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Choong DJ, Ng JL, Vinciullo C. Pyoderma gangrenosum associated with Takayasu's arteritis in a young Caucasian woman and response to biologic therapy with tocilizumab. JAAD Case Rep 2021; 9:4-6. [PMID: 33598515 PMCID: PMC7868742 DOI: 10.1016/j.jdcr.2020.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dean J Choong
- Dermatology Department, Fiona Stanley Hospital, Western Australia
| | - Jeremy L Ng
- Dermatology Department, Royal Perth Hospital, Perth, Western Australia
| | - Carl Vinciullo
- Dermatology Department, Royal Perth Hospital, Perth, Western Australia
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Smith H, Borchard K, Cherian P, Vinciullo C. Multivariate logistic regression of risk factors for surgical site infection following Mohs surgery. Australas J Dermatol 2020; 61:288-289. [PMID: 32049357 DOI: 10.1111/ajd.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/29/2019] [Accepted: 01/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Harvey Smith
- Oxford Dermatology, Mount Hawthorn, Perth, Western Australia, Australia
| | - Kate Borchard
- Oxford Dermatology, Mount Hawthorn, Perth, Western Australia, Australia
| | - Paul Cherian
- Oxford Dermatology, Mount Hawthorn, Perth, Western Australia, Australia
| | - Carl Vinciullo
- Oxford Dermatology, Mount Hawthorn, Perth, Western Australia, Australia
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Smith H, Borchard K, Vinciullo C. Preoperative Topical Decolonization—An Additional Strategy to Reduce Oral Antibiotic Prophylaxis for Mohs Infections? JAMA Dermatol 2019; 155:1089. [DOI: 10.1001/jamadermatol.2019.2139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Smith H, Borchard K, Vinciullo C. Antibiotic prophylaxis for surgical site infection: no proof, no effect. Time to consider an alternative? J Dtsch Dermatol Ges 2019; 17:976-979. [DOI: 10.1111/ddg.13918_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Carl Vinciullo
- Department of Dermatology, Royal Perth Hospital, Oxford Dermatology, University of Western Australia Clinical School, Mount Hawthorn, West Australia, Australia
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Tucker SC, Vinciullo C. Tangential excision debulking with vertical sections prior to Mohs micrographic surgery. Australas J Dermatol 2019; 60:221-223. [DOI: 10.1111/ajd.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Simon C Tucker
- Oxford Dermatology Mount HawthornWestern Australia Australia
| | - Carl Vinciullo
- Oxford Dermatology Mount HawthornWestern Australia Australia
- University of Western Australia Perth Western Australia Australia
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Smith H, Borchard K, Cherian P, Vinciullo C. Systematic review and meta‐analysis of surgical site infection following Mohs surgery without prophylactic antibiotics. Australas J Dermatol 2019; 60:340-342. [DOI: 10.1111/ajd.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Harvey Smith
- Oxford Dermatology Mount Hawthorn Perth Western Australia Australia
| | - Kate Borchard
- Oxford Dermatology Mount Hawthorn Perth Western Australia Australia
| | - Paul Cherian
- Oxford Dermatology Mount Hawthorn Perth Western Australia Australia
| | - Carl Vinciullo
- Oxford Dermatology Mount Hawthorn Perth Western Australia Australia
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Affiliation(s)
- C. Vinciullo
- Department of Dermatology Royal Perth Hospital University of Western Australia Wellington Street Perth 6000 West Australia
- Oxford Dermatology Mohs Surgery Fellowship Training 416–418 Oxford Street Mount Hawthorn 6016 West Australia
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Yap FHX, Ricciardo B, Manjri Tiwari S, French MA, Italiano CM, Vinciullo C. A rare case of lues maligna with ocular involvement presenting as an unmasking immune reconstitution inflammatory syndrome in a patient with HIV infection. Australas J Dermatol 2017; 59:148-150. [DOI: 10.1111/ajd.12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Francis HX Yap
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Bernadette Ricciardo
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
| | - Shevya Manjri Tiwari
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Martyn A French
- Department of Immunology; Royal Perth Hospital; Perth Western Australia Australia
| | - Claire M Italiano
- Department of Microbiology and Infectious Diseases; Royal Perth Hospital; Perth Western Australia Australia
| | - Carl Vinciullo
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
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Abstract
A 68-year-old gentleman presented with a lesion that resembled a pyogenic granuloma in his inferior fornix. The lesion was excised and biopsy demonstrated a proliferation of malignant spindle cells. Three weeks following initial excision, the lesion recurred and was removed via wedge excision of the eyelid. Definitive clearance was achieved through Mohs micrographic surgery. The patient received adjuvant postoperative radiotherapy and remains disease-free. This case demonstrates the need to consider sinister pathology in the setting of recurrent periocular lesions.
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Affiliation(s)
- Pavindran Gounder
- a Department of Ophthalmology , Royal Perth Hospital , Perth , Australia
| | - Minh Lam
- b Department of Pathology , Royal Perth Hospital , Perth , Australia
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O'Halloran L, Smith H, Vinciullo C. Periocular Mohs micrographic surgery in Western Australia 2009-2012: A single centre retrospective review and proposal for practice benchmarks. Australas J Dermatol 2016; 58:106-110. [DOI: 10.1111/ajd.12432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/01/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Louise O'Halloran
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Harvey Smith
- Department of Dermatology; Oxford Day Surgery and Dermatology; Perth Western Australia Australia
| | - Carl Vinciullo
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
- Department of Dermatology; Oxford Day Surgery and Dermatology; Perth Western Australia Australia
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Abstract
The skin of the nasal dorsum and bridge is more forgiving in terms of reconstructive options. Individual differences in skin laxity, nasal length and sebaceous composition impact on reconstructive choice as do the size, depth and exact location of the surgical defect. For many, if not all, defects in this area there are multiple different reconstructive options available all of which can result in equivalent and excellent results. Oftentimes there is no clear advantage of one repair over another and the choice becomes one of personal preference based on experience. No proscriptive approach or algorithm can be usefully applied in this setting. Key considerations include the location of the defect (distal vs. proximal nasal dorsum), the position of the defect (midline or off-centre) and the texture of the skin involved (sebaceous vs. non-sebaceous). Defects may be considered complex if they border on, or cross onto adjacent cosmetic units. Examples include defects extending onto the nasal tip, tip-ala junction, sidewall, nasal root-glabella and medial canthus. The adjacent reservoirs of tissue redundancy that can be utilized in flap reconstruction include the nasal sidewall, the nasal dorsum itself, the glabella, the midline/paramedian forehead and the medial cheek. Nearly all flaps on the nasal dorsum require subnasalis muscle dissection to effect sufficient movement and to ensure adequate flap vascularity and viability. The nasal bridge and glabella have much thicker skin and it is usually sufficient to dissect in the subcutaneous plane rather than disrupting the deeper procerus and corrugator muscles. Thick sebaceous skin is generally stiffer, moves less easily and closures may result in greater wound tension. These factors together with a tendency for sutures to tear through easily potentially increases the risk of complications. Greater consideration should be given to the exact type of flap or graft chosen in these patients.
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Affiliation(s)
- C Vinciullo
- Oxford Day Surgery and Dermatology, Perth, WA, Australia
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Cherian P, Gunson T, Borchard K, Tai Y, Smith H, Vinciullo C. Oral antibiotics versus topical decolonization to prevent surgical site infection after Mohs micrographic surgery--a randomized, controlled trial. Dermatol Surg 2013; 39:1486-93. [PMID: 24090258 DOI: 10.1111/dsu.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization. METHODS A randomized, controlled trial with 693 patients was conducted over a 30-week period at a single surgical practice. Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab. Nasal carriers of S. aureus were randomized to receive topical decolonization with intranasal mupirocin twice daily plus 4% chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre- and postoperative doses of oral cephalexin. RESULTS One hundred seventy-nine patients (25.8%) were identified as carriers of S. aureus. Ninety received topical decolonization, and 89 received oral antibiotics. These groups were compared with a swab-negative Mohs surgical cohort over the same time period. There were no significant differences between the groups in terms of demographic characteristics or comorbidities. Nine percent of patients receiving oral antibiotic prophylaxis and 0% receiving topical decolonization developed early SSI (p = .003). CONCLUSION In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.
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Affiliation(s)
- Paul Cherian
- Oxford Day Surgery and Dermatology, Mt Hawthorn, Western Australia, Australia
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Borchard KLA, Gunson TH, Smith HR, Vinciullo C. Pushing the perialar: a modified perialar crescentic advancement flap for the reconstruction of large nasal sidewall defects. Dermatol Surg 2013; 39:956-9. [PMID: 23631438 DOI: 10.1111/dsu.12198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tai YJ, Borchard KLA, Gunson TH, Smith HR, Vinciullo C. Nasal carriage of Staphylococcus aureus in patients undergoing Mohs micrographic surgery is an important risk factor for postoperative surgical site infection: a prospective randomised study. Australas J Dermatol 2013; 54:109-14. [PMID: 23425142 DOI: 10.1111/ajd.12028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/30/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical site infection (SSI) can be a problematic complication of Mohs micrographic surgery (MMS). Previous reports have cited nasal Staphylococcus aureus (S. aureus) carriage as a risk factor for SSI, but none thus far in dermatologic surgery. OBJECTIVE The aim was to determine the difference in infection rates between nasal carriers of S. aureus and non-carriers, and whether decolonisation with intranasal mupirocin ointment and chlorhexidine wash would reduce the infection rate in nasal carriers. METHODS In all, 738 patients presenting for MMS at the Oxford Day Surgery and Dermatology underwent a nasal swab to determine their S. aureus carriage status. S. aureus carriers were randomised for decolonisation with intranasal mupirocin ointment and chlorhexidine body wash. Non-carriers were untreated. All patients were followed up for SSI. RESULTS The rate of SSI was 11 per cent in untreated S. aureus carriers, 4 per cent in treated carriers, and 3 per cent in non-carriers. The difference in infection rate between carriers and non-carriers was significant (P < 0.001). The difference between treated and untreated carriers was also significant (P = 0.05). CONCLUSION Nasal S. aureus carriage is an important risk factor for SSI in MMS, conferring an over threefold increase in SSI risk. A pre-operative nasal swab provides a simple and effective risk stratification tool. The use of a topical decolonisation regimen reduces the infection rate in carriers to a level approaching non-carriers without exposure to systemic antibiotics.
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Affiliation(s)
- Yee J Tai
- Oxford Day Surgery and Dermatology, Perth, Western Australia, Australia.
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Kearney C, Sheridan A, Vinciullo C, Elliott T. A tunneled and turned-over nasolabial flap for reconstruction of full thickness nasal ala defects. Dermatol Surg 2010; 36:1319-24. [PMID: 20584046 DOI: 10.1111/j.1524-4725.2010.01631.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chris Kearney
- Sydney Specialist Dermatology, Bondi Junction, Australia.
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Abstract
We present a case of sclerosing lipogranuloma of the penis in a 25-year-old man of Burmese origin complicating injection of an unknown non-biodegradable oily foreign material into his external genitalia. Despite frequent complications, penile augmentation with exogenous paraffin material is still practised in some parts of the world. Sclerosing lipogranuloma is a rare condition in Australia that dermatologists need to consider in the differential of a genital ulcer or indurated penile mass, particularly in young men from South-East Asia. A causal relationship between the procedure and adverse events may not be made because complications are frequently delayed for many years. A high degree of clinical suspicion and a skin biopsy is essential, as a history of injection may not be disclosed.
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Affiliation(s)
- Glen Foxton
- Department of Dermatology, Royal Perth Hospital, Perth, Western Australia, Australia.
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Abstract
The key to obtaining excellent scars is perfect wound edge apposition with little or no tension across the sutured wound. Unsightly 'dog ear' protrusions at the ends of the wound should be avoided as they can detract from the cosmetic result. A simple, practical and efficient surgical technique is described, which can provide the optimal conditions for a perfect scar.
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Affiliation(s)
- Carl Vinciullo
- Royal Perth Hospital, Perth, Western Australia, Australia.
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Vinciullo C, Elliott T, Francis D, Gebauer K, Spelman L, Nguyen R, Weightman W, Sheridan A, Reid C, Czarnecki D, Murrell D. Photodynamic therapy with topical methyl aminolaevulinate for 'difficult-to-treat' basal cell carcinoma. Br J Dermatol 2005; 152:765-72. [PMID: 15840111 DOI: 10.1111/j.1365-2133.2005.06484.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients. OBJECTIVES To investigate the efficacy and safety of PDT using MAL for BCCs defined as 'difficult to treat', i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications. METHODS This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with 'difficult-to-treat' BCC were treated with MAL PDT, using 160 mg g(-1) cream and 75 J cm(-2) red light (570-670 nm), after lesion preparation and 3 h of cream exposure. Results Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years. CONCLUSIONS MAL PDT is an attractive option for 'difficult-to-treat' BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures.
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Affiliation(s)
- C Vinciullo
- Fremantle Hospital, Fremantle, Western Australia, Australia.
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Thai KE, Fergin P, Freeman M, Vinciullo C, Francis D, Spelman L, Murrell D, Anderson C, Weightman W, Reid C, Watson A, Foley P. A prospective study of the use of cryosurgery for the treatment of actinic keratoses. Int J Dermatol 2004; 43:687-92. [PMID: 15357755 DOI: 10.1111/j.1365-4632.2004.02056.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Actinic keratoses are the most common actinic lesions on Caucasian skin. Cryosurgery with liquid nitrogen is commonly used to treat actinic keratoses, but there have been few studies examining the true rate of cure in everyday dermatologic practice. AIM To determine prospectively the true efficacy of cryosurgery as a treatment for actinic keratoses in everyday dermatologic practice. METHODS A prospective, multicentered study (a subsidiary study of a photodynamic therapy trial) was performed. Patients with untreated actinic keratoses greater than 5 mm in diameter on the face and scalp were recruited. Eligible lesions received a single freeze-thaw cycle with liquid nitrogen given via a spray device and were reviewed 3 months thereafter. Each center used their preferred freeze time. The only treatment criterion was complete freezing of actinic keratoses and a 1-mm rim of normal skin. Treated lesions were assessed as complete response or noncomplete response. The influence of the duration of freeze, cosmetic outcomes, and adverse events were examined. RESULTS Ninety adult patients from the community with 421 eligible actinic keratoses were recruited. The overall individual complete response rate was 67.2%[SEM = +/-3.5%; 95% confidence interval (CI) = 60.4-74.1%]. Complete response was 39% for freeze times of less than 5 s, 69% for freeze times greater than 5 s, and 83% for freeze times greater than 20 s. Cosmetic outcomes were good to excellent in 94% of complete response lesions. The main adverse events were pain, stinging, and burning during treatment, and hypopigmentation after healing. CONCLUSIONS Cryosurgery is an effective treatment for actinic keratoses. The true complete response rate is significantly lower than that previously reported. The freeze duration influences successful treatment. Adverse events are mild and well tolerated.
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Affiliation(s)
- Keng-Ee Thai
- Department of Medicine (Dermatology), The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
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Abstract
BACKGROUND Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained. OBJECTIVE The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion. METHODS The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion. RESULTS Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images. CONCLUSION Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.
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Affiliation(s)
- Suresh Chandra
- Dermatology Surgery and Laser Center, South Perth, Western Australia, Australia
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Pagliaro J, Elliott T, Bulsara M, King C, Vinciullo C. Cold air analgesia in photodynamic therapy of basal cell carcinomas and Bowen's disease: an effective addition to treatment: a pilot study. Dermatol Surg 2004; 30:63-6. [PMID: 14692930 DOI: 10.1111/j.1524-4725.2004.30011.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is considerable interpatient variability in pain tolerance during and after treatment of skin cancer with photodynamic therapy (PDT). Additionally, erythema and edema are common, with mild crusting and healing over 1 to 2 weeks. OBJECTIVE To determine whether concurrent cold air analgesia improves the tolerability of PDT. METHOD Twenty-six patients with two similar superficial skin cancers were treated with PDT. One lesion was treated with cold air analgesia and the other without. Patients rated their pain during treatment using the Wong Baker Faces Pain Scale and detailed duration of posttreatment pain. At week 2, the inflammatory response was assessed. RESULT A statistically significant difference in the analgesia group was shown with respect to the mean duration of pain and the level of erythema after the first treatment as well as pain scores during the second treatment. CONCLUSION Patient acceptance of PDT for treatment of nonmelanoma skin cancer is improved with lessened morbidity assessed with concurrent use of cold air analgesia to the treatment field.
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Affiliation(s)
- John Pagliaro
- Dermatology Specialist Centre, Clayfield, Brisbane, Queensland, Western Australia.
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Abstract
A 38-year-old man presented with numerous dermal nodules, similar to xanthoma disseminatum, that were histologically consistent with his diagnosis of Erdheim-Chester disease, a non-Langerhans cell histiocytosis. Other cutaneous manifestations of this disease include eyelid xanthelasma, pretibial dermopathy and pigmented lesions of the lips and buccal mucosa. The histological diagnosis of Erdheim-Chester disease was originally made on the patient's retroperitoneal tissue, obtained at a laparotomy for surgical treatment of a presumed phaeochromocytoma, and confirmed by the pathognomonic long bone X-ray findings of this disease.
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Affiliation(s)
- Kimble M Opie
- Department of Dermatology, Royal Perth Hospital, Perth, Western Australia, Australia
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25
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Smith H, Elliot T, Vinciullo C. Repair of nasal tip and alar defects using cheek-based 2-stage flaps: an alternative to the median forehead flap. Arch Dermatol 2003; 139:1033-6. [PMID: 12925392 DOI: 10.1001/archderm.139.8.1033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe our use of cheek-based 2-stage transposition flaps for repairing Mohs surgery defects of the lower third of the nose. DESIGN Retrospective case series. SETTING Private dermatologic day surgery facility. Patients Twenty-eight patients with defects of the lower third of the nose after Mohs surgery. Intervention Ten alar and 18 nasal tip defects repaired using cheek-based 2-stage transposition flaps. MAIN OUTCOME MEASURES Acceptability of procedure to patient, complications, and appearance from photographic records. RESULTS The procedures were well tolerated and achieved good cosmetic results without major complications. CONCLUSIONS These flaps allow repair of extensive defects of the nasal tip and ala with the patient under local anesthesia. This approach provides an alternative to the median forehead flap for nasal tip repairs.
