Axillary basal cell carcinoma: literature survey and case report.

BACKGROUND: Primary basal cell carcinoma (BCC) in the axilla has rarely been reported in the literature. No systematic review has yet been conducted. OBJECTIVE: To present a case of basal cell carcinoma of the axilla. This is a rare presentation of a common disease in a non-sun-exposed part of the body. METHODS: An extensive literature search for axillary BCCs was performed. An additional case is reported. RESULTS: Only 14 cases of primary axillary BCC have been reported in the literature. Metastatic axillary BCC is also rarely reported. CONCLUSION: BCC in the axilla is extremely uncommon. Factors other than sun exposure are likely involved in tumorigenesis.

Predictable tissue shrinkage during frozen section histopathologic processing for Mohs micrographic surgery.

BACKGROUND: When confronted with a histologic specimen that is appreciably smaller than the same tissue specimen immediately after acquisition, the Mohs surgeon is faced with two possibilities, namely that the tissue has either shrunken during laboratory processing or that the histologic specimen is incomplete due to the introduction of technical errors during embedding, cutting, or staining of the skin specimen. Because the entire objective of Mohs micrographic surgery is to precisely examine the entire surgical margin of skin specimens, the surgeon must be able to determine that any size discrepancies introduced during laboratory processing are not related to incomplete surgical specimens. Although there are anecdotal suggestions that skin, like other human tissues, undergoes some degree of shrinkage during routine frozen section processing, the exact nature and magnitude of this phenomenon has not been previously investigated. OBJECTIVE: To quantify the degree of tissue shrinkage in Mohs micrographic surgical specimens processed with routine frozen sections and subsequent hematoxylin and eosin staining. METHODS: A total of 117 Mohs surgery patients (135 cutaneous tumors) were prospectively enrolled. The dimensions of initial stage surgical specimens were determined after removal from the patient, after freezing in a mounting medium, after placement on a glass microscopic slide, and after hematoxylin and eosin staining. Statistical analyses were performed in order to determine the significance of any discrepancies in specimen sizes introduced during laboratory processing. RESULTS: Skin specimens processed by frozen section techniques during Mohs micrographic surgery undergo statistically significant alterations in length. On average the measurements of specimens at the conclusion of histologic processing were 11.6% shorter than the measurements of the same specimens obtained immediately after surgical excision. Tissue specimens obtained from the trunk or extremities showed a greater degree of tissue shrinkage (16.3%) than specimens obtained from the head and neck (10.2%). CONCLUSIONS: Our results support anecdotal suggestions that skin specimens do indeed shrink during frozen section processing. By realizing that frozen section specimens can be expected to show some slight degree of shrinkage, the Mohs surgeon can appreciate situations that might allow greater confidence that a smaller specimen is nonetheless representative of the entire lateral and deep surgical margins.

Granular cell tumor treated with Mohs micrographic surgery: report of a case and review of the literature.

BACKGROUND: Granular cell tumors are uncommon soft tissue neoplasms of neural origin that most often arise in the oral cavity. Penile lesions are distinctly uncommon. Mohs micrographic surgery (MMS) is a highly effective treatment for several cutaneous neoplasms when tissue conservation is crucial. OBJECTIVE: To examine the use of MMS for this soft tissue malignancy. METHODS: We report only the eighth granular cell tumor of the penis. The literature was reviewed regarding the use of MMS for these neoplasms. RESULTS: MMS was performed to minimize the destruction of normal tissue in treating this patient's granular cell tumor. Only one previous article documented the use of MMS for this soft tissue tumor. CONCLUSION: Although utilized infrequently to treat granular cell tumors, MMS may prove beneficial when lesion location or size render tissue conservation or assuredness of cure paramount.

Single-handed needle holder loading: a safer and more efficient cuticular stitch.

BACKGROUND: Needle sticks are one of the most common and feared occupational hazards that surgeons face. OBJECTIVE: To devise a safer and more efficient suturing method. METHODS: A cuticular stitch that minimizes direct contact with the needle is described. The literature is searched for similar suturing methods. RESULTS: Decreased direct contact with the needle lowers the risk for inadvertent sticks. Efficiency is improved when superfluous steps are eliminated from the suturing technique. CONCLUSION: Single-handed needle holder loading enhances safety while optimizing efficiency during the placement of cuticular stitches.

