Chondrodermatitis helicis nodularis is a painful ear that is usually seen in older patients whose upper rim of ear cartilage has hardened with age and becomes sore from pressure. These patients usually sleep on a favorite side on which the the sore develops.

The usual treatment is to do surgery and remove the hardened cartilage and suture the skin.

Another treatment is to use a stockinette doughnut around the ear that is held in place by a hair net during sleeping hours.

A treatment that helps but the insurance companies do not pay for is to freeze the cartilage, which tends to soften it.

For a long time it has been known that cortisone injected into joints for arthritis eventually softens the cartilage. A treatment that has amazed me is to inject the hardened cartilage of the ear with triamcinolone acetonide. First the skin is anesthetized with plain lidocaine and the affected part of the ear is held between the thumb and forefinger with a sterile tongue blade between the ear and the forefinger to protect the finger just in case the needle pops through the opposite side of the ear when being injected. A full strength of forty milligrams of triamcinolone acetonide per cc, in the amount of 8 to 10 mg., is injected into the cartilage with multiple penetrations.

Another long time knowledge in the use of cortisone is that it causes fat atrophy when injected subcutaneously, and in small dilute doses has been injected for the destruction of acne cysts. The danger here is that the corticosteroid will cause a dimple from fat destruction if too much is injected and it leaks out of the acne cyst. A little known fact is that in this event the cortisone can be washed out with injectons of normal saline. Afterward the fat will fill in the defect in a relatively short time.

Likewise an epidermoid cyst (formerly known as a sebacious cyst)can be destroyed regardless of the age of the cyst when the cyst will hold 8 milligrams or more of full strength triamcinolone acetonide without leaking it out through the oil gland duct. The secret to success is to choose a cyst that is not apt to leak; to feel the tension in the cyst as it is being injected, and to stop before the medication begins to leak out.

Myxoid cysts are cysts on a finger located usually between the distal IP joint and the base of the finger nail. These as a rule communicate with the distal IP joint and because of this needle-like communication too frequently recur after surgical excision. By injecting the distal IP joint with full strength triamcinolone acetonide, the white solution of the triamcinolone acetonide can be seen leaking out of the joint along the needle sized communication channel into the cyst. As a rule this offers superior results to surgical intervention and is much more practical in terms of cost and postoperative pain and care. Again the ICD-9 diagnostic code and the intrajoint injection CPT procedure code are not compatible for payment by most insurance companies.

Tonight 60 Minutes had a program on the possible use of nano carbon fibers in cancer treatment, using radio waves to heat the nano particles injected into the cancer.

Nano particle carbon cones and probes have been proved to be most useful in my practice, using them as a heat pump in cryosurgery of skin cancers. The nano particles conduct the heat out of the tissue approximately 2 1/2 times faster than the standard cones that have been on the market for years for use in cryosurgery.

Cryobiology studies have shown that a faster freeze and a slower thaw time is best for killing cells. Also the temperature needs to be taken low enough to freeze all of the salts in the cell, i.e. minus 50-59C. Depth of freeze has always been a problem to achieve in cryosurgery. The nano carbon particles help the ice ball to travel faster and colder, making the depth of freeze much less of a problem.

To my knowledge, the use of using nano particles in treating cancer, was first reported in this dermatology diary blog.

Two significant changes in my dermatology practice for this year compared to 2006, are that there have been about a third less melanomas in the same number of patients, and there is a significant change in the way I do some of my cryosurgery.

The new nanofused carbon and steel particles conduct heat much faster than other materials previously available. In cryosurgery of skin cancers, the faster the cell is frozen and the slower it thaws the better the kill. Using nanofused material for probes and cones, pumps the heat out of the lesion approximately twice as fast as any material I have previously tried. This makes it possible to reduce the temperature sufficiently to kill a small skin cancer in about eighteen seconds compared to thirty five seconds previously needed when using an eighteen gauge aperature.

It will take several years to compare the cure rate percentages, but a significant improvement should result. Since cryosurgery already produces the highest cure rates when done using the criteria established for my practice, this use of nanofusion material in the treatment of skin cancer should prove to be even more exciting with time.

Dermatology diary
Posted 04/08/2007

Over the weekend the path report came in over the fax on the biopsy of the skin lesion on the second patient of mine with Merkel cell carcinoma. The lesion biopsied is a keratoacanthoma, not related to Merkel cell carcinoma.

Thursday, March 29, 2007

The second patient of mine with the diagnosis of Merkel cell carcinoma was referred back to me by her oncologist for a biopsy of a skin cancer on her forearm that came up suddenly.

The appearance of the lesion is that of a squamous cell carcinoma or of a keratoacanthoma.

She is the one who was shuffled between practitioners and consequently was delayed in diagnosis until she reached the point of requiring primary excision as well as node dissection and radiation and chemotherapy. It was afterward that she came to me.

Patients with Merkel cell carcinoma statistically have more different cancers than average. Hopefully this new cancer is not a Merkel cell carcinoma.