Several genes are associated with hereditary susceptibility to breast cancer.
There are two forms of AN: Benign AN may be hereditary, or may be related to systemic diseases or drugs. Malignant AN is most often associated with gastric adenocarcinoma but cancers of other sites and types may also occur. This case report is based on a case of a year-old woman suffering from invasive bladder papillary transitional cell carcinoma accompanied by extensive papillomatous areas of normal mucosal color and soft consistency involving the lips, buccal mucosa and hard palate.
Verrucous changes with tiny pigmented macules were also found on the skin of the right ear auricle. Oral lesions occurred after the tumor had been diagnosed, i. The fifth operation for tumor recurrence resulted in slight improvement of oral changes.
It is concluded that the severity of oral changes is in correlation with tumor progression. The occurrence of oral lesions may be an indicator of tumor progression. Rom J Morphol Embryol. Periorificial lentiginosis, also knew as Peutz-Jeghers Syndrome PJS , is an autosomally dominant inherited condition determined by a mutation localized at 19p Skin- and mucosal pigmentation may be present at birth but usually occur in early childhood, and occasionally may develop later.
Round, oval or irregular patches of brown or almost black pigmentation 1 to 5 mm diameter, irregularly distributed over the oral mucosa, gums, hard palate and lips especially the lower are observed. The pigmented maculae on the face, encountered especially around the nose and mouth are smaller. Polyps may appear in the stomach, small bowel or colon, with hamartomatous aspects on histology.
Acute upper gastrointestinal bleeding and chronic fecal blood loss may appear during the course of disease. There is a higher risk of intestinal and extraintestinal cancers in those patients. We present the case of an year-old young girl accusing since the age of 3 slight intermittent episodes of bloating and abdominal pain without a particular localization, as well as mild iron-deficiency anemia. Physical examination revealed pigmented lesions suggesting PSJ on the palatine and jugal mucosa while endoscopy found a lot of polyps in stomach and a few, isolated in the colon, all having the same hamartomatous pattern.
The presence in early infancy of small, well-demarcated and dark-brown to blue-black lentigines on the lips, buccal mucosa and perioral skin, should alert the clinician to PJS. About patients have been reported worldwide but the real incidence of LS has not been assessed. Facial dysmorphism includes ocular hypertelorism, palpebral ptosis and low-set ears. Stature is usually below the 25th centile.
Cardiac defects, in particular hypertrophic cardiomyopathy mostly involving the left ventricle, and ECG anomalies are common. The lentigines may be congenital, although more frequently manifest by the age of years and increase throughout puberty. Mutation analysis can be carried out on blood, chorionic villi and amniotic fluid samples. LS is largely overlapping Noonan syndrome and, during childhood, Neurofibromatosis type 1-Noonan syndrome.
Mutation-based differential diagnosis in patients with borderline clinical manifestations is warranted. LS is an autosomal dominant condition, with full penetrance and variable expressivity. LS should be suspected in foetuses with severe cardiac hypertrophy and prenatal DNA test may be performed.
Clinical management should address growth and motor development and congenital anomalies, in particular cardiac defects that should be monitored annually. Hypertrophic cardiomyopathy needs careful risk assessment and prophylaxis against sudden death in patients at risk. Hearing should be evaluated annually until adulthood.
With the only exception of ventricular hypertrophy, adults with LS do not require special medical care and long-term prognosis is favourable. Semin Cutan Med Surg. Fractional resurfacing is a new laser treatment modality that creates numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing for rapid repair of laser-induced thermal injury.
This unique modality, if implemented with proper laser-delivery systems, enables high-energy treatments while minimizing risks. In this article, we review the various fractional laser devices, including the new fractional ablative devices, as well as the results of studies on the clinical efficacy of fractional photothermolysis.
This technology offers patients significant clinical improvement in photodamage, melasma, and scarring with modest treatment-related downtime and minimal risk of complications. Hydroquinone-induced exogenous ochronosis in Chinese—two case reports and a review. Neurocutaneous melanosis in association with Dandy-Walker malformation: Epub May A ventriculoperitoneal shunt operation was performed when she was 1 day old.
Her neurological symptoms to date comprise headaches, nausea and vomiting as a result of ventriculoperitoneal shunt dislocation at the age of 4 years. Epub Mar 4. Although it is a very rare event, these polyps can become malignant, as demonstrated by this report. The patient had colonic carcinoma which developed in a hamartomatous polyp. This case also shows a sequence of hamartoma-dysplasia-carcinoma in a hamartomatous polyp without adenomatous changes.
Lessons from the skin—cutaneous features of familial cancer. As the molecular basis of disease continues to be elucidated, familial cancer syndromes, which consist of a range of neoplastic and non-neoplastic features, are emerging. The usual pathway of referral to a genetics clinic or familial cancer centre is via an oncologist, when high-risk features that suggest a possible hereditary basis for the presenting cancer are recognised.
Traditionally, these high-risk features include more than two family members with similar cancers over two or more generations, a young age of onset, and more than one synchronous or metachronous tumour. These features are effective in ascertaining a substantial proportion of families with hereditary breast and ovarian cancer due to a BRCA mutation, or the more common bowel-cancer predisposition syndromes, such as hereditary non-polyposis colon cancer and familial adenomatous polyposis.
However, there are a range of familial cancer syndromes that are not easily detected and that can remain undiagnosed when history and examination are not extended to include non-malignant features. The identification of cutaneous signs associated with rare familial-cancer syndromes provides individuals and their families with the opportunity to undertake early surveillance for malignant and non-malignant complications that might in time be shown to improve outcomes.
