phenylephrine-hydrochloride and Melanoma

A quarter of cutaneous melanomas occur on the head and neck. Despite close collaboration between the dermatology, oncology, pathology, nuclear medicine and otorhinolaryngology departments, the survival of patients presenting with this type of melanomas remains inferior to that of other parts of the body. The morbidity of head and neck surgery significantly alters the quality of life. Therefore, specific multidisciplinary expertise is required. We present here the specificities of ENT management.. Un quart des mélanomes cutanés se présentent au niveau de la tête et du cou. Malgré une étroite collaboration entre les services de dermatologie, oncologie, pathologie, médecine nucléaire et oto-rhino-laryngologie (ORL), la survie des patients qui présentent ce type de mélanomes reste inférieure à celle des patients ayant un mélanome d’une autre partie du corps. La morbidité d’une chirurgie cervico-faciale modifie significativement la qualité de vie. Ainsi, une expertise spécifique multidisciplinaire est nécessaire. Nous présentons ici les spécificités de la prise en charge ORL des mélanomes cervico-faciaux.

Topics: Ear; Head and Neck Neoplasms; Humans; Melanoma; Nose; Pharynx; Physician's Role; Quality of Life; Skin Neoplasms

Während einfache Defekte auch durch freie Hauttransplantate oder lokale Lappenplastiken rekonstruiert werden können, stellen komplexe dreischichtige Defekte eine Herausforderung für den rekonstruktiv tätigen Chirurgen dar. Diese bezieht sich in erster Linie auf eine suffiziente Wiederherstellung der inneren Nasenauskleidung, ohne die physiologischen Funktionen der Nasenschleimhaut zu kompromittieren. Die Autoren gehen auf verschiedene Rekonstruktionstechniken zur Wiederherstellung der inneren Nasenauskleidung ein. Eine besondere Bedeutung kommt hier dem epithelialen Kipplappen und dem kürzlich erst beschriebenen prälaminierten Stirnhautlappen bei (sub)totalen Nasendefekten zu. Beide haben sich in der Wiederherstellung der inneren Nasenauskleidung als sehr wertvolle und schleimhautschonende Alternativen zu herkömmlichen intranasalen Schleimhautlappen bewährt.

Topics: Carcinoma, Squamous Cell; Cartilage; Composite Tissue Allografts; Esthetics; Humans; Melanoma; Microsurgery; Nasal Cavity; Nasal Mucosa; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps

Fibrous papules present clinically as benign, asymptomatic, dome-shaped, flesh colored papules on the face. Histologically, fibrous papules are characterized by fibrous stroma with fibroblasts and dilated blood vessels. Multiple variants of fibrous papules have been reported. Although scattered multinucleated cells in fibrous papules have been well described, we report a fibrous papule with abundant multinucleated ganglion-like giant cells that were immunoreactive with CD34. Recognition of such fibrous papule variants is important to avoid misdiagnosis as potentially more worrisome and/or aggressive melanocytic, soft tissue, or neural lesions that may require more aggressive treatment. Indeed, fibrous papules do not commonly appear on the differential diagnosis for lesions with multinucleated giant cells or ganglion-like cells and consideration should be given to their inclusion in the appropriate clinical setting.

Topics: Adult; Angiofibroma; CD4 Antigens; Cell Transformation, Neoplastic; Diagnosis, Differential; Giant Cells; Humans; Male; Melanoma; Nose; Risk Factors; Skin Neoplasms

