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In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when
nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires
multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and
color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system
(Ultrapulse® EncoreTM Laser, Lumenis Inc., Santa Clara, CA).
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Nevoid basal cell carcinoma syndrome (NBCCS) is a genetic disorder characterized by multiple basal cell carcinomas (BCCs) in addition
to skeletal abnormalities and other neoplasms. Difficulty lies in treating the large number of BCCs that develop in these patients.
The authors report a case of a patient with NBCCS treated successfully with photodynamic therapy (PDT) using 20% 5-aminolevulinc
acid and blue light. The authors also review the literature and summarize past case reports and series using PDT to treat patient with
NBCCS. Based on their experience and the reports of others, the authors assert that PDT should become the first-line therapy in the
treatment of multiple BCCs in patients with NBCCS.
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The incidence of malignant melanoma has reached more than 62,000 people this past year alone. Much is unknown about the genetic
predisposition of this cancer. The authors present a 62-year-old woman with a history of Charcot-Marie-Tooth disease (CMTD),
diagnosed at age five, who has also developed multiple primary cutaneous malignant melanomas since 2003. The patient presented
to the authors’ clinic with a pigmented lesion on the left thigh, which was increasing in size and changing color. The patient was
diagnosed with malignant melanoma in situ on biopsy. As both CMTD and malignant melanoma are neural crest derived disorders,
this may suggest a shared underlying genetic defect. A gene locus of particular interest is 1p36, both previously recognized in the
proposed pathogenesis of CMTD and malignant melanoma (MM).
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Subungual melanoma is a relatively rare variant of melanoma, accounting for 0.7–3.5% of all melanoma cases in the Caucasian
population. Curiously, it occurs in 8–33% of cases in black, Asian, Native American and Hispanic populations, which generally face a
substantially lower risk of melanoma. Herein the authors report the case of a 69-year-old Hispanic female with a subungual melanoma
of the acral lentiginous type that directly invaded the periosteum, cortex and medulla of the distal phalanx. In addition, we review published
reports of acral lentiginous melanoma with osseous invasion and discuss the evidence, on a molecular level, for this entity’s
aggressive pattern of invasion. The review of cases is limited to those found through the PubMed search engine.
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Skin cancer risk from the use of immunosuppressive medications used to treat inflammatory conditions is not well understood,
though studies clearly establish an exaggerated risk of skin cancer in solid organ transplant recipients (SOTRs) receiving these
medications. The authors report a patient with Behcet’s disease treated with combination immunosuppressive therapy and common
variable immunodeficiency developing multiple squamous cell carcinomas (SCCs) of the skin, necessitating adjustment of her immunosuppressive
regimen. As more patients are treated with immunosuppressive medications for chronic inflammatory diseases,
clinicians must be aware of the possible increased risk of skin cancers associated with these medications. Skin cancer risk assessment,
screening for sub-clinical malignancies and frequent skin exams of high risk patients may represent strategies to improve the
safety of these medications.
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Background: Malignant proliferating trichilemmal tumor (MPTT) is a rare neoplasm originating in the outer sheath of a hair follicle
that often presents as a slowly enlarging, painful, subcutaneous scalp nodule. The authors describe a case of malignant proliferating
trichilemmal tumor (MPTT) in an elderly 65-year-old Asian male who presented with a 5.5 x 5.0 cm mass on the posterior scalp.
Methods: The authors present a unique dual approach to treatment of MPTT in both the excision and wound revision phases. First,
Mohs micrographic surgery is utilized for more discrete removal of malignant tissue, as opposed to wide excision. Then, a novel
device called DermaClose® RC is used in wound revision, a device that has proven to be more effective in promoting wound closure
than traditional suturing.
Results: Mohs micrographic surgery was used to excise the tumor in three stages. The resulting irregular wound measured 6.3 x
5.6 cm, and was repaired with the device. Following the application of the device, the wound reduced in size to 1.5–1.0 cm. Postoperatively,
the patient had no evidence of recurrent disease at seven months.
Conclusion: Use of the DermaClose RC tissue expander following a Mohs surgical procedure provides an effective functional and
cosmetic alternative to a skin graft which creates a donor site wound and creates a more complicated, time consuming procedure.
The dual approach discussed here–of Mohs micrographic surgery performed in tandem with wound revision via the tissue expanding
device is one that may yield promising benefits but warrants further evaluation.
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Background: Methyl aminolevulinic acid photodynamic therapy (MAL-PDT) has antitumor activity and may promote wound healing.
Superficial and nodular basal cell carcinomas (BCCs) have been successfully treated with MAL-PDT in prior reports. In vitro and animal
studies have shown more rapid re-epithelialization and decreased myofibroblast response after treatment thus suggesting that PDT
may play a possible role in promotion of wound healing.
Objectives: To describe a novel case of a large multifocal BCC treated with postoperative PDT that showed results of tumor clearance
and rapid re-epithelialization and to review the relevant literature.
Case Report: A patient presented for Mohs micrographic surgery (MMS) after recent biopsy revealed recurrent BCC. Mohs
micrographic surgery was performed, where after six stages were taken, approximately 50% of the peripheral margins of the
tumor remained positive for superficial BCC. Given the large size of the wound defect (12.5 cm x 9 cm) and superficial nature of
the persistent tumor, the authors opted to treat the patient with adjuvant MAL-PDT in lieu of pursuing additional stages with MMS.
The patient returned the following day for adjuvant therapy with MAL-PDT. Two consecutive treatments one week apart were given
as an adjunctive treatment course for persistent BCC. At follow-up four weeks after the PDT treatment, the defect had fully reepithelialized.
In the authors’ clinical practice, an untreated wound of this size typically heals in 10–12 weeks. The patient has been
seen in six months of follow-up to date. Review of the literature relevant to use of MAL-PDT in treatment of basal cell carcinoma and
literature describing effects of PDT on wound healing was performed.
Conclusion: MAL-PDT may be an effective adjuvant tool against large multifocal BCCs for which surgery has not resulted in clearance.
Treatment with PDT resulted in rapid re-epithelialization of the surgical wound in this case. This observation is supported by
prior in vitro studies and in vivo animal experiments demonstrating more rapid re-epithelialization of wounds and decreased scarring response after PDT.
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Sorafenib is a multikinase inhibitor that blocks tumor cell proliferation and angiogenesis and is used for the treatment of advanced
renal cell carcinoma, unresectable hepatocellular carcinoma, and other solid tumors. Various dermatologic side effects have been
reported, most notably a hand-foot-skin reaction (HFSR). This is a case of a sorafenib-induced psoriasiform eruption in a patient
with metastatic thyroid carcinoma. This patient also developed cutaneous squamous cell carcinoma and HFSR in association with
sorafenib. To the authors’ knowledge, a psoriasiform eruption due to sorafenib has not been reported in the literature and has important
therapeutic implications.