Search

Background: The perioral location has great functional, aesthetic and social importance. Over 100 procedures have been described for lip reconstruction, emphasizing the challenges that reconstructive surgeons face when dealing with such defects., Objectives: To outline the surgical reconstruction techniques of perioral defects post-Mohs micrographic surgery (MMS)., Methods: The design and surgical techniques of reconstruction of perioral defects post-MMS are described., Results: The results of the surgical techniques described are illustrated., Conclusions: Herein, we describe the nuances of reconstructive techniques that we have found useful for repairing perioral defects post-MMS., (© 2014 British Association of Dermatologists.)

Calciphylaxis is a rare life-threatening form of skin necrosis. Although traditionally observed in patients with end-stage renal disease and/or hyperparathyroidism, calciphylaxis has also been reported to occur in 'non-traditional' patients with normal renal and parathyroid function. We report a case of warfarin-induced calciphylaxis treated successfully with sodium thiosulphate and discuss the role of Vitamin K2 as a potential therapeutic option in the management of warfarin-induced calciphylaxis., (© 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.)

Primary adenocarcinomas of the parotid gland are rare, accounting for < 5% of all head and neck malignant neoplasms. The biological behaviour of these tumours varies considerably. Low-grade tumours are minimally invasive, whereas high-grade tumours show a high incidence of local recurrence and distant metastases. We report a case of metastatic parotid adenocarcinoma which presented with cutaneous features. This case illustrates that such salivary gland malignancies can very rarely present to the dermatologist. These potentially aggressive tumours require prompt diagnosis and management with multidisciplinary team input to ensure that the appropriate treatment is instigated., (© 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.)

Background: Defects of the distal nose and nasal tip are inherently challenging to reconstruct. Although the bilobed flap has a pivotal role for the closure of such defects to achieve a satisfactory outcome, it demands meticulous planning and execution., Objective: We sought to present our experience of the advancement and inferior rotation of the nasal sidewall (AIRNS) flap as a possible alternative to the bilobed flap for reconstruction of the distal nose., Methods: All patients who underwent AIRNS repair after Mohs tumor extirpation of the nose at 2 regional skin cancer units since April 2011 were reviewed., Results: In all, 45 patients underwent the AIRNS flap repair. There were 25 men and 20 women, with a mean age of 70 years (range 41-88). The average defect size was 1.2 × 1.2 cm. The majority of cases involved the nasal tip. A single case of postoperative infection occurred in a smoker, which resolved without any long-term sequelae. No cases of flap necrosis or nasal airflow obstruction were seen. All cases produced good or excellent cosmetic results., Limitations: Because of blunting of the superior alar crease, which may be avoided in a bilobed repair, the AIRNS flap is best avoided in laterally based defects of the nasal alar., Conclusions: The AIRNS flap is a reliable, single-stage closure option that, in our opinion, is simpler in design and execution compared with the bilobed flap and thus adds to the reconstructive surgeon's armamentarium when faced with centrally located defects of the distal nose., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background:   Mohs micrographic surgery (MMS) is regarded as the gold standard for treating nonmelanoma skin cancers of the head and neck. Surgical interventions can generate anxiety for patients and efforts to minimize this may enhance their experience., Objectives: To assess the perceived patient benefits of post-operative telephone follow-up (TFU) calls after MMS., Methods: A prospective, controlled, questionnaire-based assessment of patient satisfaction with TFU calls in patients undergoing MMS was conducted in two centres (New Zealand and U.K.) over a 4-month period from June to September 2011. All individuals in the study group were telephoned on the evening of their surgery by the operating surgeon. Questionnaires were completed by all patients at the time of suture removal., Results: The median Likert score on a 10-point scale relating to patients' perception of the TFU service was higher in the study group compared with the control group (10 vs. 9), with no correlation to closure type of the surgical defect. Overall patient satisfaction with the TFU service was high (94% New Zealand; 96% U.K.), and this was independent of the patient's place of residence. There was no age or sex difference in the minority who did not find the TFU call helpful. The majority of patients felt the best time to call was the night of the surgery (89% New Zealand; 94% U.K.). All patients who had undergone MMS previously found the TFU call just as useful as the first time. The majority of patients (94% New Zealand; 96% U.K.) did not need to call the doctor post-surgery, although 7% of patients in the control group rang the surgeon with issues that could have been readily dealt with by the TFU service. Comparatively, more patients from the U.K. felt their satisfaction would have been the same with a nurse-led TFU call service compared with New Zealand (94% vs. 66%). A significant proportion of those who preferred to be called by the doctor underwent cutaneous flap closures. Patients felt that other specialities that perform surgical procedures under local anaesthetic should adopt a TFU service post-surgery., Conclusions: TFU calls post-MMS are a cost-effective, time-efficient way of achieving high levels of patient satisfaction., (© 2012 The Authors. BJD © 2012 British Association of Dermatologists.)

This study explores the relationship between different types of spitzoid tumours, spindle cell naevus of Reed and spitzoid melanomas. Clinical and histopathological data were retrospectively reviewed from our hospital database in Cambridge from January 2006 to July 2009. Clinical images, where available, were recorded. Search headings from our pathology database included 'spitzoid tumours', 'Spitz naevi', 'atypical spitzoid tumours', spitzoid tumours of uncertain malignant potential ('STUMP'), 'spindle cell naevus of Reed' and 'spitzoid melanomas'. The total number of spitzoid tumours was 118 comprising Spitz naevi (72), atypical spitzoid tumours (30), spitzoid melanomas (eight), and other naevi with spitzoid features (eight). In total, 60% of Spitz naevi were diagnosed clinically and 50% reported a history of change with spitzoid melanoma, compared with 32% with Spitz naevi. In all, 60% of Spitz naevi and atypical spitzoid tumours were pigmented in contrast with spitzoid melanomas (83%). Variegated pigmentation was found in 20% of Spitz naevi and atypical spitzoid tumours, however, no spitzoid melanomas had mixed pigmentation. There were 30 atypical spitzoid tumours (9 M : 21 F); 16 occurred on the lower limbs, peaking in the 20-30-years age group. There were eight patients with spitzoid melanomas with a 7:1 F : M ratio, 50% of which were diagnosed clinically. Of the 34 spindle cell naevus of Reed (10 M : 24 F), 31 were misdiagnosed, most commonly as melanoma. Reed naevi peaked in the 30-40 year age group and on the upper limbs and lower limbs in the 20-30-years age group. In summary, age and sex appeared helpful in distinguishing benign from malignant spitzoid tumours, however history was less discriminatory. Spitzoid melanomas, most of which were pigmented occurred more commonly in females. Atypical spitzoid tumours were more common in females and pathologists favoured malignancy in this group beyond 20 years of age., (© 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.)

Background:   Basal cell carcinoma (BCC) is the commonest cancer in many countries, but the current incidence in young people from the UK is unknown., Aim: To ascertain a recent incidence of BCC in the under-30 population in the UK. Methods.  Cancer registry data from part of the Eastern Region of the UK was analysed for two periods: 1981-1989 and 1998-2006. Case notes were examined for a cohort of the patients from 1998 to 2006., Results: The incidence of BCC increased from 0.73 to 1.79 per 100 000 in those aged < 30 years over the study period. More than half (55%) of BCCs were on the head and neck, and the most common histological subtype was superficial BCC (38%)., Conclusions: The reported incidence of BCC in those aged < 30 years has increased by 145% during this period, corresponding to an average annual increase of 8.53%. This may be partially due to earlier presentation and to increased use of surgical treatments., (© The Author(s). CED © 2011 British Association of Dermatologists.)

Background: Medium- to large-sized surgical defects of the forehead and frontal scalp provide a challenge for the reconstructive surgeon., Objectives: To highlight the utility of a frontalis-based island pedicle flap (FIPF) for the single-stage, aesthetic reconstruction of such defects., Methods: The design and detailed surgical technique required for a FIPF are described., Results: The long-term results are illustrated., Conclusions: FIPFs, despite significant tissue dissection, are readily performed under local anaesthesia and are well tolerated by patients. The FIPF adds to the dermatological surgeon's armamentarium in the reconstruction of large defects of the central forehead and frontal scalp., (© 2012 The Authors. BJD © 2012 British Association of Dermatologists.)

Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.