To report on 25 cases of sinonasal melanoma at our institution during 1977 to 1995 and to perform a literature meta-analysis on sinonasal melanoma and study survival statistics.. A retrospective search of pathology and clinical records at our institution to identify patients with sinonasal melanoma; a retrospective search of the English-language literature for cases of documented sinonasal melanoma.. Cases from our institution were included if there was adequate pathologic material confirming the pathologic diagnosis. For the meta-analysis, cases were accepted if they included convincing histologic illustrations or documentation of melanin by Fontana-Masson staining or ultrastructural examination or had an acceptable immunohistochemical profile with some documented clinical follow-up on individual patients.. The following parameters were monitored for patients from our institution: age, sex, possible exposure histories, tumor site, tumor size, type of therapy, clinical outcome, cytochemistry (Fontana-Masson stain), and immunohistochemical profile (S-100, HMB-45, vimentin, cytokeratin). The parameters of the meta-analysis were age, sex, tumor site, and survival data.. Our patient population included 10 men and 15 women aged 23 to 83 years (mean, 65 years). Tumor sites included inferior turbinate, superior nasal cavity, nasal cavity floor/palate, ethmoid sinuses, and maxillary sinus. The immunohistochemical profile was as follows (positive cases): S-100 (14 of .14), HMB-45 (12 of 14), vimentin (9 of 10), cytokeratin (0 of 9). Melanin was demonstrated by Fontana-Masson stain (8 of 8 cases). Follow-up information was available in 25 cases, with follow-up ranging from 1 to 217 months (mean, 39 months). Eleven patients were disease free at 1 to 217 months (mean, 59 months) after excision. Local single recurrences developed in 6 patients at 3 to 84 months (mean, 14 months), and were treated with surgery. Multiple local recurrences were seen in 2 patients. One of them died of disseminated disease, after 2 local recurrences, 60 months after original diagnosis. The other was disease free after 38 months. Ten patients ultimately died of disease within 2 to 60 months after diagnosis (mean, 21 months). Only 2 patients may have developed metastatic disease in the absence of local recurrence. A total of 163 cases were identified from the literature: 53 women, 54 men (56 gender unknown). Stratification by era (pre-1980 vs post-1980) did not reveal any gender differences (pre-1980: 34 women [48%], 37 men [52%]; post-1980: 34 women [55%], 27 men [44%]). However, stratification by era did reveal an age shift toward older patients in the 1980-1995 era. The 5-year median survival for all patients was 36 months. Stratification by era of treatment revealed a long-term survival trend: patients treated before 1980 had somewhat better survival at 60 and 100 months (40% and 36%, respectively) than patients diagnosed and treated between 1980 and 1995 (30% and 23%, respectively), although statistical significance was not reached.. It is unclear why the long-term survival for patients with sinonasal melanoma seems to be decreasing. Despite advances in imaging techniques, which would potentially allow for earlier tumor discovery, and advances in surgical techniques and adjuvant therapeutics, the mean survival for patients with sinonasal melanoma has not improved during the past 15 years.

Topics: Aged; Female; Follow-Up Studies; Humans; Male; Melanoma; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Retrospective Studies; Survival Rate; Time Factors

Complex nasal defects in the distal regions of the nose are cosmetically difficult to repair. In 70 patients over a period of 10 years, defects of the nasal ala and the soft triangle, nasal tip, columella, and columellar-lobular junction were reconstructed with modified auricular composite grafts. A randomized group of 40 of these patients was assessed after a mean of 55.5 months to evaluate the method's functional and cosmetic long-term results. The majority of the patients (60%, N = 48) had been treated primarily for basal cell carcinoma. Of all defects, 57% ( N = 46) measured 2 to 3 cm in width and 43% ( N = 34) 1 to 2 cm. Seventy-five percent ( N = 60) of all defects were composite lesions involving skin, cartilage, and vestibular mucosa, in contrast to 25% ( N = 20) involving skin and cartilage with intact vestibular skin. Two crucial technical modifications seemed to have improved survival for larger grafts: first, the use of hinge flaps from the margins of the defect to obtain a well-vascularized recipient bed and optimization of the raw contact surface; second, postoperative gentle scarification of the graft in combination with a constantly applied heparin solution decongests venous stasis normally seen in such grafts. This maneuver establishes a stable and early blood supply enhancing graft take. With this type of treatment, 67 (84%) grafts healed well without further complications, whereas 13 (16%) grafts developed complications, resulting in partial ( N = 9) and total ( N = 4) necrosis of the transplant. Six of these patients underwent a secondary reconstruction using another auricular composite graft. Long-term results of this method have turned out to be very satisfying in terms of functional and cosmetic outcome and patient acceptance.

Topics: Adolescent; Adult; Aged; Burns; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear Cartilage; Esthetics; Female; Follow-Up Studies; Graft Survival; Humans; Male; Melanoma; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Skin Transplantation; Treatment Outcome; Young Adult

Topics: Globus Sensation; Humans; Melanoma; Nose; Pharynx; Skin Neoplasms

To illustrate a potentially concerning artifact on Optos wide-angle imaging.. Case report.. A healthy 11-year-old girl, with no medical history, was found to have a lightly pigmented superotemporal choroidal tumor, suspicious for melanoma, which was detected on Optos wide-angle imaging by her optometrist. On referral to the retinal specialist, the mass was not visible on funduscopy. B-scan ultrasonography depicted flat retina and no visible mass. Review of the Optos image revealed that the pseudomelanoma represented the patient's nose.. Optos wide-angle imaging provides broad retinal imaging; however, artifacts from patient positioning can lead to the nose artifact.

