1/38. Mohs' surgery as an approach to treatment of multiple skin cancer in rhinophyma. BACKGROUND: skin cancer arising within a rhinophyma is rare, less than would be expected from the coexisting chronic active inflammatory process. In rhinophyma, multiple coexisting tumours of different histologic types present an unusual challenge and have never been described in the literature. OBJECTIVE: The treatment approach to multiple tumours occurring in rhinophyma, utilizing Mohs' surgery, is reported and discussed. PATIENT: The case of a 64-year-old farmer with basal cell carcinoma, squamous cell carcinoma, and basosquamous carcinoma occurring in the setting of longstanding rhinophyma is described. CONCLUSION: skin cancer, especially basal and squamous cell carcinoma, diagnosed simultaneously in a rhinophyma creates a challenge; the enlarged, inflamed, and hypertrophied tissue masks their margins. In our opinion, Mohs' micrographic surgery is the treatment of choice and should be primarily considered in view of the malignant potential of these tumours, as is shown by the substantial tumour extension in the case described. ( info) |
2/38. Giant rhinophyma--a case report. rhinophyma is an uncommon condition that often results in both functional and cosmetic impairment. A 65-year old male with a huge rhinophyma, that had extremely grown in the last three years, is presented. The huge tumor was removed under local anaesthesia with electrosurgical knife preserving the alar cartilage. Both, the immediate and late result were satisfactory. The relevant literature is discussed. ( info) |
3/38. Application of artificial dermis prior to full-thickness skin grafting for resurfacing the nose. Two patients with nasal skin defects resulting from excision of rhinophyma and multiple angiofibromas were treated with artificial dermis followed by full-thickness skin grafts taken from the postauricular region. The secondary skin grafts took completely in both patients, and the postoperative results were excellent. Although a two-stage operation is required, application of artificial dermis prior to full-thickness skin grafting is a reliable method for resurfacing the nose. ( info) |
4/38. Conventional cold excision combined with dermabrasion for rhinophyma. A 65-year-old man, farmer by occupation, presented with redness and gradual enlargement of the nose. Examination revealed marked nodular enlargement of the nose and loss of normal nasal contours. Sebaceous material could be expressed from widened pores. The patient was diagnosed as rhinophyma of moderate degree. He was treated with cold knife excision combined with dermabrasion. A literature scan revealed that currently there is no evidence of superiority of much popular laser surgery over conventional cold knife surgery combined with dermabrasion for rhinophyma. Conventional surgery is time-tested, and it does not require expensive equipment or special training. ( info) |
5/38. phenytoin induced rhinophyma treated by excision and full thickness skin grafting. A 49-year-old man suffering from post-traumatic epilepsy presented with a severe rhinophyma probably induced by phenytoin. Initial surgical shaving was soon followed by recurrence, formation of intraepidermal cysts and persistent infection. Ultimate treatment by full thickness excision and a full thickness skin graft resulted in a pleasing cosmetic result. Radical excision of the affected skin followed by full thickness skin graft nasal reconstruction should be considered for cases of recurrent severe rhinophyma with inclusion cysts to eradicate chronic infection and improve cosmesis. ( info) |
6/38. Angiosarcoma arising on rhinophyma. We report an 82-year-old man who presented with a tumor which had developed over the previous year on the right nasal ala of a rhinophyma. Histopathological, immunohistochemical, and electron microscopic study confirmed the diagnosis of angiosarcoma on the head and neck. He was treated with radiotherapy of the tumor and cervical adenopathy, which developed later. The possible etiological and pathogenetic role of lymphedema due to inflammatory flares of rosacea on the nose is discussed, together with the histological and immunohistochemical data leading to the diagnosis of this tumor. ( info) |
7/38. rhinophyma and coexisting occult skin cancers. BACKGROUND: Although coexistent tumors have been reported in patients with rhinophyma, few reports have described the coexistence of rhinophyma and an occult infiltrating squamous cell carcinoma (SCC). OBJECTIVE: Preoperatively and during rhinophymaplasty, recognition of subtle changes can suggest an underlying malignancy. methods: A large infiltrating SCC was noted during electrosurgical rhinophymaplasty. Mohs micrographic surgery was performed to clear the tumor. RESULTS: The patient was tumor-free with no evidence of recurrence at 1-year follow-up. CONCLUSION: In the evaluation of changing rhinophyma or subtle changes in tissue noted during rhinophymaplasty, physicians must consider the possibility of an underlying malignancy. ( info) |
| rhinophyma is a disfiguring soft-tissue hypertrophy of the nose. It is an uncommon disease that primarily affects Caucasian men in the fifth to seventh decades of life. Nine cases from the authors' series and a comparison of results following various treatment modalities are presented. Eight of the patients were Caucasian and one was African American. Excision of the diseased tissue with a scalpel or Goulian dermatome using loupe magnification provided the safest means of preserving the underlying sebaceous gland fundi that permit spontaneous re-epithelialization with the least scarring. ( info) |
9/38. rhinophyma: plastic surgery, rehabilitation, and long-term results. Rhinophymas are characterized by slowly progressive enlargement of the nasal skin that will not resolve spontaneously. The usual indication for treatment has plastic cosmetic and functional reasons, above all in advanced cases with an obstruction of the nasal respiration or reduction of the visual field. Treatment of rhinophyma consists of surgical removal of the hyperplastic alterations. It should always be carried out by an experienced rhinosurgeon, because of possible complications and injury to the more deeply situated nasal structures. Different surgical procedures have been described, such as excision with primary suture or extirpation with plastic covering of the defect by free transplants, subcutaneous rhinophyma resection, as well as decortication with peeling off the proliferations, dermal abrasion, or dermal shaving. In addition, there are various abrasion procedures with abrasive cylinders, burrs, or wire brushes. The methods of exfoliation and abrasive polishing can be effectively combined. Care should be taken to preserve follicular epidermal islets from the more deeply situated layers of the skin. The follicular epithelium left behind is the point of departure for re-epithelization of the wound surface. If decortication is too deep, injuries to the perichondrium or the nasal cartilage may arise, leading to cosmetically unattractive scar formations and necessitate plastic surgery. The author's own method, which involves a combined procedure with peeling or dermal abrasion, remodeling with abrasive cylinders, as well as preoperative injection into the nasal tumor masses and a subsequent covering of the wound area with fibrin glue, is shown with reference to several examples of more than 60 cases. The cosmetic and long-term results are excellent. ( info) |
| learning Objectives: After studying this article, the participant should be able to discuss: 1. Clinical features and anatomy of rhinophyma. 2. The etiology and epidemiology of rhinophyma. 3. Associated diagnosis that can complicate rhinophyma. 4. Common nonsurgical and surgical therapies for rhinophyma. 5. A safe and integrated treatment plan for the patient with rhinophyma. ( info) |