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.

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.

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.

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.

Chemosurgery for familial malignant melanomas.

Three patients with numerous melanomatous lesions of the B-K mole syndrome are reported who were the first to be treated chemosurgically. The fixed-tissue chemosurgical technique provided a microscopically controlled, safe, effective, and conservative means of removing the melanomas. Atypical moles suspected of malignant change were removed by biopsy-excision.

Mobile encapsulated lipomas. Formerly called encapsulated angiolipomas.

Lipomas with true capsules are rare. Those that move about, cause pain, and show no permanent attachment to a blood supply deserve special consideration. In this report of two cases, I have designated this entity "mobile encapsulated lipoma".

Necrobiosis lipoidica diabeticorum. Localization in surgical scars.

Necrobiosis lipoidica is a skin disorders with an interesting predisposition for areas of trauma such as the anterior shins. In this report a patient with diabetes mellitus and generalized necrobiosis lipoidica diabeticorum with localization in surgical scars is described. A brief review of other skin disorders occurring in scars is also included.