Dupuytren's contracture
Treatment
In the early stages of disease when metacarpophalangeal joint contracture is below 15 degrees and there is sickness interphalangeal contracture can be treated medically.
Medical therapy. Multiple therapies have been tried: creams with vitamin E, allopurinol, colchicine, physical therapy and ultrasound, some without success. Topical retinoids have proved effective, topical corticosteroids, calcium channel blockers, tamoxifen. Therapies are still under study: Acetate Intralesional injections of triamcinolone in Colagenazo-enzyme-fasciomiotomia intralesional collagenase-injected -Ilomastat promising agent that inhibits fibroblast matrix formation 5-fluorouracil decreases collagen formation by inhibiting fibroblast differentiation and miofibroblastelor -Radiation Immunomodulator imiquimod, which decreases TNF-alpha and fibroblast growth by lowering IL2 infiba Botulinum toxin-inflammatory pathway inhibits the activation of IL2 intralesional.
Surgical therapy. Surgery is indicated when the contraction is over 20 metacarpofalangiana joint degrees and over 30 degrees at the interphalangeal. Surgical methods include: Involves excision-fasciectomia-palmar fascia -Fasciomiotomia-limited incisions, diseased tissue is removed but not incised. Complications of surgery include infection, damage to arteries, nerves, carpal tunnel syndrome, hematoma formation, wound necrosis, scar contraction. Regional pain syndrome known as reflex dystrophy simpatico occurs in 10% of patients who have surgery.
Prognosis. Dupuytren's contracture Treatment Spontaneous resolution without treatment does not appear. Progression is unpredictable and not all cases anatomic deformation progresses. Patients with early onset disease tend to present the picture more aggressive, often requiring surgery. The rate of recurrence is related to disease severity, multiple lesions and coexistent diabetes. Postoperative recurrence rate is 60%.
Monday, January 31, 2011
Dupuytren's contracture Signs and symptoms
Dupuytren's contracture
Signs and symptoms
Mean age of onset in men is 50 years, the onset is delayed in women. The patient describes a feeling of tightening and firmly on the palm area, fingers or less. This thickening is often present for several years and may be slowly progressive. Ring finger is most commonly affected, followed by the little finger. The disease can be bilateral but is generally not symmetric in severity. The nodules are painless. Tenosynovitis can develop and lead to pain when the nodules are large. With progression of the disease may develop a flexion deformation. Patients unable to gather accusing fingers. Dupuytren's diathesis is observed in patients with onset at ages younger than 40 years with bilateral disease, family history of disease and ectopic lesions. They are considered risk factors for disease recurrence and extension. The disease may be associated with damage to the penis, Peyronie's disease, the disease-affected Ledderhose plantar fascia.
Physical examination. Depending on the stage of disease is seen more presentations to describe: Early stage: localized thickening of the palmar skin and subcutaneous tissue adjacent skin loss of mobility. Can this be a depression or a band supradenivelata the affected area. Nodular stage: initial nodes are palpable, they are visible late. Nodules are firm, fixed and well located. When the disease affects the palm, nodules are located in line with his chic little ring finger. Nodules are located on digital interphalangeal joint or the metacarpofalangiana. Stage band: the band is a similar linear thickening of the tendon. Progressive contraction of its cause deformation in flexion of the fingers. When deflection is 30 degrees you can not slap the patient lying on a flat surface.
Diagnosis. Dupuytren's contracture Signs and symptoms
The differential diagnosis is made with the following conditions: Callus, epithelioid sarcoma, galglionar cysts, stenosing tenosynovitis, tendon flexors Prolab, ulnar nerve palsy, camptodactilie, fibroids and fibromatoze.
