Dermatologic Surgery最新文献

Background: Scarring is a common side effect of cutaneous surgery. Scarring has been linked to decreased quality of life and patient satisfaction after surgery.

Objective: To provide a framework for dermatological surgeons to best choose intraoperative interventions to minimize scarring.

Methods: A MEDLINE search was conducted using keywords: "surgical scars," "scarring," "scar intervention," and "scar reduction." Clinical trials and professional opinion pieces were included. Articles were excluded if they were not in the English language or did not describe interventions in the intraoperative period.

Results: Variations in closure techniques and suture material can impact scar outcomes. Intraoperative abrasion of tissue through dermabrasion, electroabrasion, and laser ablation can also impact wound outcomes. Exogenous materials, such as botulinum toxin, intralesional steroids, platelet preparations, and human mesenchymal stem cells, can be utilized to promote improved wound healing. No single best intervention for scar optimization was determined, but varying interventions may be used based on specific patient and wound characteristics.

Conclusion: Many intraoperative options exist for dermatological surgeons to improve scarring outcomes. Wound and patient characteristics can be utilized in selecting the most effective interventions for a given patient.

Background: In the histologic analysis of melanoma, Breslow depth is a critical component of prognostication. Transecting the tumor through tangential biopsy technique potentially affects staging, treatment, and outcomes.

Objective: Compare outcomes of transected and nontransected melanomas biopsied by tangential biopsy technique.

Patients and methods: This is a single-center retrospective cohort study. Patients were matched based on American Joint Commission on Cancer eighth edition Tumor (T) stage and tumor transection status.

Results: Patients with transected melanomas experienced significant increases in 5-year recurrence ( p = .023), 5-year mortality ( p = .004), metastasis ( p = .035), and melanoma-related mortality ( p = .002). However, after stratifying by T stage, there were no significant differences in recurrence, metastasis, or mortality between transected and nontransected tumors. Transected tumors <1.0 mm had a higher rate of sentinel lymph node biopsies (SNLB) performed compared with the nontransected tumors <1.0 mm. Limitations include population size, single-institution retrospective nature of the study, and homogenous population.

Conclusion: While there were no significant differences in patient outcomes by T stage when melanomas were transected by shave biopsy, shallow (<1.0 mm) transected melanomas were more likely to receive sentinel lymph node biopsy compared with nontransected melanomas. Biopsy technique should aim to a depth that provides the full Breslow depth of melanoma tumors.

Background: Understanding histologic and ultrastructural changes in pigmented lesions after laser/energy-based device (EBD) treatment is essential for elucidating treatment mechanisms, optimizing outcomes, and preventing complications.

Objective: To summarize histologic and imaging findings after laser/EBD for pigmented lesions.

Methods: A systematic review using PubMed identified 39 studies examining laser/EBD treatment, correlating light microscopy (LM), electron microscopy (EM), reflectance confocal microscopy (RCM), and optical coherence tomography findings.

Results: Light microscopy and EM of lentigines revealed that picosecond lasers created smaller vacuoles with minimal surrounding damage, possibly explaining reported lower rates of postinflammatory hyperpigmentation compared with nanosecond lasers. Reflectance confocal microscopy showed that smooth-bordered café-au-lait macules have denser papillae and more elongated rete ridges, possibly hindering laser penetration to the lesion base and contributing to poorer outcomes. Electron microscopy after laser toning for melasma demonstrated sub-cellular selective photothermolysis, removing melanosomes without destroying melanocytes. However, cumulative toxicity induced melanocyte malfunction, which could explain confetti hypomelanosis after aggressive treatments. Picosecond lasers confined tattoo particles within lysosomal structures, whereas nanosecond lasers dispersed them into surrounding tissues, which may help explain superior efficacy and safety reported with picosecond lasers.

Conclusion: Histologic and imaging analyses can enhance the understanding of mechanisms of treating pigmented lesions with laser/EBD, providing insights regarding reported efficacy and safety.

Background: Melasma is an acquired hypermelanosis. Chemical peels have been found efficacious in melasma. However, limited studies have compared the efficacy of various peels in melasma and used dermoscopy to evaluate improvement.

Objective: To compare the efficacy of 35% glycolic acid peel and 4% retinol peel in melasma using clinical, dermoscopic, and quality of life assessments.

