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Radiation Carcinogenesis

As acceptance of radiation therapy for skin cancer grows, questions arise as to the long-term risks therapeutic radiation poses. This is an area extensively measured and studied by radiation physicists and medical dosimetrists. However, from practical point of view, most of empirical data comes form epidemiological population studies. The most dramatic of these being atomic…

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Superficial Radiotherapy – An Alternative Treatment of Superficial Carcinomas

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First successful treatment of skin cancer with fractionated radiation therapy was reported by Steinbeck and Sjogren in Sweden in 1899. Since then, superficial radiation and low energy Grenz X-rays have been utilized in office settings by radiation oncologists and dermatologists for the same purposes. In the United States, the practice continued through the 1970’s and…

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Vismodegib – A Breakthrough in Basal Cell Carcinoma Treatment

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Vismodegib, a Hedgehog Pathway Inhibitor, has been recently shown to be highly effective for advanced basal cell carcinoma in Phase II clinical studies. Discovery of the Hedgehog Signaling Pathway is enlightening in how three unrelated basic science research paths can meet at crossroads of cancer treatment breakthrough. First, there were sheep in Idaho in 1957…

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Peri-Auricular Neoplasm – Deception in Waiting

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  Peri-auricular subcutaneous lesions can be deceptive. These neoplasms have a higher risk of being non-dermal-related tumors than neoplasms of other areas of the face. Attempts at excision without consideration of a differential diagnosis can often lead to tumor compromise. Over the last several months, SCARS Center has treated several tumors previously excised partially by…

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Smoothened and Patched and Sonic Hedgehogs – From Cyclopic Sheep to Targeted Basal Cell Carcinoma Treatment

Continuing Medical Education Conferences at Scar Center

What does Frizzled, Frazzled, Dishevelled, and Smoothened have to do with the Sonic Hedgehog? These are some of the humorously named genes in Drosophila fruit flies that also happened to be expressed in humans. Besides adding character to the genes, these names occasionally reflect the traits they describe. Hedgehog (Hh) gene is part of the…

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New Melanoma Staining: SOX10 and MiTF

S-100, tyrosinase, Melan A, and HMB 45 have been the workhorses of melanocyte histopathology. A new immunohistochemical stain, SOX10, has recently been shown to be a useful marker in the diagnosis of melanocytic tumors.  It is strongly expressed by desmoplastic melanoma and is less likely to be expressed by background fibrocytes and histiocytes. Sry-related HMG-BOX…

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Radiation Therapy of Skin Cancer: Dosing and Complications

Although, radiation of ear carcinomas can pose a risk of chondritis and poor healing, that risk can be virtually eliminated with lower dose fractions (radiation dose per treatment) spread over a longer course. Total dose requirement for skin cancer treatment ranges from 3500 cGy to 6000 cGy depending on the size and depth of the…

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Acceptance of Residual Melanoma-In-Situ: Avoiding Cosmetic and Functional Deformation

Radical Excision of Melanoma in Situ

Acceptance of residual melanoma-in-situ (lentigo maligna) after an excision can avoid cosmetic and functional deformation. Is the residual risk of recurrence and transformation into invasive melanoma low enough to warrant observation? Melanoma-in-situ (MIS) is a high risk lesion due to three primary reasons. The first is that a partially biopsied melanocytic lesion with a diagnosis…

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Perineural Invasion

Perineural invasion is strongly indicative of aggressive behavior and risk of metastases. True perineural invasion requires histologic finding of cancer invasion of the nerve or cancer invasion of the epineurium adjacent to the nerve.  This must be distinguished from cancer near a nerve, cancer encompassing a nerve, and perineural inflammation. Cancer cells within the nerve…

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