Different criteria have been used to define giant basal cell carcinoma (BCC). However, the majority of tumors of 10 cm or greater in diameter have a characteristic clinical and histopathologic presentation. As a group, these tumors often show metastatic spread as opposed to all other BCCs that rarely metastasize. We present an additional patient with a giant BCC greater than 100 cm2. This tumor had a characteristic location and infiltrative growth pattern. Unusual features of this tumor included a lack of expression of BCL-2 with a greater proportion of cycling tumor cells expressing proliferation markers than conventional BCC, as well as expression of anogenital human papillomaviruses (HPV) subtypes with oncogenic potential. The association of HPV with BCCs has rarely been studied and may not be identical to HPV-induced genital squamous cell carcinomas. However, the findings in this patient suggest that HPV may play a role in the development of some chronic giant BCCs.

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Paralytic lagophthalmos caused dry eyes and superficial punctate keratitis in our patient. To avoid this complication, if an injection is to be done in the lateral brow area, it should be done 1 cm above the orbital rim.

Wood's light examination has limited utility if complete excisional biopsy of MIS is performed before treatment. In this study, surgical margin based on the Wood's light examination would have resulted in an increased average wound size and would not have reduced the number of stages needed when performing the square procedure.

Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun-sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk which may aid dermatologists in targeting extra sun protection counseling for certain groups. A sixteen-question survey was distributed to subjects nineteen years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance-related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6% vs 17.5%, p<0.001), and to report regret for previous sun exposure (12.5% vs 3.6%, p<0.001). Subjects who thought tanned skin was important were significantly more likely to report interest in improving their appearance through cosmetic procedures and medical means. We conclude that individuals with an interest in improving their physical appearance through cosmetic procedures or medical means may be especially in need of sun protection counseling.

Pyogenic granulomas are vascular benign tumors that commonly appear secondary to trauma. The source of the trauma in this case was the exposed sternotomy wires.

Noninvasive skin-tightening devices have become increasingly popular over the last decade to improve skin laxity with minimal risk and recovery time. Proper patient selection improves patient outcomes and satisfaction. There are many devices available for tightening including monopolar radiofrequency, bipolar radiofrequency, fractional radiofrequency devices, infrared devices, combined light and bipolar radiofrequency devices, and intense focused ultrasound devices. There have been shortcomings with tightening devices including inconsistent clinical outcomes. The question arises, why are there inconsistent results and variability among patient outcomes? Variability could be related to different devices, treatment protocols, body area treated, and patient selection. Patient age, degree of laxity, history of smoking, ethnicity, body mass index, and individual patient pain threshold could all possibly contribute to patient response to tightening devices. The literature does not elucidate consistently, which variables are the most important in predicting best patient response. Included is a review of the literature discussing skin tightening and patient selection.

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