Superficial Cutaneous Lesions Research Articles

Unusual soft tissue metastases in a patient with chondrosarcoma: a case report.

Chondrosarcoma (CS) is the second most frequent primary malignant bone tumour, characterized by production of non-osteoid cartilage matrix. Up to more than 30% of patients with CS present distant metastases, and the lungs represent the preferred site. Hence, CS soft tissue metastases and superficial cutaneous lesions are extremely rare. We report the case of a female who developed unusual multiple soft tissue CS metastases. This patient underwent left hindquarter amputation for recurrent grade 3 chondrosarcoma of the femoral neck with extension to the pelvis approximately 4years after internal fixation with an intramedullary nail for pathological fracture of left proximal femur and subsequent total proximal femoral endoprosthetic replacement for grade 1-2 chondrosarcoma. In the following years, she underwent metastasectomy for several grade 2 pulmonary metastatic chondrosarcomas. More than 14years after the amputation, she presented with multiple unusual superficial cutaneous lesions, and a whole-body magnetic resonance imaging demonstrated multiple soft tissue foci of metastatic disease. The histology of multiple soft tissue lesions excised confirmed metastatic chondrosarcoma. Then, she underwent marginal excision of further multifocal soft tissue metastatic high-grade chondrosarcoma. Unlike the poor survival from the onset of these metastases in the other cases reported in the literature, our patient is still alive 2years after the first multiple soft tissue excision of metastatic chondrosarcoma, and approximately 20years after the diagnosis of chondrosarcoma. Soft tissue CS metastases are a rare entity with few cases described in literature. This study aims to make the reader aware of this lesser-known CS manifestation.

High-resolution ultrasound imaging of cutaneous lesions

High-resolution variable frequency ultrasound imaging is increasingly being used in the noninvasive evaluation of various cutaneous diseases. It plays a complimentary role to physical examination in the assessment of cutaneous lesions. It is the only imaging modality useful in the evaluation of superficial cutaneous lesions that are too small to be evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) and is helpful in reducing invasive procedures like biopsies and fine needle aspirations. In this article, we seek to describe the relevance and basic principles of cutaneous ultrasound, imaging findings of normal skin, current applications of high-resolution ultrasound in the diagnosis and management of various dermatological conditions, along with the features of some commonly encountered lesions.

Dermatophytoses in Monterrey, México

In the present report we reviewed a total of 2397 cases of dermatophytosis from superficial cutaneous lesions between the years 1978 and 1990. The cases included were from the Department of Dermatology at the University Hospital located in the city of Monterrey, México. A total of 726 tinea pedis, 613 tinea unguium, 441 tinea capitis, 395 tinea corporis and 222 tinea cruris cases were observed. The most commonly isolated dermatophyte species was Trichophyton rubrum (45%), followed by Trichophyton mentagrophytes (23.7%), Trichophyton tonsurans (21%), Microsporum canis (7.1%) and Epidermophyton floccosum (2.5%). Less frequently we isolated Microsporum audouinii, Microsporum gypseum, Trichophyton violaceum and Trichophyton verrucosum. Most of the cases were observed in the warmest months of the year (from March to September), and were equally distributed in both genders, except for tinea cruris which was more prevalent in men (3.5 : 1 ratio).

The effects of a diode laser (810 nm) on pigmented guinea-pig skin.

Various types of lasers, such as the Q-switched ruby laser and the Alexandrite laser, cause selective damage to cutaneous pigmented cells and are currently used in the therapy of pigmented lesions. The aim of this study was to evaluate the effects of a diode laser at a wavelength of 810 nm on pigmented guinea-pig skin. The diode laser was supplied by OcuLight Iris Medical Instruments, Inc. and was used to deliver 0.15, 0.2, 0.3, 0.4, 0.5, 1 and 1.5 J/cm2 laser beams in micropulses of 100 micros. The study was carried out on albino and black-spotted guinea pigs (GP). After irradiation, punch biopsies were taken and analysed by light and electron microscopy. Albino animals developed just a few signs of cutaneous injury. This mostly consisted of spongiotic disarray, after the highest doses were administered (>1 J/cm2). In the black skin of spotted GPs alterations appeared at 0.15 J/cm2 and included melanosome damage and, at doses higher than 0.3 J/cm2, also melanocyte damage. These observations demonstrate that the diode laser at 810 nm selectively affects pigmented structures and that the cellular targets of diode laser radiation are the melanosomes. The diode laser specificity for melanin may provide a biological basis for the treatment of pigmented superficial cutaneous lesions.

Fish tank granuloma--a frequently misdiagnosed infection of the upper limb.

