Another Interesting Article on Rhinophyma

[Guest guest]

Hi,

I found another interesting article on rhinophyma, in the April 2002

issue of Dermatology Times.

Here's the link if you want to look at the photos (make sure to copy

and paste both lines into your browser):

http://www.dermatologytimes.com/dermatologytimes/article/articleDetail

..jsp?id=14999

Here's the text --

Techniques should preserve resected tissue for pathologic evaluation

April 15, 2002

By: a Moyer

Dermatology Times

Dr. Lopardo

New Orleans - Rhinophyma resection needs to be performed in a way

that allows for postoperative histopathologic study, according to

A. Lopardo, MD, speaking here at the 60th annual meeting of the

American Academy of Dermatology.

Dermatologists often treat rhinophyma by using destructive methods,

he and his co-investigators reported in a poster session here.

However, because rhinophyma patients are at increased risk of basal

cell carcinoma (BCC), he recommends the use of techniques that

preserve the resected tissue for pathologic evaluation.

Rhinophyma in 63-year-old patient, treated by shaving technique using

local anesthesia.

" I have a special interest in the treatment of rosacea, " Dr.

said. " An increasing number of clinical findings of basal cell

carcinoma in rhinophyma led me to research these simultaneous

pathologies. Because of the increasing incidence of rhinophyma,

dermatologists should be aware of new diagnostic and surgical

techniques for this condition, in order to help these patients

achieve a better quality of life. " He is a practicing dermatologist

in Buenos Aires, Argentina, where he has previously served as

associate professor of dermatology and pharmacology at the University

of Buenos Aires.

Careful planning

Because of the possibility of finding a cutaneous carcinoma within a

rhinophyma, the dermatologist should plan for a careful

histopathologic study of the resected tissue, with multiple sections,

he said. If a malignancy is found, the dermatologist always faces the

task of assessing whether the resection has been complete and with

clear margins, or whether further evaluation is warranted. Therefore,

he prefers techniques such as decortication, because such techniques

make a histopathologic assessment feasible.

Tissue resected with shaving technique.

To illustrate his point, Dr. Lopardo reported on a case in which a 65-

year-old male patient with rhinophyma had a subclinical BCC. The

lesion had not been previously diagnosed but instead was found when

the excessive tissue was removed by shaving. As a result of using

this technique, the dermatologist was able to preserve tissue to be

sent to the pathologist so that the patient's BCC could be diagnosed.

The reason for the overlap in rhinophyma and BCC may be due to

several immunological factors, Dr. Lopardo said. For example, Demodex

Folliculorum, a mite that usually inhabits the follicular apparatus,

is found in large numbers in rosacea. As dermatologists know, sun

exposure is implicated in both rosacea and BCC.

Immediate post-operative.

Bolstered regeneration

Multiple therapeutic procedures have been described in the literature

for the treatment of rhinophyma. Dr. Lopardo stressed that

dermatologists should choose a method that preserves the sebaceous

glands' fundus, in order to allow for epidermal regeneration.

Epidermal regeneration completed 10 days after surgery.

" Some clinicians perform a resection that encompasses the entire

depth of the skin, and close the wound with sutures or cover it with

a skin implant, " he said. " Others carry out a subcutaneous resection

of the lesion, and use the nasal skin surplus as a graft or implant.

Other methods have been described for the destruction of the

hypertrophic tissue, such as radiotherapy, dermabrasion, cryosurgery,

electro-coagulation. " In addition, various lasers have been pressed

into service, including the argon laser alone or combined with

surgical resection, carbon-dioxide laser, and neodymium-YAG (Nd-YAG)

laser. Some surgeons also use cryosurgery along with radiofrequency.

Preoperative (left) and 40 days postoperative. (Photographs courtesy

of A. Lopardo, M.D.)

The typical treatment involves the tangential excision of the

hypertrophic tissue, so that sebaceous glands funds are preserved.

This method is called either " decortication " or " shaving. " In order

to control the subsequent diffuse bleeding, Dr. Lopardo suggested

either applying pressure with gauzes impregnated with epinephrine, or

by applying fibrin sealers topically.

" Once hemostatic control is achieved, the wound should be treated

with topical bacteriostatics or with temporary skin [grafts], until

epidermic regeneration is achieved, " Dr. Lopardo said. He noted that

re-epithelialization has usually commenced by the tenth postoperative

day.