Dermatologic Surgery最新文献

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.

Background: The high-intensity parallel beam ultrasound device is clinically safe and effective for skin tightening. Mild to moderate pain during treatment is frequently reported, which may impact patient satisfaction and retention.

Objective: This study aims to evaluate the analgesic effects of forced air cooling during treatment with the novel ultrasound device.

Methods: A prospective, randomized controlled trial involving 20 healthy participants was conducted. A combination of forced air cooling and topical anesthetics was randomly applied to one side of the arm, while topical anesthetic monotherapy was applied to the other. The visual analog scale was utilized to measure pain sensation immediately after treatment. In addition, the abdomens of Bama miniature pigs were treated under varying energy settings. Histologic changes were examined immediately and 6 weeks post-treatment.

Results: The mean pain scores for combined and single regimens were 6.58 (±1.59) and 4.64 (±1.62), respectively ( p < .001). Forced air cooling effectively reduces the pain with minimal complications. Histologic analysis indicated that the temperature reduction at the skin's surface does not affect collagen remodeling.

Conclusion: The combination of forced air cooling and topical anesthesia effectively relieves pain during treatment with the high-intensity parallel beam ultrasound device.