Microcystic adnexal carcinoma: First reported case in an African American man.

Microcystic adnexal carcinoma (MAC) is a relatively uncommon adnexal neoplasm that can display aggressive local invasion. MAC occurs most commonly on the central part of the face and can be clinically asymptomatic with a benign appearance. We describe the first reported case of MAC in an African American man who was treated by Mohs micrographic surgery.

Squamous cell carcinoma in situ arising within clear cell acanthoma.

BACKGROUND: A brief discussion of the subject. OBJECTIVE: The purpose of the work to be described. METHODS: How the work was performed. RESULTS: The outcome of the work. CONCLUSION: The conclusion that can be reached based on the work described.

Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing.

BACKGROUND: Hidradenitis suppurativa is a disabling disease. Although medical management can at times control the disease, the treatment of choice is surgical excision. Surgical defects have been managed by second-intention healing, simple surgical closure, or complex surgical repairs. OBJECTIVE: Our purpose was to determine the benefit of carbon dioxide laser excision with healing by second intention to treat lesions of hidradenitis suppurativa. METHODS: We treated seven patients who had axillary and inguinoperineal hidradenitis suppurativa with carbon dioxide laser excision followed by second-intention healing. A total of 12 procedures were performed (five bilateral and two unilateral). Follow-up periods were 10 to 27 months. RESULTS: After a healing time of 4 to 8 weeks, scars were flat and linear. Only one recurrence of hidradenitis suppurativa has been observed; this occurred along the margin of the surgical scar in a previously treated area. Some patients, however, had continued disease activity in untreated areas. All subjects were satisfied with the results of the procedure, and complications were minimal. CONCLUSION: Carbon dioxide laser excision with second-intention healing is safe and effective for hidradenitis suppurativa.

Eyelid microcystic adnexal carcinoma.

Microcystic adnexal carcinoma is an uncommon cutaneous tumor with multiple synonyms. On cursory microscopic examination, the tumor mimics syringoma and other benign skin adnexal tumors. However, the asymmetric, infiltrative growth pattern clearly sets the lesion apart as carcinoma. The tumor is locally aggressive, with recurrences common, but regional metastases are rare. Histogenesis is controversial. Optimal treatment consists of complete surgical excision with clear surgical margins.

Unilateral erythromelanosis follicularis faciei et colli in a young girl.

Erythromelanosis follicularis faciei et colli is uncommon. Fewer than 20 cases have been reported. Except for one case in a woman and one case of unilateral distribution, all other reported cases have been bilateral in young male patients. We report the first case of unilateral distribution in a white girl.

Carbon dioxide laser treatment of pitted acne scarring.

Laserabrasion has been shown to have limited application in the treatment of acne scarring. Focal laserabrasion used to treat individual pitted acne scars may have broader clinical application. We present 8 patients with pitted acne scars who were treated with either conventional continuous wave carbon dioxide (CO2) laser, or with the superpulsed CO2 laser, or both. Cosmetically acceptable results were attained, particularly in the patients treated with the superpulsed laser.

Laser therapy of the skin. A review of principles and applications.

Advances in laser technology now permit the physician to provide an effective form of treatment for a variety of cutaneous disorders for which no previous therapy existed. Additional refinements in both laser instruments and treatment techniques are certain to have a profound impact on the treatment of skin lesions. For that reason, a complete understanding of the basic properties of lasers and how they can be utilized in various clinical settings is the goal of this article.

Treatment of essential telangiectasia: effects of increasing concentrations of polidocanol.

A double-blind, double-paired comparison study was performed to evaluate the effects of increasing concentrations of polidocanol in the sclerotherapy of essential telangiectasias of the legs. Polidocanol 0.25%, 0.50%, 0.75%, and 1.0% were compared with regard to clinical effectiveness, safety, and patient acceptance. All dosages were well tolerated by the patients. There were no allergic reactions to polidocanol and no cases of superficial ulceration nor necrosis. Among those whose veins cleared, there was little difference in time to clearing for the four concentrations, which averaged three to four treatment sessions. No statistically significant differences existed among the four dosages with respect to level of improvement, itching, or neovascularization. Polidocanol 0.75% and 1.0%, however, caused more side effects noted by patients and induced more hyperpigmentation than did the lower concentrations. Polidocanol 0.25% yielded the lowest percentage of patients whose veins cleared. The 0.50% solution was the most effective concentration for total overall clearing of the types of vessels treated in this study. From this information it appears that 0.50% polidocanol may be the sclerosing agent of choice.

Carbon dioxide laser treatment of chronic actinic cheilitis.

The carbon dioxide laser in both conventional and superpulsed modes was used to treat 13 patients with chronic actinic cheilitis. The procedure was well tolerated. Focal, but not functionally restricting, scarring developed in three patients. The cosmetic result was otherwise excellent. No recurrences have been noted.

Treatment of angiolymphoid hyperplasia of the external ear with carbon dioxide laser.

Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.

Multiple symmetric lipomatosis: treatment with liposuction.

Multiple symmetric lipomatosis is a fascinating disease of uncertain etiology that manifests as massive lipomatous deposits in specific areas of the body. The clinical syndrome and possible pathogenesis are discussed. Classic surgical lipectomy has been the only treatment thus far reported; we report a patient successfully treated with liposuction.

Treatment of dermatofibrosarcoma protuberans with Mohs micrographic surgery.

Ten patients with dermatofibrosarcoma protuberans, all of whom had been treated previously by conventional excisional surgery without success, were treated with Mohs micrographic surgery. A team approach utilizing margin control by Mohs-trained physicians and reconstruction by surgical specialists was employed. Average follow-up exceeds 3 1/2 years, with no recurrences. Microscopically controlled excision appears to be the treatment of choice for dermatofibrosarcoma protuberans.

Argon laser treatment of angiokeratomas.

The argon laser, used in either a pulsed or continuous fashion, is highly effective for treatment of angiokeratomas. Local anesthesia is usually not required. Because energy deposition is well localized, wounds heal rapidly with excellent cosmetic results.

Treatment of telangiectasia: comparison of sclerosing agents.

A double-blind, double-paired comparison, placebo-controlled study was undertaken to determine the optimal agent for sclerotherapy of spider telangiectasias of the lower extremities. Sodium tetradecyl sulfate 0.5%, polidocanol 0.25%, heparsal, and normal saline control were evaluated in terms of clinical effectiveness and patient acceptance. Although all of the agents, except for the control, were effective, polidocanol was found to have the fewest adverse reactions and afforded the greatest patient comfort.

Superpulsed lasers: minimizing thermal damage with short duration, high irradiance pulses.

Superpulsed carbon dioxide lasers emit a controlled train of short duration, high-power pulses which minimize the protein coagulation effects of the laser. Very high irradiances can be used with superb control of vaporization without significant peripheral heating. In incisional work, superpulsing permits the surgeon to advance the hand piece as slowly and as accurately as desired, while experiencing a fraction of the necrosis attendant to conventional continuous-wave lasers. In vaporizational applications, target tissue volumes are flash vaporized before significant heat can be transferred to surrounding tissue, promoting faster wound healing and reduced scarring. The superpulse feature may significantly change the way in which the carbon dioxide laser is used in cutaneous surgery.