Topics: Artifacts; Child; Choroid Neoplasms; Female; Fluorescein Angiography; Humans; Melanoma; Nose; Ophthalmoscopy

Topics: Aged; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cryosurgery; Curettage; Female; Humans; Male; Melanoma; Mohs Surgery; Nose; Radiotherapy; Skin Neoplasms

Topics: Aged; Female; Humans; Melanoma; Nose; Skin Neoplasms

Topics: Antineoplastic Agents, Immunological; Biopsy; Chemical and Drug Induced Liver Injury; Humans; Liver; Liver Function Tests; Melanoma; Nivolumab; Nose; Nose Neoplasms; Positron Emission Tomography Computed Tomography; Treatment Outcome; Tumor Burden

Mucosal melanoma is a rare malignant disease developed from melanocyte. We report the case of a patient with nasal cavity mucosal melanoma with a primary clinical and histological diagnosis of malignant lentigo with mucosal spreading. The presence of a c-Kit mutation, in a second lecture and the evolving nature of the lesion, reorientated the diagnosis of malignant lentigo to mucosal melanoma with skin extension. Extensive surgical resection and foramen free flap with costal graft reconstruction may have a local control of the disease. Yet, after one year, a regional evolution involving a parapharyngeal node was treated by stereotaxic radiotherapy. After 5 years, the patient was considered in clinical and radiological remission. Malignant lentigo with mucosal extension is a very rare situation, this diagnoses must be evoqued after setting mucosal melanoma diagnosis.

Topics: Aged; Diagnosis, Differential; Humans; Hutchinson's Melanotic Freckle; Male; Melanoma; Mutation; Nasal Cavity; Nasal Mucosa; Nose; Nose Neoplasms; Photography; Proto-Oncogene Proteins c-kit; Skin Neoplasms

Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result.. We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.. A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred.. In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.

Topics: Adult; Aged; Aged, 80 and over; Blepharoplasty; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyelid Neoplasms; Female; Humans; Male; Melanoma; Middle Aged; Myocutaneous Flap; Nasal Cartilages; Nose; Plastic Surgery Procedures; Respiratory Mucosa; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome; Young Adult

Desmoplastic malignant melanoma (DMM) is a rare and usually misdiagnosed type of melanoma. Delayed detection at complicated anatomical locations can lead to the necessity of alternative therapies.. Characterization of DMM on the nose, which is the second more frequent type of MM.. Review of case series of eight pathologically proven DMM on the nose from two referral centres with a mean follow-up of 69 ± 40.5 months.. According to a single centre experience, there is a more than 70-fold increased risk of having a DMM on the nose compared with a non-DMM (P < 0.0005, CI99% 16.3-317.3). Clinical and pathological misdiagnoses were frequent, only three of the eight cases were properly diagnosed and treated and indeed they did not experience relapses. Due to non-clinical suspicion and superficial biopsies, three cases were initially pathologically misdiagnosed as basal cell carcinomas and a nevus respectively. Atypical vessels and remnants of pigment on dermoscopy are indicative findings even in non-pigmented cases. Although not significant, the mean disease-free survival differed between cases with a correct initial management (four cases, 66.7 ± 57.3 months) in contrast to improper (four cases, 16.25 ± 18.9 months). Electrochemotherapy achieved a complete local control of disease in two cases unsuitable for surgery.. Use of dermoscopy and correctly selected biopsy of lesions on the face is mandatory to improve early diagnosis of DMM. Improper management of challenging cases implies a more complicated therapy and loco-regional invasion risk. Electrochemotherapy could be a promising therapy in local advanced tumours.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Combined Modality Therapy; Electric Stimulation Therapy; Female; Humans; Male; Melanoma; Nose

Topics: Aged; Drug Eruptions; Granuloma, Pyogenic; Humans; Indoles; Male; Melanoma; Nose; Skin Neoplasms; Sulfonamides; Vemurafenib

Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life.

Topics: Carcinoma, Squamous Cell; Child; Face; Humans; Male; Melanoma; Nose; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Design; Skin Neoplasms; Treatment Outcome; Xeroderma Pigmentosum

Topics: Adult; Female; Humans; Melanoma; Nose; Nose Neoplasms

Head and neck melanomas (HNMs) are frequent and have a poorer prognosis than melanomas at other sites. Photoprotection in these locations is difficult. In this population-based study of 279 HNMs diagnosed in a French region between 2004 and 2009, major differences were found between genders. A clearcut, sex-related distribution was found between a "peripheral" area (scalp, forehead, temples, ears, and neck) and a "central" one (other parts of the face), with 56.7% of HNMs being located in the peripheral area in men and 79.3% in the central area in women (P<0.0001). Moreover, HNMs located in the peripheral area occurred on the left side in 57.6% of men and on the right side in 73.1% of women (P=0.009). Peripheral HNMs differed from central HNMs by a higher proportion of invasive tumors, nodular or superficial spreading melanomas, and a lower proportion of lentigo maligna melanomas (LMMs). We hypothesized that this differential distribution between men and women could be explained mostly by a major role of long-term photoprotection by hair and sun exposure in a car. Important public health messages could result from these observations, such as the role of hairstyles in melanoma prevention and the importance of reducing sun exposure in a car, particularly in professional drivers.

