Showing papers in "Dermatologic Surgery in 2022"
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TL;DR: In this paper , the authors have indicated no significant interest with commercial supporters with respect to commercial supporters in their work. But they did not reveal any significant interest in commercial support with commercial support.
Abstract: *Department of Dermatology, Mayo Clinic Scottsdale, Scottsdale, Arizona †Phoenix Surgical Dermatology Group, Phoenix, Arizona; The authors have indicated no significant interest with commercial supporters.
29 citations
TL;DR: In this article , the authors performed histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative laser, and ablative laser.
Abstract: BACKGROUND Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists. OBJECTIVE To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices. MATERIALS AND METHODS A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers. RESULTS Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation. CONCLUSION Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser–tissue interaction.
11 citations
TL;DR: The risk for wound infection in other body locations was not different or remained uncertain because of substantial heterogeneity among studies as discussed by the authors , but studies were clinically heterogeneous and the risk of bias according to the Newcastle-Ottawa Scale.
Abstract: Identifying risk factors for wound infection may guide clinical practice for optimal use of perioperative antibiotic prophylaxis in dermatologic surgery.To summarize the current evidence whether specific body sites have higher risks for surgical site infections (SSI).The systematic literature search included MEDLINE, Embase, CENTRAL, and trial registers. Only observational studies qualified for inclusion and meta-analysis. We assessed the risk of bias according to the Newcastle-Ottawa Scale.Eighteen studies with 33,086 surgical wounds were eligible. Eight studies were of good, 4 of fair, and 6 of poor quality. The mean infection rate was 4.08%. Meta-analysis showed that the lips had significantly higher infection rates. The lower extremity and ears had or tended toward a higher risk for infection, but studies were clinically heterogeneous. A large prospective trial found that surgical wounds on the hands were at higher risk for infection. The trunk showed the lowest infection rate. The risk for SSI in other body locations was not different or remained uncertain because of substantial heterogeneity among studies.Lips, lower extremities, and probably ears and hands may have a higher risk for wound infection after skin surgery. The trunk showed the lowest infection rate.
9 citations
TL;DR: In this article , the authors evaluated the efficacy and safety of a pulsed-type microneedling RF device for treatment of facial pigmentary disorders, and found that most of the patients showed clinical improvement.
Abstract: Numerous treatments for pigmentary disorders have been used with variable outcomes. Recently, a new radiofrequency (RF) device with minimal pulse duration has been introduced.The aim of this study was to evaluate the efficacy and safety of a pulsed-type microneedling RF device for treatment of facial pigmentary disorders.Forty-four patients diagnosed with facial melasma or Riehl melanosis received 5 treatments with RF at 2-week intervals, and evaluation was performed at each visits, including 4 and 8 weeks after the last treatment. Treatment outcomes were evaluated by investigator global assessment, patient global assessment score, and skin biophysical parameters of erythema index, melanin index (MI), and transepidermal water loss. Gene array and immunohistochemical staining including melan-A, Fontana silver, CD44, basic fibroblast growth factor (bFGF), and periodic acid-Schiff were performed.Most of the patients showed clinical improvement. Erythema index, MI, and transepidermal water loss decreased after the first treatment. Histopathologic examination showed decrease of melanin pigment, melanophages, and blood vessel proliferation but thickened basement membrane after treatment. Expression of CD44 and b-FGF was decreased after treatment. There were no serious adverse events reported during the study.Pulsed-type microneedling RF could be a treatment option for facial pigmentary disorders.
6 citations
TL;DR: How lasers and EBD alter skin histology and improve the overall understanding of these devices is described to describe how safe and effective use of devices requires understanding the histologic laser–tissue interaction.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists. OBJECTIVE To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices. MATERIALS AND METHODS A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers. RESULTS Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation. CONCLUSION Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser–tissue interaction.
6 citations
TL;DR: In this paper , a systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers, and the authors calculated risk factors and performed meta-analysis using random effects models.
