Review of Cutaneous Repairs on the Hand and Fingers Following Dermatologic Surgery.

Removal of cutaneous malignancies on the hand and fingers can result in challenging surgical defects to close. The dermatologic surgeon must not only be highly skilled, but also be knowledgeable regarding the complex anatomy of this area to perform reconstruction that provides optimal functional and cosmetic results. This review highlights key anatomic factors that must be considered when operating in this region. Wound management options discussed below include secondary intention, primary linear repair, local skin flaps, interpolation flaps, and skin grafting. The surgeon's choice is based on defect size, the presence/absence of adjacent skin laxity, and other patient-specific factors that may impact healing such as medical comorbidities, utilization of anticoagulant medications, and smoking status. This manuscript serves as an up-to-date review of closure considerations and techniques for physicians who surgically treat cutaneous malignancies of the hand and fingers.

Isolated Cutaneous Langerhans Cell Histiocytosis Presenting in an Adult Male.

Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are well-established clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.

A Rare Case of Cutis Verticis Gyrata with Underlying Cerebriform Intradermal Nevus.

Cutis verticis gyrata (CVG) is an uncommon condition of the scalp known for redundant, thickened folds, which emulate the cerebral gyri of the brain. This unusual finding is catalogued as primary essential, primary non-essential, and secondary. While primary essential CVG is an isolated and idiopathic condition, primary non-essential CVG is deemed to be related to neurological, ophthalmological, or psychiatric disorders. Secondary CVG may be due to a variety of systemic disorders, inflammatory dermatoses, or cutaneous neoplasms or infiltrates. This report serves as an example of secondary CVG due to a cerebriform intradermal nevus, with specific focus on clinical course, treatment options, and critical screening guidelines for these patients.

Nocturnal leg symptoms are not associated with specific patterns of superficial venous insufficiency.

BACKGROUND: Certain nocturnal symptoms such as leg cramping (LC) and restless leg symptoms (RLS) are found in patients with venous disease. This study investigates the relationship between nocturnal symptoms and anatomic locations of superficial venous insufficiency. METHODS: A retrospective review of 371 consecutive patients presenting to a venous disease practice over a 1-year period was conducted. Patients underwent comprehensive assessment including standardized duplex scans. Superficial venous disease was classified by anatomic location (great saphenous vein [GSV], small saphenous vein [SSV], tributaries). Information on patient symptoms was obtained from questionnaires and patient interviews. RESULTS: Most patients in the cohort were female (315/371, 85%) with an average age of approximately 56 years. The 56 men had an average age of 63.2. Nearly all patients (92%) had findings of superficial venous reflux with the anatomic site of involvement as follows: GSV (51%), SSV (16%), and tributaries (33%). Thirty-two percent of patients experienced LC and 16% experienced RLS. The patterns of reflux did not differ between patients with nocturnal symptoms compared to those without nocturnal symptoms. Nine percent of patients with nocturnal symptoms had no evidence of venous disease. Of those patients with LC, 76% had reflux in the GSV, 48% had reflux in the SSV, and 92% had reflux in at least one segment of the superficial venous system. Of those patients with RLS, 78% had reflux in the GSV, 35% had reflux in the SSV, and 87% had reflux in at least one segment of the superficial venous system. CONCLUSIONS: No significant difference was detected between patterns of superficial venous reflux in patients with nocturnal symptoms compared to those without nocturnal symptoms. In addition, the presence of nocturnal symptoms does not predict a specific pattern of disease. Future studies are needed to determine whether correction of the main truncal disease is sufficient or if ablation of both the truncal and tributary veins is necessary for alleviation of nocturnal symptoms.