"Invasive squamous cell carcinoma in a patient with epidermodysplasia verruciformis"Dhillon I; Zouzias D; GERONEMUS R
A patient with epidermodysplasia verruciformis died of intracranial invasion by squamous cell carcinoma (SCC). A biopsy of clinically normal skin had revealed perineural invasion by malignant keratinocytes. Because SCCs arising in patients with epidermodysplasia verruciformis may be biologically aggressive, it is best to excise them with careful control of the surgical tissue margins.
"Ethics and the academic-corporate relationship" [Comment]GERONEMUS R
"Lasers in the treatment of skin cancer"GERONEMUS R; Ashinoff R
The development and use of various laser systems for the treatment of carcinomas of the skin constitute a relatively new therapeutic approach. Because the skin is a readily accessible organ, it is an excellent site at which to attempt different therapeutic modalities. What is truly astounding has been the development of specific lasers designed to treat certain dermatologic problems. Because the field of laser biotechnology is still rapidly emerging, it is very likely that new lasers and modifications of existing ones will improve our ability to treat skin cancer and precancerous conditions.
"Argon laser surgery in children under 13 years of age" [Comment]GERONEMUS RG
"Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser"GERONEMUS RG
Twelve children 2 to 10 years of age with spider telangiectases of the face were treated with a flashlamp-pumped pulsed dye laser at a wavelength of 585 nm and a pulse width of 450 microsec. Complete resolution of the telangiectases was noted in all 12 patients, without scarring or permanent pigmentary alteration of the skin.
"The medical necessity of evaluation and treatment of port-wine stains"GERONEMUS RG; Ashinoff R
New lasers and improved laser delivery systems have allowed for the safe and effective treatment of port-wine stains in patients of all ages. The satisfactory results obtained by laser treatment have increased the number of patients seeking consultation regarding their birthmarks. It is imperative that physicians recognize the various medical syndromes and problems associated with port-wine stains. A review of 415 patients with facial port-wine stains has revealed hypertrophy and/or nodularity in 65% of patients by the fifth decade of life, which increases significantly the morbidity of these lesions. It is believed that laser treatment will minimize the medical and psychologic complications that result from the natural evolution of port-wine stains.
"Treatment of the poikilodermatous component of the Rothmund-Thomson syndrome with the flashlamp-pumped pulsed dye laser: a case report"Potozkin JR; GERONEMUS RG
The Rothmund-Thomson syndrome is a rare disorder characterized by poikiloderma, juvenile cataracts, bone abnormalities, short stature, sparse hair, hypogonadism, defective dentition, nail dystrophy, hyperkeratosis, and mental retardation. A 12-year-old boy with the syndrome was referred to us for evaluation and treatment of poikiloderma. This component of the disease was markedly improved with the use of pulsed dye laser photocoagulation.
"Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains"Ashinoff R; GERONEMUS RG
EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment.
"Porokeratosis of Mibelli with underlying hemangioma treated by the flashlamp-pumped pulsed dye laser"Ashinoff R; GERONEMUS RG
Porokeratosis of Mibelli is a disorder of epidermal proliferation in which an abnormal clone of cells expands in a centrifugal manner. We present a case of porokeratosis of Mibelli with an underlying hemangioma that was treated with a 585 nm flashlamp-pumped pulsed dye laser. The underlying hemangioma responded well to laser therapy while the porokeratosis remained unchanged. The implications of this for the pathogenesis of porokeratosis and the specificity of the pulsed dye laser are discussed.
"Dermatologic laser surgery"Garden JM; GERONEMUS RG
The laser is becoming an increasingly important surgical and medical instrument in the field of dermatology. Developments in the areas of laser technology and application have significantly broadened its clinical use over the past several years. These rapid changes and advances in the use of the laser for cutaneous processes may make it difficult for the physician to maintain a current base of knowledge in this area. Relevant laser systems and their clinical applications are presented and discussed, as are investigational laser systems, which may be of importance for the future. This will allow the dermatologic surgeon the opportunity to update concepts and evaluate the various laser systems and their cutaneous applications.
"Poikiloderma of civatte" [Letter]GERONEMUS R
"Presuturing in alopecia reductions"Meirson D; Reyes BA; GERONEMUS R
The technique of presuturing for alopecia reductions is described. With this procedure, the area of potential reduction is sutured 12-24 hours prior to surgery to enhance the laxity of the scalp.
"Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser"Reyes BA; GERONEMUS R
Seventy-three patients between the ages of 3 months to 14 years (average age 6 years 2 months) with port-wine stains were treated with the flashlamp-pumped pulsed dye laser. More than 75% lightening was achieved with an average of 2.5 treatments in 33 patients (45%), 50% to 74% lightening after an average of 1.7 treatments in 31 (42%), 26% to 49% lightening after 2 treatments in 5 (7%), and less than 25% lightening after 1 treatment in 4 (5%). The overall average lightening after one treatment was 53%. The percentage of lightening increased as the number of treatments increased. Three patients had 100% clearance of the port-wine stain. Patients aged between 3 months and 6 years (44 patients) had a better response after the first treatment (55% lightening) than did patients aged between 7 and 14 years (29 patients with a 48% lightening; p = 0.027). Complications included cutaneous depressions in four patients, hyperpigmentation in 16 patients, and hypopigmentation in three patients. All complications were transient and disappeared completely.
"The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma"Bain L; GERONEMUS R
Two cases of squamous cell carcinoma (SCC) of the penis, one verrucous type and one in situ, arising in association with an inflammatory dermatosis most consistent with lichen planus, are described. Although SCC has previously been reported to have arisen from lichen planus of the oral mucosa, these are the first reported cases of the coexistence of these processes on the penis.
"The treatment of Zoon's balanitis with the carbon dioxide laser"Baldwin HE; GERONEMUS RG
Zoon's balanitis, or plasma cell balanitis, is a chronic erosive process of the uncircumcised penis. The lesions are often refractory to conservative topical and surgical therapy and frequently require circumcision as a curative measure. This case report describes the first reported successful use of the carbon dioxide laser in the defocused mode to vaporize the chronic penile erosions of Zoon's balanitis.
"Microcystic adnexal carcinoma of the scalp"Chow WC; Cockerell CJ; GERONEMUS RG
Microcystic adnexal carcinoma (MAC) is a recently described rare adnexal neoplasm showing benign histologic features but a locally aggressive behavior. It has most commonly been reported to occur on the face but it has also been noted in the axilla and buttock. We describe a 41-year-old white male with a 5-year history of MAC on the scalp and treatment by Mohs micrographic surgery. To our knowledge, this is the first case of MAC reported to occur on the scalp.
"Continuous arteriovenous hemofiltration for acute renal failure"Bartlett RH; Bosch J; GERONEMUS R; Paganini E; Ronco C; Swartz R
"Ultraviolet laser ablation of skin: healing studies and a thermal model"Lane RJ; Wynne JJ; GERONEMUS RG
We have followed the course of healing of incisions made with the krypton-fluoride excimer laser. Incisions were made in guinea pig skin, in vivo, under identical conditions of irradiation. The progressive healing of these incisions was followed over the course of 3 weeks. We noted excellent healing with re-epithelialization, and the re-formation of collagen fibers with minimal fibrosis. We present a simple thermal model for ablation of tissue by a short pulse of strongly absorbed laser radiation..
"DERM/RX. A computer aid to the management of diseases of the skin"Kopf AW; GERONEMUS R; Sanchez M; Natow A; Grossman D; Goldberg D
DERM/RX (dermatologic therapy) is a computerized data base representing a compendium of therapeutic management options for over 600 diseases of the skin. This data base is housed in the National Headquarters of the American Academy of Dermatology in Evanston, Illinois. It is accessible via DERM/INFONET to members of the American Academy of Dermatology via telephonic communication lines that blanket the United States. The data base is constantly updated by the Task Force on DERM/RX of the Committee on Biomedical Communications of the American Academy of Dermatology..