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A significant proportion of vitiligo patients are children. Systemic PUVA therapy, the most consistently effective and practical therapy for this disease, has not been recommended in pediatric patients because of concerns regarding potential long-term side effects. We report a 9-year-old Caucasian girl with progressive vitiligo who was successfully treated with bath PUVA. This form of PUVA therapy may provide a wider margin of safety, in that less exposure to ultraviolet A (UVA) radiation is required and systemic absorption of psoralen is minimal.

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Local skin flaps are an integral part of the dermatologic surgeon's reconstruction efforts. An understanding of the basic categories of flaps and their characteristics is essential. This article reviews the broad categories of flaps and common examples of each.

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Mohs surgery is a well-established surgical technique that involves conservative, microscopically guided excision of malignant lesions, thereby sparing the maximum amount of normal surrounding tissue. Current surgical therapy for oral cancer frequently involves resection with wide margins, resulting in significant cosmetic and functional deficits. This pilot study used the Mohs technique for in situ fixation and excision of maxillary and mandibular bone in mongrel dogs. Histologic examination of the excisional sites was carried out at 8 weeks to examine changes in the surrounding bone, periodontal ligament, and dental pulp of adjacent teeth. The findings suggest that zinc chloride fixative paste does not result in destruction of the dental pulp or surrounding dentoalveolar bone of teeth in the vicinity of a fixed-tissue excision. The Mohs fixed-tissue technique may allow preservation of oral structures that would otherwise be sacrificed in the presence of bony tumor involvement.

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We describe a patient with both Muir-Torre syndrome and alpha 1-antitrypsin deficiency. A keratoacanthoma developed after immunosuppressive therapy for necrotizing vasculitis. To our knowledge, this is the first reported case of Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency.

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Recently, magnetic resonance imaging (MRI) has been reported to be clinically useful, in selected cases, in patients with melanocytic skin lesions. This report describes good resolution, clinically useful MRI scans of squamous cell carcinoma, dermatofibroma, and primary cutaneous B-cell lymphoma. The tumor depth measured by MRI was in excellent correlation with Breslow's depth measurements, indicating that MRI is probably the radiologic technique of choice for preoperative evaluation of the extent and depth of primary and recurrent skin tumors. This report also provides the authors' recommendations for obtaining optimal MRI images of cutaneous lesions.

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In a 1984 survey, 2750 members of the American Academy of Dermatology were asked which dermatologic surgery procedures they performed and which procedures they expected to be performing in 5 years. A similar survey was completed by the American Society for Dermatologic Surgery in 1988. In this article, the results of the 1988 survey are presented and compared to that of 1984.

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Advances in laser technology now permit the physician to provide an effective form of treatment for a variety of cutaneous disorders for which no previous therapy existed. Additional refinements in both laser instruments and treatment techniques are certain to have a profound impact on the treatment of skin lesions. For that reason, a complete understanding of the basic properties of lasers and how they can be utilized in various clinical settings is the goal of this article.

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The skin barrier was evaluated as a function of transepidermal water loss (TEWL) and electrolyte loss. Combination electrodes for chloride and pH determinations and a potassium ion electrode were utilized. Delipidization of the skin did not impair the electrolyte barrier, but did damage the epidermal water barrier. Cellophane tape stripping of normal stratum corneum resulted in an increase in outward transepidermal potassium and chloride ion flux, an increase in skin surface pH, and an increase in TEWL. It appears that damage to the epidermal water barrier does not necessarily result in damage to the epidermal electrolyte barrier. We found the potassium electrode facile to use and believe that a combination potassium electrode would be useful for investigating and assessing the epidermal electrolyte barrier.

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Cutaneous carcinoma of the auricular and periauricular region can be diagnosed early and often can be cured; however, many of these tumors become difficult to treat because of local spread and regional metastasis. Those tumors that are not treated early often require more aggressive treatment with ear canal resection, partial temporal bone resection, or even parotidectomy and radiation therapy. Mohs histographic surgery combined with conventional excision affords the best marginal control for local eradication of these tumors.

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This is the first literature report on magnetic resonance imaging (MRI) examination of cutaneous melanocytic or any other type of skin lesions. Good resolution, clinically useful MRI scans of a congenital nevus and a metastatic melanoma to the skin are presented. The potential usefulness of MRI technique to physicians dealing with cutaneous disease is discussed.

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The carbon dioxide laser in both conventional and superpulsed modes was used to treat 13 patients with chronic actinic cheilitis. The procedure was well tolerated. Focal, but not functionally restricting, scarring developed in three patients. The cosmetic result was otherwise excellent. No recurrences have been noted.

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Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.

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