Topics: Adult; Aged; Aged, 80 and over; Automobiles; Cheek; Ear; Female; Forehead; Hair; Head; Head and Neck Neoplasms; Humans; Incidence; Male; Melanoma; Middle Aged; Neck; Neoplasms, Radiation-Induced; Nose; Registries; Retrospective Studies; Sex Factors; Skin Neoplasms; Ultraviolet Rays

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics.

Topics: Aged; Epistaxis; Esthetics; Humans; Male; Maxillary Sinus; Melanoma; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nasopharyngeal Neoplasms; Nose; Nose Neoplasms; Sphenoid Sinus; Turbinates

Topics: Aged; Carcinoma, Squamous Cell; Forehead; Humans; Lip; Male; Melanoma; Nose; Nose Neoplasms; Surgical Flaps

The occurrence of neoplasms in injury scars--as consequence of occupational accidents--may lead to compensation according to the statutory accident insurance regulations. According to newer regulatory attempts in occupational dermatology, certain criteria have to be met before the diagnosis of a neoplasm induced by a scar is accepted and compensation is due.. Based on a retrospective analysis of 217 dermatological claim files between 2007 and 2009 of the IPA (including 22 follow-ups), medical opinions on neoplasms developing in possible occupational scars were re-evaluated using criteria of the German social accident insurance and the Bamberg medical bulletin, part II (Bamberger Merkblatt, BM II) to see how well they qualified for recognition as an occupational or accident-related disorder.. Three cases were identified where a neoplasm was suspected of having developed in an occupationally-related scar. One of the insured events entitled for compensation. Following the guidelines of the BM II, this case was approved as an occupational disease secondary to injuries with resultant reduction in earning capacity, whereas the others did not meet the requirements.. Two problems in evaluating malignant tumors in occupational scars are the long latency period and the documentation of a scar. The tumor excision specimen should be histologically re-examined to document the presence of an associated scar.

Topics: Accidents, Occupational; Arm Injuries; Burns; Carcinoma in Situ; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Cicatrix; Expert Testimony; Germany; Head and Neck Neoplasms; Humans; Insurance, Accident; Melanoma; Nose; Nose Neoplasms; Retrospective Studies; Skin; Skin Neoplasms; Workers' Compensation

Primary sinonasal malignant melanoma (SNMM) is a rare clinical entity. There is neither a classification nor a staging system nor an evidence-based treatment concept established. Our objective was to find potential risk factors predicting the outcome.. Twenty-five patients with histologically confirmed SNMM were consecutively included and retrospectively analyzed. Staging methods were nasal endoscopy, CT, MRI, and positron emission tomography (PET) scan. Patients were selected for a curative or palliative concept. All patients had postoperative follow-up with control-MRI at 3 and 6 months. Restaging was performed when local recurrence occurred.. Nineteen patients underwent primary surgery with curative intention; in 16 cases with tumor free margins. Thirteen patients (68%) had transnasal endoscopic surgery, 4 lateral rhinotomy, and 2 transfacial approach with orbital exenteration. Six patients (32%) had palliative therapy and 7 patients (37%) had adjuvant radiotherapy. Despite radical operations, 6 patients (37%) showed local recurrence and 8 patients (50%) developed distant metastasis. In 2 patients with incomplete surgery, regional metastasis was noted. The median disease-free interval was 18 months, and the median overall survival rate was 23 months.. SNMMs of the ethmoid and maxillary sinuses have a worse prognosis than other localizations in the nasal cavity; infiltration into the skull base, orbit, or facial soft tissue correlates with a very poor outcome corresponding to the palliative situations. Furthermore, local recurrence insinuates aggressive disease with short survival rate. A main difference from its cutaneous counterpart seems to be a primary tendency to hematogenic spread. Further research is needed to confirm these findings.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Diagnostic Imaging; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Melanoma; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Palliative Care; Paranasal Sinus Neoplasms; Paranasal Sinuses; Radiotherapy, Adjuvant; Retrospective Studies

The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease.. Retrospective chart review.. Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps.. This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009.

