Dermoscope-guided Laser Excision of a Pilomatricoma – a Novel Surgical Procedure Performed in Primary Care Settings

Hypothesis:Dermoscope-guided laser excision is applicable for some cutaneous lesions seen in primary care, particularly those in body flexures or in regions with high blood perfusion.Summary:A male patient presented with an asymptomatic mass behind his left pinna. Polarised dermoscopy revealed signs compatible with malignancy. Excision was difficult owing to the location being concave and the region being one with hyper-perfusion.Dermoscope-guided laser excision was performed. The edge of the lesion and clear margins were marked via dermoscope-guidance. Laser incisions were made following the margins. Dermoscopy confirmed precision of the incision. Upon three laser-dermoscope cycles, the mass separated itself. Laser in coagulation mode achieved haemostasis.Dermoscope-guided laser excision was performed. The edge of the lesion and clear margins were marked via dermoscope-guidance. Laser incisions were made following such margins. Dermoscopy confirmed precision of the incision. Lesion incisions and dermoscopy were then reapplied. Upon three laser-dermoscope cycles, the mass separated itself. Laser in coagulation mode achieved haemostasis.Outcome:The histopathological diagnosis was a pilomatricoma. Healing was uneventful, with minimal scarring. There was no relapse one year post-operatively.Recommendation:Investigations on dermoscope-guided laser incision and other dermoscope-guided surgical procedures in primary care settings can beconducted to evaluate the outcomes of these procedures.

Neonates Investigated for Influenza-Like Illness During the Outbreak of Pandemic H1N1 2009: Trivial Infections But Major Triage Implications.

Abstract We report eight cases of neonates (from birth to 25 days) admitted to the neonatal service of a teaching hospital with influenza-like illness during the outbreak of pandemic H1N1 2009, and discuss their management and infection control issues. Empirical antibiotics were often promptly initiated and timely stopped when sepsis was ruled out. Also, there was no pandemic H1N1-09 but influenza A (H3N2, n=1), parainfluenza (type 3, n=3) and respiratory syncytial virus (n=1) have been isolated. The infants recovered spontaneously without any antiviral therapy. There was no outbreak of the respiratory infections in the neonatal service during the admissions. Respiratory viral infections can occur in neonates although the clinical course may be milder and nonspecific. Emergency room and frontline staff must be vigilant of the non-specific clinical features of infections with respiratory viruses in the neonates so that prompt triage and isolation can be implemented to avoid outbreaks in the neonatal service.