Hidradenitis suppurativa polyposa.

A case of severe chronic hidradenitis suppurativa of the perineum complicated by disfiguring fibrous, polypoid lesions is presented. The patient, a 41-year-old woman, had a long history of axillary hidradenitis which subsequently involved the perineum. Draining sinuses, scars and large pendulous masses of the vulva developed over 10 years. Cutaneous scars, ridges, papules and large fibrous polyps were present. Deep clefts, sinuses, dense fibrous scars and foci of chronic inflammation were seen. Rarely, large fibrous polyps may develop in chronic hidradenitis suppurativa and may be due to chronic local lymphedema. Careful pathologic examination is necessary to exclude squamous cell carcinoma.

Lymphedema after sentinel lymph node biopsy for cutaneous melanoma: a report of 5 cases.

BACKGROUND: Sentinel lymph node (SLN) biopsy has rapidly become the procedure of choice for assessing the lymph node status of patients with 1992 American Joint Committee on Cancer stages I and II melanoma. The procedure was designed to be less invasive and, therefore, less likely to cause complications than a complete lymph node dissection. To our knowledge, this is the first report in the literature documenting extremity lymphedema following SLN biopsy. OBSERVATION: We report 5 cases of lymphedema after SLN biopsy in patients being routinely followed up after melanoma surgery at the Massachusetts General Hospital Melanoma Center, Boston. Three cases were mild, and 2 were moderate. Potential contributing causes of lymphedema were present in 4 patients and included the transient formation of hematomas and seromas, obesity, the possibility of occult metastatic melanoma, and the proximal extremity location of the primary melanoma excision. Four of the patients underwent an SLN biopsy at our institution. We used the total number of SLN procedures (N = 235) that we have performed to calculate a 1.7% baseline incidence of lymphedema after SLN biopsy. CONCLUSIONS: Sentinel lymph node biopsy can be complicated by mild and moderate degrees of lymphedema, with an incidence of at least 1.7%. Some patients may have contributing causes for lymphedema other than the SLN biopsy, but many of these causes are difficult to modify or avoid.

Treatment of facial rhytids with a nonablative laser: a clinical and histologic study.

BACKGROUND: Current facial resurfacing modalities (laser, chemical peels, and dermabrasion) remove the epidermis and thus cause open wounds which carry significant risks and extended recovery periods. The nonablative laser is a novel Nd:YAG system designed to alleviate facial rhytids without injuring the epidermis. This new modality may offer patients rhytid removal without the risk seen in currently used resurfacing techniques. OBJECTIVE: To describe a novel nonablative laser system and assess its safety profile and efficacy. METHODS: Ten patients received laser treatments of their periocular rhytids and postauricular skin. Clinical variables (rhytid severity, hyperpigmentation, hypopigmentation, scarring, and level of discomfort) were assessed at 1 and 3 months posttreatment. Postauricular skin biopsies were taken both pre- and posttreatment for histologic analysis. RESULTS: Patient discomfort was minimal. Three months posttreatment, 4 of 10 patients showed a one-point improvement in periocular rhytid severity when judged on a six-point scale. The results were not statistically significant. Biopsy analysis showed a small posttreatment increase in the amount of dermal collagen in three patients. A small decrease in collagen was noted in one patient. Three patients also showed a small posttreatment increase in the degree homogenization of dermal collagen. No change from baseline was noted in other assessed histologic parameters. Complications observed included hyperpigmentation in three patients and pitted scarring in three patients. CONCLUSIONS: The nonablative laser gave clinically subtle and statistically insignificant improvement in rhytid severity. Unfortunately its use was associated with complications that included hyperpigmentation and scarring. This technology may eventually offer patients a new resurfacing option, but its efficacy and complication rate must be improved first.

Melanoma and pregnancy: eight questions with discussion.

In a question-and-discussion format, the authors summarize the major studies on melanoma and pregnancy. The laboratory studies reviewed give conflicting results; however, excellent epidemiologic studies suggest that pregnancy and melanoma are not closely linked. Specifically, the prognosis of pregnant women with melanoma is similar to the prognosis of nonpregnant women with melanoma of equal tumor thickness, and melanoma is neither more nor less likely to occur in previously pregnant women. Some studies have shown that pregnant women have melanomas that are thicker than nonpregnant women's melanomas. The reason is unclear, but it may be because malignant changes in pigmented lesions during pregnancy have been ignored. Treatment options for pregnant women with melanoma are limited, but early detection and surgical excision of thin melanomas is the goal. Changes in mole size or color during pregnancy can be normal, but all changing moles warrant careful examination, and irregular or asymmetric change is suspicious for melanoma.

Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California.

BACKGROUND: We have noted a high frequency of aggressive-growth basal cell carcinomas (BCCS) in our patient population. Subtypes observed with increased frequency include morpheaform, infiltrative, and micronodular. OBJECTIVE: Our purpose was to examine the frequency of histologic subtypes of all BCCs seen in the dermatology clinics in the Veterans Affairs Palo Alto Health Care System in an 18-month period. METHODS: We reviewed 432 consecutive primary BCC biopsy specimens taken from 252 patients. RESULTS: Aggressive-growth BCC was observed in 20.7% of biopsy specimens, including 13.4% morpheaform, 5.7% infiltrative, and 1.6% micronodular subtypes. The mean age of the patient population was 70 years, with a standard deviation of 9.1 years. CONCLUSION: Our observed percentage of aggressive-growth BCC is substantially higher than in most other large studies. A high frequency of aggressive-growth BCC coupled with the increasing incidence of nonmelanoma skin cancer may have significant implications for future health care resource allocation.