Sentinel lymph node biopsy with a gamma probe in patients with high-risk cutaneous squamous cell carcinoma: follow-up results of sentinel lymph node-negative patients.

OBJECTIVE: Lymphoscintigraphy (LS) and sentinel lymph node biopsy have become the standard of care for melanoma and breast cancer. However, the data on patients with cutaneous squamous cell carcinoma (SCC) are limited. We aimed to evaluate and identify the role of LS and sentinel lymph node biopsy in patients with high-risk cutaneous SCC. METHODS: Nineteen patients (13 men, six women; 47-87 years of age, mean age 67.5 ± 12.3) with SCC were included in the study. LS was performed on all patients after intracutaneous injection of Tc-99m nanocolloid. Primary lesions and sentinel lymph nodes (SLNs) were excised with the help of a gamma probe. RESULTS: A total of 26 SLNs and 32 secondary lymph nodes were imaged on LS and were marked. During surgery, 29 SLNs, 21 secondary lymph nodes and three nonactive lymph nodes were excised. In total, 53 lymph nodes were removed surgically. A histopathological study revealed that all lymph nodes were negative for metastasis. Patients were followed up for an average of 41.1 ± 22.2 months (7-80 months). Until the time of data collection, 14 patients were alive and had no regional lymph node or distant metastasis. Local recurrence was seen in only one patient. He was reoperated upon 38 months ago. CONCLUSION: The feasibility of determining SLNs using LS and an intraoperative gamma probe in patients with cutaneous SCC was shown. Unnecessary elective lymph node dissection and possible complications could be avoided in 19 patients.

Squamous cell carcinoma arising from a fibroepithelial polyp.

Fibroepithelial polyps (FEPs) are among the most common benign skin lesions treated frequently without submitting for histologic examination since malignant degeneration is exceedingly rare. In this case report, we describe an aggressive gross squamous cell carcinoma mass arising from a large pedunculated-type FEP located at the lower limb, which, to our knowledge, has not been reported yet.

Necrotizing fasciitis of the scalp: a case of an uneventful healing.

Necrotizing fasciitis is a rare, rapidly progressing soft tissue infection, characterised by extensive necrosis of subcutaneous fat and fascia with relative sparing of skin and underlying muscle. It is usually caused by toxin producing virulent bacteria. Although it can occur in otherwise healthy patients, the disease is usually seen in conjunction with immune deficiency disorders, intravenous drug abuse, peripheral vascular disease and diabetes. Necrotizing fasciitis is more frequent in abdominal wall, perineum and extremities. Involvement of the head and neck structures and especially the scalp is rare. We treated a diabetic and chronic renal failure patient with necrotizing fasciitis of the scalp without any complication.

Direct skin excision fat reshaping and repositioning for correction of prominent nasolabial fold.

In addition to all the consequences mentioned elsewhere in the literature, the aging process causes the most dramatic changes in the midface and nasolabial complex. Genetic predisposition also plays a role in the final appearance of this area. The nasolabial complex in the aged face generally is accepted as a "hard-to-treat area" for which many different techniques have been described. Among the techniques described to date, direct excision still keeps its popularity for selected patients. However, some controversies in the technique are open to discussion. To overcome these problems, we did skin excision, reshaping and repositioning the fibrofatty tissue lateral to the fold, which is contrary to fat excision in the classical technique. It seems to be a better approach to reshape and reposition the ptotic tissue so as not to obliterate but rather to smooth out the nasolabial area. Excision of fat would decrease the amount of tissue in the already atrophic and ptotic face. This technique offers a new approach to nasolabial complex problems. The most significant drawback is the scar, which usually is imperceptible in selected patients.