Melasma can be a source of embarrassment for men because of its association with women and pregnancy. Four of 5 patients achieved complete clearance of melasma at 12 weeks, and 1 patient showed moderate improvement. Side effects were minimal and consisted of stinging in one patient.
All patients maintained results at the week follow-up visit. The vehicle resulted in good compliance and minimal adverse effects in patients. The hereditary polyposis syndromes and non-polyposis colorectal carcinoma have been considered as scarcely occurring but inheritable dominant autosomal syndromes. The increasing risk of small bowel carcinoma and prevention of obstruction and intussusception have been making frequent and acute surgical interventions unavoidably led to the necessity of screening and surveillance the patients.
Earlier the diagnosis of these symptoms was difficult to establish because traditional radiological methods have a low yield for small polyps. Furthermore, small bowel is only partially accessible with traditional endoscopic techniques such as upper endoscopy, colonoscopy and push-enteroscopy. This method can be applied safely even consequently to repeatedly performed surgical interventions by low risk of capsule retention. As the results compared of the diagnosed familial adenomatous polyposis and of Peutz-Jeghers syndrome reflect on capsule endoscopy, its diagnostic sensitiveness is stated as significantly higher than the Barium-contrast X-Ray and MR-enterography.
Nevertheless, determination of size and location of polyps has become more problematic when evaluating the test results. Latest insights into skin hyperpigmentation. J Investig Dermatol Symp Proc. Hyperpigmentary problems, including postinflammatory hyperpigmentation, solar lentigos, and melasma, occur widely in the human population and are thus of broad interest for control.
On the basis of genomic and proteomic understanding of the melanocyte and melanogenesis, there are potentially hundreds of proteins and other effectors involved in pigmentation. This knowledge, although complex, should prove most useful in identifying specific abnormalities that lead to the hyperpigmentary problems.
Also available are new laboratory screening methods and skin color measurement tools that are increasing the pace at which materials can be screened and evaluated clinically for their effectiveness. Combined with a clear consumer need for effective pigmentation control agents, advanced pigmentary system understanding and new research capabilities are setting the stage for future technological advancements.
Diverse cellular processes are regulated by tyrosyl phosphorylation, which is controlled by protein-tyrosine kinases PTKs and protein-tyrosine phosphatases PTPs. PTPs, because they oppose the action of PTKs, had been considered to be prime suspects for potential tumor suppressor genes. Surprisingly, few, if any, tumor suppressor PTPs have been identified. Shp2 also is an essential component in several other oncogene signaling pathways.
Elucidation of the events underlying Shp2-evoked transformation may provide new insights into oncogenic mechanisms and novel targets for anti-cancer therapy. Smoking related systemic and oral diseases. Acta Medica Hradec Kralove. This article reviewed smoking related systemic diseases and oral diseases. Smoking is related to lung cancer, cardiovascular diseases and many other systemic diseases. The article also discusses the relationship between smoking and dental caries in detail.
Birthmarks in newborns are common sources of parental concern. Although most treatment recommendations are based on expert opinion, limited evidence exists to guide management of these conditions. Large congenital melanocytic nevi require evaluation for removal, whereas smaller nevi may be observed for malignant changes. With few exceptions, benign birthmarks e. Supernumerary nipples are common and benign; they are occasionally mistaken for congenital melanocytic nevi.
High- and intermediate-risk skin markers of spinal dysraphism e. Family physicians should be familiar with various birthmarks and comfortable discussing disease prevention and cosmetic strategies. Rashes are extremely common in newborns and can be a significant source of parental concern.
Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Miliaria rubra also known as heat rash usually improves after cooling measures are taken.
Seborrheic dermatitis is extremely common and should be distinguished from atopic dermatitis. Parental reassurance and observation is usually sufficient, but tar-containing shampoo, topical ketoconazole, or mild topical steroids may be needed to treat severe or persistent cases. Melasma or chloasma is a common acquired hypermelanosis of the face and neck that is notoriously difficult to treat. Laser treatment has been employed in patients who do not respond to conventional topical agents but has failed to achieve an acceptable compromise between efficacy and side effects.
Fractional photothermolysis FP combines the efficacy of ablative and the tolerability of non-ablative laser treatment in some skin conditions. There are few studies on using FP in melasma and its value cannot be estimated presently. Pigmented lesions of the oral mucosa and perioral tissues: Epub Feb Lesions not associated with an accumulation of pigment e.
Two groups of pigmented lesions of the oral mucosa are recognized: This paper presents a clinicopathologic review of the recent literature with emphasis on the main diagnostic features, including the use of immunohistochemical markers. A flow-chart is added that may help the clinician in the diagnosis and management of these lesions. Oral manifestations of internal malignancy and paraneoplastic syndromes. Woo VL, Abdelsayed R. Dent Clin North Am. Malignant tumors of visceral organs are a fundamental feature of familial cancer and paraneoplastic syndromes.
In many instances, the presence of an internal and often occult malignancy may be forewarned by various external manifestations. Several of these findings are preferentially localized to the head and neck region, including the oral cavity proper. Because these markers may present before an established syndrome or cancer diagnosis, even representing the first expression of disease in some cases, early recognition by a dentist may lead to timely diagnosis and management of these cancer-associated syndromes.
Clinical findings in 15 patients and review of the literature. J Am Acad Dermatol. Epub Nov Phakomatosis pigmentovascularis PPV is a rare syndrome characterized by the association of a vascular nevus with an extensive pigmentary nevus. We sought to study and evaluate clinical findings in patients with PPV referred to the laser department of our hospital.
