Optimal Timing for Surgical Excision of Nevus Sebaceus on the Scalp: A Single-Center Experience.
- 作者列表："Kong SH","Han SH","Kim JH","Oh YW","Park HJ","Suh HS","Choi YS
BACKGROUND:Treatment of nevus sebaceus (NS) on the scalp is usually surgical excision, but the optimal timing is debatable. The scalp presents significant challenges to the reconstructive surgeon because the lack of elasticity of the scalp makes the repair of defects difficult. OBJECTIVE:The aim of this study was to investigate the optimal timing for surgical excision of NS on the scalp through postoperative outcomes. METHODS:The authors retrospectively reviewed the postoperative cosmetic results of patients with a follow-up period of 12 to 15 months. The variables analyzed were patient demographics, preoperative tumor size, location, operative time, cosmetic results, and complications. RESULTS:This study enrolled 62 patients, including 30 adults and 32 children. The main complications were hair loss, hypertrophic scar, and widening of the scar. The overall complication rate was 17.7%, and the complication rate in children (9/32, 28.1%) was higher than that in adults (2/30, 6.7%) (p < .05). Tumor location, shape, and size showed no association with complications. CONCLUSION:Complications after surgical excision of NS on the scalp are more likely to occur in children than in adults. On the basis of these findings, surgical excision of NS on the scalp can be delayed until after childhood.
背景: 治疗头皮上的痣 (NS) 通常是手术切除，但最佳时机值得商榷。头皮对重建外科医生提出了重大挑战，因为头皮缺乏弹性使得缺损的修复变得困难。 目的: 本研究的目的是通过术后结果探讨头皮上NS手术切除的最佳时机。 方法: 作者回顾性分析了随访 12 ~ 15 个月的患者的术后美容结果。分析的变量包括患者人口统计学、术前肿瘤大小、位置、手术时间、美容结果和并发症。 结果: 本研究纳入了 62 例患者，包括 30 例成人和 32 例儿童。主要并发症为脱发、增生性瘢痕和瘢痕增宽。总的并发症发生率为 17.7%，儿童 (9/32，28.1%) 高于成人 (2/30，6.7%) (p <.05)。肿瘤位置、形状和大小与并发症无关。 结论: 手术切除头皮上的NS后并发症在儿童中比成人更容易发生。根据这些发现，头皮上NS的手术切除可推迟到儿童期后。
METHODS::Blue rubber bleb naevus syndrome (BRBNS) is an extremely rare venous malformation that often manifests as multiple haemangioma-like lesions in the skin and gastrointestinal tract. The drug sirolimus plays a key role in the signalling pathway of angiogenesis and subsequent development of BRBNS and its use has been described in several case reports. We present a case series of four patients with BRBNS who exhibited good treatment response to sirolimus. All four patients were administered oral sirolimus at doses of 1.0-1.5 mg/m2 /day with a target drug level of 5-10 ng/mL and median treatment duration of 20 months. All patients had a reduction in the size of the lesions and a normalization of coagulopathy with tolerable drug adverse reactions at follow-up. Sirolimus may be effective and safe in paediatric patients with BRBNS. Further prospective studies are suggested to evaluate the long-term effectiveness of this drug.
METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.
METHODS::Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.