Dermatologic Surgery最新文献

Background: The proportion of acral/ungual melanoma varies by ethnicity, with populations of higher Fitzpatrick phototypes (IV-VI) showing frequencies of 15% to 23%. Evidence on tissue-conserving surgical approaches in Latin-American populations remains limited.

Objective: To describe demographic, clinical, and surgical outcomes of patients with ungual melanoma in situ treated with Mohs micrographic surgery (MMS) and explore the distribution of those variables in a dermatologic center in Bogotá, Colombia.

Methods: Retrospective cross-sectional study including patients with ungual melanoma treated with MMS between 2013 and 2023. Outcomes included histologic clearance, recurrence, surgical margin status, and functional preservation. Multiple correspondence analysis (MCA) identified clusters between the variables.

Results: Thirty-six patients were included. All achieved complete histologic clearance with no recurrences or melanoma-related mortality at 5 years (95% confidence interval upper-bound ≈8.3%). Most tumors cleared in a single MMS stage, with final margins <6 mm in 83% of cases. MCA revealed three clusters: nodular/scar lesions in middle-aged women with hand involvement; plaque/papule lesions in men with foot involvement and higher reintervention rates; macular lesions in younger patients with fewer reinterventions.

Conclusion: MMS provided long-term, function-preserving management of ungual melanoma in situ. MCA identified clinically meaningful subgroups suggesting potential for personalized approaches. Further multicentric validation is needed.

Background: Scarring, particularly the atrophic type, is one of the most distressing consequences of acne. Despite the availability of various treatment options, no single best treatment option has been recognized.

Objective: To compare the efficacy of carbon dioxide (CO 2 ) pinhole method and needleless microsubcision with hyaluronic acid (HA) to identify a more effective treatment option for acne atrophic scars.

Materials and methods: A 4-week prospective, single-center, evaluator-blinded, randomized, split-face study was conducted. Clinical evaluation using the VISIA imaging tool, reflectance confocal microscopy (RCM), and histopathologic analysis was performed a month after a single-treatment session.

Results: Microsubcision with HA improved scarring depth and postacne erythema more than CO 2 pinhole method, although the differences were not statistically significant. Histopathologic analysis revealed that microsubcision with HA induced diffuse soft tissue remodeling and evenly distributed fine collagen fibers. In addition, RCM analysis revealed evenly distributed hyper-reflective collagen fibers in the dermis and regular honeycomb patterns in the epidermis. No serious adverse effects were observed.

Conclusion: This study demonstrated that needleless microsubcision with HA shows a nonsignificant trend toward superiority than CO 2 pinhole method in treating atrophic acne scars.

Background: Despite evidence supporting efficacy of low-fluence Q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm lasers, treatment protocols are not standardized and limited to mostly retrospective, observational, or inadequately controlled studies.

Objective: To investigate the safety and efficacy of low-fluence QS Nd:YAG (1,064 nm) laser in the treatment of melasma.

Materials and methods: A prospective, blind, randomized, placebo-controlled split face trial was conducted. Patients with Fitzpatrick skin types I-IV, and melasma severity scores of at least 2 received 3 monthly treatments using mechanical exfoliation, low-fluence QS Nd:YAG laser, hydroquinone 4% twice daily, and sunscreen.

Results: Both treatment and control sides of the face showed a comparable decrease in melanin index (MI), with a statistically significant difference only after treatment 2 ( p = .04). The Modified Melasma and Severity Index (mMASI) score for both the treatment and control decreased but without any significant difference (.18 < p < .57). The highest level of patient-reported improvement occurred at week 8; however, patient-reported improvement decreased by the 6-month follow-up.

Conclusion: Placebo and laser treatment groups showed an effective, safe, yet similar decrease in both MI and mMASI scores, indicating that low-fluence, QS Nd:YAG laser treatments did not add significant benefit beyond combination topical therapies.