We studied 11 female patients and 4 male patients with a mean age of 21 years. Thirteen had phakomatosis cesioflammea, one cesiomarmorata, and one an unclassifiable form. Of 15 patients, 12 had nevus of Ota. The vascular involvement was extensive in our PPV population and 14 patients were affected in two or more areas. The mosaicism pattern in 13 patients was patchy and without a midline separation.
Limitations include the methods of case collection, that this is a retrospective study, and that there were a relatively small number of patients. PPV are rare syndromes with a wide variability in their clinical expression. Most of the publications in the literature have only reported isolated cases.
Skin lightening preparations and the hydroquinone controversy. Skin lightening preparations are widely used in dermatology by persons of all Fitzpatrick skin types. Fitzpatrick skin types I-III require local pigment lightening for the treatment of hormonally induced melasma and postinflammatory hyperpigmentation caused by acne and trauma. Fitzpatrick skin types IV and darker have an even greater need for skin lightening for social reasons, as well as pigmentary changes that occur around the eyes, in the intertriginous areas, following dermatitis, or with acne and trauma.
The gold standard dermatologic agent for skin lightening was hydroquinone, until regulatory agencies in Japan, Europe, and most recently in the United States questioned the safety of this substance. This has encouraged research into alternative agents to inhibit skin pigmentation such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract, ascorbic acid, soy proteins, and N-acetyl glucosamine. The efficacy and safety of each of these ingredients is examined as possible topical alternatives to hydroquinone.
Fractionated delivery systems for difficult to treat clinical applications: Fractional resurfacing or laser therapy FLT represents a technology that seeks to address the limitations of both ablative resurfacing and nonablative treatments. Many companies now offer versions of fractionated erbium or carbon dioxide lasers. The purpose of this paper is to examine FLT for difficult to treat applications such as melasma, acne scarring, atrophic scarring, striae distensae, and deep rhytides.
Fractional laser therapy is a truly novel approach to many conditions, especially those with dermal pathology. Although published peer review data is limited, the ability to effectively and safely treat these conditions in all skin types appears to have been significantly enhanced with this new modality.
We are early in our scientific explorations of what is possible with FLT. Hereditary colorectal cancer syndromes: Hereditary forms of colorectal cancer, as is the case with virtually all forms of hereditary cancer, show extensive phenotypic and genotypic heterogeneity, a phenomenon discussed throughout this special issue of Familial Cancer.
Thus, a family with features of the Lynch syndrome will merit microsatellite instability testing, consideration for immunohistochemistry evaluation, and mismatch repair gene testing, while, in contrast, a patient with FAP will require APC testing. However, other germline mutations, yet to be identified, may be important should testing for these mutations prove to be absent and, therein, unrewarding to the patient.
Our purpose in this paper is to provide a concise coverage of the major hereditary colorectal cancer syndromes, to discuss genetic counseling, molecular genetic evaluation, highly targeted surveillance and management, so that cancer control can be maximized for these high hereditary cancer risk patients.
Basics of laser application to dermatology. Q-switched lasers, with a pulse of light sufficiently short nanosecond-domain is demonstrated to be useful for treatment of dermal melanocytosis, blue-black tattoos, melanocytic nevi, and solar lentigines, although transient postinflammatory hyperpigmentation usually developed in the irradiated area during the following months.
If the postinflammatory pigmentation does not disappear after 1 year, incontinentia pigmenti histologica is a possibility. Melasma shows no response to laser. Therefore, accurate diagnosis is the key to success in the laser treatment. Laser treatment of vascular lesions is based on selective absorption by blood with thermal injury to the vessel wall. Therefore, the pulse-width of the vascular-specific lasers must be longer microsecond-domain than that of pigment-specific lasers.
Because the wavelength of the lasers for vascular lesions, however, cannot penetrate into the deep areas of the skin, not all vascular lesions can be treated. Laser or light-assisted hair removal offers an efficient way to permanently reduce excessive hair growth. Skin rejuvenation is possible by laser or pulsed light with millisecond-domain pulse-width. Because these light sources, however, cause severe damage to the skin surface, the exposure energy must be reduced and the treatment must be combined with cooling devices.
Therefore, the clinical results of light-assisted skin rejuvenation are not prominent. In conclusion, the pulse-width and wavelength of the laser light are critical parameters for laser treatments. If we obtain information about these parameters for specific lasers, we can expect the results of the treatment to be positive.
The genetic basis of sporadic colorectal cancer has illuminated our knowledge of human cancer genetics. This has been facilitated and catalyzed by an appreciation and deep understanding of the forms of colorectal cancer that harbor an inherited predisposition, including familial adenomatous polyposis FAP , hereditary nonpolyposis colorectal cancer HNPCC or Lynch syndrome, the hamartomatous polyposis syndromes, and certain other rare syndromes.
Identification of germline mutations in pivotal genes underlying the inherited forms of colorectal cancer has yielded many dividends, including functional dissection of critical molecular pathways that have been revealed to be important in development, cellular homeostasis, and cancer; new approaches in chemoprevention, molecular diagnostics and genetic testing, and therapy; and underscoring genotypic-phenotypic relationships.
Susceptibility to breast cancer: Several genes are associated with hereditary susceptibility to breast cancer. Most notably these include BRCA1 and BRCA2; however, other less common gene mutations which confer elevated breast cancer risk are associated with Cowden syndrome, Li-Fraumeni syndrome, Peutz-Jeghers syndrome, ataxia-telangiectasia heterozygosity and hereditary diffuse gastric cancer.
In this article we highlight the genetic epidemiology, gene function, genotype-phenotype correlations, cancer risks and clinicopathologic findings for the cancer susceptibility genes related to these syndromes. We also examine genes, such as CHEK2, which confer a lower penetrance for breast cancer in comparison to these highly penetrant genes. Dermatological conditions in young adults years —part 1.
Is Acanthosis Nigricans a reliable indicator for risk of type 2 diabetes? Jones LH, Ficca M. Acanthosis nigricans AN is a thickening and hyperpigmentation of the skin commonly found on the neck, axilla, or groin and is generally caused by hyperinsulinemia, a consequence of insulin resistance associated with obesity. Insulin resistance is a primary risk factor for the development of type 2 diabetes, hypercholesterolemia, and hypertension.
Screening for acanthosis nigricans is controversial and not recommended by the Centers for Disease Control and Prevention; however, some states, such as Texas, are implementing AN screenings in schools to identify those children who are at highest risk for developing type 2 diabetes. With the current epidemics of obesity and diabetes, school nurses will see students in the health office with AN and should be knowledgeable about this skin condition and the association with hyperinsulinemia and obesity.
This article will explore the controversy associated with screening for AN and make recommendations for school nursing practice. Forcet C, Billaud M. Disruption of cell architecture and change of energy metabolism are two traits of malignant cells. Yet, there was scant evidence that these two cancer hallmarks involved perturbations of a common signaling pathway.
Enter LKB1, a kinase that is a tumor suppressor and that is an upstream activator of the adenosine monophosphate AMP -activated protein kinase AMPK , a key sensor of cellular energy status. Four studies now reveal that LKB1 signals through AMPK to facilitate the formation of tight junctions and to maintain epithelial polarity. Thus, LKB1 appears to be a novel class of tumor suppressor that acts as an energy-sensing and polarity checkpoint.
Fractional resurfacing produces a distinctive thermal damage pattern by creating discrete columns of thermal damage referred to as microthermal treatment zones. It characteristically spares the tissue surrounding each microthermal treatment zone leading to fast epidermal repair.
Fractional resurfacing has been successfully used in treating a variety of skin conditions including melasma, dyschromia, lentigenes, wrinkles, and acne scars with minimal downtime. It is safer to use off the face and in darker skin types. Zbuk KM, Eng C. Nat Clin Pract Gastroenterol Hepatol. The hamartomatous polyposis syndromes are a heterogeneous group of disorders that share an autosomal-dominant pattern of inheritance and are characterized by hamartomatous polyps of the gastrointestinal tract.
Although the syndromes are uncommon, it is important for the clinician to recognize these disorders because they are associated with considerable morbidity and mortality, not only from malignancy but also from nonmalignant manifestations such as bleeding, intussusception, and bowel obstruction. Each hamartomatous polyposis syndrome has its own distinctive organ-specific manifestations and each requires a different surveillance strategy, which makes accurate diagnosis crucial for appropriate patient management.
The availability of clinical genetic testing for these disorders means that appropriate recognition allows for timely referral for cancer genetic counseling, and often allows for predicative testing in at-risk family members. Promisingly, an understanding of the molecular pathogenesis of these disorders offers insights into the mechanisms underlying the development of sporadic malignancy, and enables rational selection of targeted therapies that warrant further investigation.
Oral melanoacanthoma and oral melanotic macule: Oral melanoacanthoma MA is a rare, benign pigmented lesion, similar to cutaneous MA, characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes. The pathogenesis of oral MA remains uncertain, although its clinical behavior is suggestive of a reactive origin. The most common intraoral sites are the buccal mucosa, lip, palate and gingiva. The average age of presentation is 28 years, mainly in blacks, with a strong female predilection.
The oral melanotic macule MM is a small, well-circumscribed brown-to-black macule that occurs on the lips and mucous membranes. The etiology is not clear and it may represent a physiologic or reactive process. The average age of presentation is 43 years, with a female predilection. A biopsy is recommended to distinguish these lesions from each other and from other oral melanocytic lesions. The clinicopathological features of these cases reflect its ample spectrum, and to the best of our knowledge, it is the first example of oral MA affecting a Caucasian boy reported in the English literature.
Therefore oral MA and MM should be considered in the differential diagnosis of pigmented lesions in the oral mucosa in these populations. Facial and neck pigmentations are significant cosmetic problems. They are common in middle-aged women, related to endogenous hormones and exogenous factors cosmetics, perfumes, sun exposure , and often represent paramount causes of emotional distress. Although melasma is the most common cause of facial pigmentation, there are many other forms including drug-induced and postinflammatory hyperpigmentation.
We review pathogenesis, clinical and histopathological data, effect on quality of life, and treatment options in facial hyperpigmentation disorders. Established treatments of skin hypermelanoses. Cutaneous hypermelanoses are frequently encountered conditions that can have severe adverse psychosocial and emotional effects on affected patients. Melasma, postinflammatory hyperpigmentation, drug-induced pigmentation, and erythema dischromicum perstans are among the most common cutaneous disorders leading to acquired skin hyperpigmentation.
The treatment of these disorders is often challenging and requires a great deal of patience from the patient and a wealth of experience and knowledge from the dermatologist. Current treatments include depigmenting agents, chemical peels, and lasers. The ideal bleaching agent has to fulfill certain pharmacologic criteria. It should have a potent bleaching effect with a rapid time of onset, carry no side effects, and lead to a permanent removal of undesired pigment. We review the established treatment approaches of cutaneous hyperpigmentation based on literature review and our personal experience.
New and experimental treatments of cloasma and other hypermelanoses. Picardo M, Carrera M. In clinical practice, acquired hyperpigmentations represent the most common disorders of pigmentation the dermatologist has to treat. Despite the large number of depigmenting agents available, the treatment of hyperpigmentations is often unsuccessful and disappointing and is still a challenge for dermatologists. This article focuses on the chemical compounds reported to be in depigmenting or skin lightening agents, their proposed mechanism of action, and their clinical efficacy in the treatment of melasma and hypermelanoses, mainly based on randomized clinical trials.
It also reviews chemical peels and their indications, together with the possible uses of laser and intense pulsed light. Origin, clinical presentation, and diagnosis of facial hypermelanoses. Facial hypermelanosis is a clinical feature of a diverse group of disorders, the most common of which is melasma. Exposure to sunlight, genetic predisposition, the use of cosmetics, and certain drugs are implicated in the pathogenesis of most facial hypermelanoses.
A detailed personal and family history and the histopathologic findings are, in most cases, enough for establishing the correct diagnosis. Melanocytic aggregation in the skin: Pigmented skin lesions are among the most common skin lesions. Among them, melanocytic proliferations are morphologically diverse and their behavior may be difficult to discern with certainty. Researchers must be able to distinguish melanocytic from nonmelanocytic pigmented skin lesions and, in particular, benign from malignant lesions.
The majority of these lesions can be diagnosed with ease; however, a minority of cases is difficult and have potential for error. The authors have systematically analyzed the clinical and dermoscopic features of melanocytic skin lesions, so as to increase in vivo diagnostic accuracy. Dermatologic manifestations of polycystic ovary syndrome. Am J Clin Dermatol. The disorder is commonly characterized by elevated levels of androgen and insulin. Women with PCOS may present with a range of signs and symptoms, and face increased risks of reproductive, metabolic, cardiovascular, psychologic, and neoplastic sequelae, particularly if the condition is left unrecognized or untreated.
The clinical definition of PCOS has changed in recent years and includes as one of its cardinal criteria the dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinemia, may also be present. The effects of androgen on pilosebaceous units in the skin can vary by anatomic location, producing pathophysiologic effects on hair growth and differentiation, sebaceous gland size and activity, and follicular keratinization.
Treatment modalities may include hormonal therapy intended to modulate androgen production and action as well as non-hormonal therapies directed toward specific dermatologic conditions. Giant congenital melanocytic nevi. After studying this article, the participant should be able to: Define what is meant by a giant congenital melanocytic nevus and understand its histologic properties.
Know the natural history and potential complications associated with a giant congenital melanocytic nevus. Outline the nonsurgical and surgical options available to treat a giant congenital melanocytic nevus. Giant congenital melanocytic nevi are rare lesions with a propensity to degenerate to malignant melanoma. Certain lesions also may be associated with neurocutaneous melanosis, which can on occasion be symptomatic. Appropriate investigations include a screening magnetic resonance imaging scan, neurologic evaluation, and serial clinical observations for the development of cutaneous melanoma.
A variety of nonsurgical and surgical options are possible for the treatment of giant congenital melanocytic nevi. Giant congenital melanocytic nevi are a difficult diagnostic and reconstructive challenge, requiring careful preoperative evaluation, staged surgical excision, and lifelong patient monitoring and follow-up. With proper treatment, patients can expect a decreased risk of melanoma, with the possibility for early detection and cure of melanoma, amelioration of symptoms, improved aesthetics and psychosocial sequelae, and maintenance of function.
Genodermatoses with malignant potential. The delineation of syndromes carrying a predisposition to malignancy has led to great insights into the molecular biology of malignancy. Many such syndromes have cutaneous findings which can precede the development of neoplasia. Early recognition of the cutaneous stigmata of the genodermatoses with malignant potential can lead to early diagnosis and initiation of proper screening and treatment when indicated.
Additionally more recently delineated syndromes and their cutaneous findings are discussed. Certain inherited syndromes with a risk of neoplasia exhibit characteristic cutaneous findings. Recognition of these findings by the astute practitioner can lead to early intervention which can impact the course of these rare diseases. Denayer E, Legius E. Epub Jul 5. The RAS-MAPKinase pathway is a signal transduction cascade which has been studied extensively during the last decades for its role in human oncogenesis.
However, because it had a lot of side effects, it is not used that much in cosmetic medicine anymore. Like argon lasers, carbon dioxide lasers were one of the first cosmetic lasers used to treat skin conditions. A carbon dioxide laser is very strong and can cut into or vaporize skin tissue. As the name suggests, it uses carbon dioxide as its medium.
A continuous wave carbon dioxide laser is not as favorable anymore to treat facial skin conditions because of the severe associated downtime. Instead, the carbon dioxide lasers used on skin today are fractional carbon dioxide lasers. Continuous wave carbon dioxide lasers are still used to remove moles and other skin issues though. An erbium laser is an ablative laser used for skin resurfacing.
Like carbon dioxide lasers, erbium lasers vaporize the surface of your skin. However, they do not penetrate as deeply as CO2 lasers and are therefore used to treat moderate wrinkles and photoaging on the face, hands, and neck. Non-fractionated ablative lasers are rarely used for the skin anymore because fractional lasers are less invasive.
There are several models of fractionated erbium lasers used today. A dye laser is a laser with organic dye as the active medium. The most popular type of cosmetic dye laser is the pulsed dye laser. A KTP laser uses potassium titanyl phosphate crystal as its medium. KTP lases are known as green colored cosmetic lasers and they are used to treat vascular lesions, such as broken capillaries, spider veins, and redness in the skin. Yag laser is a laser that uses n eodymium- d oped y ttrium a luminium g arnet as its medium.
