Journal of Cutaneous PathologyVolume 35, Issue 5 p. 513-514 Detection of human papillomavirus in cutaneous clear cell squamous cell carcinoma in situ: viral-associated oncogenesis may contribute to the development of this pathologic variant of skin cancer Philip R. Cohen MD, Philip R. Cohen MD University of Houston Health Center, University of Houston, Houston, TX, USA Dermatologic Surgery Center of Houston, Houston, TX, USA Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorKeith E. Schulze MD, Keith E. Schulze MD Dermatologic Surgery Center of Houston, Houston, TX, USA Fort Bend Skin Cancer Center, Sugar Land, TX, USASearch for more papers by this authorPeter L. Rady MD, PhD, Peter L. Rady MD, PhD Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorStephen K. Tyring MD, PhD, MBA, Stephen K. Tyring MD, PhD, MBA Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA Department of Dermatology, Center for Clinical Research, Houston, TX, USA(e-mail: [email protected])Search for more papers by this authorQin He MD, Qin He MD Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorPaul T. Martinelli MD, Paul T. Martinelli MD Dermatologic Surgery Center of Houston, Houston, TX, USASearch for more papers by this authorBruce R. Nelson MD, Bruce R. Nelson MD Dermatologic Surgery Center of Houston, Houston, TX, USASearch for more papers by this author Philip R. Cohen MD, Philip R. Cohen MD University of Houston Health Center, University of Houston, Houston, TX, USA Dermatologic Surgery Center of Houston, Houston, TX, USA Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorKeith E. Schulze MD, Keith E. Schulze MD Dermatologic Surgery Center of Houston, Houston, TX, USA Fort Bend Skin Cancer Center, Sugar Land, TX, USASearch for more papers by this authorPeter L. Rady MD, PhD, Peter L. Rady MD, PhD Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorStephen K. Tyring MD, PhD, MBA, Stephen K. Tyring MD, PhD, MBA Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA Department of Dermatology, Center for Clinical Research, Houston, TX, USA(e-mail: [email protected])Search for more papers by this authorQin He MD, Qin He MD Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USASearch for more papers by this authorPaul T. Martinelli MD, Paul T. Martinelli MD Dermatologic Surgery Center of Houston, Houston, TX, USASearch for more papers by this authorBruce R. Nelson MD, Bruce R. Nelson MD Dermatologic Surgery Center of Houston, Houston, TX, USASearch for more papers by this author First published: 08 April 2008 https://doi.org/10.1111/j.1600-0560.2007.00831.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Al-Arashi MYH, Byers HR. Cutaneous clear cell squamous cell carcinoma in situ: clinical, histological and immunohistochemical characterization. J Cutan Pathol 2007; 34: 226. 10.1111/j.1600-0560.2006.00593.x CASPubMedWeb of Science®Google Scholar 2 Cohen PR, Schulze KE, Rady PL, et al. Coincidental consort clear cell cutaneous carcinoma: facial squamous cell carcinoma in situ containing human papillomavirus and cancer cells with clear cytoplasm in an octogenarian couple. South Med J 2007; 100: 525. 10.1097/01.smj.0000261462.83238.84 PubMedWeb of Science®Google Scholar 3 Hazard K, Karlsson A, Andersson K, Ekberg H, Dillner J, Forslund O. Cutaneous human papillomavirus persist on healthy skin. J Invest Dermatol 2007; 127: 116. 10.1038/sj.jid.5700570 CASPubMedWeb of Science®Google Scholar 4 Harwood CA, Proby CM. Human papillomaviruses and non-melanoma skin cancer. Curr Opin Infect Dis 2002; 15: 101. 10.1097/00001432-200204000-00002 PubMedWeb of Science®Google Scholar 5 Pfistser H. Chapter 8: Human papillomavirus and skin cancer. J Natl Cancer Inst Monogr 2003; 31: 52. 10.1093/oxfordjournals.jncimonographs.a003483 PubMedGoogle Scholar Citing Literature Volume35, Issue5May 2008Pages 513-514 ReferencesRelatedInformation

The purse-string suture provides complete or partial closure of round postoperative skin defects. It is a rapid and simple procedure to perform. Tension placed on the suture uniformly advances the skin from the entire periphery of the wound, resulting in a significant reduction of the defect size and enhancement of hemostasis at the wound edge. The history, modifications of the technique, advantages, and potential complications of the purse-string suture are reviewed. It is not only useful following the removal of nonmelanoma skin cancer but also after the local excision of melanoma. In addition, this technique is especially suitable for the repair of round surgical wounds for patients who are unable to modify their active lifestyles during the week following surgery, individuals concurrently being treated with anticoagulants, antiplatelet agents or both, and people with extensive postoperative defects that would otherwise require either a skin graft or a large cutaneous flap. Typically, the site of the surgical wound following partial or complete closure with the purse-string suture demonstrates excellent long-term cosmetic and functional results.

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BACKGROUND:The purse string suture can be used to provide primary closure for small skin defects or as a partial closure for larger round wounds. The size of the defect is reduced secondary to the tension placed on the suture, which uniformly advances the skin from the entire periphery of the wound. METHODS:We reviewed retrospectively the features of 98 consecutive patients for whom a total of 100 cuticular purse string sutures were used to partially close their postoperative surgical defects. The location and types of the tumors removed were also summarized. RESULTS:Postoperative wounds were created following Mohs' micrographic excision of nonmelanoma skin cancer (basal cell carcinoma, 44; squamous cell carcinoma, 25), wide local excision of melanoma (29), or conservative excision of benign cutaneous neoplasms (two). The incidence of purse string suture for partial closure of each tumor was 4.1% for basal cell carcinoma, 7.3% for squamous cell carcinoma, and 46.3% for melanoma. The tumors were equally distributed on the trunk, head and neck, and extremities; however, purse string closures for basal cell carcinomas were more frequent on the trunk, head, and neck, relative to squamous cell carcinomas and melanomas, which were more common on the extremities. Concurrent medical problems and/or the use of an agent with anticoagulant or antiplatelet effects were noted in more than 50% of patients. Absorbable material of thicker diameter was most frequently used for the suture, and the postoperative wound area decreased by 6-90% (mean, 60%) following purse string partial closure. The suture was usually removed after 3-4 weeks. Postoperative complications occurred in six patients: allergic contact dermatitis in two, wound infection in two, exuberant granulation tissue in one, and hypertrophic scar in one. All of the wounds healed completely with either a round or linear scar. CONCLUSION:The cuticular purse string suture is a rapid and simple procedure that provides complete or partial closure of round skin defects and excellent long-term cosmetic and functional results. This closure provides uniform tension to the wound, enhances hemostasis at the tissue edge, and significantly decreases the size of the defect. Partial wound closure with the purse string suture may be advantageous following the local excision of melanoma, either as definitive surgical wound management or as a temporary partial wound closure prior to subsequent complete repair of the surgical defect. The purse string suture is also useful following nonmelanoma skin cancer removal in patients who insist on maintaining an active lifestyle in the immediate postoperative period, who are receiving one or more systemic anticoagulant and/or antiplatelet agents, and who have large surgical wounds that would require either a skin graft or a local cutaneous flap in order to close the postoperative defect.

Childhood onset basal cell carcinoma is uncommon. In addition to occurring in children with albinism, Bazex syndrome, basal cell carcinoma nevus syndrome, nevus sebaceus, radiotherapy-treated cancers, solid organ transplants, and xeroderma pigmentosum, childhood onset basal cell carcinoma has also occurred, albeit less commonly, de novo. We describe a boy with idiopathic childhood onset basal cell carcinoma. Previously published children with de novo basal cell carcinoma were collected from computerized medical literature search (PubMed) and citations from earlier reports. To our knowledge, childhood onset idiopathic basal cell carcinoma has been observed in a total of 107 children, including our patient. Tumors were most commonly located on the head (90%). The tumors are most frequently nodular in appearance (52%) and in histology (at least 17%); however, aggressive histologic variants were observed in 20% of tumors. Basal cell carcinoma in children may be associated with prior sun exposure. The most common treatment is excision, with or without using the Mohs technique. However, 15 of 85 children, nearly 20%, developed recurrent tumors during a follow-up period ranging from 4 months to 20 years.

Clear cell squamous cell carcinoma in situ, also referred to as pagetoid or clear cell Bowen disease, is a rare pathologic variant of this neoplasm. It is characterized by neoplastic cells with clear or pale cytoplasm. An octogenarian husband and wife concurrently developed new facial skin lesions which demonstrated squamous cell carcinoma in situ consisting of cancer cells with clear cytoplasm. Cutaneous human papillomavirus (HPV) typing detected HPV Type 5 and HPV Type 21 in the tumors of the husband and wife, respectively. HPV is a potential etiologic factor in the oncogenesis of nonmelanoma skin cancer, and HPV DNA has been demonstrated in extragenital squamous cell carcinoma in situ. The detection of DNA from different HPV types in the tumors of our patients suggests that the concurrent occurrence of their skin cancers may have been coincidental. However, the presence of HPV DNA in their tumors introduces the possibility of a viral-associated oncogenesis for clear cell squamous cell carcinoma in situ.

Ulceration of the nose may be inadvertently induced by the patient. Although trigeminal trophic syndrome is an uncommon cause of chronic ulcers, healthcare providers should consider the possibility of this disorder when encountering a patient with nasal ulcerations. Trigeminal trophic syndrome most commonly occurs in older women following therapy for trigeminal neuralgia. The ulcers usually involve the nasal ala and paranasal areas. The clinical vignette of a man with a self-induced nasal ulcer secondary to trigeminal trophic syndrome, which was initially Suspected to be skin cancer, is presented. Since nasal ulcerations can be secondary to other conditions, a lesional biopsy should be performed to exclude other diagnoses when trigeminal trophic syndrome is entertained. In addition to trigeminal trophic syndrome, the differential diagnosis of conditions that can cause nasal ulcers include factitial disorders with self-induced ulcerations (such as dermatitis artifacta and neurotic excoriations), granulomatous conditions, infectious diseases, malignancy, and pyoderma gangrenosum. Treatment of trigeminal trophic syndrome requires prevention of digital manipulation of the lesion - either by occluding contact with the ulcer, initiating psychotropic medication, or both. Psychiatric and/or pharmacologic intervention should be considered to reduce or resolve further habitual self-inflicted injury before surgical intervention.

International Journal of DermatologyVolume 45, Issue 11 p. 1377-1378 Mohs micrographic surgery for tubular apocrine adenoma Paul T. Martinelli MD, Paul T. Martinelli MDSearch for more papers by this authorPhilip R. Cohen MD, Philip R. Cohen MDSearch for more papers by this authorKeith E. Schulze MD, Keith E. Schulze MDSearch for more papers by this authorJaime A. Tschen MD, Jaime A. Tschen MDSearch for more papers by this authorBruce R. Nelson MD, Bruce R. Nelson MDSearch for more papers by this author Paul T. Martinelli MD, Paul T. Martinelli MDSearch for more papers by this authorPhilip R. Cohen MD, Philip R. Cohen MDSearch for more papers by this authorKeith E. Schulze MD, Keith E. Schulze MDSearch for more papers by this authorJaime A. Tschen MD, Jaime A. Tschen MDSearch for more papers by this authorBruce R. Nelson MD, Bruce R. Nelson MDSearch for more papers by this author First published: 31 October 2006 https://doi.org/10.1111/j.1365-4632.2006.02842.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Toribio J, Zulaica A, Peteiro C. Tubular apocrine adenoma. J Cutan Pathol 1987; 14: 114–117. 2 Umbert P, Winkelmann RK. Tubular apocrine adenoma. J Cutan Pathol 1976; 3: 75–87. 3 Wildemore JK, Lee JB, Humphreys TR. Mohs surgery for malignant eccrine neoplasms. Dermatol Surg 2004; 30: 1574–1579. 4 Leibovitch I, Huilgol SC, Selva D, et al. Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol 2005; 52: 295–300. 5 Burket JM, Zelickson AS. Tubular apocrine adenoma with perineural invasion. J Am Acad Dermatol 1984; 11: 639–642. 6 Ishiko A, Shimizu H, Inamoto N, et al. Is tubular apocrine adenoma a distinct clinical entity? Am J Dermatopathol 1993; 15: 482–487. 7 Okun MR, Finn R, Blumenthal G. Apocrine adenoma versus apocrine carcinoma. Report of two cases. J Am Acad Dermatol 1980; 2: 322–326. 8 Biernat W, Biernat S. Cutaneous adnexal carcinoma arising within a solitary cylindroma-spiradenoma. Am J Dermatopathol 1996; 18: 77–82. 9 Puttick L, Ince P, Comaish JS. Three cases of eccrine porocarcinoma. Br J Dermatol 1986; 115: 111–116. 10 Ishikawa K. Malignant hidroacanthoma simplex. Arch Dermatol 1971; 104: 529–532. 11 Lim SC, Lee MJ, Lee MS, et al. Giant hidradenocarcinoma: a report of malignant transformation from nodular hidradenoma. Pathol Int 1998; 48: 818–823. 12 Hugel H, Requenza L. Ductal carcinoma arising from a syringocystadenoma papilliferum in a nevus sebaceus of Jadassohn. Am J Dermatopathol 2003; 25: 490–493. Citing Literature Volume45, Issue11November 2006Pages 1377-1378 ReferencesRelatedInformation

BACKGROUND Articaine is a unique amide anesthetic that contains a thiophene ring and an additional ester group. The rapid diffusion and enhanced tissue-penetrating properties of articaine enable its use for infiltrative anesthesia. OBJECTIVE To describe the effective use of articaine as an adjuvant local anesthetic for surgical excisions requiring dissection at the level of the muscular fascia. METHODS AND MATERIALS We discuss the successful adjunctive use of articaine to provide effective infiltrative anesthesia of muscular fascia. We review the composition, the pharmacologic properties, and the safety profile of articaine. RESULTS Adjuvant local anesthesia using articaine results in painless surgery at the level of the muscular fascia without any perioperative complications. CONCLUSION Articaine is not only well tolerated but also rapidly effective for anesthesia in the fascial plane of the trunk and extremities. We recommend it be considered as an adjunctive local anesthetic for consistently painless cutaneous surgery near the muscular fascia.

Pleomorphic basal cell carcinoma is a pathologic variant of basal cell carcinoma characterized by the presence of atypical-appearing, mononuclear or multinucleated giant cells. Including our 3 patients, a total of 52 pleomorphic basal cell carcinomas have been described in 48 individuals. The tumors usually present as a nodule on the head or neck. The nuclei of the giant tumor cells are irregularly shaped, hyperchromatic, and 2 to 10 times larger than the nuclei of the surrounding cancer cells. Atypical mitoses may be present. The pathogenesis of pleomorphic basal cell carcinoma remains to be determined; however, investigations utilizing electron microscopy, immunohistochemistry, image analysis, and flow cytometry have provided additional insight regarding the features of the giant tumor cells and the etiology of this cancer. All of these tumors are aneuploid. Although these aneuploid tumors have alarming microscopic features, their clinical course is similar to that of basal cell carcinomas without pleomorphic giant tumor cells. Therefore, appropriate therapy to ensure adequate treatment of the tumor is recommended. Our patients' pleomorphic basal cell carcinomas were successfully treated by excision using the Mohs micrographic surgical technique.

BACKGROUND Basal cell carcinoma, the most common malignancy in humans, rarely occurs on the nail unit and may be frequently misdiagnosed clinically. OBJECTIVES To present a case of basal cell carcinoma of the nail unit successfully treated with the mohs technique and to review the literature regarding this unique presentation of this tumor. MATERIALS AND METHODS Case report and review of the English literature of nail unit basal cell carcinoma. RESULTS In addition to the currently described patient, 17 other patients with nail unit basal cell carcinaoma have been reported. The tumor occurred approximately 3 times more often on the fingers then on the toes and had a slight predilection to occur in men. Ulceration, noted in more than one-half of patients, was the most common presentation of nail unit basal cell carcinoma. Mohs micrographic surgery. Often with second intention healing, was successfully employed in 39% of patients. CONCLUSIONS Basal cell carcinaom infrequently involves the nail unit and often presents as ulceration. Adequate biopsy of the lesion is essential in making a timely diagnosis. Mohs micrographic surgery with second intension healing is an effective treatment that may offer excellent cosmetic and functional results.

We report the case of a 21-year-old white male with an ectopic sebaceous gland and duct located within the bulb of an anagen hair follicle. This is an incidental finding in one of two biopsies from his chin, performed as part of the workup for a recalcitrant perioral acneiform eruption. The embryogenesis and development of sebaceous glands in human scalp hair follicles are reviewed. To our knowledge, this is the first report of such a developmental anomaly.

Extramammary Paget disease is an uncommon cutaneous neoplasm that presents as erythematous plaques most frequently located in the anogenital region. Management of patients with extramammary Paget disease involves evaluation of the individual for: (1) a disease-associated, unsuspected, visceral malignancy and (2) secondary adenocarcinoma in the underlying dermis or regional lymph nodes. Several modalities, each with variable effectiveness, are available to treat the cutaneous component of the disease: electrodesiccation and curettage, laser surgery, aminolevulinic acid photodynamic therapy, radiotherapy, topical chemotherapy, and wide surgical excision. However, surgical excision using the Mohs micrographic technique is currently the modality of choice for treating the cutaneous lesions of extramammary Paget disease. Recently, a topical imidazoquinoline immunomodulator that induces cytokine production and stimulates the innate and cellular immune responses--imiquimod cream-has been used for the management of primary or relapsing extramammary Paget disease. Complete healing, without recurrence, of extramammary Paget disease in patients whose cutaneous lesions were treated topically with imiquimod 5% cream was observed. We describe a man with suprapubic extramammary Paget disease whose condition was primary and limited to his skin. Biopsy-confirmed complete resolution of his disease was observed after the topical application of imiquimod 5% cream 3 times per week (on alternate days) for 16 weeks. After reviewing the published reports of other patients with extramammary Paget disease whose disease was successfully treated with imiquimod cream, we suggest that topical imiquimod 5% cream-at least 3 times per week (with 1-2 d of nontreatment in between) for a minimum of 8 to 16 weeks--be considered as an initial treatment for primary cutaneous extramammary Paget disease. Surgical excision or an alternative therapeutic modality is recommended for patients whose extramammary Paget disease persists or recurs after treatment with topical imiquimod.