Five patients attended the accident and emergency (A&E) department with fish tank granuloma caused by an infection with Mycobacterium marinum. All patients had forearm symptoms which were initially misdiagnosed. They...

Technetium-99m labeled monoclonal antibodies in the detection of metastatic melanoma.

Twenty-six stage II/III malignant melanoma patients with 321 measurable metastatic lesions were imaged using Fab fragments of an IgG murine monoclonal antibody labeled specifically with 10-30 mCi Tc-99m with a bi-functional chelating method (NeoRx, Seattle, WA). There were no side effects or adverse reactions. Immunoscintigraphy demonstrated 66.6% of lesions larger than 1 cm and 92.5% of lesions larger than 3 cm. Most frequently detected metastases were in lymph nodes, subcutaneous areas, and bone. Of lesions less than 1 cm, 23.6% were detected if superficial cutaneous lesions were excluded. The smallest detectable lesion was 4 mm. Twenty-one additional clinically unsuspected sites were visualized in 12 of the 26 patients studied. Of these, 56% were confirmed as metastasis by other tests. There were apparent nonspecific localizations owing to other causes, including fracture, varicosities, skin abscess and pneumonitis. Increased experience in image analysis facilitates correct interpretation of these localizations. This study demonstrates that imaging with Tc-99m labeled antibody fragments detects melanoma lesions in organs routinely surveyed and in other areas not routinely assessed by other imaging techniques. The procedure is readily performed and safe. The principal advantage of the test is its ability to survey the entire body and all organs with a single test. Its principal limitation, in common with other diagnostic imaging procedures, is its poor sensitivity for detecting lesions less than 1 cm.

Melanosomes Are a Primary Target of Q-Switch Ruby Laser Irradiation in Guinea Pig Skin

The specific targeting of melanosomes may allow for laser therapy of pigmented cutaneous lesions. The mechanism of selective destruction of pigmented cells by various lasers, however, has not been fully clarified. Black, brown, and albino guinea pigs were exposed to optical pulses at various radiant exposure doses from a Q-switched, 40 nsec, 694 nm ruby laser. Biopsies were analyzed by light and electron microscopy (EM). Albino animals failed to develop clinical or microscopic evidence of cutaneous injury after irradiation. In both black and brown animals, the clinical threshold for gross change was 0.4 J/cm2, which produced an ash-white spot. By light microscopy, alterations appeared at 0.3 J/cm2 and included separation at the dermoepidermal junction, and the formation of vacuolated epidermal cells with a peripheral cytoplasmic condensation of pigment. By EM, enlarged melanosomes with a central lucent zone were observed within affected epidermal cells at 0.3 J/cm2. At 0.8 and 1.2 J/cm2, individual melanosomes were more intensely damaged and disruption of melanosomes deep in the hair papillae was observed. Dermal-epidermal blisters were formed precisely at the lamina lucida, leaving basal cell membranes and hemidesmosomes intact. Possible mechanisms for melanosomal injury are discussed. These observations show that the effects of the Q-switched ruby laser are melanin-specific and melanin-dependent, and may be useful in the selective destruction of pigmented as well as superficial cutaneous lesions.

Carbon dioxide laser vaporization of lymphangioma circumscriptum

Lymphangioma circumscriptum consists of persistent localized or diffuse, grouped, translucent vesicles of the skin. Surgical removal of extensive lymphangioma circumscriptum is frequently unsuccessful and is characterized by rapid regrowth. We describe our results with the use of the carbon dioxide laser in a vaporization mode to successfully ablate superficial cutaneous lesions in seven patients with lymphangioma circumscriptum.

Enzyme-linked immunosorbent assay for detection and typing of herpes simplex virus.

An enzyme-linked immunosorbent assay for herpes simplex virus was tested using commercially available peroxidase-conjugated and unconjugated rabbit antibodies to herpes simplex virus type 1 and type 2 (DAKO immunoglobulins A/S, Copenhagen, Denmark). One hundred and thirty-seven clinical specimens from vesicles and superficial cutaneous lesions were tested and the results compared with virus isolation. In addition 210 herpes simplex virus isolates were typed. Forty-four specimens yielded herpes simplex virus both in the enzyme-linked immunosorbent assay and in tissue culture and 79 were negative in both tests. Fourteen were positive in isolation but negative in the enzyme-linked immunosorbent assay. Seventy-three isolates were typed as herpes simplex virus type 1 and 137 as herpes simplex virus type 2. The enzyme-linked immunosorbent assay was found to be rapid and easy to perform but less sensitive than conventional isolation in routine diagnostic work. For typing of isolates it was found to be a useful method for distinguishing herpes simplex virus type 1 and type 2.