Use Of Nonsurgical Treatment Research Articles

The “Signature” Pattern of Multiple Basal Cell Carcinomas

T HE CONCEPT OF THE “SIGNATURE” PATtern, which is widely recognized in the treatment of patients with multiple nevi, refers to the observation that most nevi in a given individual are morphologically similar. We also recently noticed that multiple basal cell carcinomas (BCCs) on the same patient and in the same anatomical region often reveal similar clinical and dermoscopic appearances. We describe 4 cases, including 1 clinical image (Figure, A [the arrow indicates the BCC that is shown in Figure, B]), an associated dermoscopic image (Figure, B), and 2 additional dermoscopic images (Figure, C and D), of multiple superficial BCCs located on the head, neck, and trunk of a 57-year-old man (Figure) and on the trunk of an 89-year-old man (eFigure 1; http: //www.archdermatol.com), a 94-year-old man (eFigure 2), and a 56-year-old man (eFigure 3). On dermoscopy, the BCCs revealed spoke wheel areas (Figure), leaflike areas and blue-gray dots and globules (eFigure 1), structureless pink areas and multiple erosions (eFigure 2), and structureless white areas with subtle linear vessels (eFigure 3). Although the dermoscopic features of multiple BCCs may vary between different patients and anatomical subsites, the morphological features of BCCs on the same patient and body area are strikingly similar. Our observation suggests that the concept of the signature pattern, which was originally introduced for the treatment of patients with multiple nevi, also applies to patients with multiple BCCs. This finding may increase diagnostic confidence and aid in the treatment plan, especially in times of increasing availability and use of nonsurgical treatments for skin cancer.

Treatment and Outcomes of Diabetic Muscle Infarction

Diabetic patients can develop spontaneous infarctions of muscle. The optimal treatment of this diabetic muscle infarction (DMI) is unknown. This analysis was conducted to compare the outcomes of conservative, medical, and surgical treatments of DMI. The primary outcome is the time to recovery. Secondary outcomes include recurrence and mortality rates. A MEDLINE search from its inception to December 2002 was used to identify reported cases of DMI. We selected those cases that reported on specified baseline characteristics of the patients, including age, gender, duration of diabetes, type of diabetes, diabetic microvascular and macrovascular complications, and the magnetic resonance imaging or computed tomography findings, the type of therapy provided, the time to recovery of initial muscle infarction, recurrences, and deaths. A total of 36 references meeting our inclusion criteria were retrieved, describing 49 patients. Thirty-four patients received conservative therapy (bedrest and analgesics), 8 received medical therapy (antiplatelet agents and/or steroids), and 7 had surgical excision of the infarcted muscle. There were no significant differences in baseline characteristics. The time to recovery from treatment onset was 8.1 weeks, 5.5 weeks, and 13 weeks in the conservative, medical, and surgical treatment groups, respectively. This was statistically significant only when comparing medical and surgical treatment. The respective recurrence rates were 35%, 29%, and 71%. The respective mortality rates within 2 years were 4%, 14%, and 29%. This study supports the use of nonsurgical treatment in patients with DMI. It also demonstrates that DMI can be temporally associated with death.

Patterns of care for cancer of the larynx in the United States.

To assess case-mix characteristics, treatment patterns, and outcomes for laryngeal cancer using the largest series of patients to date. Analyses performed on retrospectively collected survey data submitted by hospitals for diagnostic periods 1980 through 1985 and 1990 through 1992 (with a 9-year follow-up for the long-term group). Broad spectrum of US hospitals (N = 769). Consecutively accrued series of patients with laryngeal cancer (N = 16,936), with only squamous cell carcinomas (N = 16,213) analyzed. Surgery, radiation therapy, and chemotherapy. Descriptive analyses of case-mix, diagnostic, and treatment characteristics plus recurrence and 5-year, disease-specific survival outcomes. There was a slight increase across these years in stage IV disease and in radiation therapy (with or without surgery and/or chemotherapy). Overall diversity of management of this disease (by site and stage) was apparent. Five-year survival rates indicated a large difference between modified groupings of the T and N classifications, separating stages III and IV cases into localized disease (87.5% for T1-T2; 76.0% for T3-T4 cases) and regional metastasis (46.2%). Regardless of improvements in entering data in hospital records (most commendably, staging), more rigorous standards are needed. Also, the small increase in advanced-stage patients indicates that efforts toward early detection have not been successful. The rise in radiation therapy perhaps reflected an increased use of nonsurgical treatment for early-stage patients and organ-sparing radiochemotherapy protocols for advanced-stage patients. Regrouping stages III and IV cases into localized disease vs regional metastasis appears to predict survival better. Ongoing refinements of the American Joint Committee on Cancer staging scheme will hopefully improve this cancer's classification.