Cryosurgery and curettage-cryosurgery for basal cell carcinomas of the mid-face.

BACKGROUND: Surgical treatment of basal cell carcinoma (BCC) can be technically difficult in mid-face area. Cryosurgery is proposed for low-risk BCC. Cryosurgery has been poorly investigated in mid-face BCC, which is considered as having a high risk of recurrence. OBJECTIVE: To assess the results of cryosurgery and curettage-cryosurgery in patients with mid-face BCC. METHODS: A retrospective study was performed between 2005 and 2012 in a reference centre for cryosurgery. Inclusion criteria were: (i) diagnosis of BCC confirmed histologically; (ii) location in the mid-face area; (iii) treatment with cryosurgery performed between August 2005 and December 2010; and (iv) minimal follow-up of 18 months after cryosurgery. Follow-up data were recorded until April 2012. Curettage was performed before cryosurgery in 55 cases of nodular BCC (38%). Patients were followed after cryosurgery either by a dermatologist (n = 48) or by their general practitioner (n = 90). Twelve patients were lost to follow-up. RESULTS: One hundred and thirty-eight patients of mean age 76.5 ± 11.1 years, with a total of 144 BCCs were included. Mean follow-up was 40.7 ± 15.6 months. Wound healing occurred after a median delay of 4 weeks (range 1-12 weeks). No severe complications were recorded. Seven recurrences (4.9%) were observed after a median time of 24 months (range 4-36 months). The 5-year Kaplan-Meier recurrence-free rate was 94%. Thirteen patients with previously treated BCC or morpheiform BCC were treated with cryosurgery as palliative indication, although their subtypes of BCC were theoretical contraindications to cryosurgery. When excluding this subgroup, the 5-year Kaplan-Meier recurrence-free rate of the rest of the population was 96.5%. CONCLUSION: Cryosurgery and curettage-cryosurgery can be considered as an alternative and simple method for treatment of BCC of the mid-face area.

Treatment of earlobe keloids by surgical excision and cryosurgery.

BACKGROUND: The long-term results of keloid treatments remain poor. OBJECTIVE: To assess the long-term efficacy of a technique combining surgical excision and immediate cryosurgery in patients with ear keloids. METHODS: A retrospective study was performed between January 2001 and June 2011. All patients referred for treatment of an ear keloid and undergoing subsequent surgical excision followed by immediate freezing of the postoperative wound using cryosurgery were included. The primary end-point was the number of patients who achieved major flattening of the keloid (defined as a reduction of more than 80% of the keloid) at the time of the study after a minimum follow-up of 24 months after treatment. RESULTS: Sixty-six patients with a total of 97 keloids were included. Median follow-up time after treatment was 43 months. 'Major' flattening was observed in 69 keloids (71%). Fifty-six of these lesions (81%) were treated with one session and 13 (19%) required a second session after keloid recurrence. Fifteen lesions (15%) were considered 'treatment failure', including 11 keloids in eight patients who were lost to follow-up and four keloids which achieved less than 30% reduction of their surface. Thirteen other keloids were evaluated as displaying significant or moderate improvement. Treatment side-effects were partial amputation of the ear lobe in three patients with a very large keloid of the ear lobe and hypopigmentation in five patients. LIMITATION: Retrospective study. CONCLUSION: The combination of surgical excision and cryosurgery can be considered for the treatment of large ear keloids.

[Cryosurgery and photodynamic therapy for the treatment of Paget's disease of the vulva: two cases]. / Traitement de la maladie de Paget vulvaire par cryochirurgie et photothérapie dynamique topique.

BACKGROUND: Surgery is the standard treatment for vulvar Paget's disease, despite its mutilating consequences and the high associated recurrence rate. Alternative treatments such as CO2 laser, application of imiquimod and topical photodynamic therapy (PDT) have recently been proposed. We report on two patients with vulvar Paget's disease treated with combined cryosurgery and PDT. PATIENTS AND METHODS: Case 1: a 40-year-old pregnant woman presented large vulvar lesions suggestive of Paget's disease. After imiquimod treatment failed, three sessions of cryosurgery were performed on all lesions at 5-month intervals, followed by PDT sessions for the residual erythema. Because of recurrent focal lesions, further sessions of localized cryosurgery were performed for 18 months. Case 2: a 61-year-old patient with extensive vulvar Paget's disease relapsed after imiquimod treatment and was treated by cryosurgery and multiple PDT sessions. She was in complete remission 12 months after this treatment. DISCUSSION: Combined cryosurgery and PDT may offer a therapeutic alternative to conventional surgery for the treatment of large or recurrent multifocal vulvar Paget's disease, or in elderly people. Indeed, although palliative, these two non-invasive techniques can be used to treat many lesions in a single session. Recurrences can be treated again using either technique, or both, without any aesthetic or functional consequences.

[Treatment of keloids with shaving and cryosurgery: preliminary reports]. / Traitement de cicatrices chéloides par "shaving" et cryochirurgie: résultats préliminaires.

