Dermatologic Surgery最新文献

Background: Image-guided superficial radiotherapy (IGSRT) has been advocated for and advertised as having lower recurrence rates, lack of surgical scars, morbidity, and being more cost-effective in comparison with Mohs surgery (MMS).

Objective: Evaluate and perform a modeled cost analysis using CPT/Medicare rates comparing IGSRT versus MMS in squamous cell carcinoma (SCC).

Materials and methods: The authors evaluated 3 exemplary and representative SCC lesions classified by stage (T1, T2, and Tis) and divided by anatomical location (head and neck/trunk and extremities).

Results: Average cost of a Mohs procedure for both the head/neck and trunk/extremities ranged from $1,010.15 to $1,566.68 depending on the repair type. IGSRT had a wide variety and range in price from $1,450.49 to $10,244.93 for a 10-session regimen versus $2,058.74 to $ 25,510.58 for the recommended 25 session regimen. SRT delivery only accounts for 3.74% of the cost per session.

Conclusion: Their results show that SRT can theoretically be 1.11 to 22.99 times more expensive regardless of MMS repair complexity. Overall time of the procedure is similar to twice as long but is also divided over the course of 10 to 25 days.

Background: As unshaven hair transplantation grows in popularity, terminology has become inconsistent across publications and advertising. This creates confusion for patients and clinicians and undermines informed consent.

Objective: To map usage, identify confusion sources, and propose definitions for the spectrum of "Unshaven" follicular unit excision (FUE) approaches.

Methods: The authors performed a structured review of scientific literature, Google Trends for public-facing terms, searches of clinic and media webpages, and standardized prompts to artificial intelligence chatbots. Findings were synthesized into operational definitions and classification.

Results: For the FUE procedure, the authors observed overlap, misuse, and conflation of techniques labeled "Unshaven," particularly between partially shaven methods and truly unshaven approaches. Synthesis yielded five categories with explicit procedural boundaries: Shaven FUE, Partially Shaven FUE, Unshaven FUE with pretrimming, Unshaven FUE without pretrimming, and Long-Hair FUE. For each, the authors outline defining steps, patient-visible outcomes, indications, and recommend patient-facing descriptors. The authors propose that 'Shaven' versus 'Unshaven' FUE terminology should be defined exclusively by the donor harvesting technique, irrespective of whether the recipient area is shaved.

Conclusion: The proposed standardized nomenclature clarifies FUE categories, improves counseling and expectation-setting, and supports transparent reporting, ethical advertising, and comparability across studies. The authors encourage adoption by clinicians, training programs, and journals.

Background: Skin quality attributes are defined inconsistently in clinical and research settings, which can impede communication between patients and health care professionals (HCPs) and hinder optimization of patient outcomes.

Objective: The authors aimed to develop a skin quality vocabulary/lexicon applicable across multiple stakeholders, including aesthetic HCPs, patients, researchers, and regulatory agencies.

Materials and methods: The authors convened advisory boards comprising 15 global aesthetic dermatologists to develop consensus definitions for 15 skin quality attributes based on a previously proposed framework. These definitions were used in qualitative patient focus groups ( n = 54) and quantitative online surveys of aesthetic HCPs ( n = 201) and patients ( n = 1,050) to assess preferred terms for each attribute.

Results: The advisory board developed definitions with 100% consensus for all 15 attributes after 2 meetings. The quantitative surveys demonstrated substantial agreement in terminology used between HCPs. However, as expected, terminology used by patients and HCPs differed for a number of conditions, including uneven pigmentation, crepiness, and laxity.

Conclusion: This research identified skin quality attribute terminology/definitions used among HCPs and patients. The authors hope this work will establish a foundation for consistent definitions that will help support patient-HCP communication, optimize outcomes, and bring clarity to the indication for approval by regulators.

Background: Postoperative complications from dermatologic surgeries lead to patient morbidity and increased health care costs. Identifying patient-specific risk factors may improve outcomes.

Objective: Evaluate risk factors for acute complications of excisional dermatologic surgery while controlling for confounding variables.

Materials and methods: This retrospective cohort study used the TriNetX database, which included data from approximately 930,000 patients undergoing excisional dermatologic surgery (Mohs micrographic surgery, malignant excisions, benign excisions). Propensity scoring balanced cohorts on a wide range of conditions and medications. Logistic regressions evaluated patient characteristics and 30-day complication rates.

Results: The overall complication rate was low (1.7%). Nicotine use, obesity, anticoagulants (e.g., warfarin, apixaban, heparin), and antiplatelets (e.g., aspirin, clopidogrel, ticagrelor) predicted complications. Vitamin D deficiency and oral corticosteroid use predicted infection and dehiscence. Oral immunosuppressants (methotrexate, azathioprine, mycophenolate, cyclosporine, tacrolimus, sirolimus, and everolimus) showed no association with complications. Poorly controlled DM or HTN were associated with greater odds of complications relative to well-controlled diabetes and hypertension.

Conclusion: Modifiable risk factors, including nicotine use, obesity, vitamin D deficiency, and poorly controlled diabetes or hypertension, predict complications. Considering these factors preoperatively and postoperatively could improve dermatologic surgery outcomes.