[Downloaded free from http://www.jcasonline.com on Wednesday, September 28, 2016, IP: 60.53.13.
46]
Letters
of myoepithelial cells. Myoepithelial cells present
immunoreactivity to cytokeratin, S-100 protein, glial
fibrillary acidic protein (GFAP), actin and vimentin,
whereas ductal epithelial cells and solid cellular nest
with tubular structure are strongly immunoreactive to
cytokeratin and moderately immunoreactive to epithelial
membrane antigen (EMA) and carcinoembryonic antigen
(CEA). In certain cases where the surgical specimen is
small, it may be difficult to histopathologically segregate
PA from basal cell adenoma and tubular variant of
adenoid cystic carcinoma. Anti-GFAP antibody can be
used because it reacts only with epithelial and stromal
components of PA.[2]
Lastly, the treatment of choice of PA is complete
excision of the tumour and its capsule. PA of the lip
merits a localised V-wedge excision. Resection of
one-third of the lower lip or one-fourth of the upper
lip can be closed primarily without interference of
cosmetic results.[2] Enucleation (simple “shell-out”) and
extracapsular dissection (ECD: Tumour extirpation in
a plane 3–4 mm peripheral to its capsule) of the lesion
should be avoided since PA has incomplete capsule
and tumour pseudopenetration outwards is common.
Data from recent meta-analyses have shown that
enucleation and ECD of PA of the parotid gland produce
9 and 10 times higher rates of recurrence compared
with superficial parotidectomy. [3] Radiotherapy is
not recommended for PA because it does not reduce
recurrence rates, a recurrence-free interval and the size
of safety margins needed intraoperatively. Moreover,
irradiation can create tissue ischaemia and fibrosis, and
osteoradionecrosis, as well as can retard the recovery
Surgical Enucleation of Corn: A Novel Technique
Sir,
A corn or clavus is an area of well circumscribed
hyperkeratosis of the skin with a dry, smooth and
slightly convex surface caused by intermittent direct
pressure exerted on a small area.[1,2] Its size varies from
1 mm to 2 cm and it is conical in shape. It is composed
of a cone shaped wedge of compressed hyperkeratotic
stratum corneum with the base of the cone towards the
surface of the skin and the apex pointing inwards. It
presses upon the adjacent tissues and causes severe pain
when pressed due to pressure on the nerves.[1-4] Corns
are mainly classified as soft corns occurring between the
toes and hard corns occurring on the exposed plantar
surface or dorsolateral surface of the small toe. Plantar
52 Journal of Cutaneous and Aesthetic Surgery - Jan-Mar 2012, Volume 5, Issue 1
of the facial nerve.[2,4] Twenty-year survival rate after
the complete excision is 96.5% if there is no malignant
transformation.[2]
Poramate Pitak-Arnnop1, Kittipong Dhanuthai1,2,
Alexander Hemprich1, Niels Christian Pausch1
1
Department of Oral, Craniomaxillofacial and Facial Plastic Surgery,
Scientific Unit for Clinical and Psychosocial Research,
Evidence-Based Surgery and Ethics in Oral and Maxillofacial
Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig,
Germany, 2Department of Oral Pathology, Faculty of Dentistry,
Chulalongkorn University, Bangkok, Thailand
E-mail: poramate.pitakarnnop@gmail.com
REFERENCES
1. Kataria SP, Tanwar P, Sethi D, Garg M. Pleomorphic adenoma of the
upper lip. J Cutan Aesthet Surg 2011;4:217-9.
2. Pitak-Arnnop P, Lupanalaploy S, Rojvanakarn M, Punyasingh J. A mass
at labial mucosa of the upper lip: Pleomorphic adenoma. Thai J Oral
Maxillofac Surg 2000;27:22-4, 46-53.
3. Pitak-Arnnop P, Dhanuthai K, Hemprich A, Pausch NC. Does pleomorphic
adenoma really require total parotidectomy? Ann Surg Oncol 2011;18
Suppl 3: S248-9.
4. Pitak-Arnnop P, Sader R, Dhanuthai K, Masaratana P, Bertolus C,
Chaine A, et al. Management of osteoradionecrosis of the jaws: An
analysis of evidence. Eur J Surg Oncol 2008;34:1123-34.
Access this article online
Quick Response Code:
Website:
www.jcasonline.com
DOI:
10.4103/0974-2077.94327
corns are recalcitrant to the medical line of treatment and
being very painful need surgical intervention. However,
before undertaking surgery, the underlying orthopaedic
problems, if any, should be corrected lest they recur.[2,3,5]
We describe here a simple and effective technique for
the excision of corns.