It is one of the most common lasers, available in both continuous and pulsed modes. There are a variety of Nd: Yag lasers, which are used to remove unwanted hair and treat skin veins and facial redness. This laser uses alexandrite as its laser source. Alexandrite lasers are used for hair and tattoo removal. They are especially good at removing green and black colored pigmentations in the skin. IPL also known as Flashlamp , photorejuvenation , and photofacial procedures stands for i ntense p ulsed l ight.
IPL is not a type of laser, but a light-based treatment often referred to as a cosmetic laser treatment because they both treat similar skin conditions in similar ways. IPL uses short bursts of high intensity light from specific flash lamps to selectively destroy pigment cells, capillaries, and hair roots on your skin.
Therefore, IPL is used to treat pigmentation, vascular lesions, rosacea, hair removal, and photorejuvenation. IPL is better for people who have light, pale skin. Though post-treatment side effects resemble a sunburn, some people actually experience skin blisters. Fraxel is a family of three cosmetic lasers made by a company called Solta. All three lasers in the Fraxel family use fractional photothermolysis to treat certain skin conditions.
There are two non-ablative Fraxel lasers and one ablative Fraxel laser. The two non-ablative lasers are Fraxel re: The ablative laser is Fraxel re: Fraxel was one of the first fractionated lasers on the market. Vbeam is the name of a pulsed dye laser manufactured by the company Candela.
It treats rosacea, port wine stains birthmarks , and broken blood vessels, essentially minimizing any skin condition involving redness. Vbeam uses a cooling spray with each laser pulse to minimize pain from the treatment. Similar to how lasers are an energy source, radiofrequency is also an energy source for aesthetic medical procedures. The most common cosmetic treatment using radiofrequency is Thermage, a device developed by the same company that makes Fraxel.
However, radiofrequency contracts fat cells so many people have experienced facial fat loss and thinner faces after receiving radiofrequency treatment. The magnetic pulse component of MP 2 induces the release of growth factors required for the sprouting of new blood vessels, as well as for proliferation of dermal fibroblast. Simultaneously, the RF component induces collagen and elastin synthesis by causing controlled thermal damage in the dermis, which triggers the self-repair mechanism of skin tissue.
The result is a marked improvement is skin tightness and elasticity, and in overall skin condition. Infrared is another source of energy used in cosmetic medicine. The most popular infrared skin device is called Titan. Ultrasound is the newest energy source used for cosmetic medical procedures.
Ultrasound imaging allows you to visualize the tissue beneath the surface of your skin. Therefore, you can see where damage is located and target them precisely. Ultrasound facial procedures rejuvenate the skin and minimize sagging. Ulthera is the name of a popular ultrasound treatment device. Skin rejuvenation and photorejuvenation basically means making your skin younger by minimizing wrinkles, pigmentation, sagginess, and other damage from photoaging.
There are three main ways to rejuvenate your skin: Laser skin resurfacing, also known as a laser peel, laser vaporization and lasabrasion, can reduce wrinkles, scars, sun damage, liver spots and blemishes. Newer laser technologies give your plastic surgeon, or Dermatologist a new level of control in laser surfacing, permitting extreme precision, for all over the body and especially in delicate areas.
It is about using beams of light. This will remove unwanted, damaged skin in a very precise manner one layer at a time. The laser beam used in laser resurfacing will remove your outer layer of skin, called the epidermis. It simultaneously heats the underlying skin, called the dermis. This action works to stimulate growth of new collagen and Elastin fibers. As the treated area heals, the new skin that forms is smoother and firmer, Bay like is fantastic!
Often these treatments begin 6 weeks or more before your scheduled procedure. These skin treatments are customized for your particular skin type to minimize complications and obtain the best result from your laser resurfacing. Laser skin resurfacing can be painful for some people and non for others. This is why your doctor may numb the skin with local anesthetics usually a cream. You may also receive a sedative to help you relax.
Afterwards, the doctor will provide painkillers to keep you comfortable or and anesthetic healing cream. But for most part, it will feel like a mild sunburn, of course evrbody is different. You may also experience itching or stinging for a few days after the procedure, like Sunburn. Depending on the treatment, some people may have what looks like a severe sunburn or discoloration.
The skin will be raw, and sencitive. Do not scratch or pick at crusts because this can cause scarring and use a strong eco friendly preferable perfume sent free Sunscreen at all times with or without operant sunlight. Usually, about five days to a week after laser skin resurfacing, your skin will peel and the beautiful new skin will be there waiting for you to love it!. You can expect that the treated area will peel. After that, the new, rejuvenated skin will be pink, but it will gradually lighten over two to three months.
It may take up to a year for the pinkness to go away. It is very important to protect your skin during this time of healing. Redness tends to last longer in blondes and redheads. Once your treated areas have healed, makeup may be used to tone down the color. Try a green-based makeup to neutralize red color. Be sure to opt for an oil-free makeup. I personally recommend waiting 3 to four days, the longer the better.
Not so good of an idea, it may create an infection and the whole purpose of the treatment in the first place. One option you have, especially if you suffer from acne, is mild light therapy. There are several forms of light therapy that could be helpful. One of the most common is intense pulsed light.
If your skin problem is over a widespread area or a more in-depth issue, it may call for a stronger form of therapy. There are several stronger types of lasers that you could try. One type is the non-ablative laser, which treats some deeper skin problems without having a major impact on the surface of the skin.
