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Surgical Excision (surgical + excision)

Distribution by Scientific Domains

Medical Sciences	99%

Distribution within Medical Sciences

Dermatology	38%
Surgery & Surgical Specialties	8%
Allergy & Clinical Immunology	3%
General & Internal Medicine	2%
23 Other Subdomains	43%

Kinds of Surgical Excision

complete surgical excision

primary surgical excision

wide surgical excision

Selected Abstracts

T- and B-Cutaneous Pseudolymphomas Treated by Surgical Excision and Immediate Reconstruction

DERMATOLOGIC SURGERY, Issue 12 2006
ALEXANDER DIONYSSOPOULOS MD
First page of article [source]

Squamous Cell Carcinoma Arising Within a Facial Port-Wine Stain Treated by Mohs Micrographic Surgical Excision

DERMATOLOGIC SURGERY, Issue 6 2006
NEIL RAJAN MRCP
No abstract is available for this article. [source]

Surgical Excision of Pedunculated Supernumerary Digits Prevents Traumatic Amputation Neuromas

PEDIATRIC DERMATOLOGY, Issue 2 2003
Geoffrey E. Leber
The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. Adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy. [source]

Does LCIS or ALH Without Other High-Risk Lesions Diagnosed on Core Biopsy Require Surgical Excision?

THE BREAST JOURNAL, Issue 1 2003
D. David Dershaw MD
No abstract is available for this article. [source]

Intralesional Cidofovir and Surgical Excision for Laryngeal Papillomatosis

THE LARYNGOSCOPE, Issue 12 2003
Ana Nusa Naiman MD
Abstract Objective To evaluate the efficacy of cidofovir intralesional therapy in recurrent respiratory papillomatosis and the role of surgical excision as an associated treatment. Study Design Prospective study and case series. Method Twenty-six patients received intralesional cidofovir. Three endoscopies were performed at monthly intervals, with intralesion injections of cidofovir at 5 mg/mL. Further endoscopic evaluation was made at 3 or 6 months depending on whether there was persistent papillomatosis. Cidofovir was again injected in the case of persistent papillomas, and treatment was repeated as long as papillomas were observed. Surgical excision of the papilloma was only performed in cases of airway obstruction or in cases proving resistant to cidofovir. Results Complete remission was obtained in 8 (31%) patients after an average of 2.6 endoscopic treatment. Seventeen (65%) patients presented slight or mild disease at endpoint (final severity score 1,4). Significant results were obtained in both adults and children. A greater response was obtained in the supraglottis and glottis subsites than in subglottis, tracheal, and other sites. Patients conforming to the 1 month interinjection schedule showed better responses in supraglottis subsite than those receiving their injections with intervals longer than 1 month. Combined therapy (cidofovir plus excision) was necessary in persistent papillomas. No patients presented with any systemic or local side effects. Conclusions Cidofovir therapy was an effective treatment in adults and in children, allowing papillomatosis to be controlled without observed side effects. Surgical excision associated with cidofovir injections remained necessary in persistent papillomatosis after cidofovir treatment. [source]

Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider Caseload

THE LARYNGOSCOPE, Issue 8 2003
Fred G. Barker II
Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source]

Idiopathic Circumscripta Calcinosis Cutis of the Knee

DERMATOLOGIC SURGERY, Issue 12 2003
FACS, Luigi Valdatta MD
Background. Calcinosis cutis, a disease characterized by the presence of calcium deposits in the skin, is classified into four types according to etiology: dystrophic, metastatic, iatrogenic and idiopathic. The dystrophic form is the most common while the idiopathic one is the rarest, but specific incidence and frequency data are not available in scientific literature. Objective. Calcinosis cutis circumscripta is a very rare form of idiopathic calcinosis cutis arising in the second half of life. It typically involves the extremities and is associated with prior trauma and scleroderma. We dealt with a very rare form of calcinosis cutis circumscripta in a healthy patient, for whom surgical excision revealed to be an effective and successful treatment. Methods and materials. We present the case of a 46-year-old woman affected by idiopathic circumscripta calcinosis cutis of the left knee, successfully treated by surgical removal. Discussion. Medical and surgical treatment are options to cure calcinosis cutis. Medical therapy is not very effective. Surgical excision has shown to be beneficial, as it can provide a symptomatic relief. However, since calcinosis cutis limits are not always well defined a recurrence of the lesions may occur. [source]

High levels of serum prostate-specific antigen due to PSA producing follicular non-Hodgkin's lymphoma

