Hemangiomas: evaluation and treatment.

BACKGROUND: Hemangiomas are common skin tumors of infancy that have undergone recent changes in nomenclature, methods of evaluation, and treatment. OBJECTIVE: To review the nomenclature, epidemiology, evaluation, and treatment of common hemangiomas. METHODS: A literature search was conducted utilizing MEDLINE and the Cochrane library databases. Text search words used were "hemangioma" and "infancy." The clinical experience of the authors was also used to formulate the review. RESULTS: There have been many advances in nomenclature and therapeutic options for children with hemangiomas. Hemangiomas are proliferative tumors of infancy that should be distinguished from structural malformations, such as port-wine stains and lymphangiomas. CONCLUSION: Natural involution remains a viable treatment option for the majority of patients with uncomplicated hemangiomas. Excisional surgery, laser, and pharmacologic remedies are indicated for a subset of complicated hemangioma patients.

The rhombic bilobed flap for nasal reconstruction.

BACKGROUND: The bilobed flap is a useful tool for reconstruction of the nose but is occasionally complicated by pincushioning or trapdoor deformity. OBJECTIVE: To describe the use of a rhombic bilobed flap for use in reconstructing defects on the lower third of the nose. METHODS: Reconstruction of skin cancer defects following Mohs surgery was performed using a bilobed rhombic flap design in 10 patients. RESULTS: Good to excellent results were seen in 9 of 10 patients. Significant pincushioning was not present postoperatively in any patient. CONCLUSION: Despite some disadvantages, the rhombic bilobed flap is useful in reconstructing nasal defects on the lower third of the nose.

The treatment of actinic keratoses.

BACKGROUND: Actinic keratoses are epidermal tumors that can develop into invasive squamous cell carcinoma. Recently, some Medicare carriers have limited reimbursement for destruction of actinic keratoses. OBJECTIVE: We review treatments for actinic keratoses and the rationale for their use. METHODS: Computerized literature searches were performed in MEDLINE. The search terms were "actinic keratoses" and "solar keratosis." Information from these searches was combined with considerable personal experience for the body of this work. RESULTS: Many effective treatments for actinic keratoses exist. Cryosurgery and curettage are the most commonly used treatments. Cryosurgery is considered the standard of care for treatment of actinic keratoses. Topical 5-fluorouracil is used in 3. 6% of cases and is rarely used alone on the first patient visit. Many other effective, less commonly used treatments are available. CONCLUSION: A physician should select the best treatment by considering features of the lesion(s) and the patient being treated. All actinic keratoses cannot be treated in the same manner. The failure to treat actinic keratoses may have serious consequences for the patient.

Onychocryptosis associated with the treatment of onychomycosis.

With the advent of effective oral therapies for onychomycosis, there have been anecdotal reports of an increased incidence of onychocryptosis associated with the use of these new agents. The authors undertook a chart review of 100 consecutive patients treated for onychomycosis in a private medical practice to determine the incidence of onychocryptosis. A total of 37 of these patients (37%) developed paronychia ranging from simple pain to a severe inflammatory response with redness, drainage, and granuloma formation. Of these, 19 patients (19%) required surgical procedures to control onychocryptotic symptoms. Podiatric physicians should be aware that ingrown toenails may be an adverse consequence of effective treatment for onychomycosis.

Q-switched neodymium:yttrium-aluminum-garnet laser treatment of lentigo maligna.

Lentigo maligna is a premalignant lesion of atypical melanocytes that typically arises on the head and neck of elderly patients. It is considered a melanoma in situ with a significant risk for transformation to invasive lentigo maligna melanoma. Surgery is the preferred method of treatment; however, because of the advanced age of the typical patient with lentigo maligna, the frequency of complicating medical problems, and the cosmetic or functional aspects of treatment, surgical excision is not always feasible. The purpose of this pilot study was to evaluate the efficacy and safety of Q-switched neodymium:yttrium-aluminum-garnet laser treatment of lentigo maligna. Eight patients were treated with 532 and/or 1064 nm wavelengths from the laser. All patients showed a response to laser therapy, and 2 patients treated with 1 treatment from each wavelength had complete eradication of the LM, with no evidence of recurrence in 42 months. Further study is warranted, but Q-switched neodymium:yttrium-aluminum-garnet laser is a promising alternative treatment for lentigo maligna.

Metastatic cutaneous squamous cell carcinoma derived from actinic keratosis.

BACKGROUND: Squamous cell carcinoma (SCC) with histologically contiguous actinic keratosis has long been thought of as a tumor with minimal risk for metastasis. The objective of this study was to determine if contiguous actinic keratosis is present in the original tumors of metastatic cutaneous SCC and to describe the histologic features of these tumors. METHODS: The primary lesions of 22 patients with metastatic cutaneous SCC were examined using light microscopy. RESULTS: Contiguous actinic keratosis was present histologically in 44% of the original lesions of cutaneous SCC that metastasized. The average tumor thickness was 6.6 mm. Greater than 66% of the tumors were well or moderately differentiated. The skin adjacent to the tumors showed solar degeneration in almost all instances. CONCLUSIONS: The histologic presence of contiguous actinic keratosis is not a useful predictor of the metastatic behavior of cutaneous SCC. Increased tumor thickness and depth of invasion are the most consistent histopathologic features of cutaneous SCC that metastasize.

Efficacy of corneal eye shields in protecting patients' eyes from laser irradiation.

BACKGROUND: The continuing development of new types and applications of lasers has appeared to surpass the development of specific eye protection for these lasers. There are a variety of eye shields on the market, but few are specifically designed for laser protection. OBJECTIVE: Our purpose was to test a variety of eye shields by two parameters, light transmission and temperature rise, and to determine from these measurements the most protective shield for patients. METHODS: We tested four plastic shields, one metal shield, and two sets of tanning goggles for temperature rise and light transmission when irradiated with a beam from a flashlamp-pumped, pulsed-dye laser. RESULTS: The temperature rise at the surface of the shield opposite the laser impacts was no more than 0.2 degree C in any case. White light was transmitted at significant levels through several of the shields, but yellow light transmittance was noted only through the green eye shield. CONCLUSION: Our measurements indicate that all except the green shield appeared safe from transmission of the 585-nm radiant energy. However, the optimal laser eye shield, in our opinion, would be a composite of several different shields' characteristics.