Linear scarring following treatment with a 595-nm pulsed dye laser.

Pulsed dye laser (PDL) treatment is well established and has been reported to be safe and effective in the management of superficial hemangiomas, port-wine stains, and other vascular lesions. Although hyperpigmentation is quite common, other side effects such as hypopigmentation, ulceration, hemorrhaging, atrophic scarring, and hypertrophic scarring are rare. We report the case of a 42-year-old woman who developed atrophic scarring of the nasal alae following cosmetic PDL treatment. Patients receiving PDL treatment should be warned about the risk for the development of scarring.

Plasma cell balanitis presenting in a patient with a history of syphilis.

Plasma cell balanitis (PCB), also knows as Zoon balanitis, is a benign asymptomatic but chronic and erosive inflammatory condition of the glans penis and prepuce that generally affects uncircumcised men in later years. Clinical presentation involves a single, shiny, well defined reddish patch. We describe the first case of PCB ever reported in a patient with a previous history of syphilis, and include a review of the current literature. A 57-year-old Hispanic man with a remote history of syphilis presented with a 6-month nonhealing, granulating ulcer of the foreskin and glans penis that had been repeatedly mistaken for syphilis and treated unsuccessfully with circumcision 3 weeks previously. Biopsy of the glans penis demonstrated sections with denuded chronic granulation tissue showing a fibrotic stroma with numerous blood vessels and a mixed inflammatory infiltrate including scattered plasma cells. It is important to differentiate PCB from a syphilitic chancre in a patient presenting with a nonhealing penile lesion. This case report demonstrates that these entities may be seen in the same patient at different times.

Central serous chorioretinopathy associated with topical corticosteroids in a patient with psoriasis.

BACKGROUND: Central serous chorioretinopathy (CSC), also known as central serous retinopathy (CSR), is a visual impairment, often temporary, usually in a single eye, which mostly affects males in the age group of 20 to 50 but may also affect women. CSC occurring after prolonged use of topical steroids in a patient with psoriasis is a novel complication in the English literature. OBSERVATIONS: We describe a case of a 25-year-old male, with a 15-year history of corticoid ointment use for psoriasis, who presented with loss of vision secondary to CSR. CONCLUSIONS: All topical steroid treatments were discontinued and the patient recovered his vision completely. Although topical corticosteroids are frequently utilized for psoriasis management with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (e.g., those with Cushing's syndrome, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy following prolonged use of topical corticosteroids.

Co-existing basal cell carcinoma and blue nevus in an African-American woman.

A 67-year-old African-American woman presented with an enlarging darkly pigmented plaque on her scalp. Histopathologic examination revealed a basal cell carcinoma juxtaposed to a blue nevus. Interestingly, the most common types of cutaneous collision tumors include melanocytic nevus and basal cell carcinoma. Whether these combinations are simply because of chance or may have a pathophysiologic mechanism is contentious. This is the first documented case of a basal cell carcinoma co-existing alone with a blue nevus.

Fractional photothermolysis for the treatment of surgical scars: a case report.

BACKGROUND: Surgical scars are a challenging condition to treat. Fractional photothermolysis provides a promising new modality for treatment. CASE REPORT: A 55-year-old white female patient with a surgical scar on the chin was treated with fractional photothermolysis (1550 nm Fraxel SR laser). A single treatment session was performed at pulse energy of 8 mJ (MTZ) and a final density of 2000 MTZ/cm2. The treatment response was assessed by comparing pre- and 2-week post-treatment clinical photography. RESULTS: A greater than 75% clinical improvement of scarring was achieved at 2 weeks after a single treatment based on independent physician assessment. No significant adverse effects were noted. The improvement was persistent at 1-month follow-up. CONCLUSION: Fractional photothermolysis offers a new, effective, and safe modality for the treatment of surgical scars.

Combined linear closure and Burow's graft for a dorsal nasal defect.

An 80-year-old man with a history of nonmelanoma skin cancers of the head and neck presented for treatment of a basal cell carcinoma of the nose. Physical examination revealed a poorly defined, exophytic, ulcerated nodule of the mid-dorsal nose. Given the size, location, and ill-defined margins of the tumor, Mohs micrographic surgical excision was indicated. The tumor was excised in three stages with microscopic control. The final defect was full thickness of the dermis, sparing the underlying muscle and measuring 3.2 x 2.4 cm on the mid-dorsal, supratip, and lateral aspects of the nose (Figure 1). How would you repair this defect?

Fractional photothermolysis for treatment of poikiloderma of civatte.

Poikiloderma of Civatte refers to a change in the skin where there is atrophy, hyper- and hypopigmentation, and dilation of fine blood vessels (telangiectasia). These alterations often cause cosmetic disfigurement, most commonly in middle-aged or elderly women with a fair complexion. Several treatment modalities, based on the theory of selective photothermolysis, including argon lasers, KTP lasers, pulsed dye lasers, and intense pulsed light devices, have been used to treat this condition in the past. Clinical experience has shown that complete clearing is difficult to achieve. Moreover, depending on the modality used, adverse effects, such as scarring with irregular hypopigmentation, post-inflammatory hyperpigmentation, post-treatment purpura, mottled appearance, crusting, and erythema, have been reported. Multiple sessions with these treatments are usually necessary to obtain optimal clearing.

Lymphoepithelioma-like carcinoma of the skin: a report of two cases treated with complete microscopic margin control and review of the literature.

Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous neoplasm with microscopic similarities to non-cutaneous lymphoepitheliomatous malignancies, particularly undifferentiated carcinoma of the nasopharynx. It can be clinically and histologically confused with other benign and malignant tumors. If not adequately treated, recurrence and distant metastasis are probable. We present two cases of LELCS treated surgically with complete microscopic margin control (one by the Mohs method and the other with en face permanent sections) and review the literature.

Dermatofibrosarcoma protuberans following tanning bed use.

Dermatofibrosarcoma protuberans (DFSP) is a rare, slowly growing, malignant dermal tumor first described by Darier and Ferrand in 1924. It typically occurs in individuals aged 20 to 40 years and frequently arises on the trunk. Although the cellular origin of DFSP is not entirely clear, dermal stem cells or undifferentiated mesenchymal cells with fibroblastic, muscular, and neuroectodermal features have been implicated. DFSP is a locally aggressive tumor with a high recurrence rate, largely attributed to the spread of tumor by direct local invasion through peripheral and deeply penetrating neoplastic cells into subcutaneous tissue and muscle. As such, there is growing evidence that Mohs micrographic surgery is the treatment of choice. Although reports of chromosomal aberrations and gene mutations have been described in the literature, excessive sun exposure is not regarded as a risk factor for the development or progression of DFSP. We describe a case of DFSP in a patient with a history of prolonged tanning bed use.