Jorge Garcia-Zuazaga, MD, MS; Malcolm Ke, MD; Director, Mohs Micrographic Surgery, University Hospitals Westlake Medical Center, Department of Dermatology, Case Western Reserve University, Cleveland, Ohio

Patrick Lee, MD, Division of Dermatology, University of California Los Angeles, Los Angeles, California

Abstract
Keratoacanthomas are fast-growing, solitary, cutaneous neoplasms that usually show spontaneous regression. The development of giant variants and aggressive behavior have been described. Clinically, a keratoacanthoma larger than 20 to 30mm is classified as a giant keratoacanthoma. A major challenge in dealing with these neoplasms is the difficulty of clinically and histologically differentiating them from squamous cell carcinoma. The authors report a practical approach using Mohs micrographic surgery for evaluation of large tumors. With this method, the lateral margins are evaluated and cleared prior to excision of the bulk of the tumor. The authors also describe alternative therapies for giant keratoacanthomas and present a case of a 61-year-old woman with a rapidly growing tumor on her left arm. Skin biopsy was consistent with a well-differentiated squamous cell carcinoma with focal features of a keratoacanthoma. The patient underwent Mohs micrographic surgery using the described approach, and no recurrence has been noted in four years. Surgical excision remains the treatment of choice for giant keratoacanthomas. Mohs micrographic surgery is a logical treatment option for giant keratoacanthomas. This case illustrates a useful approach that may prove valuable when treating large specimens during Mohs micrographic surgery.  (J Clin Aesthetic Dermatol. 2009;2(8):22–25.) Read the rest of this article »

James Q. Del Rosso, DO, FAOCD, Valley Hospital Medical Center, Las Vegas, Nevada

Abstract
Acne vulgaris is the most common disorder encountered in ambulatory clinical practice comprising 11.3 percent of office visits to dermatologists in 2005.[1] By comparison, eczematous dermatoses, psoriasis, and skin cancer accounted for 6.2, 3.5, and 10 percent of office visits, respectively.[1] A variety of topical therapeutic options are available for treatment of acne vulgaris, including benzoyl peroxide, antibiotics, retinoids, azelaic acid, and sodium sulfacetamide-sulfur.[2,3] Sodium sulfacetamide 10%-sulfur 5% has been used for the topical treatment of seborrheic dermatitis, acne vulgaris, and rosacea since the mid-1950s and is available in a variety of formulations, including lotions, creams, cleansers, and emollient foams.[4] Recently, an emollient foam sodium sulfacetamide 10%-sulfur 5% formulation indicated for topical therapy of acne vulgaris, rosacea, and seborrheic dermatitis has become available.[5] This article provides an overview of the sodium sulfacetamide 10%-sulfur 5% emollient foam and reports the results of a case report series of patients with acne vulgaris treated with sodium sulfacetamide 10%-sulfur 5% emollient foam as monotherapy or in combination with other topical acne products.

(J Clin Aesthetic Dermatol. 2009;2(8):26–29.) Read the rest of this article »

Heather J. Higgins, DO; Melissa Voutsalath, DO; Jean M. Holland, MD
Oakwood Southshore Medical Center, Trenton, Michigan

Abstract
Muir-Torre syndrome is an autosomal dominant genodermatosis associated with sebaceous neoplasms and visceral malignancies. Characteristic sebaceous neoplasms include sebaceous adenoma, sebaceous carcinoma, sebaceoma, and keratoacanthoma with sebaceous differentiation. The most common visceral malignancies are colorectal and genitourinary tumors. Investigations into the molecular genetics of Muir-Torre Syndrome have revealed an association with germ-line mutations in hMSH2 and hMLH1 genes. The clinical and histological features of a patient with Muir-Torre syndrome who had two sebaceous adenomas, multiple basal cell carcinomas, and frontal bossing in association with colon cancer are presented in this report.

(J Clin Aesthetic Dermatol. 2009;2(8):30–32.) Read the rest of this article »

Susun Bellew, DO; James Q. Del Rosso, DO, FAOCD; Valley Hospital Medical Center, Las Vegas, Nevada;

Narciss Mobini, MD; University of Nevada School of Medicine, Las Vegas, Nevada

Abstract
Primary carcinosarcoma is a very rare neoplasm comprising two intermingling malignant components—epithelial and mesenchymal. The authors report a new case of primary cutaneous carcinosarcoma involving the helix of the ear. Immunohistochemical analysis revealed epithelial components of both basal cell and squamous cell carcinomas with a partially ossified sarcomatous-like component.

(J Clin Aesthetic Dermatol. 2009;2(8):33–35.) Read the rest of this article »

Leonid Izikson, MD; Evelyn Lilly, BA
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Abstract
Primary varicella zoster infection in adults and immunocompromised persons may result in serious complications. For this reason, a speedy and accurate diagnosis is essential to prevent life-threatening sequelae. Primary varicella presents as a vesicular exanthem with fevers and other constitutional symptoms. The differential diagnosis of primary varicella zoster infection comprises several other important entities, including smallpox infection, which should be considered before definitive diagnosis of varicella is made. Here, the authors describe an immunocompetent adult with primary varicella infection and review the literature on its clinical presentation and treatment. (J Clin Aesthetic Dermatol. 2009;2(8):36–38.) Read the rest of this article »

Grace K. Kim, DO; Dermatology Research Fellow, Mohave Skin & Cancer Clinics, Las Vegas, Nevada

James Q. Del Rosso, DO, FAOCD; Dermatology Residency Director, Valley Hospital Medical Center, Las Vegas, Nevada, and Dermatology Research Director, Mohave Skin & Cancer Clinics, Las Vegas, Nevada

Susun Bellew, DO; Dermatology Resident (PGY-3), Valley Hospital Medical Center, Las Vegas, Nevada

Abstract
Since the 1960s, basal cell carcinoma and squamous cell carcinoma among the Caucasian population have increased 3 to 8 percent annually. Although Asians display relative protection from basal cell carcinoma and squamous cell carcinoma, incidence rates of these nonmelanoma skin cancers have been increasing over the past three decades. With changing demographics and a steady rise in the minority population in the United States, there is an increased need for further studies of cutaneous malignancies within Asian and other ethnic populations. This article reviews nonmelanoma skin cancers in the Asian population with an insight into contributing factors, such as skin type, occupation, cultural practices, and genetic components.

(J Clin Aesthetic Dermatol. 2009;2(8):39–42.) Read the rest of this article »

An informational newsletter for pediatricians

Atopic Dermatitis

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