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BACKGROUND There have been several articles characterizing cases of pigmented basal cell carcinomas (PBCC). Previous studies have also evaluated the relationship between histologic pattern and frequency of basal cell carcinoma (BCC) associated with pigment formation. No specific studies, however, have examined the subclinical extension and surgical margins of PBCC tumors. OBJECTIVE A prospective study of 345 Mohs micrographic BCC surgical cases revealed 67 PBCC cases. Analysis of patient details included patient age and sex, the lesional site, histologic subtype, tumor size, final surgical margin, and the number of stages required to achieve tumor-free margins together with the presence or absence of pigment. METHODS This study was performed between May 2004 and January 2005 at the Department of Dermatology and Cutaneous Surgery, University of Miami, Mohs Surgery Center. RESULTS Total mean surgical margin was smaller in the PBCC than the nonpigmented BCC (NPBCC) group (3.89 mm vs. 5.85 mm; p<0.05). In lesions less than 2 cm in size, there were even more significant differences between the two groups (3.32 mm vs. 5.33 mm; p<0.05), and also between the aggressive and nonaggressive histologically diagnosed groups (3.13 mm vs. 5.01 mm; p<0.05). CONCLUSIONS We have demonstrated that PBCC requires a smaller surgical margin for complete tumor excision than NPBCC, especially in smaller tumors and in the nonaggressive histologic subtype group. Treatment within the early growth stages also involves less subclinical microscopic invasion and a smaller surgical margin in PBCC. [ABSTRACT FROM AUTHOR]

Laser epilation is based on the principle of selective photothermolysis, absorption of laser energy by the target chromophore melanin. It is claimed that larger spot sizes may be more effective for hair removal at identical fluences. To compare the efficacy of 18- vs. 12-mm spot size in hair removal using a Gentlelase Alexandrite laser from Candela Corporation (Boston, MA). In this double-blind, randomized control trial, patients underwent laser-assisted hair removal on the axillary region. Regions were randomly selected and treated with either an 18- or a 12-mm spot size. Three treatments at 6-week intervals with a 755-nm Gentlelase Alexandrite laser (Candela Corp., Canton, MA) at a fluence of 16 J/cm2 with cooling and delay times of 60 ms. Hair counts were taken before each treatment session and compared. The mean percentage hair reduction and student's paired t-test were used to compare 18 versus 12 mm versus control sites at each visit and compared it with the baseline hair count. There was a 10.3% difference in mean reduction favoring the 18-mm spot size treated area at the 6-month follow-up. Our results indicate that a larger spot size appears to be more effective for laser assisted hair removal. K. NOURI, MD, H. CHEN, BS, S. SAGHARI, MD, AND C. A. RICOTTI JR., MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

Background. The optimal time frame to improve the quality and cosmetic appearance of scars by laser therapy has not been clearly elucidated by prior controlled clinical trials. Objective. To determine the efficacy of the 585-nm pulsed dye laser (PDL) in the treatment of surgical scars starting on the day of suture removal. Methods. Eleven patients (skin types I–IV) with 12 postoperative linear scars that were greater than 2 cm were treated three times on monthly intervals with the 585-nm PDL (450 μs, 10-mm spot size, 3.5 J/cm2 with 10% overlap) on one scar half, whereas the other half received no treatment. Scars were later evaluated by a blinded examiner using the Vancouver Scar Scale (VSS) for pigmentation, vascularity, pliability, and height. Scars were then blindly examined for cosmetic appearance using a visual analog scale. Results. One month after the last treatment, final scar analysis by the blinded examiner revealed a significant difference between treated and untreated sites, with the treated halves scoring better in all scar parameters in the VSS and in cosmetic appearance. The treated halves demonstrated an overall average improvement in the VSS between the first treatment score and the final score of 54% versus 10% in the controls (P =0.0002). The cosmetic appearance score (0=worst; 10=best) at final assessment was significantly better for the treated scars, scoring 7.3 versus the averaged control score of 5.2 (P =0.016). Conclusion. The 585-nm PDL is effective and safe in improving the quality and cosmetic appearance of surgical scars in skin types I–IV starting on the day of suture removal. [ABSTRACT FROM AUTHOR]

background. Dermatofibrosarcoma protuberans (DFSP) is a relatively rare cutaneous malignancy with the potential for significant local destruction and morbidity. This neoplasm has a tendency for recurrence following excision due to its infiltrative nature. Surgical excision with wide margins has been considered the standard therapy for DFSP but has had reported recurrence rates of up to 60%. objective. The results of 20 patients with DFSP treated with Mohs micrographic surgery (MMS) are reported. We also reviewed the world literature on the role of MMS for treatment of this tumor. methods. Twenty patients between the ages of 20 and 82 years with DFSP were treated with MMS. The patients were followed for recurrences between 4 and 216 months (mean 56.4 months). results. None of the 20 patients had a recurrence of DFSP following MMS. Of 221 DFSP patients in our review of the world literature treated with MMS, only 5 (2.3%) had a recurrence. conclusion. MMS is an effective treatment of DFSP. [ABSTRACT FROM AUTHOR]

background. Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. objective. To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. methods. Six patients with pigmented hypertrophic scars and skin phototypes II–IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 μsec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4–6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t -test was used to determine the statistical significance of the values obtained. results. Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P = .005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference... [ABSTRACT FROM AUTHOR]

Examines the use of ultrapulse carbon dioxide in the treatment of basal cell carcinomas in patients with basal cell nevus syndrome (BCNS). Characterization of BCNS; Detection of complete histologic clearance of tumors; Reduction in recurrences.

