Dermatologic Surgery最新文献

Background: Population-based investigations of leiomyosarcoma (LMS) of the skin are limited; many studies of LMS have not stratified results by dermal versus subcutaneous origin of the tumor.

Objective: To characterize the incidence, tumor characteristics, and prognostic factors of skin primary LMS.

Methods: Retrospective population-based analysis of the 17 registries of the Surveillance, Epidemiology, and End Results Program (2000-2021).

Results: Dermally-based LMS (dLMS) has an incidence of 0.59 (95% CI, 0.56-0.63) cases per million person-years, whereas subcutis-based LMS (sLMS) has an incidence of 3.87 (95% CI, 3.78-3.96). Dermally-based LMS has a 5-year disease-specific survival (DSS) of 96.8% (95% CI, 95.7-98.0) whereas sLMS has a DSS of 62.9% (95% CI, 61.7-64.2). Advanced age, female sex, head and neck disease, distant stage at diagnosis, and income <$75,000 were associated with worse DSS for dLMS and sLMS. Tumor size and Fédération Nationale des Centres de Lutte Contre le Cancer grade 2/3 were observed to negatively affect DSS for sLMS but not dLMS.

Conclusion: Dermally-based LMS generally has a favorable prognosis, whereas sLMS is characterized by a much more aggressive course. Advanced age, female sex, head and neck disease, and distant stage at diagnosis are high-risk features for both dLMS and sLMS.

Background: Bleeding remains a frequent complication during Mohs micrographic surgery, particularly among patients receiving anticoagulant or antiplatelet therapy. The growing use of these medications has prompted increased exploration of adjunctive methods to improve perioperative hemostasis.

Objective: To systematically review the literature on topically and locally administered hemostatic agents used to reduce bleeding in Mohs micrographic surgery.

Methods: A systematic search of PubMed, Scopus, Cochrane, and EMBASE was conducted through March 2024. Original studies evaluating hemostatic agents applied topically or by local injection during Mohs micrographic surgery were included.

Results: Seven studies met inclusion criteria, encompassing 458 patients. Agents evaluated included tranexamic acid, brimonidine gel, hemostatic powders, and microporous polysaccharide materials. These agents were generally well tolerated and associated with reductions in intraoperative and postoperative bleeding.

Conclusion: Locally administered hemostatic agents offer a promising adjunct to improve bleeding control in Mohs micrographic surgery. Their use may be particularly beneficial in patients at elevated bleeding risk and warrants further investigation in larger, controlled studies.

Background: The illegal practice of medicine in aesthetic procedures poses significant public health risks because of complications from unqualified individuals. Invasive treatments such as botulinum toxin and fillers are frequently performed by nonmedical professionals without proper medical training, resulting in infections, necrosis, and lasting sequelae.

Objective: This study aimed to analyze the complications from nonphysicians encountered by Brazilian specialists (dermatologists, plastic surgeons, and other specialists) in their clinical practice.

Materials and methods: A multicenter survey involving 1,058 physicians (primarily dermatologists and plastic surgeons) across Brazil assessed complications from aesthetic procedures performed by nonmedical individuals. Descriptive statistics categorized complications by type and severity, identified responsible practitioners, and estimated the health care and economic burdens.

Results: Over half of the respondents treat more than 100 patients monthly, and 12.69% of patients had undergone procedures by nonmedical professionals. On average, five complications were treated monthly per physician; 17% led to permanent sequelae. Common issues included scarring (78.68%), inflammation (72.15%), and infection (65.43%). Most cases required up to 3 specialists and 7 to 8 consultations per year, often involving multiple surgeries.

Conclusion: These findings underscore the urgent need for regulatory enforcement, public education, and legal protection. Brazil's experience may inform other countries confronting similar issues related to the unauthorized practice of aesthetic medicine.

Background: Keratinocyte carcinomas (KCs) are the most common cancers in the United States. Despite existing preventative strategies, their incidence continues to rise, highlighting a need for better intervention. The pulsed dye laser (PDL) has a myriad of medical indications but has not been studied in skin cancer prevention.

Objective: The objective of this study was to assess the effect of PDL treatment on subsequent facial KC development.

Materials and methods: A retrospective cohort study was conducted on patients with a history of facial KC who received treatment at the Dermatology Laser and Cosmetic Center at Massachusetts General Hospital between 2000 and 2024.

Results: Fifty-nine patients with a history of facial KC who received PDL treatment and 59 matched controls met inclusion criteria for the study. Subsequent facial KC was observed in 27.1% of PDL-treated patients, compared with 54.2% of controls (RR 0.50, p = .0047). After adjusting for age, sex, and skin type, control subjects remained at a higher risk for developing new facial KC compared with PDL-treated patients (HR 2.88, p = .0008).

Conclusion: These data suggest a potential association between PDL treatment and a reduced rate of subsequent facial KC development in patients with a history of KC.

Background: Mohs micrographic surgery (MMS) is the gold standard for complete margin analysis of skin cancer in the United States; however, its global acceptance varies. Limited information exists regarding international MMS practices.

Objective: This study aimed to gather information regarding the education, training, and practice of MMS worldwide, recognize variances in practices, and understand challenges international Mohs surgeons encounter.

Materials and methods: Providers outside the United States practicing MMS were surveyed from 8/2023-5/2024. The online survey compromised 47 questions addressing participants' certification/accreditation, practice of MMS in their current country, and potential barriers to practice.

Results: One hundred fifty-eight participants representing 31 countries were included. In total, 95.6% participants completed primary training in dermatology. Certification/accreditation requirements varied, with 32.3% and 27.2% completing a minimum of 100 MMS cases and repairs as primary surgeon, respectively. Barriers to increasing patient volume include lack of public knowledge regarding MMS (41.1%), limited infrastructure (40.5%), and minimal/no reimbursement (31.0%).

Conclusion: This study highlights the diverse challenges in expanding the global recognition of MMS. A comprehensive international survey and registry is critical to understand the current state of MMS training and practice internationally. This knowledge can help promote universal standards, ensure competent training, and foster collaborations that elevate the recognition of MMS globally.