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2007
Jan Jelrik Oosterheert
Abstract Objective:, Both carcinoma of the prostate and non-Hodgkin's lymphoma are common in elderly patients. Measurement of serum prostate-specific antigen (PSA) is a frequently used tool to diagnose and monitor prostate carcinoma and is generally specific for diseases of the prostate. Case:, We describe a 68-yr-old patient with voiding difficulties and high PSA levels, but without inflammatory or malignant changes upon multiple transrectal ultrasound guided prostate biopsies. Digital rectal examination was normal. Laboratory showed a strongly elevated PSA level (62 ,g/L, Immulight 2000®; DPC, USA). A CT-scan showed a retroperitoneal process with mass in the right pelvis and infiltration of the bladder wall, suggestive for metastatic prostate carcinoma. Surgical excision of an axillary lymph node set the diagnosis at a stage IV follicular lymphoma, Berard grade I to II in which the majority of neoplastic cells expressed PSA. After lymphoma-specific treatment, there was a positron emission tomography (PET) confirmed complete remission with normal PSA levels (6 ,g/L), which still persists. Conclusion:, Although rare, high PSA levels can be due to the presence of non-Hodgkin's lymphoma. Such a diagnosis should be considered when patients present with lymphadenopathy other than regional prostatic lymphadenopathy. [source]

Pediatric submandibular triangle masses: a fifteen-year experience,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2004
Neil G. Hockstein MD
Abstract Background. The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes. Methods. We retrospectively reviewed the medical records of 105 patients aged 6 months to 21 years who underwent surgery in the submandibular triangle at a major pediatric tertiary care hospital from 1987 to 2001. Results. One hundred five patients who underwent surgery in the submandibular triangle were included in the study. Twenty patients had neoplastic processes, six of which were of primary salivary origin (two mucoepidermoid carcinomas and four pleomorphic adenomas). Twenty-four patients underwent excision of inflamed or infected lymph nodes, and 23 patients underwent excision of inflamed or infected submandibular glands. Thirty-eight patients were included who underwent surgery for sialorrhea or to gain access for another surgical procedure. Complications included tumor recurrence, transient and permanent marginal mandibular nerve weakness, ranula, postoperative fluid collection, and cellulitis. Duration of follow-up ranged from no follow-up to 11 years. Conclusion. Surgical excision of submandibular triangle masses is uncommon. We present our experience with these lesions, with a discussion of diagnosis, surgical indications, and surgical complications. © 2004 Wiley Periodicals, Inc. Head Neck26: 675,680, 2004 [source]

Combined Medical and Surgical Treatment of Intracardiac Hydatid Cysts in 11 Patients

JOURNAL OF CARDIAC SURGERY, Issue 2 2010
Alireza Molavipour M.D.
We report 11 cases of cardiac hydatidosis who were treated medically and surgically. Patients and methods: Eleven patients diagnosed with cardiac echinococcosis were referred to the Cardiac Surgery Department of Shahid Madani Hospital from 1992 to 2004. Symptoms included dyspnea, palpitation, limb ischemia, fever, weight loss, hemiplegia, and loss of consciousness. Patients underwent surgical removal of the cyst followed by medical treatment until the titer of echinococcus hemaglutination test came to normal. Results: Hospital stay and recovery time were uneventful in nine patients. One patient died due to acute renal failure before hospital discharge (9%) and another patient experienced cerebral hydatidosis 12 months after surgery (probably due to cyst embolism). The other nine patients had no complications during five years of follow-up. Conclusion: Surgical excision using cardiopulmonary bypass combined with medical therapy provides the most optimal treatment for cardiac echinococcosis.,(J Card Surg 2010;25:143-146) [source]

