Faculty Bibliography

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 authors performed a prospective, randomized trial of topical 2% lidocaine jelly in patients with basal cell or squamous cell carcinomas to test the effectiveness of the jelly in prolonging the time of anesthesia between the multiple stages of Mohs micrographic surgery. There was a 48% increase in the duration of anesthesia achieved by the use of 2% lidocaine jelly in patients given 1% lidocaine with epinephrine. In patients given 1% lidocaine without epinephrine, there was approximately a 2.5 times greater duration of anesthesia achieved by using topical 2% lidocaine jelly

Cyclosporine, an immunosuppressive drug, is effective in the treatment of recalcitrant psoriasis. Previous work suggested that keratinocyte hyperproliferation and inflammation are linked in psoriasis and that immune mechanisms participate in the pathogenesis of psoriasis. Transforming growth factor (TGF) alpha may be an important regulatory factor of epidermal growth as overproduction of TGF-alpha is associated with epidermal hyperplasia in psoriatic plaques and epidermal growth factor receptors are overexpressed in psoriatic epithelium. In this study, the effects of cyclosporine on cultured human keratinocytes were examined. Cyclosporine specifically inhibited keratinocyte cell-cycle progression in the G1 phase without causing keratinocytes to terminally differentiate. Cyclosporine did not decrease the expression of TGF-alpha or epidermal growth factor receptors. These results suggest that the effects of cyclosporine on psoriatic skin are unrelated to direct effects on autocrine growth regulation of keratinocytes via TGF-alpha production or of epidermal growth factor receptor modulation

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

Strawberry, or capillary, hemangiomas are common vascular neoplasms, with an incidence of approximately 2.6% in neonates. They usually develop in the first few weeks of life, so that between 1 month and 1 year the incidence rises to between 8.7% and 10.1%. These lesions may grow quite large in the first year of life, and they may ulcerate or obstruct a vital organ or function. The great majority will spontaneously regress after the first year of life. Parents are often alarmed at the sight of these hemangiomas and need reassurance that the great majority will regress spontaneously. Treatments such as cryosurgery, irradiation, radium instillation, corticosteroid therapy, or surgical excision are often ineffective or cause significant morbidity. We describe 10 children with capillary hemangiomas treated with the flash lamp-pumped pulsed dye laser. The patients ranged in age from 7 weeks to 5.5 years at the beginning of laser therapy. The patients underwent 3.1 +/- 1 (mean +/- SD) laser treatments, with a mean regression of the lesions of 69.9% +/- 4.5%. All patients demonstrated some diminution in the size and color of their hemangiomas after the treatments, and there were no ill effects, such as ulceration, hemorrhage, infection, or scarring. There was no evidence of hyperpigmentation or hypopigmentation. Pulsed dye laser therapy should be considered as an option in the treatment of capillary hemangiomas, preferably prior to their full evolution. It is also a useful therapeutic approach in those hemangiomas that are slow to regress in older children

New lasers and improved laser delivery systems have allowed for the safe and effective treatment of port-wine stains in patients of all ages. The satisfactory results obtained by laser treatment have increased the number of patients seeking consultation regarding their birthmarks. It is imperative that physicians recognize the various medical syndromes and problems associated with port-wine stains. A review of 415 patients with facial port-wine stains has revealed hypertrophy and/or nodularity in 65% of patients by the fifth decade of life, which increases significantly the morbidity of these lesions. It is believed that laser treatment will minimize the medical and psychologic complications that result from the natural evolution of port-wine stains

Porokeratosis of Mibelli is a disorder of epidermal proliferation in which an abnormal clone of cells expands in a centrifugal manner. We present a case of porokeratosis of Mibelli with an underlying hemangioma that was treated with a 585 nm flashlamp-pumped pulsed dye laser. The underlying hemangioma responded well to laser therapy while the porokeratosis remained unchanged. The implications of this for the pathogenesis of porokeratosis and the specificity of the pulsed dye laser are discussed

EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment