- Email: [email protected]
Bilateral incomplete cleft lip
782
Short reports and correspondence
Figure 1
Size of the scalp defect at the age of 1 week.
discharged with the same dressing regime. The scalp has almost completely re-epithelialised and the patient is being currently followed up in the outpatient clinic. To summarise, we would like to highlight the fact that a simple, nonadherent, atraumatic and relatively cheap dressing such as Mepitelw is sufficient for the initial conservative treatment phase for managing large defects in aplasia cutis congenita.
References 1. Azad S, Falder S, Harrison J, Graham K. An adherent dressing for aplasia cutis congenita. Br J Plast Surg 2005;1159–61.
Anindya Lahiri Hiroshi Nishikawa Birmingham Children’s Hospital, Birmingham, UK E-mail address: [email protected]
q 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2006.01.002
Figure 2 The defect following conservative management at the age of 5 months.
Bilateral incomplete cleft lip I read with interest the article by Hikosaka et al.1 on bilateral incomplete cleft lip. The authors stated that there were no studies in the literature focusing on the results of bilateral incomplete cleft lip repair. I would like to bring their attention to our article published in 2002.2
References 1. Hikosaka M, Nakajima T, Onishi H, Tamada I. The change in the appearance of the vermilion border region caused by the difference of the design in symmetric bilateral incomplete cleft lip repair. Br J Plast Surg 2005;58: 475–80. 2. Al-Qattan MM. Bilateral one stage rotation advancement technique for Saudi children with isolated bilateral incomplete cleft lip: low revision rate despite multiple imperfections. Ann Plast Surg 2002;48:365–9.
M.M. Al-Qattan Division of Plastic Surgery, King Saud University,
Short reports and correspondence P.O. Box 18097, Riyadh 11415, Saudi Arabia E-mail address: [email protected]
q 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.12.008
Metastatic giant basal cell carcinoma and radiotherapy We read the report on giant basal cell carcinoma (BCC) of the thoracic wall by Lorenzini et al.1 It was describing an 81-year-old man with an ulcerated cutaneous giant BCC, measuring 6!2 cm2, on the anterior chest wall. The lesion infiltrated the mediastinum, with complete occlusion of the left brachiocephalic vein. Neither surgical treatment nor radiotherapy was feasible. They noted that specific histological features are associated with an aggressive course, and early diagnosis and treatment with close follow-up are mandatory. In agreement with their observation, additionally we think that radiotherapy might be an appropriate treatment approach for BCC in the definitive or palliative purposes. A 67-year-old man was referred to our clinic for a treatment of a bleeding exophytic tumour located on the nasal tip and alae. On his past-medical history, he had initially a lesion in diameter of 2 cm treated with excision 10 years ago. At that time the histopathological diagnosis was BCC and surgical margins were free of tumour. After 8 years of a silent period, the tumour recurred in the same location and was excised again. Histological examination of the specimen confirmed the previous diagnosis as BCC but its surgical margins were positive. The patient refused further treatment. Although the tumour recurred again 6 months after the second excision, he neglected the medical advice again and did not undertake any treatment. However, the tumour progressed rapidly and the patient complained of bleeding and bone pain within last 2 months. On physical examination, we determined an ulcerated lesion which were approximately in 8!5 cm2 located on nasal tip and bilateral alae with multiple skin nodules ranging from 0.5 to 1 cm in diameter on the skin of the chin. He also had back pain especially in the lomber region. A bone scan was conducted and it showed multiple metastatic areas on lomber vertebras.
783 There was no abnormal finding on examination. Computed tomography findings of his chest and abdomen were normal. Biopsies were performed to his primary tumour on the nasal alae and skin metastases, which confirmed the presence of solid BCC in these regions. The bone metastases were thought to be originated from BCC of the skin. The patient received external radiotherapy with a total dose of 54 Gy in 27 fractions for primary tumour and skin lesions and of 30 Gy in 10 fractions for lomber bone metastases. The tumour and skin metastases revealed a complete response and the back pain relieved completely. However, he died of a heart attack 7 months after the radiotherapy. BCC is the most common malignancy and giant BCC is defined, by the American Joint Committee on Cancer, as a tumour larger than 5 cm in diameter. Only 1% of all BCC were giant tumour.1,2 Two-thirds of metastatic BCC appears from primary tumour on the face. BCC usually has multiple skin recurrences before metastases become evident. The most common organs involved are lung, bone and skin, as in the present case here.2 Tumours greater than 5 cm in diameter have a 25% incidence of metastasis. The prognosis of metastatic BCC is extremely poor. Once metastasis is detected, there is a high mortality rate of 50% within 8 months.2 Systemic chemotherapy has been used with some success for advanced, large, inoperable, or metastatic BCC. The most effective single agent appears to be cisplatin.3 Radiotherapy is an important option in the management of BCC and is useful as definitive or palliative treatment or combined approach with surgery. It offers an advantage in the treatment of large lesions where clear surgical margins may be difficult to obtain4 and have deep tissue infiltration by allowing tissue preservation. In conclusion, we think that radiotherapy may be an effective treatment for palliation of BCC symptoms in patients with recurrent disease after surgery.
References 1. Lorenzini M, Gatti S, Giannitrapani A. Giant basal cell carcinoma of the thoracic wall: a case report and review of the literature. Br J Plast Surg 2005;58(7):1007–10. 2. Copcu E, Aktas A. Simultaneous two organ metastases of the giant basal cell carcinoma of the skin. Int Semin Surg Oncol 2005;2(1):1. 3. von Domarus H, Stevens PJ. Metastatic basal cell carcinoma. Report of five cases and review of 170 cases in the literature. J Am Acad Dermatol 1984;10(6):1043–60.
Short reports and correspondence
Figure 1
Size of the scalp defect at the age of 1 week.
discharged with the same dressing regime. The scalp has almost completely re-epithelialised and the patient is being currently followed up in the outpatient clinic. To summarise, we would like to highlight the fact that a simple, nonadherent, atraumatic and relatively cheap dressing such as Mepitelw is sufficient for the initial conservative treatment phase for managing large defects in aplasia cutis congenita.
References 1. Azad S, Falder S, Harrison J, Graham K. An adherent dressing for aplasia cutis congenita. Br J Plast Surg 2005;1159–61.
Anindya Lahiri Hiroshi Nishikawa Birmingham Children’s Hospital, Birmingham, UK E-mail address: [email protected]
q 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2006.01.002
Figure 2 The defect following conservative management at the age of 5 months.
Bilateral incomplete cleft lip I read with interest the article by Hikosaka et al.1 on bilateral incomplete cleft lip. The authors stated that there were no studies in the literature focusing on the results of bilateral incomplete cleft lip repair. I would like to bring their attention to our article published in 2002.2
References 1. Hikosaka M, Nakajima T, Onishi H, Tamada I. The change in the appearance of the vermilion border region caused by the difference of the design in symmetric bilateral incomplete cleft lip repair. Br J Plast Surg 2005;58: 475–80. 2. Al-Qattan MM. Bilateral one stage rotation advancement technique for Saudi children with isolated bilateral incomplete cleft lip: low revision rate despite multiple imperfections. Ann Plast Surg 2002;48:365–9.
M.M. Al-Qattan Division of Plastic Surgery, King Saud University,
Short reports and correspondence P.O. Box 18097, Riyadh 11415, Saudi Arabia E-mail address: [email protected]
q 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.12.008
Metastatic giant basal cell carcinoma and radiotherapy We read the report on giant basal cell carcinoma (BCC) of the thoracic wall by Lorenzini et al.1 It was describing an 81-year-old man with an ulcerated cutaneous giant BCC, measuring 6!2 cm2, on the anterior chest wall. The lesion infiltrated the mediastinum, with complete occlusion of the left brachiocephalic vein. Neither surgical treatment nor radiotherapy was feasible. They noted that specific histological features are associated with an aggressive course, and early diagnosis and treatment with close follow-up are mandatory. In agreement with their observation, additionally we think that radiotherapy might be an appropriate treatment approach for BCC in the definitive or palliative purposes. A 67-year-old man was referred to our clinic for a treatment of a bleeding exophytic tumour located on the nasal tip and alae. On his past-medical history, he had initially a lesion in diameter of 2 cm treated with excision 10 years ago. At that time the histopathological diagnosis was BCC and surgical margins were free of tumour. After 8 years of a silent period, the tumour recurred in the same location and was excised again. Histological examination of the specimen confirmed the previous diagnosis as BCC but its surgical margins were positive. The patient refused further treatment. Although the tumour recurred again 6 months after the second excision, he neglected the medical advice again and did not undertake any treatment. However, the tumour progressed rapidly and the patient complained of bleeding and bone pain within last 2 months. On physical examination, we determined an ulcerated lesion which were approximately in 8!5 cm2 located on nasal tip and bilateral alae with multiple skin nodules ranging from 0.5 to 1 cm in diameter on the skin of the chin. He also had back pain especially in the lomber region. A bone scan was conducted and it showed multiple metastatic areas on lomber vertebras.
783 There was no abnormal finding on examination. Computed tomography findings of his chest and abdomen were normal. Biopsies were performed to his primary tumour on the nasal alae and skin metastases, which confirmed the presence of solid BCC in these regions. The bone metastases were thought to be originated from BCC of the skin. The patient received external radiotherapy with a total dose of 54 Gy in 27 fractions for primary tumour and skin lesions and of 30 Gy in 10 fractions for lomber bone metastases. The tumour and skin metastases revealed a complete response and the back pain relieved completely. However, he died of a heart attack 7 months after the radiotherapy. BCC is the most common malignancy and giant BCC is defined, by the American Joint Committee on Cancer, as a tumour larger than 5 cm in diameter. Only 1% of all BCC were giant tumour.1,2 Two-thirds of metastatic BCC appears from primary tumour on the face. BCC usually has multiple skin recurrences before metastases become evident. The most common organs involved are lung, bone and skin, as in the present case here.2 Tumours greater than 5 cm in diameter have a 25% incidence of metastasis. The prognosis of metastatic BCC is extremely poor. Once metastasis is detected, there is a high mortality rate of 50% within 8 months.2 Systemic chemotherapy has been used with some success for advanced, large, inoperable, or metastatic BCC. The most effective single agent appears to be cisplatin.3 Radiotherapy is an important option in the management of BCC and is useful as definitive or palliative treatment or combined approach with surgery. It offers an advantage in the treatment of large lesions where clear surgical margins may be difficult to obtain4 and have deep tissue infiltration by allowing tissue preservation. In conclusion, we think that radiotherapy may be an effective treatment for palliation of BCC symptoms in patients with recurrent disease after surgery.
References 1. Lorenzini M, Gatti S, Giannitrapani A. Giant basal cell carcinoma of the thoracic wall: a case report and review of the literature. Br J Plast Surg 2005;58(7):1007–10. 2. Copcu E, Aktas A. Simultaneous two organ metastases of the giant basal cell carcinoma of the skin. Int Semin Surg Oncol 2005;2(1):1. 3. von Domarus H, Stevens PJ. Metastatic basal cell carcinoma. Report of five cases and review of 170 cases in the literature. J Am Acad Dermatol 1984;10(6):1043–60.