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The Best of the Best
June 20, 2011

Top Accessed Article: Ganglion of the Distal Interphalangeal Joint (Myxoid Cyst)

Author Affiliations

Author Affiliation: Department of Dermatology, Henry Ford Health System, Detroit, Michigan.

Arch Dermatol. 2011;147(6):678. doi:10.1001/archdermatol.2011.93

de Berker D, Lawrence C. Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid. Arch Dermatol. 2001;137(5):607-610.

De Berker and Lawrence present an innovative, minimally traumatic, surgical treatment of digital myxoid cysts (DMCs). Traditionally, these benign lesions, also considered ganglions of the distal interphalangeal joint (DIPJ), have been treated by puncture and drainage, cryosurgery, and surgical excision, all with varying cure rates.

In an open, nonrandomized trial of therapy, the authors evaluated a novel technique that allowed them to visualize the connection (in 90% of cases) between the DMC and the DIPJ during the procedure by injecting methylene blue dye into the DIPJ. The visible connection was destroyed with suture ligation or electrocautery, and the cyst contents were evacuated without any skin being excised. Fifty-four cysts were treated, of which 47 were on the fingers and 7 were on the toes. At 8 months, 48 of 54 patients (89%) remained cured, although the outcomes varied depending on the location of the cyst; the cure rate on the fingers was 94% compared with 57% on the toes.

The authors elegantly describe and visually demonstrate a minimally traumatic surgical technique with good outcomes. Dermatologists can use this technique for the in-office treatment of DMCs.

From August 2009 through August 2010, this article was viewed 2155 times on the Archives of Dermatology Web site.

Contact Dr Nallamothu at Department of Dermatology, Henry Ford Health System, 3031 W Grand Blvd, Detroit, MI 48202 (pnallam1@hfhs.org).