Skin carcinoma of the head and neck with perineural invasion.

PURPOSE: The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT). MATERIALS AND METHODS: From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy. RESULTS: The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively. CONCLUSIONS: Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.

Practical guidelines for the management of toxic epidermal necrolysis and Stevens-Johnson syndrome.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are acute life-threatening dermatoses characterized by extensive sloughing and mucositis. At the University of Florida, we use practical guidelines for the management of these gravely ill patients. These can be of help to other practitioners.

Chemoprevention of nonmelanoma skin cancer.

UNLABELLED: Skin cancer is the most common cancer in human beings. The increased incidence of skin cancer has brought much attention to the process by which these tumors develop and how they can be prevented. Efforts have been made to educate the public about the importance of protecting skin from excessive ultraviolet light. Despite this work, the incidence of skin cancer continues to increase. Available compounds may be useful in the chemoprevention of skin cancer. Chemoprevention is defined as oral or topical use of dietary or pharmacologic agents to inhibit or reverse the development of cancer. Potential agents included are the retinoids; difluoromethylornithine; T4 endonuclease V; polyphenolic antioxidants, such as (-)-epigallocatechin gallate, found in green tea and grape seed extract; silymarin; isoflavone genestein; nonsteroidal anti-inflammatory drugs; curcumin; lycopene; vitamin E; beta-carotene; and selenium. Many of these agents are available over the counter as topical or oral preparations. LEARNING OBJECTIVE: At the conclusion of this activity, participants should be familiar with the chemopreventive agents and their efficacy, as well as any significant side effects associated with them.

Peritumoral fibrosis in basal cell and squamous cell carcinoma mimicking perineural invasion: potential pitfall in Mohs micrographic surgery.

BACKGROUND: Perineural invasion (PI) in cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is linked to an aggressive course. We describe a histologic mimic for PI that we termed peritumoral fibrosis (PF). OBJECTIVE: To describe the morphologic changes associated with PF and to determine the incidence of PF and PI in Mohs frozen sections of BCC and SCC. MATERIAL AND METHODS: All cases of BCC and SCC that were treated by Mohs micrographic surgery (MMS) at the Skin and Cancer Center, University of Florida College of Medicine, Gainesville, Florida, and the Center for Dermatology and Skin Surgery, Tampa, Florida, during the period from January 1, 2003, to August 1, 2004, were reviewed for the presence of PI and PF. The latter was defined as the presence of concentric layers of fibrous tissue that either surround and/or were surrounded by tumor formations mimicking perineural or intraneural invasion. Seven hundred six cases of BCC and 264 cases of SCC were surveyed. Eleven cases (10 BCC and 1 SCC) with equivocal areas were destained, and immunohistochemical staining with S-100 protein was performed, proving actual PI in all of these cases. Available original hematoxylin-eosin biopsy slides were correlated with the MMS frozen sections. RESULTS: PF was noticed in 4.5% of SCCs and 5.8% of BCCs. The incidence of unequivocal PI was noted to be 2.6% in SCC and 2.1% in BCC. CONCLUSION: We describe a specific pattern of fibrosis noted in BCC and SCC that we called PF. It shows concentric layers of fibrous tissue surrounding and/or surrounded by tumor formations and resembles carcinomatous perineural and/or intraneural invasion. Moreover, PF was found to be a sensitive marker for PI. Mohs micrographic surgeons should be aware of this phenomenon to avoid triggering unnecessary steps in managing these cases, such as irradiation.

Treatment of primary limited cutaneous extramammary Paget's disease with topical imiquimod monotherapy: two case reports.

We present two cases of primary limited cutaneous perineal and genital extramammary Paget's disease (EMPD) that were successfully treated with imiquimod 5% cream. Clinical and histologic cure was confirmed after 7.5 to 12 weeks of monotherapy. Treatment-associated morbidity is minimal compared with more invasive therapies, and self-application by the patient improves convenience and appeal. Imiquimod may offer a minimally invasive and promising therapeutic option for the treatment of limited cutaneous EMPD. The diagnosis and management of EMPD and the current literature regarding imiquimod therapy are reviewed.