Signs and symptoms
Mean age of onset in men is 50 years, the onset is delayed in women. The patient describes a feeling of tightening and firmly on the palm area, fingers or less. This thickening is often present for several years and may be slowly progressive. Ring finger is most commonly affected, followed by the little finger. The disease can be bilateral but is generally not symmetric in severity. The nodules are painless. Tenosynovitis can develop and lead to pain when the nodules are large. With progression of the disease may develop a flexion deformation. Patients unable to gather accusing fingers. Dupuytren's diathesis is observed in patients with onset at ages younger than 40 years with bilateral disease, family history of disease and ectopic lesions. They are considered risk factors for disease recurrence and extension. The disease may be associated with damage to the penis, Peyronie's disease, the disease-affected Ledderhose plantar fascia.
Physical examination. Depending on the stage of disease is seen more presentations to describe: Early stage: localized thickening of the palmar skin and subcutaneous tissue adjacent skin loss of mobility. Can this be a depression or a band supradenivelata the affected area. Nodular stage: initial nodes are palpable, they are visible late. Nodules are firm, fixed and well located. When the disease affects the palm, nodules are located in line with his chic little ring finger. Nodules are located on digital interphalangeal joint or the metacarpofalangiana. Stage band: the band is a similar linear thickening of the tendon. Progressive contraction of its cause deformation in flexion of the fingers. When deflection is 30 degrees you can not slap the patient lying on a flat surface.
Diagnosis. Dupuytren's contracture Signs and symptoms
The differential diagnosis is made with the following conditions: Callus, epithelioid sarcoma, galglionar cysts, stenosing tenosynovitis, tendon flexors Prolab, ulnar nerve palsy, camptodactilie, fibroids and fibromatoze.
Keilah plasmacytoma
Keilah plasmacytoma
Keilah plasmacytoma is a benign inflammation characterized by mucosal infiltration plasmacytoma located anywhere near the hole on the body: the lips, penis, vulva, buccal mucosa, palate, gums, tongue, epiglottis and larynx.
It can be isolated, but more commonly associated with gingivitis and glossitis plasmacytoma.
It manifests as erythematous boards, usually located on the lower lip. It seems that this disease was common in U.S. between 1960-1980, was caused in this period of sensitization to an unidentified antigen, contained in various products, especially in chewing gum and toothpaste.
The condition responds to treatment with potent dermocorticoizi or intradermal injection of triamcinolone acetonide. Keilah plasmacytoma
Keilah plasmacytoma is a benign inflammation characterized by mucosal infiltration plasmacytoma located anywhere near the hole on the body: the lips, penis, vulva, buccal mucosa, palate, gums, tongue, epiglottis and larynx.
It can be isolated, but more commonly associated with gingivitis and glossitis plasmacytoma.
It manifests as erythematous boards, usually located on the lower lip. It seems that this disease was common in U.S. between 1960-1980, was caused in this period of sensitization to an unidentified antigen, contained in various products, especially in chewing gum and toothpaste.
The condition responds to treatment with potent dermocorticoizi or intradermal injection of triamcinolone acetonide. Keilah plasmacytoma
Cheilitis caused by retinoids
Cheilitis caused by retinoids
Cheilitis caused by retinoids appears constantly as a side effect of systemic treatment with retinoids.
It is manifested by erythema, drying, peeling, cracking and this sometimes crusts on the lips.
Treatment consists of systemic administration retionizi stopped.
Cheilitis caused by retinoids
Cheilitis caused by retinoids appears constantly as a side effect of systemic treatment with retinoids.
It is manifested by erythema, drying, peeling, cracking and this sometimes crusts on the lips.
Treatment consists of systemic administration retionizi stopped.
Cheilitis caused by retinoids
Keilah factors
Keilah factors
Factice Cheilitis is caused by repeated trauma, and sometimes by scratching with the nails of labial semimucoasei made deliberately by subjects with mental disorders, anxious, unable to cope with a difficult situation emotionally. Keilah patomimica is seen in subjects that will draw attention to oneself niches of affective benefits.
Clinically, squamous lesions are characterized by yellowish-white or yellowish-brown, located predominantly in the lower lip, which will highlight the detachment semimucoasa an erythematous, sometimes fissured.
Treatment consists of avoiding injuries and treating mental disorders.
Factice Cheilitis is caused by repeated trauma, and sometimes by scratching with the nails of labial semimucoasei made deliberately by subjects with mental disorders, anxious, unable to cope with a difficult situation emotionally. Keilah patomimica is seen in subjects that will draw attention to oneself niches of affective benefits.
Clinically, squamous lesions are characterized by yellowish-white or yellowish-brown, located predominantly in the lower lip, which will highlight the detachment semimucoasa an erythematous, sometimes fissured.
Treatment consists of avoiding injuries and treating mental disorders.
Granulomatous Cheilitis
Granulomatous Cheilitis
Granulomatous Cheilitis is characterized by enlargement of the upper lip and / or lower due to a granulomatous inflammation of unknown cause. It can be accompanied by fever, headache, visual disturbances. Edema can spread to the cheeks and tongue may associate scrotal and cranial nerve palsy.
At first, the lesions disappear in a few hours / days, so after several recurrent episodes, to become permanent.
Granulomatous Cheilitis may be a manifestation in other diseases: Melkersson-Rosenthal syndrome, sarcoidosis, Crohn's disease.
Treatment consists of intralesional administration of corticosteroids (triamcinolone acetonide), surgical treatment (cheiloplastie).
Granulomatous Cheilitis is characterized by enlargement of the upper lip and / or lower due to a granulomatous inflammation of unknown cause. It can be accompanied by fever, headache, visual disturbances. Edema can spread to the cheeks and tongue may associate scrotal and cranial nerve palsy.
At first, the lesions disappear in a few hours / days, so after several recurrent episodes, to become permanent.
Granulomatous Cheilitis may be a manifestation in other diseases: Melkersson-Rosenthal syndrome, sarcoidosis, Crohn's disease.
Treatment consists of intralesional administration of corticosteroids (triamcinolone acetonide), surgical treatment (cheiloplastie).
Glandular Cheilitis
Glandular Cheilitis
There is a divergence of views on the pathogenesis of glandular cheilitei - some authors believe that is characterized by a salivary hypersecretion and inflammatory changes in the structure of lip salivary glands, sometimes with a family character, other authors believe is due to heterotopic of salivary glands lip structure, the disease has no erditara components and observed a higher frequency in the tropics.
It can occur at any age, being located almost exclusively in the lower lip. The rim is slightly thickened and has many holes through which saliva may protrude.
In more severe forms, the lip is much larger, the surface is covered with scales and crusts, which can be seen in salivary duct openings.
In very severe forms of infection spreads deeper, with abscess and fistula formation. Some authors consider that there is a malignant transformation in squamous cell carcinoma in 20-30% of cases, while other authors deny the existence of malignant transformation.
Treatment consists of excision eliptiaca vermilionectomie or when the lips are much enlarged. Glandular Cheilitis
There is a divergence of views on the pathogenesis of glandular cheilitei - some authors believe that is characterized by a salivary hypersecretion and inflammatory changes in the structure of lip salivary glands, sometimes with a family character, other authors believe is due to heterotopic of salivary glands lip structure, the disease has no erditara components and observed a higher frequency in the tropics.
It can occur at any age, being located almost exclusively in the lower lip. The rim is slightly thickened and has many holes through which saliva may protrude.
In more severe forms, the lip is much larger, the surface is covered with scales and crusts, which can be seen in salivary duct openings.
In very severe forms of infection spreads deeper, with abscess and fistula formation. Some authors consider that there is a malignant transformation in squamous cell carcinoma in 20-30% of cases, while other authors deny the existence of malignant transformation.
Treatment consists of excision eliptiaca vermilionectomie or when the lips are much enlarged. Glandular Cheilitis
Actinic Cheilitis
Actinic Cheilitis
Cheilitis Actinic keratosis is a premalignant lip caused by chronic exposure to solar radiation. There was a higher incidence in hot areas, the workers who work outdoors, people with phototype I and II.
Starts with a tingling sensation and redness, and lips become dry and descuameaza. Lower lip is predominantly affected. Epithelium becomes thin, small plates appear gray-white, vertical cracks, sometimes blisters that break, causing erosion and crusting.The lesions may develop into malignant transformation should be suspected if the needles that develop an ulcer, red or white spot appears with an irregular margin at the vermillion, generalized atrophy with a whitish central area, thin scales or scabs persist.
Treatment consists of topical application of 5-fluorouracil 5% vermilionectomie, laser excision. Actinic Cheilitis
Cheilitis Actinic keratosis is a premalignant lip caused by chronic exposure to solar radiation. There was a higher incidence in hot areas, the workers who work outdoors, people with phototype I and II.
Starts with a tingling sensation and redness, and lips become dry and descuameaza. Lower lip is predominantly affected. Epithelium becomes thin, small plates appear gray-white, vertical cracks, sometimes blisters that break, causing erosion and crusting.The lesions may develop into malignant transformation should be suspected if the needles that develop an ulcer, red or white spot appears with an irregular margin at the vermillion, generalized atrophy with a whitish central area, thin scales or scabs persist.
Treatment consists of topical application of 5-fluorouracil 5% vermilionectomie, laser excision. Actinic Cheilitis
Angular Cheilitis
Angular Cheilitis
Angular Cheilitis: is an acute or chronic inflammation of the mouth corners.
Factors involved in its appearance are:
a) Infections:
- Candida albicans is the most frequently involved in causing cheilitei
angular;
- staphylococci, streptococci, enterococci are more rarely involved, but sometimes they can be mixed infections (candidiasis and bacterial).
b) Mechanical:
- undershot;
- edentation;
- aggressive brushing teeth, etc..
c) nutritional deficiencies:
- riboflavinelor;
- folate;
- iron, etc..
d) Skin conditions: cheilitei angular appearance was found in atopic dermatitis, seborrheic dermatitis.
Clinically, it looks like a rough triangular areas, erythematous and / or edema, both located at and, more rarely, one of the corners of the mouth. In more severe forms are observed radiating cracks from the corners (ragade).
Treatment consists of correction triggers
Angular Cheilitis: is an acute or chronic inflammation of the mouth corners.
Factors involved in its appearance are:
a) Infections:
- Candida albicans is the most frequently involved in causing cheilitei
angular;
- staphylococci, streptococci, enterococci are more rarely involved, but sometimes they can be mixed infections (candidiasis and bacterial).
b) Mechanical:
- undershot;
- edentation;
- aggressive brushing teeth, etc..
c) nutritional deficiencies:
- riboflavinelor;
- folate;
- iron, etc..
d) Skin conditions: cheilitei angular appearance was found in atopic dermatitis, seborrheic dermatitis.
Clinically, it looks like a rough triangular areas, erythematous and / or edema, both located at and, more rarely, one of the corners of the mouth. In more severe forms are observed radiating cracks from the corners (ragade).
Treatment consists of correction triggers
Keilah infectious
Keilah infectious
Cheilitis can be infectious:
a) Viral: herpes simplex virus is the agent most frequently involved in triggering the emergence of infectious cheilitei.Starts with a eritematosa gingivitis, then the blisters appear semimucoasei and sometimes peribucal the skin, they break and cause the formation of scabs.
b) Bacterial: is due to a chronic infection of the gums or dental origin, it is difficult to identify the bacteria responsible because many saprophytic flora.
c) yeast: the agent most frequently incriminated pathogen is Candida albicans, is an early and constant lip location in mucocutaneous candidiasis.Perles may be associated with candidiasis.
Cheilitis can be infectious:
a) Viral: herpes simplex virus is the agent most frequently involved in triggering the emergence of infectious cheilitei.Starts with a eritematosa gingivitis, then the blisters appear semimucoasei and sometimes peribucal the skin, they break and cause the formation of scabs.
b) Bacterial: is due to a chronic infection of the gums or dental origin, it is difficult to identify the bacteria responsible because many saprophytic flora.
c) yeast: the agent most frequently incriminated pathogen is Candida albicans, is an early and constant lip location in mucocutaneous candidiasis.Perles may be associated with candidiasis.
Contact Cheilitis
Contact Cheilitis
Cheilitis of contact can be triggered by the following factors:
- perfumes, dyes, preservatives present in lipsticks, lip balms;
- toothpaste (in particular, which contains propolis), mouth rinses, the materials are made restorations;
- food (especially citrus fruits);
- objects: pieces of musical instruments, etc..
Begins with local itching, followed by erythema and sometimes even swelling and blisters on the lips. The lesions may spread to the skin around the lips and, less commonly, mucosal.
Diagnosis is established based on the clinical, patch tests may be used to detect trigger factor.
Treatment consists of local administration of corticosteroids and avoiding contact with the trigger agent.
Cheilitis of contact can be triggered by the following factors:
- perfumes, dyes, preservatives present in lipsticks, lip balms;
- toothpaste (in particular, which contains propolis), mouth rinses, the materials are made restorations;
- food (especially citrus fruits);
- objects: pieces of musical instruments, etc..
Begins with local itching, followed by erythema and sometimes even swelling and blisters on the lips. The lesions may spread to the skin around the lips and, less commonly, mucosal.
Diagnosis is established based on the clinical, patch tests may be used to detect trigger factor.
Treatment consists of local administration of corticosteroids and avoiding contact with the trigger agent.
Carotenodermia Diagnosis and treatment
Carotenodermia
Diagnosis and treatment
Signs and symptoms Carotenemia is a common condition in children, especially due to the excessive consumption of carrots, but may be associated with the ingestion of many other yellow and red vegetables and fruits. Lipocrom determining carotene is a yellow skin. With its high levels in the blood is intense yellow coloration. Carotenemia may be evident when the stratum corneum is thick or when subcutaneous fat is well represented. The condition is not serious but can lead to a wrong diagnosis of jaundice.
History of excessive intake of carotene with hipercarotenemie diagnosis is usually present. Carotenemia can be verified by a high level of serum beta-carotene, vitamin A levels and normal liver function tests normal. Accumulation of beta-carotene in the skin is delayed until two weeks from the serum. Due to the nature lipoidice carotenes sufficient quantities may remain in tissues for several months forcing the yellow color even after serum carotene levels returned to normal. Metabolic Carotenemia no history of excessive intake of carotenoids may be due to a genetic defect in the metabolism of carotenes. Amenorea carotenemia may be associated with. It occurs in patients who consume a predominantly vegetable diet without red meat. Changes in food can reduce the level of carotenoids, which in turn normalizes the menstrual cycle.
An association between carotenemie and biliary dyskinesia has been suggested. In patients with metabolic carotenemie identified a cause-effect relationship between gallbladder contraction and the level of serum carotene, vitamin A and lipids. Carotenemia may be due to ingestion of red palm oil. Due to the nature lipoidice carotenes remain in the skin enough to cause discoloration to 5 months, even if serum carotenes nvelul returns to normal.
Physical Exam: Yellow discoloration of the skin, especially palms and soles is characteristic without affecting the sclera. Yellowing of the skin-xantodermia may be caused by multiple conditions. Highlight the presence or absence of yellow coloration of the whites is important in determining the diagnosis. Yellow whites are found in patients with all etiologies that involve high levels of serum bilirubin as conjunctival tissues are rich in elastin with special affinity for bilirubin. Enlarged spleen and liver are not volume.
Carotenodermia Diagnosis and treatment Diagnosis: The differential diagnosis is made with the following conditions: jaundice, riboflavinemia, lycopene after ingestion of large quantities of tomatoes.
Carotenodermia Diagnosis and treatment Treatment: The condition is benign and does not require treatment along with improving thus eliminating the carotenes in the diet. Usually there are no complications. A carotene-free diet leads to progressive disappearance of yellow coloration of the skin. This stain can remain up to several months regardless of the level of serum carotene accumulation in tissues.
Diagnosis and treatment
Signs and symptoms Carotenemia is a common condition in children, especially due to the excessive consumption of carrots, but may be associated with the ingestion of many other yellow and red vegetables and fruits. Lipocrom determining carotene is a yellow skin. With its high levels in the blood is intense yellow coloration. Carotenemia may be evident when the stratum corneum is thick or when subcutaneous fat is well represented. The condition is not serious but can lead to a wrong diagnosis of jaundice.
History of excessive intake of carotene with hipercarotenemie diagnosis is usually present. Carotenemia can be verified by a high level of serum beta-carotene, vitamin A levels and normal liver function tests normal. Accumulation of beta-carotene in the skin is delayed until two weeks from the serum. Due to the nature lipoidice carotenes sufficient quantities may remain in tissues for several months forcing the yellow color even after serum carotene levels returned to normal. Metabolic Carotenemia no history of excessive intake of carotenoids may be due to a genetic defect in the metabolism of carotenes. Amenorea carotenemia may be associated with. It occurs in patients who consume a predominantly vegetable diet without red meat. Changes in food can reduce the level of carotenoids, which in turn normalizes the menstrual cycle.
An association between carotenemie and biliary dyskinesia has been suggested. In patients with metabolic carotenemie identified a cause-effect relationship between gallbladder contraction and the level of serum carotene, vitamin A and lipids. Carotenemia may be due to ingestion of red palm oil. Due to the nature lipoidice carotenes remain in the skin enough to cause discoloration to 5 months, even if serum carotenes nvelul returns to normal.
Physical Exam: Yellow discoloration of the skin, especially palms and soles is characteristic without affecting the sclera. Yellowing of the skin-xantodermia may be caused by multiple conditions. Highlight the presence or absence of yellow coloration of the whites is important in determining the diagnosis. Yellow whites are found in patients with all etiologies that involve high levels of serum bilirubin as conjunctival tissues are rich in elastin with special affinity for bilirubin. Enlarged spleen and liver are not volume.
Carotenodermia Diagnosis and treatment Diagnosis: The differential diagnosis is made with the following conditions: jaundice, riboflavinemia, lycopene after ingestion of large quantities of tomatoes.
Carotenodermia Diagnosis and treatment Treatment: The condition is benign and does not require treatment along with improving thus eliminating the carotenes in the diet. Usually there are no complications. A carotene-free diet leads to progressive disappearance of yellow coloration of the skin. This stain can remain up to several months regardless of the level of serum carotene accumulation in tissues.
Basal cell carcinoma Treatment
Basal cell carcinoma
Treatment
Medical therapy. Local chemotherapy and immunomodulatory therapy is useful in some cases of carcinoma. In particular small and superficial carcinomas may respond to these compounds. In addition they can be used for prophylaxis and maintenance in patients who are predisposed to develop multiple carcinomas such as those in basal cell nevus syndrome.
Imiquimod 5% cream successfully used to treat superficial tumors. Its antitumor effects that induce apoptosis in tumor regression. We recommend using five times a week for six weeks but the frequency and duration must be addressed according to each patient.
Topical Cream 5% 5-fluorouracil is sometimes used for small superficial tumors btrata. It has a cure rate of 80%. Apply twice daily for at least six weeks. Percutaneous absorption of 5-fluorouracil is the main limiting factor. Penetrates only 1 mm into the skin. One advantage is that it works on tumors that are not large enough to be seen with the naked eye. Therefore it can be used in patients with basal cell nevus syndrome or those prone to develop subclinical forms. Cosmetic results vary from good to excellent.
Treatment with interferon alfa-2b has shown some success in treating small nodular and superficial tumors. Intralesional is administered 3 times per week, three weeks. Cure rate is 80%. Interferon did not become a practical therapy because of its cost carcinoma, the frequent visits to the doctor, the discomfort of administration and no adverse effects. Flu-like symptoms are common. Cardiovascular side effects, myelosuppression and neurological uncommon with this treatment. Because interferon is an immune stimulant treatment should not be used for transplantation or carcinoma in patients with autoimmune diseases.
Photodynamic therapy, PDT has been used for over 20 years. It uses different wavelengths to excite porphyrins that have been applied and paraneoplazice elulelor cancer. The energy released is quickly absorbed into the tissue adjacent to destroy you. 5-aminolevulinic acid is used to excite cells. It is administered for one hour and then fotoactiveaza labastra light.
Surgical therapy. The purpose of this therapy is to destroy or remove such a tumor is not malignant tissue left to proliferate further. Factors that are considered to choose a therapy include histological subtype, tumor location and size, patient age, its ability to withstand surgery and cost. Recurrent tumors are generally more aggressive than primary lesions and subclinical extension tends to increase. Tumors that are aggressive and which are located near the vital organs are best treated by methods that allow examination of tissue margins.
Curettage with electrodesicare. Use a scoop to remove the tumor from the skin. This technique works better in nodular and superficial subtypes of carcinoma because these tumors tend to be loose and not contained in the fibrous stroma. Curettage followed by electrodesicare, and the entire process can be repeated 1-2 times. Cure rate is 90% for low risk carcinoma. The method is simple, fast and less expensive.
Curettage is a blind technique which can examine specimens from the edge of control. Aggressive subtypes such as the morfeaform, infiltrative, micronodular and appellant are loose and can not be removed by curette. Healing leaves atrophic scars.
Surgical excision. The excised tumor can also apparently normal appearance of the skin edge. This method can be performed in an outpatient setting and allows for pathological examination control edges. Healing time is shorter than the granulation by suturing and has a good cosmetic appearance.
Surgical excision is more expensive and requires more time than chiretajul. This method requires the killing of normal tissue to obtain an acceptable healing of. At least 4 mm margins are necessary even in the less aggressive carcinomas, to achieve 95% healing.
Mohs micrographic surgery. It involves removal of clinically apparent tumor and a thin ring surrounding normal skin. The entire edge of the excised tumor is examined microscopically to minimize errors. It uses a freezing-sectioning technique to assess tissue when the patient is still a doctor. Microscopic tissue will present a map that will mark the remaining tumors to be excised. The Mohs technique 100% of the tissue margins are examined compared with the rest of techniques that are considered less than 1%. Excision and repair can be done in one day. This technique has the cure rate of cure is highest in the long term.
Radiotherapy. It is effective as primary treatment for a variety of carcinomas. For most of the cure rate is 90%. It is especially useful in patients who can not tolerate surgery, such as the elderly or debilitated. It can be useful when patients have aggressive tumors that have failed surgical treatment. It is an excellent option for avoiding vital structures adjacent. Initial cosmetic results tend to be better, and this therapy is less disfiguring than surgical excision. However long term results can be disfiguring. Another disadvantage is that the edges of the tumor can not be considered. Tumors that recur in irradiated areas tend to be more aggressive and difficult to treat.
Cryotherapy. It is an effective method for nonagresive carcinomas, with a cure rate of 90%. However, treatment success is dependent on operator experience. Patients must be able to pottratament swelling, necrosis and scarring of treated areas. This method is not used frequently.
Basal cell carcinoma Treatment Prognosis. Incompletely treated basal cell carcinoma can recur. All treated areas should be monitored after therapy. Persons with basal cell carcinoma have a 30% risk of developing other carcinomas combined with the previous comparable general population.
Treatment
Medical therapy. Local chemotherapy and immunomodulatory therapy is useful in some cases of carcinoma. In particular small and superficial carcinomas may respond to these compounds. In addition they can be used for prophylaxis and maintenance in patients who are predisposed to develop multiple carcinomas such as those in basal cell nevus syndrome.
Imiquimod 5% cream successfully used to treat superficial tumors. Its antitumor effects that induce apoptosis in tumor regression. We recommend using five times a week for six weeks but the frequency and duration must be addressed according to each patient.
Topical Cream 5% 5-fluorouracil is sometimes used for small superficial tumors btrata. It has a cure rate of 80%. Apply twice daily for at least six weeks. Percutaneous absorption of 5-fluorouracil is the main limiting factor. Penetrates only 1 mm into the skin. One advantage is that it works on tumors that are not large enough to be seen with the naked eye. Therefore it can be used in patients with basal cell nevus syndrome or those prone to develop subclinical forms. Cosmetic results vary from good to excellent.
Treatment with interferon alfa-2b has shown some success in treating small nodular and superficial tumors. Intralesional is administered 3 times per week, three weeks. Cure rate is 80%. Interferon did not become a practical therapy because of its cost carcinoma, the frequent visits to the doctor, the discomfort of administration and no adverse effects. Flu-like symptoms are common. Cardiovascular side effects, myelosuppression and neurological uncommon with this treatment. Because interferon is an immune stimulant treatment should not be used for transplantation or carcinoma in patients with autoimmune diseases.
Photodynamic therapy, PDT has been used for over 20 years. It uses different wavelengths to excite porphyrins that have been applied and paraneoplazice elulelor cancer. The energy released is quickly absorbed into the tissue adjacent to destroy you. 5-aminolevulinic acid is used to excite cells. It is administered for one hour and then fotoactiveaza labastra light.
Surgical therapy. The purpose of this therapy is to destroy or remove such a tumor is not malignant tissue left to proliferate further. Factors that are considered to choose a therapy include histological subtype, tumor location and size, patient age, its ability to withstand surgery and cost. Recurrent tumors are generally more aggressive than primary lesions and subclinical extension tends to increase. Tumors that are aggressive and which are located near the vital organs are best treated by methods that allow examination of tissue margins.
Curettage with electrodesicare. Use a scoop to remove the tumor from the skin. This technique works better in nodular and superficial subtypes of carcinoma because these tumors tend to be loose and not contained in the fibrous stroma. Curettage followed by electrodesicare, and the entire process can be repeated 1-2 times. Cure rate is 90% for low risk carcinoma. The method is simple, fast and less expensive.
Curettage is a blind technique which can examine specimens from the edge of control. Aggressive subtypes such as the morfeaform, infiltrative, micronodular and appellant are loose and can not be removed by curette. Healing leaves atrophic scars.
Surgical excision. The excised tumor can also apparently normal appearance of the skin edge. This method can be performed in an outpatient setting and allows for pathological examination control edges. Healing time is shorter than the granulation by suturing and has a good cosmetic appearance.
Surgical excision is more expensive and requires more time than chiretajul. This method requires the killing of normal tissue to obtain an acceptable healing of. At least 4 mm margins are necessary even in the less aggressive carcinomas, to achieve 95% healing.
Mohs micrographic surgery. It involves removal of clinically apparent tumor and a thin ring surrounding normal skin. The entire edge of the excised tumor is examined microscopically to minimize errors. It uses a freezing-sectioning technique to assess tissue when the patient is still a doctor. Microscopic tissue will present a map that will mark the remaining tumors to be excised. The Mohs technique 100% of the tissue margins are examined compared with the rest of techniques that are considered less than 1%. Excision and repair can be done in one day. This technique has the cure rate of cure is highest in the long term.
Radiotherapy. It is effective as primary treatment for a variety of carcinomas. For most of the cure rate is 90%. It is especially useful in patients who can not tolerate surgery, such as the elderly or debilitated. It can be useful when patients have aggressive tumors that have failed surgical treatment. It is an excellent option for avoiding vital structures adjacent. Initial cosmetic results tend to be better, and this therapy is less disfiguring than surgical excision. However long term results can be disfiguring. Another disadvantage is that the edges of the tumor can not be considered. Tumors that recur in irradiated areas tend to be more aggressive and difficult to treat.
Cryotherapy. It is an effective method for nonagresive carcinomas, with a cure rate of 90%. However, treatment success is dependent on operator experience. Patients must be able to pottratament swelling, necrosis and scarring of treated areas. This method is not used frequently.
Basal cell carcinoma Treatment Prognosis. Incompletely treated basal cell carcinoma can recur. All treated areas should be monitored after therapy. Persons with basal cell carcinoma have a 30% risk of developing other carcinomas combined with the previous comparable general population.
Subscribe to:
Posts (Atom)