Telemedicine in the ICU
This text provides a concise, yet comprehensive overview of telemedicine in the ICU. The first part of the book reviews common issues faced by practitioners and hospital administrators in implementing and managing tele-ICU programs, including the merits o
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Bone Invasion by Squamous Cell Carcinoma In Situ (Bowen’s Disease) of the Finger During Treatment With Imiquimod 5% Cream: Case Report Hyun Sik Gong, MD, Jae Hwan Cho, MD, Young Hak Roh, MD, Moon Sang Chung, MD, Goo Hyun Baek, MD Imiquimod 5% cream is known as an alternative treatment option for squamous cell carcinoma in situ (SCCIS), frequently termed Bowen’s disease. Although imiquimod cream has been reported by many authors to treat SCCIS successfully, its efficacy and safety have not been fully established. The authors experienced a case in which ray amputation was necessary because of bone invasion by SCCIS in a finger being treated with imiquimod cream. (J Hand Surg 2010;35A:999–1002. Copyright © 2010 by the American Society for Surgery of the Hand. All rights reserved.) Key words Imiquimod, squamous cell carcinoma, bone invasion.
QUAMOUS CELL CARCINOMA in situ (SCCIS, also known as Bowen’s disease) is a precancerous lesion of invasive squamous cell carcinoma (SCC),1 with a risk of progression to invasive SCC of about 3%.2 Although the best treatment option is surgical excision, many nonsurgical treatments, such as cryotherapy,3 topical 5-fluororacil,4 radiotherapy,5 and laser therapy,6 have been introduced for patients with poor medical conditions or for lesions with potentially poor wound healing capacity or poor cosmetic outcomes after surgery. However, no single treatment modality has been proven to be superior to any other.7 Imiquimod 5% cream (Aldara, Graceway Pharmaceuticals LLC, Bristol, TN) is one such modality. It is a topical immune response modifier that has been widely used by dermatologists to successfully treat SCCIS and various other skin lesions.8 –13 Despite these results, 2 cases of invasive squamous cell carcinoma in the scalp
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From the Department of Orthopaedics, Hand and Upper Extremity Service, Seoul National University Bundang Hospital, Seongnam, Korea. Received for publication October 27, 2009; accepted in revised form February 22, 2010. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Correspondingauthor:HyunSikGong,MD,DepartmentofOrthopaedicSurgery,SeoulNational University Bundang Hospital, Gumi-dong 300, Seongnam-si, Gyeonggi-do, 463-707, Korea; e-mail: [email protected]. 0363-5023/10/35A06-0021$36.00/0 doi:10.1016/j.jhsa.2010.02.027
and lower leg have been reported after treatment of SCCIS with imiquimod 5% cream14; to our knowledge, however, there is no previous report of invasive SCC in the finger during imiquimod 5% cream treatment. We report a case of SCC bone invasion from finger skin during imiquimod 5% cream treatment of SCCIS.
CASE REPORT A 75-year-old man presented to the dermatology clinic in our institution with a 6-month history of a changing skin lesion located along the entire length of his left middle finger. Initially, a thick skin lesion that waxed and waned was noticed; it subsequently involved the entire finger and developed a verrucous plaque (Fig. 1). A punch biopsy by a dermato
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