The role of human papillomavirus in the development of pyogenic granulomas.

BACKGROUND: Pyogenic granulomas (lobular capillary hemangiomas) and condyloma acuminata share similar locations and risk factors. Human papillomavirus (HPV) types 6 and 11 are commonly associated with condyloma acuminata, but their association with pyogenic granulomas has not been evaluated. The purpose of this study was to determine whether pyogenic granulomas contain evidence of infection with condyloma-producing HPVs. METHODS: Polymerase chain reaction assays for the E6 and E7 gene sequences of HPV types 6 and 11 and another assay for the E7 region of HPV types 16, 31, 33, 35, 42, and 58 were used to evaluate deoxyribonucleic acid (DNA) extracted from archival pyogenic granuloma biopsies taken from cutaneous and oral epithelium. RESULTS: Neither cutaneous nor oral pyogenic granulomas contain amplifiable E6 or E7 sequences from any of these viruses. CONCLUSIONS: Pyogenic granulomas are not caused by HPV 6, 11, 16, 31, 33, 35, 42, or 58. This study does not exclude the possibility that other viruses may be responsible for these tumors.

Pseudopelade: an inherited alopecia.

BACKGROUND: Pseudopelade is a rare idiopathic progressive alopecia that has no initial inflammatory phase. Even so, pseudopelade has been classified as scarring alopecia with postinflammatory alopecias. Atrophy rather than true scarring is the cardinal feature of pseudopelade. MATERIALS AND METHODS: A review of reported cases of pseudopelade, especially those with a family history, was undertaken. The discovery of a young man and his mother, who had pseudopelade, plus two other familial cases prompted this study. RESULTS: Examination of the clinical and pathologic material shows pseudopelade to be a disease separate from other alopecias. The striking familial association in these cases demonstrates a plausible etiology. CONCLUSIONS: Pseudopelade is an autosomal dominant disorder of the scalp marked by atrophic loss of hair follicles.

The "shutter flap" for large defects of the forehead.

Acquired defects involving exposed bone in the central forehead can be challenging to reconstruct. We present a simple technique in which two superiorly based flaps of galea frontalis and skin are transposed medially, like the shutter of a camera. Full-thickness grafts are used to close the donor site. This is a remarkably easy way to close some very large forehead wounds.

Basal cell carcinoma and lifestyle characteristics.

BACKGROUND: A number of lifestyle factors are important in the etiology of basal cell carcinoma. Previous studies have investigated smoking, alcohol, diet, and sun exposure as possible contributing factors. No previous studies have investigated case-controlled lifestyle influences in basal cell carcinomas referred for Mohs micrographic surgery. METHODS: Cases were obtained from Mohs-referred basal cell carcinoma patients. Matched controls were selected from a busy dermatology clinic. The only criteria for selection of controls was never having had cancer previously. Cases and controls were surveyed regarding lifestyle characteristics. RESULTS: Forty-six age, sex, and skintype-matched controls were compared. Sun exposure, alcohol, and smoking were not significant factors. Dietary fat, fiber, and the vitamins A, C, and beta carotene, as well as selenium showed important, but not significant differences. Caffeine consumption was higher in the cancer group. CONCLUSIONS: Our findings agree with previously published studies in regard to antioxidant consumption as a protective factor for basal cell carcinoma. Caffeine consumption was higher in the cancer patients.

Microcystic adnexal carcinoma (sclerosing sweat-duct carcinoma) of the head and neck.

We report 7 cases of microcystic adnexal carcinoma (MAC) that involved the face (n=6) and neck. The neck case occurred in a 10-year-old boy. MAC are tumors that typically extend far beyond their assessed clinical margins. This report emphasizes the need for early microscopically controlled excision of lesions because of the unreliability of clinical assessment and frequent perineural and bone extension. Treatment results of 35 cases treated by Mohs surgery are tabulated.

Giant basal cell carcinoma. Report of two cases and review of the literature.

Only 10% of all basal cell carcinomas are located on the trunk. Giant basal cell carcinomas are rare and are preferentially located on the trunk. We report two giant basal cell carcinomas of the trunk, one of which was fatal. Our review also includes a summary of previously reported cases of giant basal cell carcinoma. An analysis of these cases discloses an interesting feature of large basal cell carcinoma: Once giant basal cell carcinomas reach a critical mass, they demonstrate extremely aggressive behavior.

Metastatic basal cell carcinoma. Report of five cases.