INTRODUCTION: Numerous treatments have been proposed in patients with keloid scars. Unfortunately, most exhibit poor efficacy. The preliminary results obtained in ten patients with large keloid scars treated by shaving followed by cryosurgery are reported. PATIENTS AND METHODS: Ten patients with one or more keloid scars were treated by shaving of the keloid immediately followed by cryosurgery of underlying scar tissue using an impedance of 500 k Ohms. Minimum post-treatment follow-up was 12 months. "Major response" was defined as a reduction in keloid thickness of 80% to 100%, "moderate response" as an improvement of 50% to 80% or partial relapse, and failure as an improvement of less than 50% or complete relapse after treatment. RESULTS: A total of 16 keloids in ten patients (7 men, 3 women) aged from 10 to 45 years old (mean age: 25 years) were treated. Keloids were localised on the lower lobe of the ear (n=10), on the ear lobe (n=3), on the neck (n=1), on the pubis (n=1), and on the presternal area (n=1). Mean duration of keloids was 3.1 years (18 months - 10 years). Mean follow-up was 23 months (12-56 months). "Major responses" were observed in 13 cases (82%) (3 cases required further treatment); "moderate response" was observed in 3 cases (18%). CONCLUSION: These preliminary results are highly encouraging since all patients showed improvement. Shaving associated with cryosurgery appears to us to be a useful treatment for large keloids scars, particularly after otoplastic surgery.

[Evaluation of the diagnosis of pigmented tumors of the skin and factors leading to a decision to excise. Dermatologists of the Postgraduate Association of Haute-Normandie]. / Evaluation du diagnostic des tumeurs pigmentées de la peau et des éléments conduisant à une décision d'exérèse. Dermatologues de l'Association de FMC de Haute-Normandie.

INTRODUCTION: The necessity of excising melanomas characterized by a slight thickness at an early stage, leads dermatologists to remove pigmented lesions which do not correspond to melanomas. The aims of this study were: a) to prospectively assess the accuracy of melanoma diagnosis, b) to quantify the number of excisions performed according to the degree of melanoma suspicion, c) to determine the specific clinical sign or signs of relevant diagnostic value. PATIENTS AND METHODS: This study was conducted prospectively from January 1996 to August 1997 by dermatologists in private practice and dermatologists from a University Hospital staff. When it was decided to excise a pigmented lesion, a form was filled out choosing the most appropriate clinical diagnosis, the degree of melanoma suspicion, and clinical signs which lead to surgery. Based on histological findings as the reference, the sensitivity, specificity, accuracy of melanoma diagnosis and the kappa test that evaluates the concordance between clinical and histological diagnosis, were performed. The diagnostic value of clinical signs was assessed by variance analysis. RESULTS: Of the 353 excised lesions, 38 (10.7 p. 100) were identified as melanoma on histologic examination. The sensitivity, the specificity and diagnostic accuracy were: 79 p. 100, 94 p. 100 and 53 p. 100 respectively. The kappa test concordance between clinical and histological diagnosis was 0.66. Two hundred and two lesions (57 p. 100) were excised even though the clinical suspicion of melanoma was poorly considered. Only one of these 202 lesions was identified histologically as a true melanoma. Thirty seven (24.5 p. 100) of the 151 remaining excised lesions with an "average" or "strong" suspicion were true melanomas. The clinical signs considered, alone or associated, had a poor predictive positive value (< 38 p. 100). An analytical approach performed with a logistic model permitted the identification of two associated signs suggesting a best diagnostic value. DISCUSSION: This is the only study, to our knowledge, reported in the literature which prospectively assesses the sensitivity, specificity and concordance between clinical and histological diagnosis of melanoma. Results were considered from average to good. The originality of this study was to assess the number of pigmented lesions excised according to the degree of melanoma suspicion, suggesting the possibility of reducing the number of nevi removed when the melanoma risk was considered clinically poor. Finally, this study emphasizes the limits of clinical semiology and the need for future diagnostic methods in the assessment of melanoma.

[Eczema-like cutaneous graft versus host disease treated by UV-B therapy in a 2-year-old child]. / GVH cutanée eczématiforme traitée par UV-B thérapie chez un enfant de deux ans.

INTRODUCTION: Chronic graft versus host disease (GVHD) has rarely been reported in children. Optimal treatment should minimize infectious complications and preserve the child's growth. We report a case of cutaneous GVHD in a two year-old boy, who presented an eczema-like eruption and responded well to broad band UV-B therapy. CASE REPORT: A two year-old boy with acute myeloblastic leukemia had a heterologous bone marrow transplantation with a graft issued from an unrelated female donor. Three month later, he developed eczema-like lesions of the trunk, arms and legs associated with diffuse alopecia, despite oral corticosteroids and cyclosporine treatment. Histologic findings were consistent with GVHD. Topical corticosteroids and broad band UV-B therapy were initiated, while oral corticosteroids and cyclosporine doses were tappered off. GVHD lesions cleared, allowing withdrawal of oral corticosteroids and cyclosporine 3 and 12 months respectively after initiation of UV-B therapy. No relapse occurred 24 months after systemic treatment discontinuation and 12 months after broad band UV-B therapy was stopped. CONCLUSION: This observation suggests that broad band UV-B therapy is an effective treatment for eczema-like, cutaneous GVHD.

