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Antineoplásicos/efectos adversos , Síndrome de Fuga Capilar/inducido químicamente , Toxina Diftérica , Interleucina-2 , Linfoma Cutáneo de Células T/tratamiento farmacológico , Proteínas/efectos adversos , Neoplasias Cutáneas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Proteínas Recombinantes de FusiónRESUMEN
The incidence of NMSC is increasing at a phenomenal rate, with a current estimated annual incidence in the United States of more than 600,000 cases. It is vitally important for all surgeons to become familiar with all modalities, surgical as well as nonsurgical, that are used to treat these skin cancers. This article was designed to inform the reader about the surgical technique called MMS (Figs. 9 and 10), and to present the facts regarding its historical evolution, actual technique, indications, and limitations. MMS has been modified and refined over a period spanning 60 years. During this time, tens of thousands of tumors have been treated, and the literature supports the fact that MMS provides the highest possible cure rates for the treatment of NMSCs.
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Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Cirugía de Mohs , Neoplasias Cutáneas/cirugía , Humanos , Cirugía de Mohs/métodos , Resultado del TratamientoRESUMEN
Nodular amyloidosis is a rare entity that predominantly affects females in the sixth and seventh decades. Frequent cutaneous sites of involvement are the extremities, trunk, and genitalia. Numerous cosmetic procedures have been employed to treat the lesions of nodular amyloidosis. Dermabrasion, which was performed on the lesions of nodular amyloidosis on the chin after surgical debulking, proved successful in the treatment of localized nodular amyloidosis. Follow-up at 26 months showed no clinical evidence of recurrence. Dermabrasion offers another acceptable modality for cosmetic treatment of nodular amyloidosis.
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Amiloidosis/cirugía , Dermabrasión , Enfermedades de la Piel/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Superficial dermabrasion has a proven beneficial effect on photoaged skin, but little is known about the differences between the two major modalities used in dermabrasion, the diamond fraise (DF) and the wire brush (WB). OBJECTIVE: We compared the clinical, immunohistologic, and biochemical changes after superficial dermabrasion with DF and WB. METHODS: Eight photoaged patients (mean age, 68 years; range, 49 to 80 years) underwent facial dermabrasion to the level of the papillary dermis. Clinical assessments were performed at baseline and at 3 and 12 weeks after dermabrasion. Biopsy specimens were taken from both dermabraded halves at the same time points and assessed by routine histologic and immunohistologic examinations, western blot analysis, and radioimmunoassay. Scoring of intracellular and extracellular transforming growth factor-beta 1 was based on a semiquantitative ordinal scale (0 = no staining to 4 = maximum staining) in half-unit increments. The score for each specimen represents the average of values obtained from four high-power fields. RESULTS: Both methods of dermabrasion resulted in significant resolution of actinic keratoses, lentigines, and wrinkling. No statistical significance was noted between the two methods in regard to clinical efficacy. Significantly fewer milia occurred after DF than after WB. Solar elastosis decreased with both the WB and DF. Immunohistologic examination demonstrated a highly significant increase in papillary dermal fibroblast staining for amino terminal procollagen I (type I pN-collagen) at 3 weeks for both DF and WB compared to baseline. Staining at 12 weeks had decreased from the peak noted at week 3, but was still significantly increased from baseline. Western blotting of type I pN-collagen demonstrated a 5.4-fold (p = 0.01) increase from baseline at 3 weeks and a 4.9-fold (p = 0.002) increase at 12 weeks after dermabrasion with the WB. Similarly, the DF produced a 4.9-fold (p = 0.006) increase at 3 weeks and a 5.1-fold (p = 0.008) increase at 12 weeks after dermabrasion. Western blotting of amino terminal procollagen III (type III pN-collagen) showed a 6.1-fold (p = 0.07) increase from baseline at 3 weeks and a 3.9-fold (p = 0.04) increase at 12 weeks after dermabrasion with the DF. The WB showed a 3.8-fold (p = 0.07) increase from baseline at 3 weeks and a 5.1-fold (p = 0.05) increase at 12 weeks. Transforming growth factor-beta 1 demonstrated a significant increase in extracellular staining with DF (3.3 +/- 0.2) and WB (3.7 +/- 0.2) from baseline (1.2 +/- 0.2, p < 0.001) at 3 weeks. CONCLUSION: Superficial dermabrasion with DF and WP appears to be similarly efficacious in the treatment of photoaged skin. Significant increases in type I pN-collagen, type III pN-collagen, and TGF-beta 1 occurred in the papillary dermis after both types of dermabrasion. These results suggest that increased fibroblast activity and consequent collagen I and III synthesis underlie the clinical improvement.