Oral myofibromatosis: an unusual cause of gingival overgrowth

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2002
Case report, review of the literature
Abstract Background:, This case report describes a rare benign tumour, which presented as discrete areas of gingival hyperplasia affecting both the mandible and the maxilla. Method:, Surgical excision of the lesions was carried out under local anaesthetic. Histopathological examination confirmed the diagnosis of oral myofibromatosis. Results: The condition responded to surgical excision and appears to have limited growth potential. It affects a wide spectrum of ages and can be alarming due to rapid enlargement and ulceration, so careful diagnosis is important to avoid unnecessary aggressive treatment. Zusammenfassung Orale Myofibromatose: eine ungewöhnliche Ursache einer gingivalen HyperplasieFallbericht und Literaturüberblick Hintergründe: In dem vorliegenden Fallbericht wird ein seltener benigner Tumor, der sich als klar abgegrenzte Bereiche einer gingivalen Hyperplasie darstellte und durch den sowohl Mandibula als auch Maxilla betroffen waren, beschrieben. Methodik: Unter lokaler Betäubung wurde eine operative Exzision der Läsionen vorgenommen. Eine histopathologische Untersuchung bestätigte die Diagnose einer oralen Myofibromatose. Ergebnisse: Die Erkrankung sprach auf die operative Exzision an und scheint lediglich über begrenztes Wachstumspotential zu verfügen. Eine breites Spektrum an Altergruppen ist betroffen und die Störung kann aufgrund einer rapiden Vergrösserung und Ulzerierung alarmierend sein. Um unnötige aggressive Therapien zu vermeiden ist eine sorgfältige Diagnose erforderlich. Résumé Myofibromatose buccale : une cause inhabituelle d'hypertrophie gingivale. Rapport d'un cas et revue de la littérature Les myofibromatoses sont des néoplasmes bénins rares qui peuvent se présenter soit de manière solitaire soit en lésions multiples. Un diagnostic attentif de cette tumeur bénigne est important pour éviter une thérapie aggressive non-nécessaire. Avec un traitement chirurgical conservateur, le pronostic est excellent. [source]

Sonographic findings in a case of scrotal lymphangioma in a 68-year-old male

JOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009
Won Chan Lee MD
Abstract Lymphangiomas are benign tumors resulting from a congenital lymphatic malformation in infant and children. Most common sites are head, neck and axilla, and scrotal lymphangioma is very rare. Lymphangiomas are classified as capillary, cavernous, and cystic type and cystic type is most common. Complete surgical excision is definitive treatment and incomplete excision leads to local recurrence. We report a case of scrotal lymphangioma in 68-year-old male patient. Gray-scale sonography revealed multiseptated, hypoechoic mass abutting the upper pole of the normal right testis. Color Doppler sonography showed no remarkable blood flow in the mass. MRI demonstrated multispetated extratesticular and extraepididymal mass in the right scrotum. Surgical excision was performed and the histopathologic diagnosis was a cystic lymphangioma. In conclusion when multiseptated cystic scrotal mass was discovered in an elderly patient, scrotal lymphangioma should be included in differential diagnosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source]

Photodynamic therapy with topical 5-aminolevulinic acid as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma: A case report

LASERS IN SURGERY AND MEDICINE, Issue 5 2006
Cheng-Ping Wang MD
Abstract Background and Objectives Surgical excision of primary nasopharyngeal papillary adenocarcinoma is sometimes incomplete with remaining microscopic disease. Post-operative radiotherapy only has limited efficacy but may cause many complications. Study Design/Materials and Methods Photodynamic therapy (PDT) was used as a post-operative adjuvant therapy for an incompletely resected primary nasopharyngeal papillary adenocarcinoma. A special form of 20% topical 5-aminolevulinic acid (5-ALA), which was originally a liquid form and became a gel form after applied on the nasopharynx, was used as the photosensitizer. A 2-mm optic fiber delivered the light (633 nm wavelength) to the lesion with a fluence rate of 100 mW/cm2 generated by a diode laser under 5 mm 0° endoscope assistance. The total energy delivered was 150 joules/cm2. Results No significant acute side effect was noted and the nasopharyngeal wound healed rapidly. The patient is alive without locoregional recurrence or distant metastasis for 5 years. Articulation, salivation, and swallowing functions are all well preserved. Conclusion Post-operative adjuvant PDT can successfully cure an otherwise difficult to treat disease with preservation of good life quality of the patient. Potential complications of PDT (e.g., photosensitivity) can be prevented by a special formulation of topical 5-ALA preparation. Lasers Surg. Med. © 2006 Wiley-Liss, Inc. [source]

Congenital lobar emphysema: Differential diagnosis and therapeutic approach

PEDIATRICS INTERNATIONAL, Issue 5 2008
Refik Ulku
Abstract Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors' experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h,12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift-herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow-up duration of all patients was 26.8 ± 29.24 months (range, 1,89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax. [source]

Intralesional Cidofovir and Surgical Excision for Laryngeal Papillomatosis

SQUAMOUS CELL CARCINOMA OF THE LIP: A RETROSPECTIVE REVIEW OF THE PETER M ACCALLUM CANCER INSTITUTE EXPERIENCE 1979,88

ANZ JOURNAL OF SURGERY, Issue 5 2000
D. Mccombe
Background: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective. Methods: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions. Results: Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period. Conclusions: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced. [source]

