Microcystic adnexal carcinoma: report of 13 cases and review of the literature.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare tumor of the skin. Clinically it often masquerades as a firm, subcutaneous nodule on the head and neck regions. Microscopically it extends far beyond assessed clinical margins spreading locally in the dermal, subcutaneous, and perineural tissue planes. The local recurrence rate by standard excision is about 50%. Recent preliminary reports indicate more favorable cure rates with Mohs micrographic surgery (MMS). OBJECTIVE: To present our data on 13 cases (12 patients) of MAC treated by MMS. In addition, we reviewed the medical literature to summarize the accumulated experience of MMS treatment in the management of MAC. We also present a case of bilateral MAC of the face and describe a renal transplant recipient on immunosuppressive therapy who developed MAC of the nasal bridge. METHODS: We reviewed and updated our series of MAC cases treated by MMS over the last 9 years. A total of 13 cases of MAC are reviewed. We also searched the literature for MAC treated by MMS with a follow-up of more than 2-years. RESULTS: One patient had bilateral MAC of the nose and cheek. Another patient developed a MAC of the nasal bridge 20 years after renal transplantation. In this patient predisposing factors were radiation for teenage acne and immunosuppression therapy. A total of 13 cases of MAC were treated by MMS with no recurrences, with a mean follow-up of 5.0 years (range 1.1-8.0 years). CONCLUSION: We update the medical literature with 13 MAC cases treated by MMS. To our knowledge there have been 148 cases of MAC reported in the world literature. Including our series, there have been 73 cases of MAC treated with MMS. There were only four treatment failures. Regional and/or distant metastasis from MAC is rare, with only one reported death. Following MMS, the 2-year success rate was 89.7% (35 of 39). The accumulated data continue to confirm that when MAC is discovered early and is readily accessible to excision by MMS and other subspecialty support, a favorable outcome can be expected.

Merkel cell carcinoma of the skin and mucosa: report of 12 cutaneous cases with 2 cases arising from the nasal mucosa.

BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon skin tumor that most frequently arises on sun-exposed facial sites. It rarely occurs on mucous membranes of the head region. The primary MCC is usually treated by wide excision followed by radiation to the primary site and regional lymph nodes. Using traditional surgery the local recurrence rate ranges from 20 to 50%. In our clinic, Mohs surgery is used to excise the primary MCC completely, followed by radiation. Here we present our treatment experiences and outcomes. OBJECTIVE: To document our experience of MCC treated by Mohs surgery. We present our series of 12 cases of MCC, 2 cases of which arose from mucosal sites of the nasal cavity. METHODS: We reviewed 12 cases of MCC from the Mohs clinic database. We also reviewed the literature for cutaneous and mucosal MCC. RESULTS: There were 12 cases of MCC: 10 cutaneous and 2 mucous. The site distribution of cutaneous MCC was eight on the head, one on the neck, and one on the groin. Of these, nine were treated by Mohs excision. Two patients developed local recurrence following Mohs treatment. The local recurrence rate was 22% (2 of 9). The sites of mucosal MCC were the nasal septum and nasopharynx. One case had a history of previous radiation and developed an MCC 40 years later. This case also demonstrated epidermotropic spread of Merkel cells to the overlying mucous epithelium. This patient required extensive intranasal and cranial surgery to remove the tumor. Both patients with mucosal MCCs died of their disease. The overall mucocutaneous survival of MCC at 1 year was 80% and at 2 years was 50%. CONCLUSION: In our series, local control of the primary MCC was achieved in 70% of patients (7 of 10) using combined Mohs excision and radiation. Two recurrences had primary tumors larger than 3.5 cm in diameter, while the other case was nonresectable by Mohs surgery. Tumor size appeared to determine the degree of local control. When the postoperative Mohs defect was less than 3.0 cm in diameter, local and regional control appeared to be more favorable. When the primary facial MCC is relatively small, removal by Mohs surgery followed by radiation was effective, therapeutic, and less disfiguring. Mucosal MCC is rare and may occur as a long-term sequelae after radiation therapy to the skin.

Renal cell carcinoma metastatic to the scalp: case report and review of the literature.

BACKGROUND: Renal cell carcinoma metastatic to the skin is rare. OBJECTIVE: To illustrate by a case report the clinical presentation and management of the disease. METHODS: We present a case of renal carcinoma metastatic to the skin of the scalp that occurred 6 years after removal of her kidney. The tumor was diagnosed using frozen tissue and paraffin sections. RESULTS: Cutaneous metastasis treated by excision. CONCLUSION: Renal cell carcinoma may metastasize to the skin of the scalp. Our case illustrated an interesting ipsilateral metastasis that occurred 6 years after treatment of her primary tumor. Physicians, dermatologists, pathologists, and Mohs surgeons should be aware of this entity.

Resin-bonded cast coverage for fractured posterior teeth.

Enamel-dentin fracture without pulpal involvement of intact posterior teeth demands restoration of form and function while preserving as much sound tooth material as possible. A partial-coverage restoration cast in nonprecious metal and air-abraded and bonded to the tooth by an adhesive resin is suggested. The strong bond of the adhesive resin to the enamel and dentin of the tooth and to the air-abraded metal allows for simple fabrication of a cast partial coverage that requires only minimal tooth preparation.

The labial endodontic access: a rational treatment approach in anterior teeth.

Labial endodontic access is an alternative to the conventional lingual endodontic access in permanent teeth. The labial approach facilitates visibility and provides direct access to the root apex. Current restorative procedures offer improved methods to overcome the esthetic impairment resulting from this approach. Labial access is especially beneficial for patients with limited mandibular opening. Other indications are in Angle's class II division 2 dentitions or in teeth with resin-bonded cast restorations. Anatomic studies for the single tooth that corroborate the labial endodontic approach are reviewed.

Adjunctive surgical management of cutaneous Mycobacterium fortuitum infection.

Atypical mycobacteria of the fortuitum-chelonei complex are being identified with increasing frequency as causes of resistant, cutaneous infection. We report a case of Mycobacterium fortuitum infection of the face, unresponsive to conventional antimicrobial therapy, which resolved following adjunctive surgical resection. We believe that prompt surgical debridement of affected tissue in such infections, combined with appropriate antimicrobial therapy, will shorten both the duration and morbidity often associated with this disease.