Pre-operative preparations are done. The hyperkeratotic
tissue surrounding and over the corn area is paired with no.
20-24 sterile surgical blade till erythema or transition from
hard to less hard tissue occurs. The central core or kernel of
the corn is visible more clearly after the above procedure.
A disposable biopsy punch, which encircles the central
[Downloaded free from http://www.jcasonline.com on Wednesday, September 28, 2016, IP: 60.53.13.46]
core, according to the size is taken and with a very slow
and gradual rotatory half circular motion is pushed into
the tissue. Before applying the punch on patient’s skin,
the patient is explained that at the point when he or she
feels pain sensation or an increase in the pain sensation,
he or she should immediately inform to surgeon. This
should be firmly explained to the patient because this is
the end point of the procedure and the surgeon should
withdraw the punch without further extension into the
tissue. If the punch is pushed deep into the tissue it may
lead to severe pain, deep tissue injury and deep wound
which may heal with a delay.
The punched out tissue is held with Adson’s toothed
forceps and is gradually pulled without cutting. This
leads to the complete extraction of the tissue with the
central intact core excised. The pressure bandage is
applied over the wound and the patient is instructed to
use soft foot wear. The dressing is changed after 5 days.
We have used this technique for the removal of corns
in six patients. All the patients were followed up for
a period of 3 months. There was no recurrence of the
lesion in any of the patients and no patient was having
pain at the site of the enucleated corn during walking
or resting position.
ADVANTAGES
This is a simple and safe office procedure. The incidence
of recurrence is reduced as the whole corn with the
central core is excised in toto. Multiple corns can be
removed in a single session.
There is immediate pain relief, no requirement of rest
and the patient can return to the workplace immediately.
This is a minimally invasive and less messy technique
with minimal blood loss.
No local anaesthesia is required, so the pain associated
with the injection of local anaesthesia on the plantar or
palmar site is eliminated. There is minimal requirement
of surgical instruments and no surgical expertise is
required. Above all this is a very economical method
for removal of corns.
Topical Zinc Sulphate (25%) Solution: A New Therapy for Actinic Keratosis
Sir,
Actinic keratosis (AK) is cutaneous neoplasms resulting
from proliferations of cytological aberrant epidermal
Journal of Cutaneous and Aesthetic Surgery - Jan-Mar 2012, Volume 5, Issue 1
Letters
DISADVANTAGES
This method cannot be used for the removal of very
large corns.
We conclude that this technique immediately relieves
the pain of the patient and removes the corn in toto
preventing recurrences. This technique can be used for
small plantar and palmar corns.
ACKNOWLEDGEMENT
Dr. Avitus John Raakesh Prasad, who demonstrated
this technique on 31 July 2011 during Dermatosurgery,
Cosmetology and Laser workshop at JSS Medical College and
Hospital, Mysore, Karnataka is greatly acknowledged.
Sacchidanand S, Mallikarjuna M,
Venkatesh Purohit, Sujaya S N
Departments of Dermatology, STD and Leprosy,
Bangalore Medical College and Research Institute,
Bangalore, Karnataka, India
E-mail: drvenkypurohit05@gmail.com
REFERENCES
1. Benett RG. Lesions of the surface epidermis. Fundamentals of
cutaneous surgery. In: Benett RG, editor. 1st ed. St. Louis: The CV Mosby
Company; 1988. p. 692-706.
2. Gibbs RC, Boxer MC. Abnormal biomechanics of feet and the cause of
hyperkeratosis. J Am Acad Dermatol 1982;6:1061-9.
3. Silverskiold JP. Common foot problems: Relieving the pain of bunions,
keratoses, corns and calluses. Postgrad Med 1991;10:112-4.
4. Pavithran K. Disorders of keratinization. IADVL Textbook and atlas
of dermatology (Valia RG, Valia AR editors) 2nd ed. Mumbai: Bhalani
Publishing House; 2003. Vol. 2; p. 799-846.
5. Arndt KA. Corns and calluses. Manuel of dermatologic therapeutics.
In: Arndt KA, Bowers KE, Chuttani KR, editors. 5th ed. Boston: Little
Brown and Company; 1995. p. 40-2.
Access this article online
Quick Response Code:
Website:
www.jcasonline.com
DOI:
10.4103/0974-2077.94329
keratinocytes that occur primarily on sun-exposed
skin surfaces[1] usually of middle aged or older people.
It presents as a skin-colored to reddish-brown or
53