Dermatologic Surgery最新文献

Background: Skin cancer incidence continues to rise, yet national treatment trends among lighter- and darker-skinned patient populations have not been compared.

Objective: To evaluate procedural skin cancer treatments trends.

Materials and methods: The authors used Optum's deidentified Clinformatics Data Mart Database (2011-2022) to identify patients with light skin (race value: White; Skin Color Ethnicity [SCE] I‒III) and those with darker skin (race values: African, Asian, Hispanic; SCE IVa-VI). The authors identified skin cancer treatments using Current Procedural Treatment codes for Mohs Micrographic Surgery (MMS), wide local excision (WLE), and destructive skin cancer treatments with same-day International Classification of Disease 9/10 codes for basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Mann-Kendall tests and Joinpoint analysis assessed trends over time and evaluated average annual percent changes (AAPCs).

Results: The authors included 1,625,367 adult patients with 4,184,496 skin cancer treatments. Annual MMS frequency increased from 2011 to 2022 for both groups {SCE IVa‒VI 53.9% increase, AAPC 3.89% (95% confidence interval [CI] 2.84-4.96, p < .001); SCE I‒III 46.7% increase, AAPC 3.86% (95% CI 3.61-4.12, p < .001)}. The rates for WLE and destructive methods decreased for both populations (p < .001).

Conclusion: Mohs micrographic surgery utilization is increasing over time for both lighter- and darker-skinned patients.

Background: Age-related volume loss in the temple results in a hollow and aged appearance. Although dermal fillers are commonly used for correction, the proximity of important blood vessels in this area increases the risk of complications.

Objective: To evaluate the vascular anatomy of the temporal region using microvascular imaging and assess its implications for anatomical planning of filler injection.

Materials and methods: Microvascular imaging was used to visualize the superficial temporal artery in 62 patients and the deep temporal artery in 56 patients. Arterial depth was measured and analyzed in relation to age, gender, and body mass index. Measurement consistency was assessed using intraclass correlation analysis.

Results: Lower-body mass index and younger age correlated with thinner soft tissue. In some cases, the deep temporal artery was 0.3 millimeters from bone, and the superficial temporal artery 1.15 millimeters from skin. Measurements showed excellent interobserver agreement. No other significant associations were found.

Conclusion: The authors' findings demonstrate that superficial and deep temporal arteries may run at variable depths, sometimes close to the skin or periosteum. These variations should be considered in planning temple filler injections. Microvascular imaging may assist in visualizing these vessels and identifying higher-risk zones.

Background: Dermatologic surgery generates considerable medical waste due to its high procedural volume, yet specialty-specific guidance on sustainable practices remains limited.

Objective: To present an evidence-based framework for reducing waste in dermatologic surgery while maintaining safety and efficacy.

Materials and methods: A comprehensive search of PubMed was conducted for articles published from 2000 onward using key terms combining predefined waste reducing interventions (e.g. multipack nonsterile gloves, reusable drapes and instruments, longer-acting anesthetics, continuous suturing, simplified dressings) with ("waste reduction" OR "sustainability"). Evidence was graded by Oxford CEBM (1a-5) and GRADE (A-D).

Results: Twenty-eight sustainability strategies were identified across the preoperative, intraoperative, and postoperative phases of dermatologic surgery, 15 of which were supported by level 1 to 2 evidence. High-level interventions included the use of nonsterile gloves, longer-acting anesthetics, reusable drapes and instruments, absorbable and continuous suturing techniques, and occlusive dressings.

Conclusion: This review summarizes evidence-based sustainability strategies shown to reduce environmental impact and provides a practical framework for potential implementation in dermatologic surgery.