Neglected microcystic adnexal carcinoma: the second reported case in a black patient.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a histologically aggressive appendageal neoplasm that often pursues a beguilingly indolent clinical course. MAC has previously been reported only once in a black patient. OBJECTIVE: To present the second MAC ever recorded in a black patient. METHODS: We describe a MAC of substantial dimension occurring in a black patient. The literature was subsequently examined for MAC occurring in ethnic patients. RESULTS: This MAC is remarkable not only for its occurrence in a black patient, but also because it is one of the largest MACs ever recorded (8 cm), it occurs in a relatively less common site (scalp), and its latency period before diagnosis is the longest ever definitively documented (31 years). CONCLUSION: MAC is rare among non-Caucasians. Its relatively indolent clinical growth, especially in sites that are poorly accessible to patient observation, may lead to significant delay in diagnosis and treatment.

Cutaneous complications of BCG vaccination in infants with immune disorders: two cases and a review of the literature.

Two infants, one with a T-cell-signaling defect resulting in a primary immunodeficiency syndrome and the other with severe combined immunodeficiency (SCID), are described. Both infants developed cutaneous infections secondary to their bacillus Calmette-Guérin (BCG) vaccinations. Both patients were from countries where BCG is routinely administered in infancy. The infant with the T-cell-signaling defect developed a disseminated infection involving the skin, while the infant with SCID developed a localized cutaneous infection at the site of his BCG immunization. These two cases resemble other reported cases of cutaneous BCG infection following routine vaccination in immunocompromised patients. Mycobacterium bovis infection should be considered in patients with cutaneous eruptions who have received BCG vaccination, especially those who are immunocompromised.

In vitro changes in non-facial human skin following CO2 laser resurfacing: a comparison study.

BACKGROUND AND OBJECTIVE: We evaluated the physical changes in human skin following CO2 laser cutaneous resurfacing with either the Sharplan SilkTouch handpiece or the Coherent UltraPulse laser. STUDY DESIGN/MATERIALS AND METHODS: Three-hundred five human tissue samples and matched controls were used. Up to five laser passes were performed per specimen. Parameters evaluated included: lateral skin shrinkage, transient temperature change, isometric tension development, elasticity change, and histologic change. RESULTS: Skin shrinkage increased in direct proportion to laser pass number. Isometric tension exponentially increased and elasticity exponentially decreased with successive laser passes. The zone of thermal denaturation for the SilkTouch handpiece was 115 +/- 15 microns, and was independent of laser pass number. The zone of thermal denaturation was patchy for the UltraPulse laser treatments, regardless of pass number. A greater temperature increase was also measured for SilkTouch irradiation than with the UltraPulse laser. CONCLUSION: The observed alterations in tissue length, tension development, and elasticity obtained with SilkTouch or UltraPulse treatment may contribute to the changes in clinical appearance associated with laser cutaneous resurfacing. Our findings support a role for extracellular matrix contraction in the mechanism of action for CO2 lasers in cutaneous resurfacing.

A vitreoretinal service.

Many serious disorders that threaten eyesight can now be treated with vitreoretinal surgery. As there was no regional facility for this treatment a service was developed to provide it. Among the first 100 patients treated over half had diabetic vitreoretinal disease. The remainder had ocular trauma (15), non-diabetic vasculopathy (10), rhegmatogenous retinal detachment (10), and miscellaneous disorders including diagnostic procedures (14). Sight was improved in most cases, 27 diabetic and 21 non-diabetic patients regaining navigating vision. Few patients were made worse: one only of the 49 non-diabetic patients and 12 of the 51 diabetic patients, and none whose vision was better than the ability to count fingers before operation. The many indications for this procedure, the size of the population that could benefit (an estimated minimum of 3800 operations per year in the United Kingdom in patients with diabetes alone), and the great potential benefit of the procedure all suggest the need for regional services. These would be cost effective in preventing blindness.

Forecasting: a cost control tool for health care managers.

Adapting the appropriate forecasting technique to a health care environment is essential for cost control. As the Chapel Hill experience shows, forecasting is within everyone's reach and can successfully reduce costs.