Case report: Reconstruction exposed bone following excision of malignant scalp tumors, multidisciplinary approach of an old method with new materials.

INTRODUCTION: Basal cell carcinoma and squamous cell carcinoma are malignant epithelial tumors that frequently occur on the scalp. The reconstruction of large surgical breaches in which the scalp was removed leaving the bone bare has always been a difficult problem to solve. CASE PRESENTATION: An 84-year-old patient in good general condition with an extensive surgical breach in the scalp comes to our observation where a sessile squamous cell carcinoma was removed 2 months ago in another hospital; The surgeon had removed the aponeurotic galea with bone exposure. CLINICAL DISCUSSION: There are numerous surgical solutions proposed: reconstruction by a secondary intention, grafts of dermal matrix, transposition flaps and finally an old technique that involves the perforation of the cranial theca. Dermal matrices cannot be used on bone as they still need blood support to facilitate the repair process. Local flaps could not be used as the skin was seriously photodamaged and treatment of this would further delay the repair. In our case the solutions adopted with other patients were not applicable, therefore we evaluated the literature to determine which solution could be adopted. We had experience with tissue perforation in large ulcers and position punch grafting to facilitate re-epithelialization therefore we also drew inspiration from this method. CONCLUSION: The technique adopted allowed an immediate reconstruction limiting the discomfort to the patient with few dressings and complete healing in about 1 month. Scalp, the graft is completely rooted in 3 month.

Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma.

Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5 mm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months.

Comparative Effects of Sunscreens Alone vs Sunscreens Plus DNA Repair Enzymes in Patients With Actinic Keratosis: Clinical and Molecular Findings from a 6-Month, Randomized, Clinical Study.

Recent experimental irradiation studies have shown that the addition of DNA repair enzymes (photolyase and endonuclease) to traditional sunscreens may reduce ultraviolet radiation (UVR)-induced molecular damage to the skin to a greater extent than sunscreens alone. In this 6-month, randomized, clinical study, we sought to compare the clinical and molecular effects of sunscreens plus DNA repair enzymes vs. those of traditional sunscreens alone in patients with actinic keratosis (AK). A total of 28 AK patients were randomized to topically apply sunscreens plus DNA repair enzymes (enzyme group; n = 14) or sunscreens alone (sunscreen group; n = 14) for 6 months. The main outcome measures included 1) hyperkeratosis, 2) field cancerization (as measured by fluorescence diagnostics using methylaminolaevulinate), and 3) levels of cyclobutane pyrimidine dimers (CPDs) in skin biopsies. Both regimens produced a significant reduction of hyperkeratosis at 6 months, with no difference between the two groups. Field cancerization was significantly reduced by both regimens, but the decrease observed in the enzyme group was significantly more pronounced than in the sunscreen group (P < 0.001). At 6 months, CPDs decreased by 61% in the enzyme group and by 35% in the sunscreen group compared with baseline values (P < 0.001). These findings indicate that, despite a similar effect on hyperkeratosis, the addition of DNA repair enzymes to sunscreens was more effective in reducing field cancerization and CPDs than sunscreens alone. Taken together, our findings indicate that sunscreens plus DNA repair enzymes may be superior to traditional sunscreens alone in reducing field cancerization and UVR-associated molecular signatures (CPDs) in AK patients, potentially preventing malignant transformation into invasive squamous cell carcinoma in a more efficient manner.

Preoperative margin detection by digital dermoscopy in the traditional surgical excision of cutaneous squamous cell carcinomas.

BACKGROUND: The incomplete excision rate is a useful clinical and performance indicator, as it correlates with the treatment, the recurrence rate, the patient's morbidity and mortality. Methods of preoperative assessment of tumoral margins are therefore of paramount importance. Dermoscopy is a simple, non-invasive method, and can also be used for the diagnosis of epithelial tumors. OBJECTIVE: The aim of the study is to assess the preoperative evaluation of margins with digital dermoscopy, and compare it with clinical evaluation; to ameliorate the surgical performance. PATIENTS AND METHODS: Ninety-four patients with histologically confirmed squamous cell carcinomas were initially selected for traditional surgical excision. Subsequently, the margin of excision was determined by both clinical (group A, 46 patients) and dermoscopy evaluation (group B, 48 patients). RESULTS: In group A, margin involvement was observed in eight (17%) patients. Positive margins were seen in three (6%) patients of group B. CONCLUSIONS: Preoperative digital dermoscopy is a better method for detecting tumoral margins than clinical evaluation, and is an effective, simple, non-invasive method for the presurgical evaluation of margins.

Usefulness of margin detection by digital dermoscopy in the traditional surgical excision of basal cell carcinomas of the head and neck including infiltrative/morpheaform type.

Incomplete or suboptimal surgical excision of basal cell carcinoma of the head and neck is a relatively frequent occurrence. Methods of preoperative assessment of tumoral margins are therefore of paramount importance. The aim of this study was to compare the preoperative evaluation of margins with digital dermoscopy and clinical definition. One hundred and 12 patients with histologically confirmed basal cell carcinoma were selected for surgical excision. Subsequently, the margin of excision was determined by either clinical (45 patients) or dermoscopic evaluation (67 patients). After pre-surgical clinical evaluation, 22% of histological specimens of excised basal cell carcinoma showed suboptimal margins of excision. Pre-surgical dermoscopic evaluation had only 7% suboptimal excision. Preoperative digital dermoscopy is a better method to determine tumoral margins than clinical evaluation alone. Indeed, preoperative digital dermoscopy is an effective, simple, non-invasive procedure for the pre-surgical determination of margins.