Faculty Bibliography

Sixty-seven patients with periorbital port-wine stains were treated with the flashlamp-pumped pulsed dye laser at a wavelength of 577 or 585 nm and a pulse-width of 450 microseconds. A retrospective analysis of the efficacy of this treatment was performed by qualitative and quantitative comparison of simultaneously projected pretreatment and post-treatment photographs and by comparison of photographs with a visual analog scale. These periorbital port-wine stains were treated with good-to-excellent results in 95% of the patients. As a result of treatment, macular (ie, nonhypertrophic) lesions, were lightened by an average of 80%. Neither scarring nor permanent pigmentary alteration was noted. Children of all ages were treated without adverse consequences, and the results were comparable to those of adults. The flashlamp-pumped pulsed dye laser treatment of periorbital port-wine stains is effective and safe in patients of all ages and should be considered the treatment of choice for flat and mildly hypertrophic lesions

A black man presenting with a port-wine stain was spot-treated with a flashlamp-pumped pulsed dye laser. The 1 cm2 area was treated with the flashlamp-pumped pulsed dye laser using rhodamine in methanol as the dye, a wavelength of 585 nm, a pulse duration of 450 microseconds, and a circular spot size of 5 mm. Energy density was 7.75 J/cm2. Superficial sloughing of the skin was noted immediately posttreatment. Persistent hyperpigmentation, textural changes to the skin, and no improvement in the port-wine stain were noted at follow-ups 2-, 4-, and 8-months posttreatment

Increasing evidence supports the association of squamous cell carcinoma of the finger and nail bed with human papillomavirus infection. We treated 12 patients with squamous cell carcinoma of the finger and nail bed, none of whom was originally diagnosed as having a malignant lesion. Half of the patients were referred for carbon dioxide laser ablation of what was believed to be a recalcitrant verruca vulgaris. Our objective was to evaluate these lesions for the presence of human papillomavirus by in situ hybridization techniques and the polymerase chain reaction. This is the first report of use of the polymerase chain reaction to detect human papillomavirus in formalin-fixed, paraffin-embedded specimens of periungual squamous cell carcinoma. Seven of the 12 lesions were evaluated for the presence of human papillomavirus by both in situ hybridization and the polymerase chain reaction. Five of the seven periungual lesions were found to contain human papillomavirus type 16 but not type 18 DNA with use of the polymerase chain reaction technique. In situ hybridization failed to identify human papillomavirus in any of these patients' tumors. Our data confirm the association between human papillomavirus and squamous cell carcinoma of the periungual region and suggest that biopsies should be performed on chronic, isolated lesions of the finger in adults before therapy is initiated

The development and use of various laser systems for the treatment of carcinomas of the skin constitute a relatively new therapeutic approach. Because the skin is a readily accessible organ, it is an excellent site at which to attempt different therapeutic modalities. What is truly astounding has been the development of specific lasers designed to treat certain dermatologic problems. Because the field of laser biotechnology is still rapidly emerging, it is very likely that new lasers and modifications of existing ones will improve our ability to treat skin cancer and precancerous conditions

The Rothmund-Thomson syndrome is a rare disorder characterized by poikiloderma, juvenile cataracts, bone abnormalities, short stature, sparse hair, hypogonadism, defective dentition, nail dystrophy, hyperkeratosis, and mental retardation. A 12-year-old boy with the syndrome was referred to us for evaluation and treatment of poikiloderma. This component of the disease was markedly improved with the use of pulsed dye laser photocoagulation

Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 +/- 1.4 [+/- standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments (+/- 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy