Rapid HMB-45 staining in Mohs micrographic surgery for melanoma in situ and invasive melanoma.

BACKGROUND: Accurate interpretation of frozen sections in the treatment of melanoma by Mohs micrographic surgery may be difficult. OBJECTIVE: Our purpose was to review the literature on the role of Mohs micrographic surgery in the treatment of melanoma and to demonstrate the added benefits of using rapid HMB-45 staining in Mohs micrographic surgery for the treatment of melanoma. METHODS: Twenty cases of melanoma were included in our study. Histologic diagnosis in each case was made by means of excisional biopsy specimens and permanent sections. Mohs micrographic surgery was performed with 3-mm margins used for each stage. Each Mohs frozen section was stained with HMB-45. In addition, routine frozen sections stained with hematoxylin-eosin were also prepared for comparison. All tissues were also sent for permanent sections. These permanent sections were cut similarly to Mohs-oriented sections because they were sectioned horizontally. Since they were serving as the standard, no staining with HMB-45 was performed on these permanent sections. Further stages with 3-mm margins were taken until tissues stained negative. Frozen sections were compared with permanent sections at each stage of resection. RESULTS: Eleven of the 20 cases stained positive with HMB-45 antibody on the first Mohs stage. These results were consistent with findings on permanent sections. Ten of the 11 cases were cleared by the first stage. One of the 11 cases required 3 stages because margins were not cleared and the specimens stained HMB-45 positive. However, permanent sections in this case revealed no tumor in the second stage. Nine of 20 cases did not stain with HMB-45 on the first layer of Mohs excision. This was consistent with findings on permanent sections. CONCLUSION: HMB-45 staining serves as a rapid technique to aid in the interpretation of frozen sections during Mohs micrographic surgery in the treatment of melanoma.

Treatment of facial rhytids with a nonablative laser: a clinical and histologic study.

BACKGROUND: Current facial resurfacing modalities (laser, chemical peels, and dermabrasion) remove the epidermis and thus cause open wounds which carry significant risks and extended recovery periods. The nonablative laser is a novel Nd:YAG system designed to alleviate facial rhytids without injuring the epidermis. This new modality may offer patients rhytid removal without the risk seen in currently used resurfacing techniques. OBJECTIVE: To describe a novel nonablative laser system and assess its safety profile and efficacy. METHODS: Ten patients received laser treatments of their periocular rhytids and postauricular skin. Clinical variables (rhytid severity, hyperpigmentation, hypopigmentation, scarring, and level of discomfort) were assessed at 1 and 3 months posttreatment. Postauricular skin biopsies were taken both pre- and posttreatment for histologic analysis. RESULTS: Patient discomfort was minimal. Three months posttreatment, 4 of 10 patients showed a one-point improvement in periocular rhytid severity when judged on a six-point scale. The results were not statistically significant. Biopsy analysis showed a small posttreatment increase in the amount of dermal collagen in three patients. A small decrease in collagen was noted in one patient. Three patients also showed a small posttreatment increase in the degree homogenization of dermal collagen. No change from baseline was noted in other assessed histologic parameters. Complications observed included hyperpigmentation in three patients and pitted scarring in three patients. CONCLUSIONS: The nonablative laser gave clinically subtle and statistically insignificant improvement in rhytid severity. Unfortunately its use was associated with complications that included hyperpigmentation and scarring. This technology may eventually offer patients a new resurfacing option, but its efficacy and complication rate must be improved first.

Granular cell tumor of uncertain malignant potential.

Granular cell tumor is an uncommon soft-tissue tumor that is usually benign and readily treated with complete resection. Malignant granular cell tumors are perhaps the rarest of all soft-tissue tumors, and they commonly metastasize to regional lymph nodes and the lungs. We present a case of granular cell tumor that exhibited both gross and microscopic features suggestive of malignancy without evidence of metastasis through a relatively short 16 months of follow-up and review the literature pertaining to granular cell tumors of uncertain malignant potential.

External ultrasonic tumescent liposuction. A preliminary study.

BACKGROUND: External ultrasonic tumescent liposuction represents a new application of ultrasound energy to the standard tumescent liposuction procedure. Hoping to retain the in vivo properties of ultrasonic delivery while avoiding the growing number of invasive complications, external ultrasonic tumescent liposuction is a new technique with the potential of improving traditional tumescent liposuction therapy. OBJECTIVE: The purpose of this preliminary study was to evaluate the role of external ultrasonic tumescent liposuction as an adjunct to traditional tumescent liposuction. METHODS: Ten patients underwent standard tumescent liposuction with the addition of 10 minutes of preoperative ultrasound therapy applied to one-half of their targeted treatment regions. Both objective and subjective parameters were assessed during the subsequent side-by-side evaluations. RESULTS: Six of the 10 cases had a measurable increase in the amount of supernatant fat extracted per unit of aspirate volume from those regions pretreated with ultrasound energy. In five of the 10 cases, the operating physician noted slightly easier cannula maneuverability through adipose tissue on the ultrasound side. Roughly half of the patients had an improved postoperative course, with less swelling/edema, less bruising or ecchymoses, more skin retraction, and less postoperative pain/discomfort. CONCLUSION: The favorable results of this preliminary study warrant further investigation and research into external ultrasonic tumescent liposuction as an adjunct to the traditional tumescent liposuction procedure.