Another type is ablative laser treatment. That can be a great treatment for some skin conditions, but it can make others worse. A third laser option that you might need to think about is Fractional, also known as Fraxal, laser treatment. Fraxal lasers can essentially drill tiny columns of light and heat through the skin, leaving most of it undamaged.
The undamaged cells around the columns are then stimulated into helping to repair and strengthen the damaged cells, creating healthier looking skin. They do that by producing more collagen and other healthy components to strengthen the surrounding tissue. Of course, there are plenty of non-laser treatments for skin problems. Two common examples are microdermabrasion and chemical peels. Both of those methods resurface the skin in much the same way that sandpaper can smooth out a piece of wood.
The major difference between chemical peels and microdermabrasion is that the former works using chemicals, while the latter is actually more like sandpaper, using a tool to buff away the top layer of skin cells. There are many others that you could potentially try, including forms of laser devices not mentioned here, as well as various types of sound wave treatment. But, whether you choose sound wave treatment, lasers, or some other method, the important thing is to pick the treatment that is best for your skin condition and skin type.
If you are Asian, you have a higher risk of hyper-pigmentation or hypo-pigmentation. Do not get this treatment if you have active acne on your skin. Sharplan old technology Fraxel re: Swelling, bruising and redness will usually subside in weeks.
Darker skin tones can use this laser. Harmony Pixel Laser fractional erbium. There is a chance of recurrence when used for the treatment of vascular lesions. They are also good at removing black, green, or yellow colored tattoos. Not good for those with darker skin tones. Titan Radiofrequency Skin tightening Facial rejuvenation Contracts underlying fats, therefore some people experience permanent fat loss in their face.
Can make face look more gaunt. No risk of fat loss. There was a time when people could only enjoy the benefits of the age-defying laser by setting up a series of appointments with their dermatologists. Thanks to the Tria Age-Defying Laser, anyone can restore the youthfulness of their entire faces in the comfort and privacy of their homes.
Nutra Laser Hair Therapy is a new treatment system that has been proven in numerous Hair Restoration Clinics around the world to be effective for women and men. Thousands of users have experienced the benefits and success of this non-invasive, pain free laser treatment. It features a sleek design with rechargeable batteries to give you the freedom of movement. Here on week, we are sharing a post on Sleep, it is amazing the non sleep issue.
Prescription sleep aids are some of the most heavily marketed drugs to the public and so much more to it with these medications. We take pride to do the research and love making a difference,. Do you suffer from the pangs of sleep loss? Some people tough it up to insomnia or they have small children and is not much selection of choices.
There are tons of ways that technology affects sleep. Have you ever walked in a room and could tell that there was technology running? You can almost feel the low hum of radio signals in the air. This is a thing. And devices that emit a Wi-Fi signal are negatively affecting our sleep. Everything from a wireless router to cell phones, iPads, etc. A study was carried out in where scientists took two groups of people and put them in different rooms.
One group had real cell phones in the room with them and the other had fake ones. Neither knew that ones were fake. But the group exposed to actual cell signals and Wi-Fi waves had a significantly harder time falling asleep and staying asleep. Spend one week with all electronic devices removed from your bedroom. After the first few days, you should experience better sleep. If not, then you should dig deeper. In order for us to comfortably fall asleep, our bodies have to go through a process. And part of that process is creating melatonin.
But when we stare at bright screens, the light that is absorbed through our eyes delays the release of melatonin. Thus, making it harder to fall asleep. A study was done by Mariana Figueiro of the Lighting Research Center at Rensselaer Polytechnic Institute where she and a group of researchers tested the effects of bright screens on volunteers.
The results were conclusive. People who stared at a screen for two hours prior to going to bed had simply could not fall asleep. It took them a long period of time. So how do you rectify this and rule it out for yourself? Spend a week quitting the screen time at least two hours before bedtime. But if you must use technology at night, there are programs and apps that to help with this issue.
We fill our brains up with information all the time. So how do you fix this one? Stop revving up your brain before bed. There are many ways technology affects sleep, but even watching a boring TV show can stimulate it because the response that happens in your body, the neurons firing up, can still keep you up.
So, anyone who owns a cell phone knows that they set an alarm on it. What about text messages and voice mails? They all create pings and sounds to alert you and our brains are discretely tuned into them. So, to remedy this issue, I tried a test for ten days. Before going to bed I turned off all electronic devices. Anything that would produce a sound, ping, or alert. I broke out my old battery operated alarm clock and used that in place of the one I normally used on my phone.
After an adjustment period of two nights, I began to sleep straight through the night and woke up feeling rested. Whether you believe it or not, electronic devices create a noise. But it is there and it affects us regardless.
The sound taps into our brains and keeps us on the edge of consciousness, never really allowing us to fall into that deep sleep we actually need. How to tackle this issue? Either turn off or remove electronic devices from your bedroom before you go to sleep. This one is a no-brainer. With the rise and increase of technology, so has our addiction to it.
We are constantly plugged in. Myself, I spent late hours sitting in bed reading eBooks, playing games, and hanging out on social media. I even caught myself turning off the TV for the night, crawling into bed and then pulling out my phone to check the time and ended up messing around with it for a couple more hours. Protection of the globe with artificial tears. Inherent errors Incorrect peel pharmacology. With resorcinol combinations, TCA, or phenol formulas, evaporation of the alcohol or water vehicle base can occur, inadvertently producing a stronger solution.
Avoid accidental spillage of the solution. Impetigo and folliculitis streptococcal and staphylococcal. Pseudomonas or Escherichia coli infections. Clinical features Delayed wound healing. Treatment of bacterial infections Swab for culture and sensitivity. Wound cleaning with potassium permanganate soaks or acetic acid soaks three to four times a day.
