ABSTRACT
Microcystic adnexal carcinoma (MAC) is an uncommon, locally aggressive, malignant cutaneous tumor with pilar and eccrine differentiation. Mohs micrographic surgery is the treatment of choice for this condition, but specific histological findings can complicate MAC removal and leave doubt as to whether the tumor has been completely removed. Here we describe the clinical and pathological characteristics of a case in which a patient with an MAC underwent multiple reexcisions because of the presence of benign subclinical syringomatous proliferations adjacent to the primary lesion. Our case raises awareness of syringomatous proliferation, a benign process histologically similar but behaviorally distinct from a primary MAC. This experience highlights the importance of continued communication between dermatopathologists and dermatologic surgeons in providing quality patient care.
Subject(s)
Carcinoma, Skin Appendage/surgery , Mohs Surgery , Neoplasms, Second Primary/surgery , Sweat Gland Neoplasms/surgery , Sweat Glands/pathology , Aged , Carcinoma, Basal Cell/epidemiology , Carcinoma, Skin Appendage/pathology , Carcinoma, Squamous Cell/epidemiology , Diagnosis, Differential , Female , Forehead/pathology , Humans , Neoplasms, Second Primary/pathology , Skin Neoplasms/epidemiology , Sweat Gland Neoplasms/pathologyABSTRACT
The role of botulinum toxin in facial rejuvenation has been greatly expanded in the last several years. In this article, we first review the traditional approach to botulinum toxin therapy in the forehead and glabella. For the advanced reader, we then discuss both the literature and our personal approaches to treatments of the periocular region, mid face, lower face, and neck. Throughout the discussion, attempts are made to include a description of relevant anatomy, the physiologic result of specific muscle activity and denervation, and perhaps most importantly, precise directions for patient treatment.
ABSTRACT
Merkel cell carcinoma is a rare cutaneous neoplasm most commonly affecting the head and neck of elderly white patients. Even with treatment, Merkel cell carcinoma has a strong propensity toward local recurrence, lymphatic spread, and distant metastasis. Because of its rarity and the subsequent lack of well-controlled clinical trials, no single standard of care exists for the treatment of this aggressive tumor. In our institution, primary lesions are excised with wide margins or by Mohs' micrographic surgery. After local removal, the excision site is treated locally with external radiation therapy. Sentinel lymph node mapping and biopsy are performed. Patients with tumor within a sentinel lymph node undergo lymph node dissection and radiation to the lymphatic basin. Adjuvant chemotherapy is offered to high-risk patients with local disease and to patients with metastases. Patients with distant metastases are treated with a combination of salvage chemotherapy and radiation therapy.
Subject(s)
Carcinoma, Merkel Cell/therapy , Skin Neoplasms/therapy , Carcinoma, Merkel Cell/pathology , Combined Modality Therapy , Humans , Lymphatic Metastasis , Sentinel Lymph Node Biopsy , Skin Neoplasms/pathologySubject(s)
Antineoplastic Agents/therapeutic use , Immunologic Factors/therapeutic use , Interferon-alpha/therapeutic use , Lymphoma, T-Cell, Cutaneous/therapy , Photopheresis , Tetrahydronaphthalenes/therapeutic use , Antineoplastic Agents/administration & dosage , Bexarotene , Clinical Trials as Topic , Combined Modality Therapy , Humans , Immunologic Factors/administration & dosage , Interferon-alpha/administration & dosage , Lymphoma, T-Cell, Cutaneous/drug therapy , Lymphoma, T-Cell, Cutaneous/immunology , Lymphoma, T-Cell, Cutaneous/mortality , Sezary Syndrome/therapy , Skin Neoplasms/drug therapy , Skin Neoplasms/immunology , Skin Neoplasms/therapy , Tetrahydronaphthalenes/administration & dosageABSTRACT
Laser-assisted hair removal has rapidly emerged as a noninvasive technique for long-term reduction in unwanted hair. This article reviews the pertinent aspects of hair follicle biology, the theoretical aspects of the physics and mechanisms of laser epilation, the different types of lasers available for hair removal, and the practical clinical aspects of laser hair removal.
Subject(s)
Hair Removal/instrumentation , Laser Therapy , Hair Follicle/physiology , HumansABSTRACT
BACKGROUND: Recent reports indicate that laser hair removal is most effective on anagen hairs. However, no published trials have examined laser epilation after hair cycle synchronization. OBJECTIVE: To evaluate the potential for enhanced laser hair removal after the induction of telogen hairs into anagen by wax epilation. METHODS: We identified four 2.5-cm square areas with equivalent hair length and density on the backs of 13 dark-haired white men. To induce typically telogen hairs into anagen, two areas on each patient were wax epilated. Two weeks later, one waxed area and one unwaxed area were treated with a long-pulsed alexandrite laser. One month after laser treatment, a subjective comparison was made based on hair density, length, and thickness. RESULTS: In 12 of 13 patients, lasered areas that had been pretreated with wax epilation were clearer of hair as compared with areas that had been pretreated by shaving (P=0.0034). No significant difference was noted between waxed and unwaxed control areas that had not been laser treated (P=1.0). CONCLUSION: Wax epilation 2 weeks before laser hair removal improves cosmetic outcomes at 1 month. This effect may be secondary to the recruitment and heightened sensitivity of early anagen hairs.
