Basal cell carcinoma of the periocular region.

BACKGROUND: Basal cell carcinomas of the periocular area present a particular challenge because of the likelihood of damage to vital structures. OBJECTIVE: More than 10-years experience of treating basal cell carcinomas by Mohs micrographic surgery was reviewed. METHODS: Chart analysis of 233 periocular basal cell carcinomas was performed. All patients were contacted either in clinical follow-up or by telephone review. RESULTS: Two hundred and thirty-three periocular basal cell carcinomas were analyzed out of a total of 3, 192 basal cell carcinomas treated during this period (7.3%). Patients ranged in age from 17 to 102 years with a mean age of 58.8 years and a median of 59.0 years. Of the patients, 54.5% were female. Mohs micrographic surgery was the prime therapy in 177 patients (75. 9%). Of the lesions, 48.5% occurred in the medial canthal area, 35. 2% on the lower eyelid, 10.7% on the upper eyelid, and 5.6% on the lateral canthus. There was no significant difference between the left/right distribution in males and females. The average follow-up time was 34 months (standard deviation 26.38 months). A cumulative rate of no recurrence tabulated by modified life table analysis was 0.9864. CONCLUSION: This study further documents the problems associated with basal cell carcinoma of the periocular area as well as the value of Mohs micrographic surgery as treatment.

The Peng flap. The flap of choice for the convex curve of the central nasal tip.

BACKGROUND: Surgical defects of the convex curve of the central nasal tip have always been difficult to repair. Most dermatologic surgeons use a full-thickness graft in this region. The pinch modification of the linear advancement flap was described by Peng et al in 1987 as a means of repairing this region. OBJECTIVE: This purpose of this paper is to discuss the effectiveness of using the Peng flap for repairs of the convex curve of the central nasal tip. METHODS: This flap was used on a series of 25 patients, all of whom had defects of the convex curve of the central nasal tip. RESULTS: Because the flap both rotates and advances, it shortens the length of the traditional advancement flap and increases flap survival rate. We found excellent cosmetic results for central nasal tip defects and had no complications of necrosis using this flap. CONCLUSION: We have found this to be an excellent flap for repairs of the convex curve of the central nasal tip, as the rotating arms of the flap conform to the three-dimensional shape and the lateral lines fit well into cosmetic lines of the nose. When repairing central nasal tip defects, we believe the Peng flap to be the flap of choice to re-create the convex curve of this region.

Females vastly outnumber males in basal cell carcinoma of the upper lip. A peculiar subset of high risk young females is described.

BACKGROUND: It was noted that females, particularly young females, outnumbered males with basal cell carcinoma (BCC) of the upper lip among patients treated by Mohs micrographic surgery in Vancouver, British Columbia. OBJECTIVE: To investigate female-to-male ratios for BCC of the upper lip at the Vancouver Mohs micrographic surgery service, and to compare this with data from the provincial-wide registry as well as with worldwide data in the literature. METHODS: The female-to-male ratios by age group were determined for 136 upper lip lesions treated at the Mohs service from 1983 to 1992. Similar data were obtained from 731 perioral BCCs recorded at the provincial-wide registry from 1982 to 1989. The literature was reviewed for comparative data worldwide. RESULTS: At the Mohs service females outnumber males 3.5:1 for upper lip BCCs. Young females 30-39 years old outnumber males 16:1. Regional data from the British Columbia Cancer Registry confirm that females outnumber males 2:1 for the lip region (including upper lip, lower lip, nasolabial fold). This is significant when compared with all BCCs diagnosed in the province (ie, all sites), in which males outnumber females 1.3:1. Data from the literature worldwide confirm this relationship. CONCLUSION: BCC of the upper lip is a female-predominated disease. Young females are at a much higher risk for this disease than young males.

Melanocytes in human skin express bcl-2 protein.

The bcl-2 gene was initially identified through its participation in the translocation 14:18 in B-cell lymphomas of follicular center cell origin. This classic translocation juxtaposes the transcriptionally active immunoglobulin heavy-chain locus on chromosome 14 to the bcl-2 gene on chromosome 18, resulting in overexpression of bcl-2 protein. The oncogene bcl-2 is thought to prolong cell survival through interference with programmed cell death. To date, bcl-2 expression has been reported in normal lymphoid, hemopoietic, neural, breast and prostatic tissues. Since melanocytes are neural crest derivatives and have an extended life-span, our objective was to determine whether the bcl-2 protein is expressed in human melanocytes. We analyzed normal skin biopsies for bcl-2 expression using standard immunohistochemistry. As hypothesized, dendritic cells in the basal epidermal layer stained strongly for bcl-2. The distribution and morphology of these cells was typical for melanocytes. Additionally, eccrine sweat glands, lymphocytes and the dermal papilla of hair follicles demonstrated bcl-2 positivity. We believe this to be the first report of bcl-2 expression in normal melanocytes.

Trends in basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin from 1973 through 1987.

Major increases have occurred in the incidence of basal cell carcinoma and squamous cell carcinoma of the skin, as well as in cutaneous malignant melanoma during the period 1973 through 1987 in British Columbia. The greatest increases in basal and squamous cell carcinomas are on the head and neck. This indicates that exposure to sunlight is the major causative factor. The greatest increase in melanoma is on the trunk in men and on the lower limbs in women. The dramatic increases in nonmelanoma skin cancers in British Columbia, a relatively low sunlight area, suggest that major prevention programs are needed in areas that are not considered "sunspots."