Candidal infections Recent intake of oral antibiotics is often a pre-disposing factor. Herpes simplex infection It is characterized by reactivation of herpes simplex on face and perioral area presenting as sudden appearance of grouped erosions associated with pain. Treatment Active herpetic infections can easily be treated with anti-viral agents. Prevention Patients with a positive history of herpes simplex should be given mg of acyclovir three times a day beginning on the day of the peel and continuing for days, depending on whether it is a medium depth or deep chemical peel.
Prevention of infections Frequent post-operative visits should be done so that it can be ensured that appropriate home wound care is being performed and to minimize the risk of infection. Avoid occlusive dressing in the immediate post-operative period because of its propensity to promote folliculitis and streptococcal and staphylococcal infections.
Delayed healing Prolongation of granulation tissue beyond 1 week to 10 days signifies delayed healing. It could be due to the following: Diminished or absent skin appendages may impair epidermal regeneration with delayed wound healing. Treatment Treatment of infections already discussed.
Change of contact agents or protection with a biosynthetic membrane. Daily dressing along with a close watch on healing skin is a must. Prevention Strict sun avoidance and use of broad spectrum sunscreens before and after the peels indefinitely. Hypopigmenting agents hydroquinone, kojic acid, and arbutin should be strictly enforced in the post-peel period too. Treatment Triple combinations of hydroquinone, tretinoin, and steroids should be started once re-epithelialization is completed.
Hypopigmentation [ Figure 2 ] superficial peels. Transient lighter complexion is seen due to sloughing off of the epidermis and removal of excess melanin. Medium peels More prolonged hypopigmentation because of removal of basal layer. Hyperpigmentation It can occur any time after a peel and can be persistent, if treated inadequately. Types I and II skin following intense sun exposure and tanning or use of photo-sensitizing agents. Use of photosensitizing agents such as Non steroidal anti-inflammatory drugs, oral contraceptives, etc.
Treatment Retinoic acid, 0. Hydrocortisone cream can be used for several weeks as needed if erythema due to retinoic acid poses a concern. Prevention Good skin care regimens can sustain more long-lasting results though studies have shown that peeled skin returns to its baseline status within months without maintenance therapy. Strict sun avoidance and use of broad spectrum ultraviolet A and B sunscreens before and after the peels indefinitely.
Cessation of use of birth pills during peripeel period because it may invoke pigmentary changes. Skin depigmentation Bleaching effect can be seen after phenol peels. Lines of demarcation These are seen in medium and deep depth peels in darker skin types. Milia These are inclusion cysts which appear as a part of the healing process and are more common with dermabrasion than chemical peels. Treatment Milia often resolve spontaneously with normal cleansing of the face.
Prevention Returning to gentle epidermabrasion after re-epithelialization or the use of tretinoin both before and after peeling may retard their appearance. Texture changes Temporary appearance of enlarged pores post-peel can occur due to removal of stratum corneum. Atrophy It is characterized by the loss of normal skin markings in the absence of scarring. Predisposing factors History of smoking. History of recent intake of 0. Clinically, it is safe to perform a peel on patients after their skin begins to produce normal oil.
Before performing any resurfacing procedure, most practitioners recommend to wait for months after high-dose isotretinoin has been stopped, except in case of superficial peels. Low-dose isotretinoin in the dose of mg three times a week is found to be safe and effective during the peel period.
Recent ablative resurfacing procedures including dermabrasion or laser within 6 months of procedure. Since re-epithelialization occurs from adnexal structures, some authors have theorized that patients recently treated for hair removal with lasers may have trouble healing after medium or deep depth peels.
Medium depth peels on the areas like mandible, neck, and chest because these areas are more likely to scar. Thin-skinned patients are more prone for scarring because the TCA is more likely to penetrate deep into the reticular dermis. Systemic side-effects Phenol peels can cause cardiac, renal, and pulmonary toxicities.
Cardiac arrhythmias In patients deliberately face peeled with phenol in min time, tachycardia was usually noted first followed by premature ventricular contractions, bigeminy, paroxysmal atrial tachycardia, and ventricular tachycardia. Laryngeal edema Stridor, hoarseness, and tachypnea have been reported developing within 24 h of phenol peeling. Toxic shock syndrome Physician should be alerted if patients develop fever, syncopal hypotension, vomiting, or diarrhea days after a peel followed by scarlatiniform rash and desquamation.
Prevention of complications Select only skin types I and II for deep peel. Intravenous hydration with 0. Full face peels should be performed over a min period of time. Each cosmetic unit forehead, cheeks, nose, perioral, and periorbital areas should be peeled in 15 min increments. Allergic reactions Allergic contact dermatitis is more common with resorcinol, salicylic acid, kojic acid, lactic acid, hydroquinone, etc.
Deeper penetration of peel Predisposing factors Beginning a regimen with tretinoin Facial shaving Use of exfoliating scrubs. Prevention Closely examine condition of skin. Table 1 Complications for peeling procedures[ 22 ]. Footnotes Source of Support: A history of chemical peeling.
Complications of chemical peeling. J Dermatol Surg Oncol. Prevention of complications in chemical peeling. Handbook of Dermatological Drug Therapy. Complications of chemical face peeling. Step by Step Chemical Peels. Jaypee Medical Publishers; Update on chemical peels. Otolaryngol Clin North Am. Singh-Behl D, Tung R. Rapaport MJ, Kamer F. Exacerbation of facial herpes simplex after phenolic face peels.
Dermabrasion and chemical peel: A guide for facial plastic surgeons.
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