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Dermabrasión/instrumentación , Procedimientos Quirúrgicos Dermatologicos , Cara/cirugía , Envejecimiento de la Piel , Anciano , Anciano de 80 o más Años , Biopsia , Western Blotting , Dermabrasión/efectos adversos , Diamante , Quiste Epidérmico/etiología , Diseño de Equipo , Fibroblastos/patología , Humanos , Inmunohistoquímica , Queratosis/metabolismo , Queratosis/patología , Queratosis/cirugía , Lentigo/metabolismo , Lentigo/patología , Lentigo/cirugía , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/análisis , Procolágeno/análisis , Piel/química , Piel/patología , Envejecimiento de la Piel/patología , Enfermedades de la Piel/etiología , Factor de Crecimiento Transformador beta/análisisRESUMEN
Intercellular adhesion molecule (ICAM)-3 is a recently described member of the immunoglobulin superfamily and, as such, is closely related to ICAM-1 and ICAM-2. All three ICAMS are cognate for the counter-receptor lymphocyte function associated antigen-1 (LFA-1, CD11a/CD18). Unlike ICAM-1 and ICAM-2, ICAM-3 is constitutively expressed at high levels on resting leucocytes. We investigated the expression and function of ICAM-3 in normal skin (n = 5), as well as its expression in psoriasis (n = 4), atopic eczema (n = 4), allergic (rhus) contact dermatitis (n = 3), and cutaneous T-cell lymphoma (CTCL, n = 2). Five-micrometre cryostat sections of skin were stained using monoclonal antibodies to ICAM-3 and a well characterized immunoperoxidase technique. In normal skin, ICAM-3 was expressed by all cutaneous leucocytes but most striking was the strong expression of ICAM-3 by Langerhans cells within both epidermis and dermis. This observation was confirmed by double-labelling with CD1a and negative staining with an IgG1 isotype control. In psoriasis, atopic eczema, allergic contact dermatitis, and CTCL, ICAM-3 was co-expressed on all CD1a+ cells, although, in psoriasis, the intensity of ICAM-3 expression was reduced. Functional blocking experiments were performed to determine whether the observed ICAM-3 expression on Langerhans cells was functionally important in antigen presentation. CD4+ T cells were prepared from peripheral blood and 10(5) CD4+ T cells combined with 10(5) epidermal cells harvested from keratome biopsies of normal skin of an individual allogeneic to the T-cell donor. Addition of 50 micrograms anti-ICAM-3 to the co-culture resulted in a consistent (50%) reduction in degree of alloantigen presentation by Langerhans cells to T cells. Inhibition was 77% of that produced by the addition of anti-LFA-1. These data indicate that ICAM-3 is constitutively expressed by Langerhans cells and is a major ligand for LFA-1 on CD4+ T cells during their response to Langerhans cells. Because fresh Langerhans cells constitutively express little ICAM-1, whereas ICAM-3 is constitutively expressed at high levels, it would appear that ICAM-3 is the dominant functional ICAM on in situ Langerhans cells in the normal epidermis.
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Presentación de Antígeno , Antígenos CD , Antígenos de Diferenciación , Linfocitos T CD4-Positivos/inmunología , Moléculas de Adhesión Celular/análisis , Células de Langerhans/química , Linfocitos T CD4-Positivos/patología , Moléculas de Adhesión Celular/fisiología , Dermatitis Alérgica por Contacto/inmunología , Dermatitis Atópica/inmunología , Humanos , Células de Langerhans/inmunología , Activación de Linfocitos , Antígeno-1 Asociado a Función de Linfocito/inmunología , Linfoma Cutáneo de Células T/inmunología , Psoriasis/inmunología , Enfermedades de la Piel/inmunologíaRESUMEN
Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It may arise in ocular or extraocular sites and exhibits such a variety of histologic growth patterns and diverse clinical presentations that the diagnosis is often delayed for months to years. We discuss incidence as well as clinical, histologic, diagnostic, prognostic, and management issues of this aggressive neoplasm.
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Adenocarcinoma Sebáceo , Neoplasias de los Párpados , Glándulas Tarsales , Neoplasias de las Glándulas Sebáceas , Adenocarcinoma Sebáceo/clasificación , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/terapia , Neoplasias de los Párpados/clasificación , Neoplasias de los Párpados/diagnóstico , Neoplasias de los Párpados/terapia , Humanos , Pronóstico , Neoplasias de las Glándulas Sebáceas/clasificación , Neoplasias de las Glándulas Sebáceas/diagnóstico , Neoplasias de las Glándulas Sebáceas/terapia , Glándulas Sebáceas/anatomía & histología , Glándulas Sebáceas/fisiologíaRESUMEN
OBJECTIVE: To determine the feasibility and safety of combining oral 8-methoxypsoralen (8-MOP) and intraarticular ultraviolet A band light (UVA) to treat rheumatoid synovitis, and to demonstrate a favorable biological effect. METHODS: Six patients with rheumatoid arthritis (RA) and clinically evident knee synovitis were given a single oral dose of 8-MOP (0.6 mg/kg) followed by arthroscopy with a UVA laser equipped small arthroscope. Nine tissue samples treated with UVA doses ranging from 4 to 52 J/cm2 were examined by light microscopy and by immunohistochemistry for vascular cell adhesion molecule 1 (VACM-1), intracellular adhesion molecule 1 (ICAM-1), E-selectin and HLA-DR expression. RESULTS: No reduction in inflammation was evident on light microscopy, nor was there any evidence of tissue injury on gross inspection or light microscopy. At 28 and 52 J/cm2, VCAM-1, ICAM-1 and E-selectin staining were reduced in the posttreatment synovial biopsies. No local or systemic complications were observed by Day 30 in any patient. CONCLUSION: This treatment modality appears to be feasible and safe and may potentially be useful in the treatment of the synovitis associated with RA.