Differences in Biopsy Techniques of Actinic Keratoses by Plastic Surgeons and Dermatologists: A Histologically Controlled Pilot Study
Objective: To compare differences in biopsy techniques of actinic keratoses between dermatologists and plastic surgeons.
Design: Blinded, comparative, retrospective study.
Setting: Dermatopathology laboratory at a major academic medical center with referral of outside cases.
Intervention: We reexamined the histopathologic slides of 405 actinic keratosis biopsy specimens obtained by plastic surgeons and dermatologists from January 1, 1992, through May 31, 2002. We were specifically interested in the type of biopsy technique (shave, punch, or excisional biopsy) used for the surgical management of actinic keratoses by both groups of physicians. We also recorded the clinical diagnoses rendered on the dermatopathology request form and compared them with the histopathologic diagnoses.
Results: Excisional biopsies were performed by plastic surgeons in 50.0% of the cases, compared with only 1.4% by dermatologists. In contrast, shave biopsies of actinic keratoses were performed by plastic surgeons in only 32.4% of the cases, compared with 89.4% by dermatologists. Only 1 (0.5%) of the 198 dermatopathology request forms submitted by the plastic surgeons mentioned actinic keratosis, compared with 82 (39.6%) of 207 histopathologic evaluation requests submitted by dermatologists.
Conclusions: The predominance of excisional biopsies of actinic keratoses by plastic surgeons may be related to a different ability in the clinical recognition of actinic keratoses compared with that of dermatologists. The surgical approach of dermatologists to shave diagnostically uncertain cutaneous lesions is less invasive than that of plastic surgeons and is more likely to achieve a better cosmetic outcome.
Sellheyer K, Bergfeld WF
Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature
Objective: To determine the diagnostic accuracy and usefulness of sentinel lymph node biopsy (SLNB) and computed tomographic scans in the initial evaluation and treatment of patients with Merkel cell carcinoma (MCC).
Design: Single-institution case series and literature-based case-level meta-analysis.
Setting: Academic cutaneous oncology clinic.
Patients: Sixty-one adults with biopsy-proven MCC (30 who had undergone SLNB) plus 92 cases from the literature of patients who had undergone SLNB.
Main Outcome Measures: Relapse-free survival.
Results: In 122 patients with no nodal disease found by physical examination, SLNB findings revealed nodal involvement in 39 cases (32%). At 3 years, the recurrence rate for those with a positive SLNB was 3 times (60%) higher than for those with a negative SLNB (20%; P = .03). Patients with a positive SLNB who received adjuvant nodal therapy had a relapse-free survival rate of 51% at 3 years (n = 26) compared with 0% for patients who did not receive nodal therapy (n = 3; P<.01). In contrast, among patients with a negative SLNB there was no significant difference in 3-year relapse-free survival rates for those who did (90%; n = 24) or did not (70%; n = 19; P = .26) receive adjuvant nodal therapy. Using SLNB plus clinical follow-up as a gold standard, computed tomographic scans had low sensitivity (20%) for detecting MCC that had spread to the lymph node basin and low specificity for distant disease (only 4 of 21 “positive” scans were confirmed during 6 months of follow-up).
Conclusions: Sentinel lymph node biopsy detects MCC spread in one third of patients whose tumors would have otherwise been clinically and radiologically understaged and who may not have received treatment to the involved node bed. There was a significant benefit of adjuvant nodal therapy, but only when the SLNB was positive. Thus, SLNB is important for both prognosis and therapy and should be performed routinely for patients with MCC. In contrast, computed tomographic scans have poor sensitivity in detecting nodal disease as well as poor specificity in detecting distant disease.
Gupta SG, Wang LC, Penas PF, Gellenthin M, Lee SJ, Nghiem P
Comparison of Stage at Diagnosis of Melanoma Among Hispanic, Black, and White Patients in Miami-Dade County, Florida
Objective: To compare stage at diagnosis of melanoma between non-Hispanic white, non-Hispanic black, and Hispanic patients.
Design: Retrospective analysis.
Setting: Melanoma cases reported to the Florida Cancer Data System, with known stage and race/ethnicity information, for residents of Miami-Dade County, Florida, from 1997 to 2002.
Patients: Those diagnosed as having melanoma according to the Florida Cancer Data System.
Main Outcome Measure: Stage of melanoma at diagnosis.
Results: Of the 1690 melanoma cases reported with both stage and race/ethnicity information, 1176 (70%) were among non-Hispanic white patients, 485 (29%) were among Hispanic patients of any race, and 29 (2%) were among non-Hispanic black patients. Late-stage (regional and distant) diagnosis was more common among Hispanic (26%) and non-Hispanic black patients (52%) compared with non-Hispanic white patients (16%) (P<.001).
Conclusion: Advanced stage of melanoma diagnosis among Hispanic and black patients suggests suboptimal secondary prevention efforts in minority populations.
Hu S, Soza-Vento RM, Parker DF, Kirsner RS
Temporary Eyelid Closure Applique
Tarsorrhaphy is used for the treatment of severe ocular surface disorders and for damage from ocular exposure. The temporary tarsorrhaphy has been shown to aid in the healing of corneal epithelial defects. A variety of temporary techniques have been suggested that allow eyelid closure not only to enable epithelial healing but also to allow access to the eye. We describe a temporary eyelid closure applique, similar to the Stamler eyelid splint, that provides nearly complete closure of the eyelid that will last for days. The technique is inexpensive, can be applied by a family member with minimal training, and can be used in almost any setting.
Robinson C, Tantri A, Shriver E, Oetting T
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2006;8(6):437-438. doi: