Biopsy techniques for skin disease and skin cancer

It is increasingly important for clinicians to be proficient at performing skin biopsies because of the prevalence of skin cancers and other skin diseases in the population. With the appropriate knowledge and training, the three major types of biopsies-shave biopsy, punch biopsy, and excisional/incisional biopsy-can be performed. The choice of biopsy type depends on the suspected disease pathology and lesion location.     

Surgical management of facial skin cancer

Surgical excision is the gold standard for management of cutaneous basal cell carcinoma or squamous cell carcinoma. Surgical management of nonmelanotic facial skin cancer requires preoperative planning and an in-depth understanding of reconstructive techniques, including primary closure, skin grafting, and local tissue flaps. The decision regarding the method of treatment of nonmelanotic skin cancer is highly individualized and depends on patient age, cancer size, histologic subtype, and site. No single therapy or technique can be used in every situation. The goals of treatment include complete removal of the lesion with preservation of normal tissue, function, and cosmesis. In this article we discuss the principles and techniques of surgical excision and reconstruction of site-specific facial skin cancers.     

See-and-treat surgery for facial skin cancer

See-and-treat surgery has been described as an efficient means of streamlining specialist diagnosis and treatment, and is commonly employed in gynaecology to reduce the delay between cytological screening and definitive treatment of cervical neoplasia. Relatively young patients with predominantly benign skin lesions have been treated in see-and-treat clinics but only in the context of referrals from primary care. The author describes the treatment of tertiary referrals for facial skin malignancies under local anaesthesia at these clinics, and analyses their acceptability to patients. A total of 100 consecutive patients were included. Data on age, coexisting conditions, diagnosis, site and size of lesion, operation, and outcomes including complications and completeness of excision, were collected. A questionnaire seeking patients’ opinions was also used. Ninety patients were treated and 98 lesions were removed, 94% of which were malignant. The complete excision rate was 95%. There were no complications, and 98% of patients were satisfied with the service. See-and-treat surgery is an effective, safe, and acceptable means of providing surgical management of facial skin malignancies.     

Introduction to immunocytochemistry

Immunocytochemistry has opened a new era in research and diagnosis. The development of immunocytochemical methods has made it possible to identify in situ normal and pathological tissue constituents, which it has not been possible to detect using ordinary histological methods. However, immunocytochemical techniques involve several pitfalls, which without proper control protocols can easily lead to incorrect findings. When interpreting the results obtained, account must always be taken of the morphological findings from routine histological sections. In other words, it is essential to understand the principles of these methods as well as to have enough basic knowledge in the field of research interest for making correct conclusions of the immunocytochemical findings.     

Introduction to email

The objective of these guidelines is to provide healthcare professionals, including primary care dental practitioners, with clear guidance on the management of patients on oral anticoagulants requiring dental surgery. The guidance may not be appropriate in all cases and individual patient circumstances may dictate an alternative approach.     

Reconstruction of skin cancer defects of the auricle

PURPOSE: This article reviews the results of reconstruction of surface defects of the auricle after removal of skin cancer, and discusses the results of the delayed reconstruction method of care and modalities of treatment. PATIENTS AND METHODS: Fifty-four patients with 62 defects involving various locations on the auricle were treated. Management included direct closure, secondary epithelization, full thickness skin grafts, local flaps using direct advancement, and rotational advancement flaps using one or more stages. RESULTS: Nine defects were treated by direct closure with adjacent tissue, 12 defects healed by secondary epithelization, and 13 patients were treated with a full thickness skin graft. Twenty-eight defects were reconstructed with local flaps, which included the direct advancement, rotational flaps, transposition, and subcutaneous island flaps. No infections occurred. CONCLUSION: Many options are available for reconstruction of auricular defects which yield acceptable results. Factors to consider before choosing a reconstructive format include size, location, and depth of the defect, patient medical history, smoking, and esthetic concerns. This review exposed that patients easily accept the "delayed" method of reconstruction. Delaying allows the surgeon time to research options for care and allows the patient choices of secondary epithelization and significantly reduced costs of care.     

Introduction to the Workshop

Public health administrators are forced to consider efficiency as a criterion in their choice of preventive programs because of the numerous programs to choose from, restricted budgets, and declining caries experience in children. Interest in cost effectiveness in dental prevention has risen considerably since the initial conference on this issue at the University of Michigan in 1978. This article introduces the goals of the workshop, the nature of the work groups, and the data they will use.     

Introduction to periodontal epidemiology

There is growing interest in, and appreciation of, the importance of epidemiological science in furthering our understanding of periodontal diseases. There is also interest in applying modern epidemiological methods to identify periodontal disease risk factors, prognostic factors and the long‐term outcomes of care, as well as periodontal–systemic associations. This volume combines critical reviews of selected areas of contemporary interest with targeted methodologically focused articles, in order to provide a valuable reference text to guide readers in their own critical assessment of new scientific findings, as well as to assist investigators in the design and analysis of their own original research in periodontal epidemiology. The 11 review articles that comprise this volume were selected with this goal in mind. They aim to inform readers on the methodological rigor that needs to be applied, both in the design of epidemiological studies and interpretation of their results, and the limitations to the inferences that may be drawn from epidemiological studies. Despite its various limitations, the field of periodontal epidemiology is expected to continue to grow in importance and relevance. There remains a need for well‐designed, carefully analyzed and correctly interpreted observational studies, including longitudinal cohort studies and case–control studies, in order to adequately understand both the causes of periodontal disease and the associations between periodontal disease and systemic disease in populations.     

Introduction to forensic science

Modern day criminal investigation has reached a point of sophistication requiring the involvement of many different disciplines to solve a crime. Each discipline inserts a part of the puzzle until it is complete. It is important to understand what each forensic expert has to offer. The coroner or medical examiner, asking for input from the various experts until enough information is received to determine the cause and manner of death, is usually the keystone to a death investigation. This information is then shared with the police investigators and prosecutor. This calls for the utmost cooperation and communication among those involved.     

Introduction to the Symposium

January 25, 1995, is the 50th anniversary of the first controlled addition of fluoride to a public water supply. Those 50 years have seen extraordinary advances in oral health and consequent quality of life, for which fluoride use is generally considered the primary reason. More extensive exposure to fluoride in the modern era, however, has led to both a continuing decline in caries experience and an increased prevalence of dental fluorosis in children. At the other end of life, fluoride's role in bone strength among older people is not well defined. This symposium examines several aspects of fluoride use in the United States today, and has the purpose of helping to define the balance between maximizing the benefits of fluoride while minimizing its undesirable side effects.