND: Immediate reconstruction after removal of skin cancer by Mohs micrographic surgery (MMS) may not be feasible in patients unwilling or unable to undergo an extensive procedure. Human cadaveric allograft (HCA) may offer a useful alternative to granulation. OBJECTIVE: To examine the usefulness of HCA in resurfacing nasal defects after extirpation of basal cell carcinoma (BCC) by MMS. METHODS: Case histories of seven patients treated with HCA were reviewed with respect to primary skin cancer histology, defect size, medical status, healing time, and cosmesis. RESULTS: Five of seven tumors were infiltrative BCCs. Defects ranged from 2.7 to 20 cm2. Average healing times for wounds with and without exposed cartilage were 42 and 35 days, respectively. There were no wound infections. Hypergranulation tissue was noted in three patients and had no effect on cosmesis, which was adequate in five patients and poor in two patients. CONCLUSION: HCA may be a useful alternative to granulation following MMS for treatment of skin cancers involving the nose

Lentigo maligna (LM) is an indolent form of melanoma in situ with the potential to progress to invasive melanoma. Early detection and adequate treatment prior to development to invasive melanoma are essential. Definitive excision with negative margins is currently the treatment of choice for LM. Conventional excision, Mohs micrographic surgical excision, and nonexcisional methods of treatment of LM will be discussed

Botulinum A exotoxin, derived from the gram-positive anaerobe Clostridium botulinum, has proven to be safe and effective in the temporary treatment of facial rhytides. In order to obtain reproducible results and avoid complications, it is necessary to understand the relevant physiology and anatomic relationships. Technical considerations including injection technique, dilution, storage, and potential complications will be discussed

Malignant melanoma continues to present a significant public health problem as its incidence is rising faster than that of any other cancer in the US. At current rates, 1 in 74 Americans will develop melanoma during his or her lifetime. Management of melanoma is a complex issue requiring a multidisciplinary approach. The most effective method of protection against the development of melanoma is minimization of ultraviolet exposure from sunlight. Early detection and treatment are critical and result in improved patient survival rates. Surgical excision remains the mainstay of treatment but many new promising therapies are being investigated. It is hoped that increased public and professional awareness and education in all areas relating to the prevention, detection, and treatment of malignant melanoma will contribute to decreasing trends in the incidence and mortality from this cancer in the future

These studies were performed to establish whether functional receptors for calcitonin gene-related peptide (CGRP) are present on human dendritic cells (DCs) and to investigate potential immunomodulatory effects of CGRP on DCs other than Langerhans cells. Reverse transcriptase-PCR revealed expression of mRNA for a type 1 CGRP receptor by mature and immature blood-derived DCs. Sequence analysis confirmed the identity of the type 1 CGRP receptor (CGRP-R1). Addition of CGRP (10-7 M) to mature and immature DCs resulted in mobilization of intracellular calcium. Treatment of immature DCs with CGRP (10-7 M), before and after maturation in monocyte-conditioned medium, resulted in decreased cell surface expression of HLA-DR MHC class II and the costimulatory molecule, CD86. Treatment of immature DCs with CGRP (10-7 M) also resulted in decreased expression of CD86, but expression of HLA-DR was unchanged. When CGRP-treated mature DCs were used to stimulate allogeneic T cells, proliferative responses were dampened (approximately 50%), especially at low DC:T cell ratios (1:360). This effect was not observed with CGRP-treated, immature DCs. In contrast, CGRP-treated mature or immature DCs were no less efficient than untreated DCs in driving syngeneic T cell-proliferative responses to staphylococcal enterotoxin B. We conclude that mature and immature DCs express type 1 CGRP receptors and that signaling through these receptors may dampen mature DC-driven T cell proliferation most likely via down-regulation of CD86 and HLA-DR