Multiple hereditary glomangiomas: Successful treatment with sclerotherapy

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2002
Kurosh Parsi
SUMMARY Glomangiomas are characterized by cavernous vascular channels surrounded by glomus cells. Multiple glomangiomas, although usually painless, can be a few centimetres in size and appear as blue phlebectatic lesions. Surgical excision of multiple glomangiomas can lead to scarring and recurrences. Laser treatment using vascular lasers and CO2 lasers has been useful in small, superficial lesions. We present the successful sclerotherapy treatment of multiple glomangiomas using sodium tetradecyl sulphate in a 59-year-old man who presented with postoperative recurrence of multiple lesions. [source]

Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction

BJU INTERNATIONAL, Issue 6 2001
P.A. Androulakakis
Objective To assess the outcome of the distal ureteric stump (DUS) after (hemi)nephrectomy with subtotal ureterectomy. Patients and methods The records of 89 patients (median age 2.7 years, range 0.25,12) who underwent nephrectomy (24) or heminephrectomy (65) with subtotal ureterectomy between 1982 and 1996 were reviewed retrospectively for symptoms caused by the DUS. The mean follow-up was 9.8 years. Nephrectomy was undertaken for a poorly functioning dysplastic (in nine), scarred (in 10) or hydronephrotic (in five) kidney, and heminephrectomy for a poorly functioning upper moiety associated with ectopic ureterocele (in 26) or stenotic hydroureter (in 15), or for a poorly functioning lower moiety associated with reflux (in 24). There were 38 refluxing and 51 non-refluxing ureteric stumps. Two additional patients primarily operated elsewhere were referred with DUS symptoms. Results Only one patient had a symptomatic DUS, with recurrent haematuria and bacteriuria. The two patients referred from elsewhere presented with febrile UTIs. The first had been left with a long refluxing stump opening ectopically into the urethra, and the second with a long stump which was converted from nonrefluxing to a refluxing stump when he developed dysfunctional voiding. Surgical excision of the distal stump was curative in each case. Conclusions The risk of a symptomatic DUS in patients who undergo subtotal ureterectomy in conjunction with (hemi)nephrectomy is very low, with no difference between refluxing and nonrefluxing stumps. Long ureteric stumps and dysfunctional voiding may cause symptoms. Because of the low morbidity associated with a short ureteric stump, we recommend subtotal ureterectomy in children who undergo (hemi)nephrectomy for reflux, vesico-ureteric obstruction or ectopic ureterocele associated with a poorly functioning kidney or kidney moiety. [source]

Granular cell tumour of the lacrimal gland

ACTA OPHTHALMOLOGICA, Issue 2009
SL VON HOLSTEIN
Purpose To report the clinical and histopathological characteristics of a patient with a granular cell tumour (GCT) of the lacrimal gland. Methods Surgical excision and histological examination. Results A 38-year old male presented with a painful swelling located temporally in the right upper eyelid. Clinical examination revealed proptosis and displacement of the right eye and a tumour was palpated at the site of the lacrimal gland. MRI scan revealed a solid tumour in the lacrimal fossa. The tumour was excised. Microscopically the tumour was composed of tumour cells with coarsely granular cytoplasm. The tumour cells were arranged in clusters and ribbons separated by collagen bundles and no necrosis or mitosis were present. The granules were PAS positive, diastase resistant and the tumour cells expressed focal staining for S100. Electron microscopy showed numerous secondary lysosomes. The diagnosis is consistent with a GCT. Conclusion This case presents for the first time a GCT of the lacrimal gland. [source]

Progressive stridor: could it be a congenital cystic lung disease?

ACTA PAEDIATRICA, Issue 9 2009
M Zedan
Abstract Bronchogenic cyst of the mediastinum, a cause of stridor early in life, is the result of abnormal budding of the ventral segment of the primitive foregut. Bronchogenic cysts are often asymptomatic in older children and adults. However, symptomatic cases usually manifest early in life with cough, stridor or wheezing due to airway compression. We report a female infant aged 4.5 months with a normal full-term pregnancy, who developed respiratory distress with stridor. This stridor was preceded by a history of slowly progressive noisy breathing. Physical examination revealed evidence of bilateral obstructive emphysema. Chest radiograph revealed bilateral overinflation. Fibro-optic bronchoscopy revealed posterior mediastinal compression. Possibility of congenital cystic lung disease (CCLD) was considered, emphasizing the value of computed tomography (CT) chest, which revealed a cyst probably bronchogenic. Surgical excision was performed with evident histological confirmation of bronchogenic cyst. Conclusion:, we highlight that in any infant, presented with slowly progressive noisy breathing in the first year of life, CCLD should be considered in the differential diagnosis even with normal X-ray chest. CT chest should be performed for exclusion or diagnosis of the case. [source]