Background. Melasma is very difficult to treat and often refractory to treatment with topical creams and pigmented-lesion lasers. Objective. Pulsed CO2 laser alone is compared with the combination of pulsed CO2 laser followed by Q-switched alexandrite laser in the treatment of dermal-type melasma. This combination is proposed to be effective by first destroying the abnormal melanocytes with the pulsed CO2 laser and then selectively eliminating the dermal melanin with the alexandrite laser. Methods. Four patients were randomly chosen for each treatment arm. There were multiple follow-up visits for examination by an objective blinded investigator. Results. All patients in the combination laser group showed complete resolution, and two patients in the CO2 laser only group had peripheral hyperpigmentation in the long-term follow-up evaluation. Conclusion. These laser therapies are safe, as there was no scarring and no infection. The combination laser therapy was highly effective in removing the hyperpigmentation and all patients in this group showed complete resolution without any peripheral hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background. Histologic studies indicate that C&D fails to mechanically remove all the tumor in a percentage of cases that far exceeds the 5-year recurrence rate. This raises the question that if C&D does not mechanically remove the tumor in a significant number of patients, why don’t we observe tumor recurrence in most of these patients? Our previous study indicates that inflammation occurring over 1 month following C&D does not clear residual tumor. It may be some other process, requiring more time, that clears the residual tumor. Perhaps the proliferative or maturation phase of wound healing or, alternatively, a slow-acting process such as a low-grade immune response set in motion earlier, clears the residual tumor. Objective. To test the hypothesis that wound healing and maturation following C&D clear residual tumor that has not mechanically removed by the procedure. Methods. The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 3 months after the C&D, an amount of time in which the maturation phase of wound healing is well under way. Results. Twenty-two of 29 primary BCC less than 1 cm in size were tumor-free immediately following the procedure (clearance rate 75.9%). Twelve primary BCC <1 cm were treated by C&D, allowed to heal for 3 months, and then excised and checked histologically. Ten of the twelve BCC were free of tumor, for a clearance rate of 83.3%, which is not a statistically significant difference (p = 0.7187). Conclusion. By 3 months, the proliferative phase of wound healing is complete, and our study indicates that this phase has no effect on clearing the tumor. The maturation phase is well under way three months following C&D, and no statistically significant effect was observed. [ABSTRACT FROM AUTHOR]

Discusses the risk factors for hypertrophic scarring after laser resurfacing. Use of higher laser energy settings; Treatment of hypertrophic scarring.

Background. Striae distensae, or stretch marks, are a very common cosmetic problem. The successful management of stretch marks has long been a source of frustration and curiosity for both the clinician and the researcher. Recent studies suggest lasers may have a role in their management. As yet, no study has reported on the effects of either of these lasers in the treatment of stretch marks on persons with skin types 4 to 6. Objective. To assess the efficacy of short pulsed CO2 laser and pulsed dye laser for the treatment of stretch marks in skin types 4, 5, and 6. Methods. Four patients were initially enrolled in the study. All were female with abdominal stretch marks, present for a range of 8 to 19 years. The patients had skin types ranging from 4 to 6. The test area consisted of a stretch mark long enough to be divided into three contiguous 2 cm sections, labeled A, B, and C. Section A served as the short pulsed CO2 test site, section B served as a control, while section C served as the 585 nm pulsed dye site. Patients were seen for evaluation after 1 week, then every 4 weeks for a total of 20 weeks. Patients were evaluated subjectively by the investigators, and the patients’ own self-evaluation was reported as well. Results. Following the 585 nm pulse dye laser, at 20 week follow-up patients with type 4 skin showed no improvement, while type 6 skin showed hyperpigmentation. The short pulsed CO2 test site showed persistent erythema in type 4 skin and marked hyperpigmentation in type 6 skin. Conclusions. For patients with types 4, 5, and 6 skin, laser treatment of striae should be avoided or used with great caution. [ABSTRACT FROM AUTHOR]

BACKGROUND. A variety of uses have been described for cotton tipped applicators. OBJECTIVE. We describe an additional application in surgeries involving the nose. This technique uses 8-inch obstetrics-gynecology applicators with oversized cotton tips, unlike most articles, which report the use of 6-inch applicators with smaller cotton heads. The applicators function to stabilize and support the nasal structures and thus provide a steadier operating field. CONCLUSION. It can be used in procedures of the nose, including curettage, electrocautery, hemostasis, and Mohs and other surgical excisions. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the use of pulsed dye laser for the prevention and treatment of hypertrophic scars in chinese persons.