Topics: Adult; Bone Transplantation; Female; Humans; Intraoperative Complications; Magnetic Resonance Angiography; Male; Mandibular Injuries; Maxilla; Melanoma; Middle Aged; Nose; Palatal Neoplasms; Reoperation; Suicide, Attempted; Surgical Flaps; Tissue and Organ Harvesting; Ultrasonography, Doppler; Venous Thrombosis; Wounds, Gunshot

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Topics: Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Immunotherapy; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Melanoma; Middle Aged; Mucous Membrane; Neoplasm Staging; Nose; Nose Neoplasms; Orbit; Orbit Evisceration; Orbital Neoplasms; Palliative Care; Quality of Life; Radiotherapy, Adjuvant; Retrospective Studies; Survival Analysis; Time Factors; Tomography, X-Ray Computed

Heterologous differentiation is exceedingly rare in melanoma. Only four cases of melanoma demonstrating exclusive cartilaginous differentiation have been documented, all having occurred on the lower extremity. We report a chondroid melanoma involving the nasal skin and presenting clinically as a basal cell carcinoma. Both Melan-A and microphthalmia transcription factor protein immunoperoxidase stains were positive in our case, demonstrating the potential utility of these two stains in chondroid melanoma. We also provide a succinct review of the literature on this rare melanoma variant.

Topics: Carcinoma, Basal Cell; Diagnosis, Differential; Female; Humans; Melanoma; Middle Aged; Nose; Skin Neoplasms

The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease.

Topics: Aged; Biopsy; Combined Modality Therapy; Epistaxis; Female; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Maxillary Sinus Neoplasms; Melanoma; Nasal Obstruction; Nose; Nose Neoplasms; Prognosis; Tomography, X-Ray Computed

The treatment of lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging due to lesion location, size, patient age, and potential for recurrence and spread. The largest studies to date confirm that for melanocytic tumours, MMS provides high local control rates while minimizing tissue loss. Herein we report our local control rate for melanoma treated by MMS over a decade.. Charts were reviewed on all patients with melanocytic tumors treated by a single physician (JPA) using MMS over the time period of 1993-2002. Demographic, surgical and pathological details were recorded. Patients were followed for local, regional and distant recurrences.. The patient population was comprised of 199 patients with 202 melanomas. There were 69 invasive lesions, with a mean Breslow depth of 0.92 mm (0.2-3.6 mm). The mean number of levels required to clear the lesions was 2.7 (1-7), resulting in a mean defect size of 11.8 cm2 (0.9-70.7 cm2). Patients with LMM were significantly older (73.2 vs. 66.5 yrs, p = 0.012) and had larger defects after MMS (16.74 cm2 vs. 10.27 cm2) than patients with LM. At a mean follow-up of 29.8 months, there were no local recurrences, four regional recurrences, and two distant recurrences.. MMS is an effective modality for the clearance of melanocytic tumors.

Topics: Adult; Aged; Aged, 80 and over; Cheek; Female; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Male; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Recurrence, Local; Nose; Skin Neoplasms; Treatment Outcome

Reconstruction of isolated nasal lining defects can be extraordinarily daunting. This report defines the uniqueness of the surgical challenges inherent to reconstruction of the nasal lining and overviews the authors' approach to management.. A retrospective review was performed of 11 consecutive patients presenting for reconstruction of the nasal lining alone during the period from October of 1996 through March of 2003. There were four men and seven women with an average age of 49.2 years. The average follow-up was 4.2 years.. Five patients required reconstruction of the total nasal lining (floor, columella, vestibule), and the remaining reconstructions involved subtotal components. Coincidental necrosis of the nasal lining during total/subtotal nasal reconstruction was the most common cause. A single microsurgical free flap was used in eight patients (six radial forearm flaps). Three patients required two free flaps. There were no flap failures. Thirteen of 14 free flaps healed primarily. Dehiscence of the flap/nasal septal juncture occurred in one cocaine-injured nose. Ten of 11 patients demonstrated patent, functional nasal airways postoperatively.. Reconstruction of the nasal lining, alone, is a very challenging endeavor that demands careful surgical planning and precise technical execution. The use of microsurgical transfer for these defects allows considerable latitude for duplication of the missing complex three-dimensional anatomy and avoids sullying the adjacent facial soft tissues. Because of the adverse condition of the local tissues, the majority of these cases could not have been brought to a successful conclusion without the use of free tissue transfer, and this is particularly relevant in the cocaine-injured nose.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cocaine-Related Disorders; Female; Granuloma; Humans; Lip; Male; Melanoma; Microsurgery; Middle Aged; Nasal Mucosa; Nasal Obstruction; Nasal Septum; Necrosis; Neoplasm Recurrence, Local; Nose; Nose Diseases; Nose Neoplasms; Pemphigus; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Surgical Flaps