Abstract: BACKGROUND Identifying risk factors is essential for preventing surgical site infections (SSIs) in dermatologic surgery. OBJECTIVE To analyze whether specific procedure-related factors are associated with SSI. METHODS This systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers. The Newcastle–Ottawa Scale was used for risk bias assessment. If suitable, the authors calculated risk factors and performed meta-analysis using random effects models. Otherwise, data were summarized narratively. RESULTS Fifteen observational studies assessing 25,928 surgical procedures were included. Seven showed good, 2 fair, and 6 poor study quality. Local flaps (risk ratio [RR] 3.26, 95% confidence intervall [CI] 1.92–5.53) and skin grafting (RR 2.95, 95% CI 1.37–6.34) were associated with higher SSI rates. Simple wound closure had a significantly lower infection risk (RR 0.34, 95% CI 0.25–0.46). Second intention healing showed no association with SSI (RR 1.82, 95% CI 0.40–8.35). Delayed wound closure may not affect the SSI rate. The risk for infection may increase with the degree of preoperative contamination. There is limited evidence whether excisions >20 mm or surgical drains are linked to SSI. CONCLUSION Local flaps, skin grafting, and severely contaminated surgical sites have a higher risk for SSI. Second intention healing and probably delayed wound closure are not associated with postoperative wound infection.
5 citations
TL;DR: Pulsed-type microneedling RF could be a treatment option for facial pigmentary disorders with clinical improvement and no serious adverse events were reported during the study.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Numerous treatments for pigmentary disorders have been used with variable outcomes. Recently, a new radiofrequency (RF) device with minimal pulse duration has been introduced. OBJECTIVE The aim of this study was to evaluate the efficacy and safety of a pulsed-type microneedling RF device for treatment of facial pigmentary disorders. METHODS Forty-four patients diagnosed with facial melasma or Riehl melanosis received 5 treatments with RF at 2-week intervals, and evaluation was performed at each visits, including 4 and 8 weeks after the last treatment. Treatment outcomes were evaluated by investigator global assessment, patient global assessment score, and skin biophysical parameters of erythema index, melanin index (MI), and transepidermal water loss. Gene array and immunohistochemical staining including melan-A, Fontana silver, CD44, basic fibroblast growth factor (bFGF), and periodic acid–Schiff were performed. RESULTS Most of the patients showed clinical improvement. Erythema index, MI, and transepidermal water loss decreased after the first treatment. Histopathologic examination showed decrease of melanin pigment, melanophages, and blood vessel proliferation but thickened basement membrane after treatment. Expression of CD44 and b-FGF was decreased after treatment. There were no serious adverse events reported during the study. CONCLUSION Pulsed-type microneedling RF could be a treatment option for facial pigmentary disorders.
5 citations
TL;DR: The Fraxel dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength as discussed by the authors .
Abstract: The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength.To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system.Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system.For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled.The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.
5 citations
TL;DR: The LR rate of DFSP in patients treating with MMS is lower than in patients treated with WLE, and MMS should be strongly considered when available because of high rates of postoperative DFSP LR.
Abstract: BACKGROUND Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown. OBJECTIVE To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). MATERIALS AND METHODS Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946–2018), Embase (1988–2018), Web of Science (1975–2018), and Scopus (1970–2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses. RESULTS Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710–3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%–2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%–11.3%; p < .001). CONCLUSION The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
4 citations
TL;DR: In this paper , the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis was evaluated and compared in two groups of 14 patients each.
Abstract: Nail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail.To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis.Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation.At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p < .001 and p = .03, respectively).Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.
4 citations
TL;DR: Overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB) is examined to support current melanoma management guidelines.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Previous studies examining melanoma biopsy technique have not demonstrated an effect on overall survival. OBJECTIVE To examine overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB). MATERIALS AND METHODS Melanoma data from the 2004 to 2016 NCDB data set were analyzed. A Cox proportional hazards model was constructed to assess the risk of 5-year all-cause mortality. RESULTS In total, 42,272 cases of melanoma were reviewed, with 27,899 (66%) diagnosed by shave biopsy, 8,823 (20.9%) by punch biopsy, and 5,550 (13.1%) by incisional biopsy. Both the univariate and multivariate analyses demonstrated that tumors diagnosed by incisional biopsy had significantly (p = .001) lower overall 5-year survival compared with shave techniques (hazard ratio [HR] = 1.140, 95% confidence interval [CI] 1.055 to 1.231). We found no difference (p = .109) between shave and punch biopsy techniques (HR 1.062, 95% CI 0.987–1.142) or between punch and incisional techniques (HR 1.074, 95% CI 0.979–1.177, p = .131). CONCLUSION Incisional biopsies were associated with decreased overall 5-year survival in the NCDB. No difference was observed between shave and punch biopsy techniques. These findings support current melanoma management guidelines.
TL;DR: The addition of microneedling or ablative laser therapy to NB-UVB phototherapy may improve repigmentation with minimal adverse effects, and meta-analyses suggest benefits for ablative lasers in combination with narrowband ultraviolet B and for suction blister epidermal grafting over punch grafting.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Although vitiligo is often treated medically, there is increasing evidence for surgical therapies. Overlap with in-office surgical therapies that are already employed for other dermatologic conditions suggest that there is a significant opportunity to expand dermatologists' therapeutic repertoire for vitiligo. OBJECTIVE To systematically review the efficacy of nonphototherapy surgical treatments for vitiligo in comparative or placebo-controlled trials. METHODS A systematic review for surgical treatments for vitiligo was conducted. Primary outcomes were treatment success (>75% repigmentation) and failure (<25% repigmentation) for which meta-analyses were performed. Adverse effects were noted. The Cochrane risk of bias tool was used to assess study quality. RESULTS Surgical treatments reviewed included platelet-rich plasma, microneedling, ablative therapies, and surgical modalities. Seventy-three studies with 2,911 patients were included. The repigmentation benefits and adverse events are summarized. Meta-analyses suggest benefits for ablative laser therapies or microneedling in combination with narrowband ultraviolet B (NB-UVB) and for suction blister epidermal grafting over punch grafting. CONCLUSION The addition of microneedling or ablative laser therapy to NB-UVB phototherapy may improve repigmentation with minimal adverse effects. Surgical therapies, such as suction blister grafting and punch grafting, may offer the highest likelihood of repigmentation but have a risk of adverse effects including scarring and hyperpigmentation.
TL;DR: A systematic review for surgical treatments for vitiligo was conducted in this article , which included platelet-rich plasma, microneedling, ablative therapies, and surgical modalities.
Abstract: BACKGROUND Although vitiligo is often treated medically, there is increasing evidence for surgical therapies. Overlap with in-office surgical therapies that are already employed for other dermatologic conditions suggest that there is a significant opportunity to expand dermatologists' therapeutic repertoire for vitiligo. OBJECTIVE To systematically review the efficacy of nonphototherapy surgical treatments for vitiligo in comparative or placebo-controlled trials. METHODS A systematic review for surgical treatments for vitiligo was conducted. Primary outcomes were treatment success (>75% repigmentation) and failure (<25% repigmentation) for which meta-analyses were performed. Adverse effects were noted. The Cochrane risk of bias tool was used to assess study quality. RESULTS Surgical treatments reviewed included platelet-rich plasma, microneedling, ablative therapies, and surgical modalities. Seventy-three studies with 2,911 patients were included. The repigmentation benefits and adverse events are summarized. Meta-analyses suggest benefits for ablative laser therapies or microneedling in combination with narrowband ultraviolet B (NB-UVB) and for suction blister epidermal grafting over punch grafting. CONCLUSION The addition of microneedling or ablative laser therapy to NB-UVB phototherapy may improve repigmentation with minimal adverse effects. Surgical therapies, such as suction blister grafting and punch grafting, may offer the highest likelihood of repigmentation but have a risk of adverse effects including scarring and hyperpigmentation.
