Dermatologic Surgery最新文献

Background: Cryolipolysis is an effective, well-tolerated noninvasive subcutaneous fat reduction treatment.

Objective: Assess participant satisfaction, effectiveness, and safety of a dual-applicator cryolipolysis system that can deliver simultaneous treatments.

Materials and methods: Adult participants received treatment to the abdomen/flanks (midsection). Participants could also receive treatment to upper arms, thighs, and submental area. Primary end point was participant satisfaction with midsection results at 12 weeks after final treatment. Secondary end points included independent photography review, participant satisfaction with additional body areas, and overall satisfaction. Exploratory end points included 3D imaging of midsection volumetric changes and assessments at 4 weeks after initial treatment. Safety was monitored throughout.

Results: Of 110 treated participants, 75% were female. Mean age and body mass index were 43 years and 25.1 kg/m 2 , respectively. Of 96 evaluable participants, 83.3% (80/96) were "satisfied/very satisfied" with midsection results. Reviewers correctly identified 88.0% (81/92) of baseline versus 12 weeks after final treatment midsection images. Mean (SD) subcutaneous fat volume loss was 194.8 (492.3) mL at 12 weeks after final treatment ( p < .001). Visible improvements were noted at 4 weeks after initial treatment by a majority of physician reviewers and participants. Five (4.5%, 5/110) participants reported 7 treatment-emergent adverse device effects.

Conclusion: The dual-applicator cryolipolysis system demonstrated high participant satisfaction, effectiveness, and safety.

Background: Eccrine porocarcinoma is a rare cutaneous adnexal malignancy. Factors associated with metastasis of porocarcinoma and evidence for the utility of sentinel lymph node biopsy are incomplete within the literature.

Objective: Determine prognostic factors that may guide the decision to pursue sentinel lymph node biopsy in patients with porocarcinoma.

Materials and methods: Retrospective analysis of the National Cancer Database and the Survival, Epidemiology, and End Results databases for cases of porocarcinoma. Multivariable logistic regression was performed examining tumor size and lymphovascular invasion for association with metastasis of porocarcinoma. The cumulative probability of sentinel node metastasis was calculated as a function of tumor size.

Results: A total of 1,351 patients were identified; 75 (5.6%) had a positive lymph node on pathology and 15 (1.1%) had distant metastatic disease. Patients with tumors greater than 17 mm in size had a 6.8% risk of occult lymph node metastasis identified by sentinel lymph node biopsy. In the subset of tumors analyzed for lymphovascular invasion, 40% (14 of 47) had metastasized at diagnosis.

Conclusion: Tumor size and lymphovascular invasion affect metastasis of porocarcinoma. Tumors greater than 17 mm in size or with lymphovascular invasion warrant consideration of sentinel lymph node biopsy.

Background: Validated clinical scales are needed to assess aesthetic improvement of the midface volume deficit after treatment with dermal fillers.

Objective: To develop a midface volume deficit rating scale and establish its reliability and sensitivity for grading subjects in clinical trials and routine practice.

Methods: A 5-grade photonumeric scale was developed by clinical experts based on real-subject photographs and validated through photographic and live subject evaluation.

Results: The mean intra-rater weighted Kappa score between the 2 sessions of photographic validation was 0.92. Inter-rater intraclass correlation coefficient (ICC) was 0.89 for the combined sessions. The average intra-rater weighted Kappa score and inter-rater ICC for the live validation reached 0.81 and 0.78, respectively. In addition, evaluators identified clinically significant differences between photographs of subjects presenting a 1-grade or 2-grade difference in 80% and 89% of cases, respectively.

Conclusion: The Teoxane Midface Volume Deficit Scale can measure the degree of volume deficit, detect a clinically meaningful difference of 1-grade, and is applicable to the ethnic diversity of the population. This scale is a repeatable, reproducible clinician-reported outcome and a useful tool for health care providers to classify midface volume depletion both in clinical trials and routine patient care.

Background: There is a scarcity of artificial intelligence models trained on frozen pathology. One way to expand the clinical utility of models trained on permanent pathology is by applying them to frozen sections and fine-tune based on weaknesses.

Objective: To qualitatively evaluate a deep learning model trained on permanent pathology to classify squamous cell carcinoma on Mohs surgery frozen sections to learn model shortcomings and inform retraining and fine-tuning.

Materials and methods: The authors trained a model for classification of tumor on 746 skin biopsy slides and tested it on 15 Mohs surgery frozen sections. The authors estimated performance metrics and compared the regions of interest generated by the model with the original H&E slides.

Results: The model achieved an AUC-ROC of 0.985 and 0.796 for tumor classification in permanent pathology and in frozen sections, respectively. Regions of interest for frozen sections with scarce tumor areas were inaccurate, focusing on normal tissue for slides classified as false negative, or highlighting structures different from tumor (e.g., inflammation, muscle, and nerves) for slides classified as true positive.

Conclusion: Deep anatomical structures more commonly present in Mohs frozen pathology might represent data out-of-distribution for models trained on permanent pathology, potentially leading to inadequate model outputs.

Background: Male and female pattern hair loss (MPHL and FPHL) significantly affect quality of life. This study compares the clinical and trichoscopic outcomes of platelet-rich plasma (PRP) and growth factor concentrate (GFC) in treating patterned hair loss, evaluating their efficacy and safety.

Objective: To compare the efficacy and side effect profiles of PRP and GFC in treating pattern hair loss and assessing associated trichoscopic changes.

Methods: A retrospective study of 42 patients (21 MPHL and 21 FPHL), divided into Group 1 (PRP, 25 patients) and Group 2 (GFC, 17 patients). Each underwent three treatment sessions, 4 weeks apart. Evaluations included trichoscopy, clinical photography, and the Global Aesthetic Improvement Scale (GAIS).

Results: GFC showed better outcomes in total hair count, shaft diameter, and GAIS score than PRP, with significant improvement in hair count after the second session ( p < .05). GFC also had more bulbar enlargement ( p < .05), while PRP showed more erythema and angiogenesis ( p < .05). At 6 months, PRP had better hair diameter and GAIS scores, indicating a more sustained effect.

Conclusion: PRP and GFC improve hair parameters with choices based on patient preference, cost, and expertise. GFC provides quick improvement, while PRP offers long-term benefits, making sequential treatments ideal for sustainable results.

Background: Penile cancer is a rare malignancy, the most common subtype of which is squamous cell carcinoma (SCC). Organ-sparing surgery (OSS) is the first-line treatment for early-stage tumors given the quality-of-life impairments of penectomy. However, the rarity of penile SCC has made the large-scale study of the efficacy of surgical approaches difficult.

Objective: To evaluate the rates of positive margins with the surgical approaches for penile SCC.

Methods: Retrospective cohort study of adult patients with excised penile SCC from the National Cancer Database diagnosed from 2004 to 2019.

Results: We found that treatment of penile SCC with OSS resulted in a positive margin rate of 18.8% (SE: 0.7%) versus 9.7% (SE: 0.4%) with partial penectomy and was associated with twice the odds of a positive margin compared with partial penectomy (odds ratio 2.312; p < .001). Positive margins were associated with poorer overall survival on multivariable analysis (hazard ratio 1.528; p < .01).

Conclusion: OSS for penile SCC results in high rates of positive margins, which are associated with poorer overall survival. Use of margin-controlled surgery may improve local control for these tumors while minimizing functional damage to an anatomically sensitive organ, allowing for the most optimal quality-of-life outcomes.