Forceps and cotton applicator method of freezing benign lesions.

BACKGROUND: Cryosurgery is one of the most common treatment methods in the dermatologists armamentarium. We describe a method combining forceps and a cotton applicator to freeze benign lesions for practitioners who prefer to use cotton-tipped applicators instead of a cryosurgery spray device. METHODS: We describe the technique using common in-office instruments. CONCLUSION: Lesions around delicate areas can be treated with forceps and a cotton-tipped applicator dipped in liquid nitrogen resulting in less pain and decreased collateral damage vs. traditional methods. For the most delicate areas, the forceps dipped directly in liquid nitrogen method is preferred.

Summertime sun protection used by adults for their children.

BACKGROUND: Because an estimated 50% to 80% of the skin's lifetime sun damage is thought to occur in childhood and adolescence, it is during these critical periods that intense, intermittent sun exposure causing burning increases melanoma risk. METHODS: A 1997 telephone survey of 503 households evaluated parental attitudes about their child having a tan, and ease of practicing sun protection, sun protection methods used, and sunburning on 5 successive summer weekends. RESULTS: In a random sample of 1 child from each household, 13% of children sunburned during the past week or weekend, and 9% of their parents experienced a sunburn during the past weekend. Children's sunburn was significantly associated with sunburn in the adult respondent, increasing age of the child, having fair skin, being white, and using sunscreens. Duration and peak hours of sun exposure were associated for children and parents. Sunscreen with a sun protection factor of at least 15 was the predominant form of sun protection used. Sunscreen use in children was significantly associated with longer duration of sun exposure, sunny weather conditions, younger age, fair skin, a history of sunburns before this study, a family history of skin cancer, and a higher family income. Feeling that a tan appeared healthy was associated with male gender of the adult and increasing age of the child. Complimenting the child on the appearance of a tan was associated with male gender of the adult, older children, children with skin type reported as olive or dark, and lower educational levels. CONCLUSION: Although there has been a promising initial effort to alert parents to the need to protect their children from sunburns, many view a tan as healthy and do not effectively implement sun protection behaviors for their children, which results in sunburns. Sun protection that prevents sunburning could be achieved by more children seeking shade, wearing protective clothing, limiting exposure during peak hours, and effectively using sunscreen.

What promotes skin self-examination?

The American Academy of Dermatology's national program of Melanoma/Skin Cancer Detection and Prevention, developed in response to the rising incidence of invasive melanoma in the United States, has annually produced extensive print, radio, and television coverage about performing skin self-examination (SSE). This study was conducted to determine factors that motivate people to perform SSE. A 1996 telephone survey evaluated performance of SSE for skin cancer and used questions to identify self-perceived. The performance of SSE was directly correlated with the self-perceived risk of the development of melanoma or skin cancer and discussions with physicians or nurses. People were motivated to perform SSE based on their perceived risk and discussions with doctors. Because patients most easily have access to primary care physicians, these physicians must be educated to identify those who are at risk for the development of melanoma. Primary care physicians and nurses should be encouraged to counsel patients about risk levels, the utility of SSE in limiting their risk, and how to perform SSE. To facilitate this process, risk levels for the development of melanoma (defined on the basis of simple and readily ascertained characteristics that help to educate physicians, nurses, and patients) are provided.

Trends in sun exposure knowledge, attitudes, and behaviors: 1986 to 1996.

BACKGROUND: The American Academy of Dermatology's national program Melanoma/Skin Cancer Detection and Prevention, developed in response to the rising incidence of invasive melanoma in the United States, has annually during the past decade produced extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection. OBJECTIVE: We measured the progress achieved in increasing the awareness and knowledge of skin cancer and changing the attitudes, beliefs, and behaviors that affect skin cancer risk. We also describe current sun-related behavior including sunburning, assess the likelihood of practicing sun protection strategies, and provide a baseline against which future changes in sun protection behavior may be evaluated. METHODS: A 1996 telephone survey repeated questions used in 1986 to evaluate change and used classifying questions to better define attitudes and behaviors. RESULTS: From 1986 to 1996, the knowledge of the perceived harmful effects of the sun significantly broadened, but the UV exposure behavior as measured by sunburning (30% to 39%) and regular use of a tanning booth (2% to 6%) also increased. There was a decline in the attitude that having a tan was healthy; however, in 1996 having a tan was still considered to enhance appearance, particularly by men. Sunscreen use increased (35% to 53%). Women, younger persons, persons residing in areas with fewer sunny days, and whites were more likely to tan intentionally, but men who lived in the South were more likely to sunburn. CONCLUSION: During the past decade, the early process of change involving cognitive and emotional activities began. With this study, high-risk population subsets performing specific adverse behavior were identified. In the future, they can be targeted with messages that promote attitudinal and behavioral change.

Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation?