Surgical excision of acne keloidalis nuchae with secondary intention healing

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2008
V. Bajaj
Summary Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that presents clinically as follicular papules and pustules. These can coalesce into firm hypertrophic plaques and nodules on the nape of the neck, most commonly affecting young adult men. Treatment includes topical steroids/antibiotics and oral antibiotics, but often has disappointing results. Surgical approaches include excision with primary closure or skin grafting, and hair-removal lasers. Another surgical approach is excision with secondary intention healing. This can result in good cosmesis with little or no recurrence. We report two men with AKN where treatment by excision with secondary intention was successful. [source]

Orbital leiomyoma: a case report with clinical, radiological and pathological correlation

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2005
Rohan Merani MB BS MMed
Abstract Orbital leiomyoma is a benign tumour of smooth muscle origin that can be clinically, radiologically and histopathologically difficult, to, diagnose, due, to, the, rarity, of, leiomyomas, in this location. A 74-year-old woman presented with a, 2-month history of painless proptosis. Computed tomography and magnetic resonance imaging studies revealed a well-circumscribed intraconal lesion separate from the optic nerve, and not eroding adjacent bone. A right lateral orbitotomy via a lid crease incision was performed to remove the firm lobulated lesion. Postoperatively there was an obvious decrease in proptosis. Microscopically the lesion was a well-circumscribed tumour composed of spindle cells. There were no light microscopic features to suggest malignancy, and immunohistochemistry was used to confirm the diagnosis of leiomyoma. Leiomyoma is a tumour that is rarely found in the orbit most likely due to the paucity of smooth muscle in this location. The differential diagnosis is wide, and the role of radiology, histology and immunohistochemistry in the diagnosis of leiomyoma is discussed. Surgical excision in this case excluded malignancy, provided a definitive diagnosis of a rare entity and resulted in marked clinical improvement. [source]

Treatment of Lentigo Maligna with Imiquimod before Staged Excision

DERMATOLOGIC SURGERY, Issue 2 2008
MURRAY A. COTTER MD
BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins. OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM. METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision. RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12,34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence. CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery. [source]

A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management

DERMATOLOGIC SURGERY, Issue 11 2007
BRIAN BERMAN MD
Silicone elastomer sheeting is a medical device used to prevent the development of and improve the appearance and feel of hypertrophic and keloid scars. The precise mechanism of action of silicone elastomer sheeting has not been defined, but clinical trials report that this device is safe and effective for the treatment and prevention of hypertrophic and keloid scars if worn over the scar for 12 to 24 hours per day for at least 2 to 3 months. Some of the silicone elastomer sheeting products currently on the market are durable and adhere well to the skin. These products are an attractive treatment option because of their ease of use and low risk of adverse effects compared to other treatments, such as surgical excision, intralesional corticosteroid injections, pressure therapy, radiation, laser treatment, and cryotherapy. Additional controlled clinical trials with large patient populations may provide further evidence for the efficacy of silicone elastomer sheeting in the treatment and prevention of hypertrophic and keloid scars. The purpose of this article is to review the literature on silicone elastomer sheeting products and to discuss their clinical application in the treatment and prevention of hypertrophic and keloid scars. [source]

Skin Angiosarcoma Arising in an Irradiated Breast: Case-Report and Literature Review

DERMATOLOGIC SURGERY, Issue 3 2006
FAUSTO CATENA MD
BACKGROUND Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy. [source]

The Kerf-Cut Dressing: Application of a Woodworking Technique for Efficient Postsurgical Wound Care

DERMATOLOGIC SURGERY, Issue 4 2005
John Starling III BA
Background. Simple surgical excision is one of the most common treatment methods in the dermatologist's armamentarium. We describe a precise postsurgical dressing technique that can be used for wound care of those patients whose treatment involves removal of lesions via cutaneous surgery. Objective. To devise a novel, precise, and effective dressing technique for postsurgical wound care. Materials and Methods. We describe the technique using common in-office instruments. Results and Conclusion. Wound dressings for lesions located on curved areas such as the ears, nose, cheeks, and chin often exhibit less than adequate adherence and stability. The kerf-cut dressing technique optimizes pliability of dressing tape, and this maximizes efficient and stable application of postsurgical wound dressings to curved areas of the body. JOHN STARLING III, BA, PURVISHA J. PATEL, MD, AND RON D. RASBERRY, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Angiokeratoma Circumscriptum Naeviforme: Successful Treatment with Carbon-Dioxide Laser Vaporization

DERMATOLOGIC SURGERY, Issue 2 2005
Jesús del Pozo MD
Background Angiokeratoma circumscriptum naeviforme (ACN) is an unusual type of localized angiokeratoma that occurs more frequently in females and is usually located on the buttocks or thighs, showing a unilateral distribution. ACN usually causes large lesions, which may require laser ablation because they often are too extensive to perform surgical excision. Carbon-dioxide laser is a known alternative for treating angiokeratomas. Objective Report of two cases of ACN treated with carbon-dioxide laser vaporization. Patients and methods A 28-year-old woman with a hyperkeratotic, violaceus plaque on her left buttock and a 24-year-old woman with a similar lesion on her right buttock were treated with a carbon-dioxide laser. Two laser passes were performed on each lesion within a single session. Results A successful cosmetic aspect of treated areas was obtained, with minimal pigmentary or textural changes. After a 2-year follow-up in the first patient and a 6-month follow-up in the second patient, no recurrence of the lesions was observed. Conclusions Our results, obtaining relevant cosmetic improvement after a few sessions of treatment, with low morbidity and minimal secondary effects, suggest that continuous-wave carbon-dioxide laser vaporization is a safe and effective treatment for ACN. JESÚS DEL POZO, MD, AND EDUARDO FONSECA, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Idiopathic Circumscripta Calcinosis Cutis of the Knee

Noninvasive Imaging, Treatment, and Microscopic Confirmation of Clearance of Basal Cell Carcinoma

DERMATOLOGIC SURGERY, Issue 3 2003
Mark Goldgeier MD
BACKGROUND. The diagnosis of basal cell carcinoma (BCC) is generally established by skin biopsy followed by tissue preparation and microscopic analysis. Treatment of BCC is often accomplished by surgical excision. Objective. To confirm the presence of BCC with a noninvasive imaging technique, to treat the patient with a topical immune response modifier, and to confirm the clearance of BCC noninvasively. METHODS. Confocal microscopy (CM) is a noninvasive technique for real-time imaging of skin in vivo. Imiquimod, an immune response modifier, is applied topically by the patient to the skin lesion. RESULTS. The presence of BCC was confirmed with CM. Posttreatment CM imaging confirmed the clearance of BCC from the entire treatment field. Both the pretreatment and the posttreatment CM findings were confirmed by invasive biopsy. CONCLUSION. The ability to use CM to image in real time without discomfort to the patient makes it a powerful tool to assist in the diagnosis of skin disease. [source]

Surgical Treatment of Chronic Gluteal Hidradenitis Suppurativa: Reused Skin Graft Technique

DERMATOLOGIC SURGERY, Issue 2 2003
Hung-wen Kuo MD
BACKGROUND The treatment of chronic lesions in hidradenitis suppurativa (HS) remains a challenge for dermatologists. In most cases, wide surgical excision of the affected skin reduces the recurrence rate to a minimum. Split-thickness skin grafts have usually been applied to resurface large postoperative defects. OBJECTIVE The aim of this study is to introduce an alternative method of skin grafting, called "reused" or "recycled" skin graft, for the reconstruction of the large skin defect with chronic gluteal HS. METHODS The study consisted of six patients (two females and four males) with gluteal HS. After a wide en bloc excision, the wound was immediately recovered with meshed-skin graft, made from the resected skin itself. Thus, the sacrifice of the skin donor is spared. The drum dermatome (Padgett-Hood) is suitable to take the split-skin graft from the resected skin of the affected buttock. The thickness of grafts was set between 12/1,000 and 20/1,000 inches, and all grafts were meshed with 1.5 times the expansion. The skin grafts were secured in place on the wound and a tie-over dressing was applied. RESULTS Postoperative complications were usually minor ones, such as hematoma, discharge, and small areas of graft skin necrosis (less than 1 cm2), although one patient developed a 3×4 cm2 graft necrosis and wound infection. The follow-up period after surgery ranged from 8 to 36 months. No patient experienced any functional disabilities or recurrence during follow-up years. CONCLUSION When the epidermal involvement remains mild to moderate, this reused skin graft technique is an alternative choice to resurface the surgical defect of gluteal HS. It is superior to the conventional procedure, which requires fresh skin donor site. [source]