[Langerhans histiocytosis in adults: cutaneous and mucous lesion regression after treatment with thalidomide]. / Histiocytose langerhansienne de l'adulte: localisations cutanéomuqueuses régressives après traitement par thalidomide.

BACKGROUND: Langerhans cell histiocytosis is a rare disorder with a wide spectrum of diseases and various clinical behaviours. The prognosis depends on the patient's age at onset and the extension of the disease. Treatment is function of evolution and extension of the disease. CASE REPORT: We report one case of Langerhans cell histiocytosis in a 33-year-old woman with resistant vulvar involvement whose cutaneous lesions improved with thalidomide. Complete healing of the genital lesions occurred within 1 month, but the patient discontinued her treatment after 3 months because of somnolence. Recurrence of the symptoms was observed within 2 weeks without treatment, but complete control was obtained with reintroduction of thalidomide. No severe adverse effect was detected at electrophysiological and clinical examinations. CONCLUSION: The simplicity and the rapid effect of thalidomide on cutaneous lesions suggest that new clinical evaluation of this old drug that can also be used in some systemic disease might be of the value.

[Melkersson-Rosenthal syndrome treated by thalidomide. 2 cases]. / Syndrome de Melkersson-Rosenthal traité par le thalidomide. Deux observations.

INTRODUCTION: Treatment of Melkersson-Rosenthal syndrome (MRS) remains uncertain. Two cases of MRS treated with thalidomide are described. CASE REPORT: Two patients with cheilitis granulomatosa and recurrent facial edema have been treated with thalidomide (100 mg daily) for 3 and 6 months respectively. The efficacy of thalidomide was complete clinically and histologically in one case. In the second one, thalidomide suppressed attacks of facial edema and reduced lip swelling. COMMENTS: These cases suggest a therapeutic effect of thalidomide in MRS.

New electron microscopic findings in a case of multicentric reticulohistiocytosis. Long spacing collagen inclusions.

The case of a 68-year-old woman with polyarthropathy and skin nodules is presented. Histologic findings of histiocytes with ground-glass cytoplasm favored the diagnosis of multicentric reticulohistiocytosis. In this article we report new electron microscopic findings of intra- and extracytoplasmic long spacing collagen (type VI). Type VI collagen inclusions are usually found in lymphohistiocytic neoplasms. We believe our findings support the concept of a proliferative rather than inflammatory etiology for multicentric reticulohistiocytosis. It may also give support for the argument of production of collagen by the histiocytic cells of multicentric reticulohistiocytosis.

[Isolated zinc deficiency and necrolytic migratory erythema. Apropos of a case]. / Déficit isolé en zinc et érythème nécrolytique migrateur. A propos d'une observation.

The case of 87-old year woman with necrolytic migratory erythematosus rash without elevated plasma enteroglucagon is discribed. Decreased serum zinc level, response to oral zinc substitution and follow up proved the zinc deficiency.

[Spontaneous rupture of subclavian artery disclosing Ehlers-Danlos disease. A case]. / Rupture spontanée d'artère sous-clavière révélant une maladie d'Ehlers-Danlos. Une observation.

The authors report the case of a 30-year old man who suffered spontaneous rupture of the right subclavian artery. Treatment consisted of carotid-axillary graft since the fragility of the vessel precluded direct suture. The clinical symptoms, together with histological and ultrastructural examinations led to a diagnosis of Ehlers-Danlos syndrome with purely arterial manifestations.

[Cutaneous metastasis disclosing primary angiosarcoma of the aorta]. / Métastases cutanées révélatrices d'un angiosarcome aortique primitif.

A 68-year old man presented with erythemato-telangiectatic nodules on his right lumbar fossa, associated with right-sciatica. A skin biopsy was performed. Microscopic examination showed tumour embolism in the lumen of the dermal vessels. Immunohistochemical staining and electron microscopy confirmed the diagnosis of angiosarcoma metastasis. An arteriography showed the primary neoplasm as a polypoid tumour with anterior pedicle, narrowing the aortic lumen below the renal arteries. The patient died a few months later, with multiple metastasis in the lower half on his body. To our knowledge, this is the twelfth case of arterial primary angiosarcoma reported in the literature and the fifth one with skin metastasis. The previously published cases are reviewed.

[Argyria in children]. / L'argyrie chez l'enfant.

A case of argyria in a 14 year-old child caused by abuse of silver containing pulveriser for sore throat is described. The distinctive skin blue gray discoloration that occurs in argyria is due to deposition of silver. Pigmentation is permanent. Self treatment is stigmatized.

[Acquired disseminated elastolysis of the mid-dermis]. / Elastolyse acquise en nappe du derme moyen.

A young woman in a good health noticed the occurrence of inelegant wrinkled plaques on her trunk and limbs. The histological aspect was particular in so far as there were no layers of elastic fibres left in the middermis. None of the classical diagnoses could be accepted. Five similar cases have been reported in the literature and make it possible to discuss a new entity among cutaneous elastolysis.