Topics: Adult; Aged; Biocompatible Materials; Carcinoma, Basal Cell; Chondroitin Sulfates; Collagen; Female; Humans; Male; Melanoma; Middle Aged; Nose; Nose Neoplasms; Skin Transplantation; Skin, Artificial; Wound Healing

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Diagnosis, Differential; Female; Hidrocystoma; Humans; Melanoma; Nevus, Blue; Nose; Skin Neoplasms

Non-ocular melanoma is considered to be a rare neoplasm in cats; however, more than 150 cases have been reported in the literature since 1961. The objective of this study was to characterise this tumour better by evaluating case outcome and survival data for cats with melanoma and to compare clinical and histopathological findings with those of previous reports. Twenty-three feline non-ocular melanomas were identified, the most common locations being the nose, digit and pinna. Cats with digital melanomas had survival rates similar to their canine counterparts. Histological assignation of benignity, malignancy or junctional activity was not found to be an accurate predictor of clinical behaviour. Melanoma should be considered as a differential diagnosis for cats presenting with pigmented or non-pigmented masses and histopathology is essential for definitive diagnosis, as other tumours may clinically appear quite similar. Regular follow-up examinations are recommended indefinitely for benign or malignant feline melanomas.

Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Ear; Female; Male; Melanoma; Nose; Records; Retrospective Studies; Skin Neoplasms; Toes

Topics: Aged; Humans; Male; Melanoma; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

The nose is particularly vulnerable to cutaneous malignancies, making it the most common location for presentation. Recurrence of these cutaneous lesions is not uncommon, often compromising the timing of nasal restoration. It is the purpose of this report to reexamine the safety of primary nasal reconstruction in selected patients.. Seventy-one patients who underwent nasal reconstruction at The University of Texas M. D. Anderson Cancer Center between 1987 and 1995 were retrospectively reviewed. There were 35 men and 36 women with an average age of 60 years. All nasal reconstructions were performed for defects secondary to malignancies. Basal cell carcinoma was the most common lesion (n = 49), followed by squamous cell carcinoma (n = 10) and melanoma (n = 7), with five additional variable malignancies. The most common location of the cutaneous lesions was the nasal dorsum, and the forehead flap was the most common adjacent tissue used for reconstruction. Immediate reconstruction was performed for 42 of the basal cell carcinomas, 6 of the squamous cell carcinomas, 6 melanomas, and 3 other lesions. Delayed restoration was performed for 7 basal cell carcinomas, 4 squamous cell carcinomas, 1 melanoma, and 2 additional lesions. The average time between surgical extirpation and the start of nasal reconstruction was 8.2 months for basal cell carcinoma, 29 months for squamous cell carcinoma, and 10 months for melanoma.. Twenty-six recurrent lesions were identified at an average of 36 months after extirpation. Despite these numbers, only three recurred after nasal reconstruction at our institution. Follow-up averaged 41 months, with none less than 1 year. Seventy patients are still alive with no evidence of disease.. Primary reconstruction is safe in selected patients. Surgical delay in reconstruction should be considered if margins are questionable, the pathology is determined to be aggressive, if there is perineural or deep bony invasion, or if postoperative radiotherapy is to be initiated. Nasal reconstruction ultimately is based upon a complex series of issues but can be performed with few complications in an effort to restore self-image.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Disease-Free Survival; Evaluation Studies as Topic; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Nose; Prognosis; Retrospective Studies; Risk Factors; Skin Neoplasms; Surgery, Plastic; Surgical Flaps; Survival Rate

We studied 722 reexcision scars of benign and malignant lesions (except melanocytic lesions) excised over a 24-month period. The formalin-fixed, paraffin-embedded tissue sections were examined histologically and immunohistochemically. The histological features of melanocytic hyperplasia were present in 59 cases (8%), 56 from the sun-exposed skin of the face and neck and three from the trunk [p < 0.00001]. The most common sites were the nose and lower eyelids, but the forehead was also frequently involved. Of the 59 patients, 41 were women (p < 0.0001). Basal cell carcinoma was the most frequent original lesion in both sexes (80%). No melanocytic hyperplasia was found in 663 cases (298 on the trunk and extremities and 365 on the head and neck). We have seen this reaction pattern following reexcision of melanocytic lesions as well. Thus, interpreting reexcision margins when lentigo maligna or similar lesions are reexcised may be fraught with difficulty. It is important for pathologists and dermatopathologists to recognize this phenomenon because histologically the presence of increased numbers of large melanocytes could be misinterpreted as melanoma in situ.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Child; Cicatrix; Eyelids; Face; Female; Forehead; Humans; Hutchinson's Melanotic Freckle; Hyperplasia; Immunohistochemistry; Male; Melanocytes; Melanoma; Middle Aged; Neck; Nose; Sex Factors; Skin Neoplasms; Sunlight

