Ronen Alkalay MD MBA, Joseph Alcalay MD, Alex Maly MD, Arieh Ingber MD, Clemens Fritsch MD, Thomas Ruzicka MD PhD, Claes D Enk MD PhD
Background: Basal cell carcinoma (BCC) is a common malignancy accounting for 80% of all nonmelanoma skin cancers. Mohs micrographic
surgery (MMS) is considered superior to alternative treatments, but the procedure is time consuming and costly. Alternative
simpler techniques to facilitate accurate tumor demarcation are therefore in demand. Fluorescence imaging following application of
5-aminolevulinic acid is a noninvasive diagnostic technique that gives rapid information about the superficial extent of the skin tumor.
Objective: To ascertain whether fluorescence imaging improves the clinical tumor border assessment by investigating the consistency
between tumor size determination by MMS, clinical assessment, and fluorescence imaging.
Methods: Eighteen patients with histologically verified nodular BCCs on the face scheduled for MMS were included in the study.
The night before the surgical procedure, 5-aminolevulinic methyl ester cream was applied to the lesion. The following morning, tumor
borders were determined clinically (clinical size), after illumination with Wood’s light (fluorescence size), and by the tumor defect left
on the skin surface following removal of the MMS specimen (Mohs size).
Results: The median tumor sizes were 93.05 mm2 (Mohs size), 61.05 mm2 (clinical size), and 72.75 mm2 (fluorescence size). The
interclass correlation coefficients between Mohs size and fluorescence size was 0.984 and Mohs size and clinical size was 0.752.
Conclusion: Tumor border estimation by fluorescence imaging and clinical assessment underestimate the genuine tumor size determined by MMS; however, the fluorescence size showed a higher degree of consistency with the Mohs size than did the clinical size.
The maintenance of normal hydration is an important function of the skin. The stratum corneum provides an antimicrobial, antioxidant,
and UV barrier and plays an integral role in maintaining skin hydration. Environmental factors and disease states may compromise
the barrier function of the stratum corneum, leading to excessively dry skin. Evidence supports the use of moisturizers in
the treatment of various skin conditions, and a wide variety of these products are currently available. The presence of moisturizing
agents in a compound, however, may not guarantee optimal moisturization effects. Pharmacologic and physiologic (eg, concentration,
bioavailability, proper determination of moisturization effects), as well as patient-based considerations, can potentially influence
the effects of moisturizer ingredients. While moisturizers as adjunctive therapy have proven benefits in enhancing the management
of certain dermatologic conditions, the incorporation of moisturizing ingredients into topical treatments may not translate into clinical
benefit, particularly in enhancing skin barrier function.
Sudeep J. Karve MS, Steven R. Feldman MD PhD, Brad A. Yentzer MD, Daniel J.Pearce MD, Rajesh Balkrishnan PhD
Basal cell carcinoma (BCC) is regarded as the most prevalent malignant skin tumor in whites. A variety of surgical and nonsurgical
interventions are available to treat BCC. In recent years, an immune response modifier drug, imiquimod, has been approved in treating
superficial BCC (sBCC). The objective of the authors was to review the published literature to evaluate outcomes such as efficacy,
safety, and quality of life associated with imiquimod treatment among patients with sBCC. A MEDLINE search of the literature was
performed to identify studies published between January 1, 1995 and March 31, 2008 that evaluated imiquimod efficacy, safety, and
quality of life in treating BCC. Overall, imiquimod 5% cream was associated with increased clinical and histologic clearance among
patients with sBCC as compared to placebo. The findings from short-term cost effectiveness studies suggest that use of imiquimod
5% cream can be more cost-effective than surgical interventions such as excision surgery among patients with superficial BCC.
Future studies evaluating long term cost effectiveness of imiquimod treatment are warranted.
Yulia K. Khan, Amer N. Kalaaji MD, Bart L. Clarke MD
Systemic glucocorticoids are widely used in dermatologic practice for various conditions including connective tissue and immunobullous
diseases, vasculitis, dermatitis, neutrophilic and other dermatoses, and androgen excess syndromes. Long-term use of systemic glucocorticoids
has been associated with substantial and rapid bone loss, which places patients at increased risk for bone fractures. Therefore,
bone density measurements and the timely initiation of lifestyle modifications and pharmacotherapy are essential for future bone
health. The use of several Food and Drug Administration–approved agents to prevent and treat corticosteroid-induced bone loss has
been inconsistent among many specialties. In this review, the authors summarize guidelines on the prevention and treatment of corticosteroid-
induced bone loss published by the American College of Rheumatology and supplement these guidelines with descriptions
of the latest approved pharmacologic therapies and user-friendly flow algorithms. This summary should aid dermatologists in providing
education and recommendations regarding bone health for their patients on systemic glucocorticoids.
Jamison E. Strahan MD, Joel L. Cohen MD
No abstract details for the moment.
Maria S. Aluma-Tenorio MD, Adam J. Mamelak MD FRCPC, Leonard H. Goldberg MD, Ming H. Jih MD PhD, Arash Kimyai-Asadi MD
The forehead is a common site for nonmelanoma skin cancer. For medium to large sized defects, the primary reconstructive challenge is the paucity of loose adjacent donor skin. The authors describe frontalis muscle plication, imbrication, and related surgical techniques utilized in reconstructing forehead defects. With these techniques, one can significantly reduce wound tension and increase the volume of tissue recruited to the defect site as necessary.