TL;DR: Transdermal uptake of 4 topicals after nonablative fractional diode laser pretreatment is analyzed to suggest device settings should be adjusted to balance outcomes with potential side effects.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Although the stratum corneum limits transdermal absorption of topicals, laser devices can enhance topical uptake by disrupting the skin barrier. Nonablative lasers are commonly used, but their effects on topical uptake should be quantified to optimize outcomes. OBJECTIVE The objective of this study is to analyze transdermal uptake of 4 topicals after nonablative fractional diode laser pretreatment. METHODS AND MATERIALS Human donor tissue was pretreated ex vivo with a nonablative fractional diode laser (1,927 nm or 1,440 nm, at varying treatment densities, powers, and peak energies) followed by application of either 2% salicylic acid, 10% ascorbic acid, over-the-counter mineral eye serum, or 4% hydroquinone. Topical uptake was quantified over 24 hours. RESULTS Despite lower power settings, pretreatment with the 1,927 nm wavelength was associated with greater uptake of 10% ascorbic acid, mineral eye serum, and 4% hydroquinone than the 1,440 nm wavelength. In addition, 1,440-nm laser pretreatment with higher density (320 microscopic treatment zones [MTZ]/cm2) and peak power (3 W) was associated with similar uptake but greater retention of 2% salicylic acid and greater uptake of 10% ascorbic acid than that with lower density (80 MTZ/cm2) and peak power (1.2 W). CONCLUSION When using laser pretreatment, device settings should be adjusted to balance outcomes with potential side effects.
TL;DR: This study identifies common causes of injury and liability claims related to cutaneous laser surgery from 2012 to 2020 and indicates that NPOs account for most cases of legal action with an increasing proportion of cases being performed by N POs.
Abstract: Supplemental Digital Content is Available in the Text. OBJECTIVE To identify common causes of injury and liability claims related to cutaneous laser surgery from 2012 to 2020. MATERIALS AND METHODS Search of online national legal database of public legal documents regarding cutaneous laser surgery litigation. RESULTS From 2012 to 2020, 69 cases of liability claims due to a cutaneous laser surgery device were identified. Of these, 49 (71%) involved a nonphysician operator (NPO); 12 incidents (17%) involved non–core physician operators performing the procedure; 6 cases (9%) involved a plastic surgeon operator; and 2 cases (3%) involved a dermatologist operator. Laser hair removal was most litigated (44 cases, 64%), followed by laser skin rejuvenation (20 cases, 30%). Thirty-six of 69 cases had a discernible outcome, 53% (n = 19) rendered judgements in favor of the plaintiff, with a mean indemnity payment of $320,975 (range, $1,665–$1.5 million). CONCLUSION Previous work evaluating trends in laser surgery litigation from 1985 to 2012 identified increasing injury and legal action when performed by NPOs. Data from this study are consistent with these previous findings. Both studies demonstrate that NPOs account for most cases of legal action with an increasing proportion of cases being performed by NPOs. In this study, unsupervised NPOs comprise nearly three-quarters of laser surgery lawsuits, but the data may underestimate the frequency of injury and litigation caused by unsupervised NPOs.
TL;DR: In this paper , the authors identify common causes of injury and liability claims related to cutaneous laser surgery from 2012 to 2020 and identify 69 cases of liability claims due to a laser surgery device were identified.
Abstract: To identify common causes of injury and liability claims related to cutaneous laser surgery from 2012 to 2020.Search of online national legal database of public legal documents regarding cutaneous laser surgery litigation.From 2012 to 2020, 69 cases of liability claims due to a cutaneous laser surgery device were identified. Of these, 49 (71%) involved a nonphysician operator (NPO); 12 incidents (17%) involved non-core physician operators performing the procedure; 6 cases (9%) involved a plastic surgeon operator; and 2 cases (3%) involved a dermatologist operator. Laser hair removal was most litigated (44 cases, 64%), followed by laser skin rejuvenation (20 cases, 30%). Thirty-six of 69 cases had a discernible outcome, 53% (n = 19) rendered judgements in favor of the plaintiff, with a mean indemnity payment of $320,975 (range, $1,665-$1.5 million).Previous work evaluating trends in laser surgery litigation from 1985 to 2012 identified increasing injury and legal action when performed by NPOs. Data from this study are consistent with these previous findings. Both studies demonstrate that NPOs account for most cases of legal action with an increasing proportion of cases being performed by NPOs. In this study, unsupervised NPOs comprise nearly three-quarters of laser surgery lawsuits, but the data may underestimate the frequency of injury and litigation caused by unsupervised NPOs.