Topics: Adult; Bone Plates; Bone Transplantation; Carcinoma, Squamous Cell; Cartilage; Female; Follow-Up Studies; Humans; Male; Melanoma; Middle Aged; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Neoplasms; Parietal Bone; Rhinoplasty; Titanium

With previous prosthetic restorations of bilateral maxillary resections, tissue erosion and bleeding on the cephalic parts of the cavity have been caused by movement and pressure from the prosthesis. Retention of a prosthesis is a major determinant in its successful use. Physical and psychologic stresses are common when one is unable to use a prosthesis comfortably. The use of a musculocutaneous flap and an obturator prosthesis had provided near-immediate reconstruction of a massive midfacial defect. This method of reconstruction resulted in soft tissue replacement for appearance and functional rehabilitation of the upper lip while maintaining sound oncologic principles.

Topics: Adult; Bone Nails; Humans; Magnetics; Male; Maxillary Sinus Neoplasms; Maxillofacial Prosthesis; Melanoma; Nose; Nose Neoplasms; Palatal Neoplasms; Palatal Obturators; Prostheses and Implants; Prosthesis Failure; Prosthesis Fitting; Surgery, Plastic; Surgical Flaps

Midfacial degloving can be characterized as an alternative surgical approach for exposing the bony structures of the midface. In combination with transient partial osteotomies the nasal cavities, the paranasal sinuses, the pterygopalatine fossa and the posterior parts of the anterior skull base are easily accessible. Using an intercartilaginous, a transseptal and a circumvestibular incision in the nose and a vestibular incision in the oral cavity the soft tissues of the upper face are mobilized and transposed cranially up to the infraorbital rim, the nasion and the lacrimal sac. Thus one can avoid scar formations in the face. In comparison with the common visible incisions in the face a bilateral exposure of midline structures is possible. The resected bone can be easily replaced and fixed with titanium miniplates for osteosynthesis. The soft tissue glove is replaced. A correct suture technique for readaptation especially in the nasal cavity is most important to avoid a circular stenosis of the nasal aperture. Between 1986 and 1991, 40 patients with various tumors (juvenile angiofibroma, inverted papilloma, esthesioneuroblastoma, squamous cell carcinoma of the maxillary sinus, benign tumors of the pterygopalatine fossa, clivus chordoma) underwent this procedure. Neoplasms and fractures of the anterior frontal skull base, the frontal sinus, the orbital cavity and the zygoma were less accessible due to the unsatisfactory exposure of these regions. Complications and side effects were rare. In five cases, a transient paresthesia of the infraorbital nerve and a facial edema were observed. In one case, a circular stenosis of the nasal aperture required a second plastic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenoma; Carcinoma; Fibroma; Hemangioma; Humans; Melanoma; Neoplasm Staging; Neurilemmoma; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Plasmacytoma; Postoperative Complications; Precancerous Conditions

After 15 years of experience and 50 cases, we think that the axial frontonasal flap is of great value for the repair of large skin defects of the nose. This flap mobilizes all the skin cover of the nose located above the defect and the adjacent frontal skin and rotates it on a vascular pedicle existing at the level of the inner canthi. The excess of skin of the glabella is then transferred to the nose, and this large flap allows coverage of the defect without tension or distortion. The long-term results are very good, with a hardly visible repair in 26 of 50 patients, the long scar being very well hidden at the periphery of the nose.

Topics: Adult; Aged; Carcinoma, Basal Cell; Face; Female; Humans; Male; Melanoma; Middle Aged; Nevus, Pigmented; Nose; Nose Neoplasms; Skin; Surgical Flaps

Topics: Adult; Aged; Amputation, Surgical; Carcinoma, Squamous Cell; Female; Humans; Male; Melanoma; Middle Aged; Nasal Septum; Nose; Nose Neoplasms; Prostheses and Implants

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Cheek; Child; Face; Facial Neoplasms; Female; Fibrosarcoma; Fistula; Humans; Male; Melanoma; Middle Aged; Mouth Neoplasms; Nose; Nose Deformities, Acquired; Surgical Flaps

This method of fabrication of an immediate nasal prosthesis has distinct advantages which recommend its use. These are (1) the use of an RTV silicone rubber impression as the refractory cast cuts fabrication time to minutes rather than hours, as compared with other methods of fabricating a nasal prosthesis; (2) the RTV silicone is permanent and stable and provides an exact reproduction of the part to be excised; (3) the initial RTV silicone impression may be used during fabrication of the definitive prosthesis as the mold for production of a wax sculpting model; (4) PVC prostheses offer a unique advantage of being soft enough for trimming with scissors at the time of surgery and are flexible and tissue-compatible; and (5) psychological trauma is minimized and the patient is better prepared for a definitive prosthetic restoration.