BACKGROUND: Curettage and electrodesiccation (C&D) is probably the technique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C&D does not completely mechanically remove all nests of BCC in a substantial number of cases. Nevertheless, the reported 5-year reoccurrence rate following C&D is significantly less than this histologically observed residual tumor frequency immediately following C&D. Among the multiple possibilities that exist to explain why these residual nests do not appear as recurrent tumor more frequently is the theory that inflammation developing after C&D clears residual tumor. OBJECTIVE: To test the hypothesis that inflammation developing after C&D clears residual tumor not mechanically removed by the procedure. METHODS: The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 1 month after the C&D, an amount of time in which an effect (if any) of inflammation could occur. RESULTS: Twenty-two of 29 primary BCC < 1 cm treated by C&D were tumor free immediately following the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate 1 month before excision and histologic analysis were tumor free, for a clearance rate of 78.6%. Examination of larger tumors immediately following C&D revealed size is a significant variable for clearance rates. Eleven primary BCC > 1 cm but < 2 cm were examined histologically immediately following C&D; only three were tumor free for a clearance rate of 27.3%. Only one of five tumors > 2 cm thus treated was tumor free, for a clearance rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and immediately examined histologically. Two were tumor free for a clearance rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following C&D; one of these was tumor free when excised. CONCLUSION: For primary BCC < 1 cm, no evidence was found that inflammation occurring over 1 month following C&D clears residual tumor. It was also noted that C&D fails to completely remove tumor in a large majority of primary BCC > 1 cm, and in recurrent BCC.

Tumors with smooth muscle differentiation.

BACKGROUND: In the classification of tumors of soft tissue, modern schemes describe tumors by the normal adult tissue type the tumor resembles. Thus, tumors are described as smooth muscle tumors if the cells are differentiating towards smooth muscle. We may infer that in fact the tumor arose from smooth muscle, but this is only an inference. Tumors showing differentiation towards smooth muscle include hamartomas, benign tumors, and malignant tumors. OBJECTIVE: This review article describes the clinical presentation and course, histology, and treatment recommendations for benign and malignant smooth muscle tumors. METHODS: An extensive literature review of tumors with differentiation towards smooth muscle. RESULTS: Benign tumors exhibiting differentiation towards smooth muscle include smooth muscle hamartoma and leiomyoma. Myofibroma is a third tumor that some have argued is a smooth muscle tumor rather than a fibroblastic tumor. Characteristic fusiform shaped cells with a round central nucleus arranged in fasicles suggest smooth muscle differentiation. Special stains such as phosphotungenistic acid-hemotoxilin, analine blue, and Masson's trichrome are helpful in differentiating muscle from collagen. Immunohistochemical stains are also helpful in establishing a diagnosis. With solitary tumors, treatment for cosmesis or for painful leiomyomas is not a problem. Multiple leiomyomas, which may be painful or sensitive to cold or touch, are a therapeutic challenge, with reports of multiple medications being attempted in the literature. Leiomyosarcoma are malignant tumors of smooth muscle. They may be cutaneous and presumably arise from the arrector pilorum muscle, or subcutaneous, where they are believed to arise from vascular smooth muscle. Cutaneous leiomyosarcomas frequently reoccur following excision, but rarely metastasize. Subcutaneous leiomyosarcomas frequently reoccur following excision and have a high metastatic rate. Several recent reports have documented an increased frequency of visceral leiomyosarcomas in immunosuppressed patients. These tumors have been found to contain the Epstein Barr virus. Treatment of leiomyosarcoma is wide excision. CONCLUSIONS: Smooth muscle tumors are rare neoplasms that may confront the dermatologic surgeon. While leiomyomas are benign, their frequent sensitivity or pain necessitates treatment. Leiomyosarcomas are malignancies with a high reoccurrence rate, and when deep, a high metastatic rate. The finding of an increased frequency of visceral leiomyomas and leiomyosarcomas in immunosuppressed patients may imply an increased frequency of cutaneous leiomyomas and leiomyosarcomas in this patient population.

Indoor tanning: risks, benefits, and future trends.

The indoor tanning industry is a $1 billion-a-year business in the United States, and use of these high-intensity UVA tanning devices continues to grow. Many members of the medical community are concerned about the safety of these largely unregulated devices, but tanning salon operators state such concerns are unfounded and unproved. A comprehensive review of current knowledge of the operation and effects of indoor tanning is presented. The effects of UV radiation (especially UVA) on experimental animals and human beings are examined. Both acute and chronic effects are delineated from experimental sources as well as from epidemiologic studies and clinical observations. Existing safety regulations are described. Information on operator knowledge and compliance with existing safety regulations is reviewed.

Mohs micrographic surgery.

Mohs micrographic surgery is a precise method of skin cancer removal that offers the highest cure rate and conserves the maximal amount of normal tissue. It is indicated for recurrent tumors and certain primary basal cell and squamous cell carcinomas, but not for small, nonrecurrent, well-defined lesions. The fresh tissue technique permits the use of horizontal frozen sections for the complete microscopic examination of lateral and deep margins.

Carcinoma of sebaceous glands on the head and neck. A report of four cases.

Carcinoma of sebaceous glands most commonly occurs on the eyelids and caruncles of the elderly. Local recurrences after would-be adequate treatment and distant metastases are common in this malignancy in this site. Carcinomas of sebaceous glands arising elsewhere in the skin also have a strong tendency to recur locally, but are said to be much less likely to metastasize. Our experience with four such carcinomas on the head and neck have led us to believe that the malignancy is biologically aggressive anywhere if not adequately treated at the onset.

Squamous-cell and basal-cell carcinomas in black patients.

Squamous-cell and basal-cell carcinomas of the skin are rare in black patients. Etiologic factors, body distribution, and aggressiveness of these cancers in blacks are discussed. The roles of ultraviolet light and pigment dispersion are noted.