Dermatologic Surgery最新文献

Background: Reconstruction after Mohs micrographic surgery (MMS) or wide local excision (WLE) requires careful consideration of defect size, location, depth, margin status, and patient preferences to optimize cosmetic, functional, and oncologic outcomes. The role of delayed full-thickness skin grafts (FTSGs) during reconstruction after skin cancer removal remains less defined.

Objective: To characterize the indications, technique, and efficacy of delayed FTSG after MMS or WLE for skin cancer.

Materials and methods: Databases were searched for studies on delayed FTSG after MMS or WLE for skin cancer removal. Data were extracted on study design, patient and tumor characteristics, surgical details, graft technique, and outcomes including graft success, complications, and aesthetic/functional results.

Results: Twenty-four studies comprising 665 patients were included. The mean age was 63.8 years, and most patients were male (52.6%). The average delay to grafting was 16.5 days, with an overall graft success rate of 89.6% at an average follow-up period of 13 months. The optimal time to delay was 2 to 3 weeks with grafts placed in ≤1 week demonstrating significantly lower success. Outcomes were overall assessed as favorable, and patients were satisfied with their results.

Conclusion: Delayed FTSGs remain a viable and highly effective option for reconstructing skin cancer defects.

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.