A novel technique using a rotation flap for repairing adjacent surgical defects.

Background: The incidence of head and neck carcinomas continues to rise. Surgical excision is a frequently used method for removing these carcinomas. It is not uncommon to have multiple skin carcinomas present at the same time or in close proximity to each other.

Versatile sterile field for nail surgery using a sterile glove.

Nail surgery is frequently done by dermatologists. Post-operative complications of nail surgery include infection, bleeding, pain, pyogenic granuloma, and nail dystrophy. Infectious complications after nail surgery can be prevented with proper aseptic techniques.

A diagnosis of chronic lymphocytic leukemia prompted by cutaneous lymphocytic infiltrates present in mohs micrographic surgery frozen sections.

Background: Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the United States. Patients with CLL are at an increased risk for the development of second malignant neoplasms, the most common of which is cuta-neous squamous cell carcinoma (SCC). Cutaneous infiltrates of CLL have been reported in association with primary cutaneous neoplasms, including SCC, basal cell carcinoma, and actinic keratosis.

Surgical tips.

A potpourri of practical surgical tips is presented in this article. Included are the clues for diagnosis, ideas for wound management, intraoperative tips, and assorted other items to enhance surgical practice.

Erythrocyanotic discoloration of the toes.

A 35-year-old woman from Virginia presented with purplish, tender toes. She was diagnosed with pernio and successfully treated, initially with nifedipine and subsequently with management of the affected area's environment. Clinical presentations and treatment strategies are discussed below.

Pilomatricoma: an alarming presentation.

Pilomatricoma is an uncommon, benign growth with origination from the hair matrix that may have several clinical presentations and is frequently misdiagnosed. This case of a rapidly growing pilomatricoma in a 26-year-old was particularly deceptive, generating a differential diagnosis, principally of malignant tumors. The typical features, variants, histogenesis, differential diagnosis, and therapy are reviewed.

Duplicitous growth of infiltrative basal cell carcinoma: Analysis of clinically undetected tumor extent in a paired case-control study.

Background: Many clinicians believe infiltrative basal cell carcinoma (BCC) is a more difficult tumor to eradicate than nodular BCC because the growth of infiltrative BCC is not easy to detect clinically. However, data supporting this observation are largely anecdotal.

Objective: Our purpose was to show that infiltrative BCC have wider and deeper tumor extensions than nodular BCC of similar clinical size.

Micronodular basal cell carcinoma. A deceptive histologic subtype with frequent clinically undetected tumor extension.

Background And Design: Micronodular basal cell carcinoma (BCC) is thought to have a greater potential for clinically surreptitious tumor spread compared with the majority of BCCs that are nodular. However, most supporting data are anecdotal. This study gives objective evidence that micronodular BCCs have wider and deeper tumor extensions than nodular BCCs of similar clinical size.

An evaluation of the efficacy and irritability of Sporicidin as a hand dip.

Sporicidin, diluted 1:16, used as a disinfectant hand dip, was found to produce substantial percent reductions in the mean number of colony-forming units in comparisons between microbial recoveries of the control and Sporicidin-dipped hands. Sporicidin at this concentration appears to demonstrate efficacy as an antimicrobial agent, but dermal irritation, sensitivity and yellowing of the skin, and its objectionable odor may preclude its routine clinical use.

Cutaneous draining sinus tract: an odontogenic etiology.

Although the most common cause of the intermittently suppurating cutaneous sinus tract in the face and neck area is chronic dental infection, chronic draining sinus tracts of the face and neck continue to be a diagnostic challenge. The attending clinician must look carefully for a potential odontogenic infection; chronicity, lasting for weeks, months, and even years and the recognition of the lesion as a sinus tract are keys to making the correct diagnosis. Diagnostic errors can result in multiple surgical excisions and biopsies, long-term antibiotic therapy, and even radiation therapy or electrodesiccation.

Insulin-induced hypertrophic lipodystrophy.

Localized asymptomatic soft tissue swellings developed in a 20-year-old woman, Type I juvenile-onset diabetic, at the site of repeated insulin injections. Histopathologic examination of specimens from these lesions in three patients showed chronic inflammatory changes and exogenous foreign material that was thought to be silicon. Lipodystrophic changes associated with insulin therapy are briefly reviewed.