TL;DR: In this article , Baucom and Mina Derm Surgery, LLC, Atlanta, Georgia, and Emory University School of Medicine, Emory, Georgia have reported no significant interest with commercial supporters.
Abstract: *North Georgia Dermatology-Advanced Dermatology and Cosmetic Surgery LLC, Lawrenceville, Georgia †Baucom and Mina Derm Surgery, LLC, Atlanta, Georgia ‡Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia The authors have indicated no significant interest with commercial supporters.
TL;DR: Mohs micrographic surgery (MMS) is becoming increasingly popular for the treatment of cutaneous melanoma (CM) as multiple studies have demonstrated favorable outcomes for local recurrence and overall survival as mentioned in this paper .
Abstract: Mohs micrographic surgery (MMS) is becoming increasingly popular for the treatment of cutaneous melanoma (CM) as multiple studies have demonstrated favorable outcomes for local recurrence and overall survival.To analyze the outcomes of noninvasive (NIM) and invasive melanomas (IM) using MMS with fresh frozen sections. The primary outcome was local recurrence. The secondary outcome was to identify mean surgical margins based on tumor type and location.Retrospective cohort study of 224 cases of CM treated from 2006 to 2016 at a tertiary academic center with MMS and fresh frozen sections by a single Mohs surgeon.The overall recurrence rate was 2.6% with a mean follow-up of 36.2 months. The recurrence rate for NIM versus IM was 1.6% and 7%, respectively. The mean margins for NIM and IM were 7.9 mm and 10.1 mm, respectively. These varied by tumor site and location.This study supports the use of MMS in the treatment of CM and highlights how narrower surgical margins for NIM of the head and neck can be achieved without increasing risk of local recurrence.
TL;DR: In this article , the authors examined the overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB).
Abstract: Previous studies examining melanoma biopsy technique have not demonstrated an effect on overall survival.To examine overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB).Melanoma data from the 2004 to 2016 NCDB data set were analyzed. A Cox proportional hazards model was constructed to assess the risk of 5-year all-cause mortality.In total, 42,272 cases of melanoma were reviewed, with 27,899 (66%) diagnosed by shave biopsy, 8,823 (20.9%) by punch biopsy, and 5,550 (13.1%) by incisional biopsy. Both the univariate and multivariate analyses demonstrated that tumors diagnosed by incisional biopsy had significantly (p = .001) lower overall 5-year survival compared with shave techniques (hazard ratio [HR] = 1.140, 95% confidence interval [CI] 1.055 to 1.231). We found no difference (p = .109) between shave and punch biopsy techniques (HR 1.062, 95% CI 0.987-1.142) or between punch and incisional techniques (HR 1.074, 95% CI 0.979-1.177, p = .131).Incisional biopsies were associated with decreased overall 5-year survival in the NCDB. No difference was observed between shave and punch biopsy techniques. These findings support current melanoma management guidelines.
TL;DR: In this article , the differences in local recurrence rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS) were evaluated through meta-analyses.
Abstract: Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown.To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS).Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946-2018), Embase (1988-2018), Web of Science (1975-2018), and Scopus (1970-2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses.Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710-3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%-2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%-11.3%; p < .001).The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
TL;DR: This study supports the use of MMS in the treatment of CM and highlights how narrower surgical margins for NIM of the head and neck can be achieved without increasing risk of local recurrence.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Mohs micrographic surgery (MMS) is becoming increasingly popular for the treatment of cutaneous melanoma (CM) as multiple studies have demonstrated favorable outcomes for local recurrence and overall survival. OBJECTIVE To analyze the outcomes of noninvasive (NIM) and invasive melanomas (IM) using MMS with fresh frozen sections. The primary outcome was local recurrence. The secondary outcome was to identify mean surgical margins based on tumor type and location. METHODS Retrospective cohort study of 224 cases of CM treated from 2006 to 2016 at a tertiary academic center with MMS and fresh frozen sections by a single Mohs surgeon. RESULTS The overall recurrence rate was 2.6% with a mean follow-up of 36.2 months. The recurrence rate for NIM versus IM was 1.6% and 7%, respectively. The mean margins for NIM and IM were 7.9 mm and 10.1 mm, respectively. These varied by tumor site and location. CONCLUSION This study supports the use of MMS in the treatment of CM and highlights how narrower surgical margins for NIM of the head and neck can be achieved without increasing risk of local recurrence.
TL;DR: Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
Abstract: BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
TL;DR: Tranexamic acid microinjection alone or combined with low-power, low-density fractional CO2 laser in a sequential pattern are comparatively effective and safe for melasma treatment; however, combined treatment is recommended as mentioned in this paper .
Abstract: Melasma is a challenging pigmentation disorder.To assess and compare the efficacy of tranexamic acid (TXA) intradermal microinjection alone versus its combination with low-power, low-density fractional CO2 laser in a sequential pattern in melasma.This study included 29 patients with melasma. Half of the face was randomly assigned to fractional CO2 laser; the other half to TXA. This split-face session was repeated every 6 weeks for 3 sessions. In between, TXA was applied to the full face every 2 weeks. Treatment duration was 4 months. Dermoscopy, melanin index (M.I), and erythema index (E.I) were evaluated at baseline and 4 weeks after the last session.Melanin index, E.I, total dermoscopic score and different dermoscopic patterns of pigmentation, and vascular features showed significant reduction posttreatment on both sides of the face. No statistically significant difference was found regarding the degree and percentage of improvement in M.I, E.I, and total dermoscopic score between both sides.Tranexamic acid microinjection alone or combined with low-power, low-density fractional CO2 laser in a sequential pattern are comparatively effective and safe for melasma treatment; however, combined treatment is recommended. Dermoscopy is an essential noninvasive tool in the assessment of melasma and monitoring patients' response to treatment.
TL;DR: In this article , serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset skin nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes.
Abstract: In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations.Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes.A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison.Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae.Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
TL;DR: The present findings provide anatomical information regarding the superficial fat and SMAS, which is useful in determining the focal penetration depth of HIFU treatment for lower face rejuvenation.
Abstract: Supplemental Digital Content is Available in the Text. BACKGROUND Knowledge of the topographic thickness of the skin and soft tissues is necessary when performing a high-intensity focused ultrasound (HIFU) procedure. Thermal tissue injury to the superficial musculoaponeurotic system (SMAS) or deeper can injure the facial nerve and its branches. OBJECTIVE To demonstrate the topographic thickness of the lower facial skin, superficial fat, and SMAS. MATERIALS AND METHODS The ultrasound data of 200 healthy patients who underwent lower facial rejuvenation were retrospectively reviewed. RESULTS The mean age was 41.1 ± 13.7 years (range, 19–76 years). The jowl had thinner skin, thicker superficial fat, and deeper superficial and deep margins of the SMAS than the preauricle or lower cheek. The thickness of the superficial fat decreased with age, especially on the preauricle, lower cheek, and jowl. Women had thicker superficial fat than men on the preauricle and lower cheek. The superficial and deep margins of the SMAS were located more superficially in old and male patients with a slim facial figure than in young and female patients with a chubby facial figure. CONCLUSION The present findings provide anatomical information regarding the superficial fat and SMAS, which is useful in determining the focal penetration depth of HIFU treatment for lower face rejuvenation.
TL;DR: RubRubin, Adam I. MD*; Richert, Bertrand MD, PhD†; Haneke, Eckart MD, RN*; and as mentioned in this paper , the authors.