Materials and methods: A randomized controlled study included 60 adults (18-60 years) with clinically diagnosed melasma. Participants were randomized into Group A (glycolic acid) and Group B (retinol), receiving 6 sessions of peels at two-week intervals. Pretreatment and post-treatment assessments included modified Melasma Area Severity Index (mMASI), dermoscopic scoring, and Hindi Melasma Quality of Life Index (HI-MELASQOL). Statistical analysis used p -values <0.05 for significance.

Results: Both groups showed significant improvements in mMASI, dermoscopic features, and HI-MELASQOL ( p < .001) with no significant difference between groups. Mild, self-limiting adverse effects were more common in the retinol group (13.3%) than the glycolic acid (3.3%).

Conclusion: Both 35% glycolic acid and 4% retinol peels are effective in treating melasma, with significant improvements in pigmentation, dermoscopic features, and quality of life. No significant difference was observed between the 2 treatments. Dermoscopy is useful to assess response.

Background: Online reviews influence patient health care decision-making and perceptions of clinicians. Although Mohs micrographic surgery is a common dermatologic procedure, the nature of negative online reviews for Mohs surgeons remains poorly understood.

Objective: To characterize negative 1-star Yelp reviews of Mohs surgeons.

Materials and methods: A retrospective analysis of 7,031 Yelp reviews for Mohs micrographic surgeons was conducted. One-star reviews specific to Mohs surgeons were included. Each review was coded for clinical and nonclinical complaints. Statistical comparisons were made between surgical and nonsurgical patients, and between cosmetic and noncosmetic patients.

Results: Of 670 reviews included, 91.2% were written by patients who did not undergo surgery. Nonclinical complaints (81.2%) were more prevalent than clinical complaints (18.8%). Surgical patients were more likely to report clinical issues such as scarring and pain ( p < .05), while nonsurgical patients were more likely to cite nonclinical issues including staff professionalism and communication. Cosmetic patients more frequently complained about cosmetic outcomes, bedside manners, and billing issues ( p < .001).

Conclusion: Negative reviews of Mohs surgeons are primarily driven by nonclinical concerns, especially among nonsurgical patients. These findings highlight the importance of communication and staff interactions in patient satisfaction.

Background: Lichen simplex chronicus (LSC) is a common itchy dermatosis. Topical steroids are usually used as first-line therapy. Fractional carbon dioxide (CO 2 ) laser has shown efficacy in reduction of pruritus in different itchy dermatoses. However, controlled studies evaluating its efficacy in LSC are scarce in the literature.

Objective: The authors aimed to compare the efficacy of fractional CO 2 laser either alone or combined with topical corticosteroid to topical corticosteroid alone in treatment of LSC.

Patients and methods: Sixty LSC patients were randomized into 3 groups receiving fractional CO 2 laser, topical corticosteroid, or both, for 3 months. Disease severity was assessed before and after treatment, using patient-reported outcomes, namely pruritus severity scale and visual analog scale (VAS), and physician-reported outcomes in the form of erythema, lichenification, scaling and excoriation scores and Investigator's Global Assessment (IGA).

Results: Treatment with combined fractional CO 2 laser and topical corticosteroid was associated with the highest incidence of achieving IGA score of 0 or 1 and VAS 50%, followed by laser and then topical corticosteroid arms (93.3%, 66.7%, and 50%, p = .016 and 100%, 86.7%, and 66.7%, p = .028, respectively).

Conclusion: Fractional CO 2 laser is an effective tool for treatment of LSC. Combination with topical corticosteroids can improve the outcome.

Background: Physicians are concerned that patients are confused by the professional titles used by nonphysician practitioners.

Objective: To assess how commonly used medical titles and specialty descriptors are understood by adult Californians in relation to the practitioner's actual training and qualifications.

Methods: A 60-question multiple choice online survey was conducted on California adults aged 18 to 99 years. The survey was designed to yield a 3.0% margin of error. Given the demographic diversity of California, participants were sourced from multiple opt-in survey panels and balanced for age, income, gender/race/ethnic diversity, education, community type, geography, and political ideology.

Results: A total of 1,033 subjects (24.6% response rate; 4,206 potential participants) met the inclusion criteria for the survey. Participants demonstrated significant confusion by the medical and specialty titles used by nonphysicians in California. Only 9% ( N = 91) of participants correctly matched a practitioner's level of training and qualifications with the medical or specialty titles provided in the survey. The understanding of medical titles also varied between age groups and across geographic locations in the state. Of the participants, 88% supported legislation to restrict the use "doctor" and "-ologist" terms to physicians only.

Conclusion: The results underscore the need for California to provide additional regulation and legislation regarding title transparency.