Topics: Aged; Humans; Male; Melanoma; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Polyvinyl Chloride; Prostheses and Implants; Prosthesis Design; Silicone Elastomers

Topics: Carcinoma, Squamous Cell; Cystadenoma; Epithelial Cells; Epithelium; Humans; Melanocytes; Melanoma; Nasopharyngeal Neoplasms; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Papilloma

Topics: Adult; Ethmoid Bone; Face; Fractures, Bone; Humans; Male; Melanoma; Mucocele; Neck; Nose; Optic Neuritis; Orbit; Orbital Neoplasms; Postoperative Complications; Rhinitis

Electron microscopic examination of malignant melanoma tumour tissue taken from a patient who has survived with the tumour without metastases for 13 years has shown spherical melanosomes with no internal fibrillar structure. This finding and other cell features described, suggest that this melanoma developed from Dubreuilh's melanosis rather than melanocytic change in a junctional naevus.

Topics: Adolescent; Cell Nucleus; Female; Humans; Melanocytes; Melanoma; Nasal Cavity; Nevus, Pigmented; Nose; Nose Neoplasms; Organoids; Precancerous Conditions; Vacuoles

Topics: Adult; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Eyelid Neoplasms; Eyelids; Face; Humans; Male; Melanoma; Methods; Middle Aged; Neck; Nose; Orbit; Skin Transplantation; Surgery, Plastic; Sutures; Transplantation, Autologous

Topics: Burns; Contracture; Ear; Extremities; Eyelids; Hand Injuries; Humans; Melanoma; Nose; Pressure Ulcer; Radiation Injuries; Surgery, Plastic; Wounds and Injuries

Topics: Child; Hemangioma; Humans; Melanoma; Neoplasm Metastasis; Neuroblastoma; Nose; Nose Neoplasms; Rhinosporidiosis; Tuberculosis

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Melanoma; Nose; Nose Neoplasms

Topics: Humans; Melanoma; Nasal Cavity; Nose; Paranasal Sinuses

Topics: Humans; Melanoma; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Humans; Medical Records; Melanoma; Nasal Cavity; Nasopharyngeal Neoplasms; Nasopharynx; Neoplasms; Nose; Paranasal Sinus Neoplasms

Nevi are the most common tumors of childhood. Pigmented nevi are classified into blue nevi, intraepidermal nevi, junction nevi, intradermal nevi (or common mole) and combination types. Cutaneous malignant disease in children is rare. Malignant melanoma is rare before puberty. Wholesale removal of benign pigmented nevi in children should be condemned. However, junction nevi located on the palms, soles, genitalia or waistline-that is, in areas subject to frequent trauma-should be excised. Hemangiomas in infants are the most common tumors for which advice is sought. Not all hemangiomas regress spontaneously, and on occasion the persistence or progression of such a lesion may bring about life-long unsightly deformities. Therapy for this type of tumor is simple when given early in life. Hemangiomas involving the ears, nose, lips or eyelids should be treated at once, preferably within a month of the time they appear.

Topics: Administration, Cutaneous; Child; Disease Progression; Eyelids; Foot; Hemangioma; Humans; Infant; Lip; Melanoma; Nevus; Nevus, Blue; Nevus, Epithelioid and Spindle Cell; Nevus, Intradermal; Nevus, Pigmented; Nose; Skin Neoplasms

Topics: Humans; Medical Records; Melanoma; Nose; Nose Neoplasms

Topics: Ear, External; Humans; Melanoma; Nasal Cavity; Neoplasms; Nose; Paranasal Sinus Neoplasms

Topics: Humans; Melanoma; Nose

Topics: Humans; Melanoma; Nose; Nose Neoplasms

Topics: Humans; Melanoma; Nose; Paranasal Sinuses

Topics: Humans; Melanoma; Neoplasms; Nose; Nose Neoplasms

Topics: Humans; Melanoma; Mucous Membrane; Nasal Mucosa; Nose

Topics: Humans; Melanoma; Nose