Abstract: Rubin, Adam I. MD*; Richert, Bertrand MD, PhD†; Haneke, Eckart MD, PhD‡ Author Information
TL;DR: A review of the literature on the treatment of vascular occlusions threatening skin barrier integrity and developing a step-wise treatment guide was provided in this article . But, the importance of high-dose, pulsed hyaluronidase was clear.
Abstract: Vascular occlusions that threaten skin integrity, although not an emergency like those that threaten a patient's vision, is an urgent situation. Accurately interpreting physical examination findings is paramount. The use of high-dose, pulsed hyaluronidase is the mainstay of therapy; however, adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and hyperbaric oxygen should be considered.To provide a review of the literature on the treatment of vascular occlusions threatening skin barrier integrity and develop a step-wise treatment guide.The authors searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords.Twenty-six articles focusing on vascular occlusions threatening the skin barrier were reviewed. The authors collectively agreed on treatments to reverse vascular occlusions and restore the skin barrier. The importance of high-dose, pulsed hyaluronidase was clear. Therapies that lacked evidence such as sodium thiosulfate were also revealed.A vascular occlusion that threatens skin integrity is an urgent matter which requires accurate interpretation of physical examination findings that will help guide intervention. High-dose, pulsed hyaluronidase along with adjunctive measures performed in a step-wise manner is key to an optimal outcome.
TL;DR: In this paper , a literature review was performed for delayed-onset reactions following hyaluronic acid dermal filler injection using PubMeb and Embase and a total of 28 studies were included in the data analysis.
Abstract: BACKGROUND Delayed-onset reactions are increasingly relevant given the growing use of hyaluronic acid dermal fillers. There is poor understanding of the phenomenon's etiology and incidence. OBJECTIVE To highlight differences between the dermal filler products with an emphasis on delayed-onset reaction incidence, pathogenesis, prevention, and treatment. METHODS A literature review was performed for delayed-onset reactions following hyaluronic acid dermal filler injection using PubMeb and Embase. Articles were included based on relevance, quality, and the predetermined definition of “delayed-onset reaction” (>30 days post injection). A total of 28 studies were included in the data analysis. RESULTS A total of 13,136 subjects from 28 studies treated with 15 filler types were included in the analysis. VYC-15L dermal filler injections carried the highest risk of delayed reaction with a mean incidence of 3.83% (n = 46/1,202), followed by VYC-20L (0.92%) and VYC-17.5L (0.88%). The mean incidence of delayed reactions among all filler types was 1.13%. CONCLUSION Incidence of delayed reaction to hyaluronic fillers ranges from 0% to 3.83% (mean = 1.13%) and varies by filler type. The exact etiology of these delayed reactions remains disputed. Future studies should report reaction description, precise timeline, and posttreatment immunologic history to better delineate the incidence of delayed-onset hypersensitivity reactions.
TL;DR: In this paper , the hyaluronic acid (HA) injection was used to improve the shape and contour of the human chin in a total of 326 patients who received HA injection for chin augmentation from January 2018 to May 2021.
Abstract: Chin augmentation with hyaluronic acid (HA) injections can effectively improve mental appearance.To introduce a HA injection technique for chin augmentation and evaluate its clinical effects.A total of 326 patients who received HA injection for chin augmentation from January 2018 to May 2021 were retrospectively reviewed. All patients were injected with the technique according to the anatomical morphology of the chin using a needle and cannula. Patient data were collected, the effects were analyzed, and adverse reactions were observed and recorded.There were 326 patients involved in this study with a mean age of 26.4 years. The median volume of HA injected was 1.85 mL. The shape and contour of the chin was significantly improved in all patients immediately after injection. Most improvements were retained up to 6 months and partial improvements remained visible for 12 months. Swelling and pain occurred in 284 patients (87.1%), local ecchymosis occurred in 31 patients (9.5%), and asymmetry was found in 8 patients (2.5%). There were no other complications such as infection, embolism, necrosis, nodule, or witch's chin. All patients reported satisfaction with results of the HA injections.Injection of HA according to the anatomical morphology of the chin is a safe and effective technique for chin augmentation and results in high patient satisfaction.