BACKGROUND: Metastatic basal cell carcinoma (MBCC) is rare. Risk factors for the development of MBCC include a history of persistent basal cell carcinoma (BCC) for many years, refractory to conventional methods of treatment and previous radiation treatment either in early adulthood or for localized cancer. Most MBCC originate from large tumors. METHODS: The authors report five patients with basal cell carcinomas (BCC) of the ear (two patients), scalp, inner canthus, and nasolabial fold that metastasized to the regional lymph nodes, skin, and submandibular gland. In addition, the authors reviewed more than 40 reports of MBCC (n = 65) from 1981 to 1991 and tabulated the primary tumors by size and depth of invasion according to TNM classification, a classification that previously has not been used for BCC. RESULTS: The authors tabulated the size distribution of tumors of 45 patients with MBCC. The overall mean and median diameters of the primary BCC were 8.7 and 7.0 cm, respectively. The mean area of the primary MBCC lesion that originated on the face and trunk was 62 and 217 cm2, respectively. Using the TNM classification, approximately 9% of MBCC originate from tumors smaller than 10 cm2. In addition, the authors found that large (T2 and T3) and deep (T4) BCC account for approximately 75% of the metastatic tumors. Metastatic BCC from primary tumors smaller than 1 cm in diameter are exceptionally rare. CONCLUSIONS: Approximately 67% of MBCC (n = 238) originate from facial sites. Using the data base of the Mohs Surgery Clinic, the authors found that BCC greater than 3 cm in diameter have approximately a 1.9% incidence of metastasis, and the overall rate of metastases for morpheaform BCC is less than 1%. Patients with tumors classified as T3 and T4 lesions ideally should be followed up for 10 or more years for the remote possibility of the development of MBCC.

Mohs' micrographic surgery and prompt reconstruction for basal cell carcinoma: report of 62 cases using the combined method.

Aggressive, recurrent, and difficult to manage skin cancers may require complex solutions. In this review of 62 skin cancers, we demonstrate a novel approach to the management of these tumors. Mohs' micrographic surgery was used to remove the tumor, and was followed by immediate or delayed plastic surgical repair. Using this combined method, the highest attainable cure rate is linked with a coordinated prompt cosmetic repair. In this series of 54 patients with 62 skin cancers, there was one recurrence with a follow-up of one to four years. Most cases (65%) involved reconstruction within ten days of tumor removal. Eighty-one percent had a single-stage reconstruction. In seventeen patients, new tumors developed at other sites during the four-year follow-up period. On the basis of our experience with this combined method, we feel that Mohs' surgery, coordinated with prompt plastic repair, offers distinct advantages in the management of difficult skin cancers.

Common facial skin lesions in children.

A variety of facial skin problems are encountered in a busy pediatric dental practice. The dentist should recognize and be able to identify the more common important skin lesions. The etiology, presentation, and prognosis of acne vulgaris, impetigo, warts, molluscum contagiosum, ringworm, tinea versicolor, spider nevus, atopic dermatitis, seborrhea, herpes simplex, and lesions of child abuse are discussed. Several of these conditions require prompt referral to a pediatrician or dermatologist.

[Nerve injuries following nerve blocking in the pterygomandibular space]. / Nervinjektionsschaden nach Leitungsanästhesie im Spatium pterygomandibulare.

In a prospective study 506 patients with nerve blocks in the pterygomandibular space were examined before and 3-7 days after local anaesthesia. Clinical neurosensory testing including two-point discrimination revealed no differences between the neurological status before and after injection. Between December 1987 and April 1991 8 patients with 9 nerve injuries (lingual nerve n = 8, inferior alveolar nerve n = 1) after nerve blocks in the pterygomandibular space were treated. In addition to hypaesthesia or anaesthesia 5 out of 8 patients with injection damages of the lingual nerve suffered from a loss of taste sensations. Only 2 of the total of 9 nerve lesions showed a complete recovery of the neurological deficit. One patient with a persistent pain syndrome of the lingual nerve after an injection damage underwent partial nerve resection and microsurgical reconstruction after intraoperative monitoring of somatosensitive-evoced-potentials. The operation was successful for only a few weeks, afterwards a relapse of the pain syndrome took place.

The use of split-thickness skin grafts for eyelid and facial reconstruction after Mohs' fresh-tissue surgery.

In the last 10 years. Mohs' fresh-tissue surgery has been increasingly employed for the treatment of extensive basal cell carcinomas and other malignancies of the eyelids. Large defects after Mohs' surgery for these lesions may involve the nose, cheek, forehead, and other parts of the face as well as the eyelids, medial canthus, and lacrimal drainage system. Split-thickness skin grafts are useful in repairing these large defects and can be combined with other eyelid procedures such as the Hughes operation for lower-eyelid reconstruction.

Chemosurgery for verrucous carcinoma.

The first cases of verrucous carcinoma treated by chemosurgery are herewith reported. We classify verrucous carcinoma in variants according to site as pan-oral, genito-gluteal, and plantar. Chemosurgery is advocated as the treatment of choice for verrucous carcinoma because ablation, being microscopically monitored, is most likely to be complete, and because by this means maximal conservation of tissue is assured.