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Affiliation(s)
- Harvey Smith
- Dermatology, Surgery, and Laser Center, Perth Surgicenter, South Perth, Australia
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Freeman M, Vinciullo C, Francis D, Spelman L, Nguyen R, Fergin P, Thai KE, Murrell D, Weightman W, Anderson C, Reid C, Watson A, Foley P. A comparison of photodynamic therapy using topical methyl aminolevulinate (Metvix) with single cycle cryotherapy in patients with actinic keratosis: a prospective, randomized study. J DERMATOL TREAT 2003; 14:99-106. [PMID: 12775317 DOI: 10.1080/09546630310012118] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a very common condition, which has the potential of progressing to squamous cell carcinoma. The present study is a prospective, randomized study comparing the lesion response, cosmetic outcome, patient satisfaction and tolerability of a new treatment modality, photodynamic therapy (PDT), using topical methyl aminolevulinate (Metvix), with the most commonly used standard therapy for AK, cryotherapy. METHODS A total of 204 patients with clinically diagnosed AK were randomized to either cryotherapy or PDT. The PDT patients were further assigned to an active or placebo group in a random, double-blind manner. Cryotherapy was performed using liquid nitrogen spray in a single freeze-thaw cycle. PDT was performed using 160 mg/g methyl aminolevulinate cream or placebo, a 3-hour application time, red light (570-670 nm) and a total light dose of 75 J/cm(2). PDT was repeated after 7 days. Two sessions of PDT were undertaken, as a previous study had shown a single session had similar efficacy to cryotherapy. Lesion response was assessed clinically after 3 months (complete response or non-complete response). RESULTS The lesion response rate was 91% in the methyl aminolevulinate PDT group, 68% in the cryotherapy group and 30% in the placebo PDT group. Methyl aminolevulinate PDT was statistically significantly better than both cryotherapy and placebo PDT in terms of response rates and cosmetic outcome. Most patients preferred PDT to other treatments. CONCLUSIONS PDT with methyl aminolevulinate is an excellent treatment option, particularly for patients with widespread damage or AK lesions in cosmetically sensitive areas.
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Affiliation(s)
- M Freeman
- The Skin Centre, Gold Coast, Queensland, Australia
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Vinciullo C. A15. Simultaneous, sequential or strategically-intervalled procedures in dermatological surgery. J Cosmet Dermatol 2002. [DOI: 10.1046/j.1473-2165.2002.00040_16.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gaspar Z, Vinciullo C, Elliott T, Vincuillo C. Antibiotic prophylaxis for full-face laser resurfacing: is it necessary? Arch Dermatol 2001; 137:313-5. [PMID: 11255331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the need for antibiotic prophylaxis when performing full-face laser resurfacing. METHOD Prospective study of 31 patients undergoing full-face laser resurfacing, 17 with and 14 without antibiotic prophylaxis. OBSERVATION Four of 14 patients without antibiotic prophylaxis had microbiologic and clinical evidence of infection. None of the 17 patients with antibiotic prophylaxis had clinical infection. Early treatment prevented adverse sequelae in the 4 patients who developed infection. CONCLUSION Antibiotic prophylaxis against Staphylococcus aureus is useful but not essential, because meticulous wound care and close clinical monitoring of patients daily with routine bacterial swabs can detect infection early.
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Affiliation(s)
- Z Gaspar
- Dermatology, Surgery and Laser Centre, South Perth, Australia
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Abstract
PURPOSE Mohs surgery (micrographically controlled excision) has been advocated as an effective method of dealing with infiltrative periorbital skin tumours. It has been shown to have high rates of tumour clearance with minimal loss of normal tissue, thus making oculoplastic reconstruction easier and functional preservation better. The aim of the present study was to confirm this. Guidelines for the selection of patients for Mohs surgery are discussed. METHODS We retrospectively reviewed 24 cases of primary (n = 18) and recurrent (n = 6) periorbital basal and squamous cell carcinomas managed by Mohs micrographic excision and plastic reconstruction who presented to the Royal Perth Hospital between 1992 and 1996. RESULTS Our high rate of tumour clearance (100%) was similar to that of previous studies, although our follow-up period was only 14.6 months. The fact that 50% of our patients with lid involvement had an intact posterior lamella after Mohs excision correlates with the high level of normal tissue preservation. The low rate of postoperative symptomatic problems suggests good maintenance of function. The infiltrative nature of these tumours was highlighted by the substantial proportion of cases (37.5%) that had a much larger excision defect than what was expected prior to excision. CONCLUSIONS Our analysis confirms that Mohs excision and subsequent oculoplastic reconstruction is an effective method to use when managing periorbital infiltrative skin tumours.
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Affiliation(s)
- B Kumar
- Department of Ophthalmology, Royal Perth Hospital, Australia
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Abstract
Spider telangiectasia is a common benign vascular malformation which can be a source of cosmetic concern for the patient. A retrospective review of 30 adults and children with spider telangiectasia treated by the flashlamp-pumped pulsed dye laser was undertaken. There was complete clearance of treated spider telangiectasia in 93% of patients after a single treatment. There were no reported permanent adverse effects with purpura being the only transient problem. Most patients were satisfied with the eventual results of treatment and would recommend treatment to other people with a similar problem. This laser should be considered as the treatment of choice for spider telangiectasia.
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Affiliation(s)
- E Tan
- Department of Dermatology, Royal Perth Hospital, Australia
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Abstract
Dermatologic surgeons are very familiar with the use of the carbon dioxide (CO2) laser for treating actinic cheilitis. When squamous cell carcinoma is proven or suspected in the affected lip, then combined CO2 laser vermilionectomy and wedge excision as a one stage procedure has significant advantages for the patient.
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Affiliation(s)
- C Vinciullo
- Perth Surgicentre, South Perth, Western Australia, Australia
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Abstract
OBJECTIVE To assess the effectiveness of the flashlamp-pumped pulsed dye laser in the treatment of port-wine stains. DESIGN A retrospective review of medical records and patients. SETTING Royal Perth Hospital (a tertiary referral hospital), August 1989 to December 1992. SUBJECTS 186 consecutive patients with port-wine stains treated with a flashlamp-pumped pulsed dye laser. OUTCOME MEASURES Degree of lesion fading; adverse reactions. RESULTS Of 131 patients who completed treatment, 78% had better than 50% fading of the lesion and only 9% had less than 25% fading. An average 3.4 treatments were needed to achieve more than 50% fading. The response was better in children than in adults, although the difference was not significant. Anaesthesia was needed for 44% of patients. Pigmentary change (usually transient) occurred in 6.1% of patients and permanent and signficiant adverse effects in only 4.6%. CONCLUSION This study confirms the efficacy of the flashlamp-pumped pulsed dye laser in the treatment of port-wine stains in children and adults. Early treatment of port-wine stains should be encouraged to reduce the physical and psychological morbidity of disfiguring lesions.
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Affiliation(s)
- E Tan
- Department of Dermatology, Royal Perth Hospital, Perth, WA
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Abstract
BACKGROUND The flashlamp-pumped pulsed dye laser is recognized as the treatment of choice for port-wine stains. Most studies assessing its effectiveness are based on clinical reviews by the treating physician. Each patient's assessment of treatment outcome is also important. OBJECTIVE To assess the patients' attitudes toward laser treatment, satisfaction with treatment outcome, and reasons for withdrawal from treatment. METHODS A questionnaire was distributed to 186 patients with port-wine stains treated with the flashlamp-pumped pulsed dye laser. Of the 186 patients, 131 had completed treatment and 55 were having ongoing treatment or had withdrawn from treatment. Replies were received from 164 patients, a response rate of 88%. RESULTS Most patients expressed satisfaction with the present appearance of their treated port-wine stains. The majority of any adverse effects experienced were transient. Over 90% of patients would recommend treatment to other people with port-wine stains. CONCLUSION The flashlamp-pumped pulsed dye laser improves the appearance of port-wine stains, and is regarded favorably by patients. Patients' assessments of treatment outcomes correlate well with clinical results obtained.
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Affiliation(s)
- E Tan
- Department of Dermatology, Royal Perth Hospital, Australia
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Affiliation(s)
- Carl Vinciullo
- Fellow in Mohs' Surgery, Department of DermatologyNew York University Medical Center 530 First Avenue New York NY 10016 USA
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Vinciullo C. Allopurinol hypersensitivity. Med J Aust 1984; 141:449-50. [PMID: 6236355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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