Dermatologic Surgery最新文献

Background: Deoxycholate is approved for submental fat reduction due to its ability to lyse cells and reduce fat accumulation, but it is used off-label in aesthetic treatments for subcutaneous fat reduction for several other parts of the body.

Objective: Review the clinical evidence supporting using sodium deoxycholate and delivery systems for aesthetic purposes.

Materials and methods: This systematic review explores the clinical evidence for sodium deoxycholate's efficacy and safety in fat reduction, exploring the use of delivery systems to mitigate adverse effects. A comprehensive literature search across Web of Science, Scopus, and PubMed was executed to prepare this review.

Results: Clinical studies confirm that subcutaneous deoxycholate injections effectively reduce submental fat, with long-term results suggesting maintained efficacy up to 3 years post-treatment. However, adverse effects are noted, prompting research into novel delivery systems, which include sustained-release liquid crystal formulations and micro/nanoparticle-based systems, promising to reduce side effects while enhancing efficacy.

Conclusion: The findings underscore that deoxycholate is clinically well-established in efficacy and safety, with substantial evidence for treating submental fat. More extensive clinical studies are necessary to establish its safety and effectiveness in larger treatment areas and optimize treatment outcomes using different delivery systems.

Background: Cellular dermatofibromas (CDFs) are uncommon benign fibrous histiocytomas with histologic patterns resembling malignancies. Despite their benign nature, CDFs can recur and metastasize. Physicians are uncertain about the management of CDF, given its resemblance to dermatofibrosarcoma protuberans.

Objective: This review aims to review CDF's clinical and histologic features, differentiate it from similar presenting malignancies, and discuss treatments and outcomes for better clinical management.

Materials and methods: In April 2024, a PubMed and Google Scholar search was completed using "cellular dermatofibroma" through the University of California Davis Medical School's library databases. The search included meta-analyses, randomized controlled trials, observational studies, reviews, and case studies published within the past 70 years. References from retrieved articles were utilized as additional resources.

Results: Clinical signs of CDF include firm, skin-colored to hyperpigmented lesions usually larger than 2 cm, typically on extremities. Currently, there are no definitive indicators for CDF recurrence or metastasis. Diagnosis requires microscopic and histopathologic examination, with surgical excision as the preferred treatment. Recurrence is not uncommon, while metastasis is rare.

Conclusion: CDFs often develop in young/middle-aged adults with a tendency to recur and in rare cases can metastasize. Future studies could explore lesion characteristics that are associated with potential for recurrence and metastasis.

Background: Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment.

Objective: This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment.

Methods and materials: A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution.

Results: Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC.

Conclusion: The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC.

Background: From the theoretical foundations of laser and energy-based applications for the skin to the development of advanced medical devices, the field of dermatologic surgery has undergone transformative changes.

Objective: To review the scientific and clinical advancement of laser and energy-based therapies within dermatologic surgery.

Materials and methods: A literature search was conducted to identify important scientific advancements and landmark studies on light, laser, and energy-based devices within the field of dermatologic surgery.

Results: Since the introduction of selective photothermolysis principles in the 1980s, numerous laser and energy-based devices have been developed to effectively treat vascular lesions, target pigmentation, remove tattoos, rejuvenate the skin, and remove hair. Beyond aesthetic applications, photodynamic therapy was introduced to treat various neoplastic and inflammatory conditions. Lasers have also been employed to enhance transcutaneous drug delivery, and new lasers continue to emerge for treating common inflammatory conditions, such as acne. These innovations have contributed to a paradigm shift toward safe and effective, but less invasive, procedure-based treatment in addressing medical and aesthetic concerns in dermatology.

Conclusion: Dermatologists have consistently led the way in the continuous development and innovative application of laser and energy-based devices to effectively address a variety of skin conditions.

Background: Low-level laser/LED therapy (LLLT) has been described as a treatment option for alopecia, but no study has comprehensively reviewed its efficacy in multiple alopecia types.

Objective: To review and evaluate LLLT for various alopecia types.

Materials and methods: A systematic search of PubMed/MEDLINE, Embase, and CENTRAL was conducted to identify studies assessing the effect of LLLT on patients diagnosed with alopecia. Prespecified outcome measure was the change in hair density. Meta-analysis was performed to calculate the standardized mean difference in hair density before and after LLLT compared with placebo.

Results: Thirty-eight studies were included that described 3,098 patients with androgenetic alopecia (2,930/3,098), scarring alopecia (49/3,098), alopecia areata (50/3,098), telogen effluvium (17/3,098), and chemotherapy-induced alopecia (32/3,098). The mean change in hair density increased significantly in androgenetic alopecia patients after LLLT for 4 to 26 weeks compared with placebo (<20 weeks: SMD = 1.14; 95% CI [0.51-1.78]; p = .000; I 2 = 88.26%; >20 weeks: SMD = 1.44; 95% CI [0.97-1.91]; p = .000; I 2 = 80.81%). Change in hair density was reported in 5 studies evaluating other alopecia types; however, statistical information was insufficient for meta-analysis.

Conclusion: LLLT is a promising treatment option for patients with androgenetic alopecia, but future studies are needed to better understand its efficacy in other alopecia types.

Background: Prior studies describe wide local excision and "slow Mohs" outcomes for periocular melanoma. Mohs micrographic surgery (MMS) with immunohistochemistry maximizes tissue preservation and offers same-day comprehensive margin evaluation, which facilitates expedited repair, and coordination of oculoplastic reconstruction when necessary.

Objective: To describe oncologic and reconstructive outcomes of invasive periocular cutaneous melanoma treated with immunohistochemistry-assisted MMS.

Materials and methods: Invasive melanoma cases affecting the eyelids or periorbital region treated with MMS between 2008 and 2018 were reviewed. Eyelid tumors and those in adjacent subunits were compared. Main outcome measures were recurrence, melanoma-specific death, and postreconstructive complications.

Results: Of 42 cases, 28 were classified as periorbital and 14 as eyelid involving. Most were T1 (37, 88.1%). There was 1 local recurrence in a patient with persistent positive conjunctival margin (2.4%). No local recurrences were observed in cases where negative Mohs margins were achieved, and no melanoma-related deaths occurred. Eyelid tumors were more likely to result in lid margin involving defects and require oculoplastic reconstruction. Eyelid complications developed in 10 cases (23.8%), and 5 (11.9%) required revision surgery.

Conclusion: Mohs micrographic surgery for periocular melanoma results in low rates of local recurrence and melanoma-specific death. Initial tumor location can aid in reconstructive planning.