Auto-Mohs.com.

BACKGROUND: Over the course of the last three decades Americans have grown more and more fond of "alternative" or homeopathic medical therapies. The explosion of the Internet has made these nontraditional remedies more accessible to the general public. OBJECTIVE: To describe two cases of auto-Mohs through patient self-application of products containing zinc chloride paste. The case of a basal cell carcinoma and the case of a squamous cell carcinoma are described. METHODS: Each of our patients applied a homeopathic paste containing zinc chloride to sites of biopsy-proven skin cancer. RESULTS: At the conclusion of the self-directed therapy in both cases, histopathologic analysis of the site determined no further skin cancer to be present. CONCLUSION: We present and describe two cases of auto-Mohs.

Three point-advancement closure for skin defects.

BACKGROUND: Circular skin defects are common following Mohs' surgery. Traditional closure (primary, flap, or graft) may involve extensive surgery. Multidirectional advancement closures such as the purse-string closure have been advocated as another useful tool in such cases. OBJECTIVE: To describe a variation on purse-string closure that, in certain cases, is an excellent alternative to other reconstructions, and will provide good cosmetic and functional outcome. METHOD: A three-point anchoring suture is placed after undermining to advance the surrounding tissue toward the centre, creating a "Mercedes Benz" or tripod closure following removal of "dog-ears." RESULTS: Circular wounds in designated areas can be more easily closed, creating well-tolerated, favourable scars. CONCLUSION: Large wounds may be closed with the advantage of avoidance of larger flaps, of decreased wound healing compared to second intention, and of minimizing removal of healthy tissue. An initial trial of closure with this method does not limit subsequent use of other repairs should it be less than satisfactory.

Microcystic adnexal carcinoma with mandibular invasion and bone marrow replacement.

A 51-year-old man with microcystic adnexal carcinoma of the face is reported. In addition to extensive soft tissue invasion by the cancer, there was direct bone invasion into the marrow of the mandible as well as perineural spread along the mental and inferior alveolar nerves. This represents the first case of microcystic adnexal carcinoma with documented bone invasion. Recognition of the aggressive nature of this cancer with potential for invasion into the skull is important for proper evaluation and treatment.

Postoperative techniques for corneal protection in Mohs micrographic surgery.

Corneal abrasion or injury can complicate periorbital surgery. In micrographic surgery of the eyelids and canthal regions, enough palpebral tissue may be sacrificed so that corneal exposure and injury can occur. In the interim between surgery and reconstruction, adequate measures must be taken to ensure protection of the globe. Techniques that protect the corneal epithelium for small or large surgical defects are described.

Management considerations for cutaneous neurophilic tumors.

The proper management of patients with neurophilic skin cancers is often quite difficult. When present, neurophilic invasion significantly worsens the prognosis. Important considerations for managing patients with cutaneous neurophilic tumors and illustrative cases are presented.

Mohs surgery report: an approach to cutaneous surgical defects of forehead and eyebrow following Mohs micrographic surgery.

Elective excisions of the forehead are relatively easy to plan because of the prominence of horizontal skin folds and vertical glabellar furrows. However, the variety of defects in that region which result from Mohs micrographic surgery for cutaneous tumors frequently present reconstructive challenges. Principles applicable to this anatomic region and illustrative cases are presented and discussed.

The polar lipids from keratinized tissues of some vertebrates.

1. The lipids from a variety of keratinized tissues from terrestrial vertebrates were extracted with chloroform:methanol and the nonpolar and saponifiable lipids were removed. The composition of the remaining polar lipids was examined by thin layer chromatography and color reactions. 2. The tissues studied included: hair from a monkey (Macacca fascicularis), dog (Canis familiaris), raccoon (Procyon lotor) and cow (Bos taurus); full-thickness epidermis from a pig (Sus scrofa) and pilot whale (Globicephala melaena); epidermal scales and feathers from a fowl (Gallus gallus); scales, feathers, beaks and claws from a turkey (Meleagris gallopavo); hoof and horn from cattle (Bos taurus); and cast skins from a Columbian boa (Boa constrictor) and a Ball python (Python regius). 3. All of the tissues contained both simple ceramides and highly polar glycolipids (presumably gangliosides). 4. Glycolipids of intermediate polarity were present in all of the tissues from birds and snakes and in the mammalian tissues which contained unkeratinized epidermal cells, but were absent from fully keratinized mammalian tissues such as hair, hoof and horn. 5. The presence of the highly polar gangliosides provides for the formation of the multiple intercellular lipid lamellae which have been observed in the epidermal horny layer of mammals, birds and reptiles and which are believed to constitute the epidermal barrier to water diffusion.