Australasian Journal of Dermatology最新文献

Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm that arises within the dermis of chronically sun-exposed skin. Although wide local excision is standard practice, patients are regularly elderly and highly comorbid and therefore, curettage may offer a suitable alternative as a same day treatment with minimal aftercare. A retrospective case series was conducted analysing the files of all patients diagnosed with histopathological AFX at a single dermatology practice in Fremantle, Western Australia between the years 2016 and 2025. Kaplan-Meier analyses estimated recurrence rate with subgroup analyses comparing recurrence with gender, lesion location and lesion size. The study analysed 77 cases of AFX tumours treated with curettage and cautery. Patients had a mean age of 78.3 years with male predominance in the sample population. A total of nine tumours had documented recurrence, within a median time of 6.41 months, reflecting a crude recurrence rate of 11.69% and a Kaplan-Meier estimated 5-year recurrence rate of 16.99%. There were no disease-specific deaths, and no cases developed metastases. Given the high efficacy of curettage and cautery reflected in the study, and the lacking risk of disease-specific deaths and metastasis, a valuable treatment option is proposed. Employing curettage and cautery for AFX may reduce the personal and economic burden of cumbersome interventions, mitigating hospital admission and extensive wound care. Curettage and cautery may be of particular benefit in the nursing home population.

Background: Surgical attire and personal protective equipment (PPE) represent significant financial and environmental costs in dermatologic surgery. Evidence suggests that lower-resource approaches can maintain low surgical site infection (SSI) rates.

Objectives: To describe international PPE use and highlight opportunities to improve sustainability and reduce unnecessary expenditure while ensuring patient safety.

Methods: A 16-item online questionnaire was developed in Google Forms, refined through colleague feedback, circulated in March 2025 via the British Society for Dermatological Surgery, the New Zealand Dermatological Society Inc., and the European Society for Micrographic Surgery, with one reminder sent. It collected demographic data and tailored questions for Mohs surgeons and those performing flap/graft repairs.

Results: Responses were obtained from 205 clinicians across 25 countries, predominantly from the UK (59.5%), New Zealand (13.7%), and the Netherlands (6.8%). Most were consultant dermatologists (79.5%); 42.0% were Mohs surgeons. Considerable variation was reported in glove type, attire, and mask use. For diagnostic biopsies, 40.0% used clean gloves, 63.9% sterile gloves, and 40.0% wore clean scrubs alone, while 26.3% operated in normal work clothes. For excisions with direct closure, 92% used sterile gloves, though over half wore only clean scrubs. Among Mohs surgeons, 20.9% used clean gloves for tumour extirpation and most (75.6%) wore clean scrubs alone. Reusable attire was limited, mainly scrubs and personal eyewear, while disposable caps and masks predominated.

Conclusion: This international survey demonstrates variability in dermatologic surgical PPE, with single-use items remaining widespread despite limited evidence of benefit. Evidence-based standardisation could improve sustainability, reduce costs, and maintain excellent patient outcomes.

Bullous pemphigoid (BP) is a common autoimmune blistering disease associated with medications, particularly dipeptidyl peptidase-4 inhibitors such as vildagliptin, funded in New Zealand since 2018. We conducted a retrospective single-centre study of histologically confirmed BP cases between 2018 and 2023. Of 49 patients identified, 15 (30.6%) had vildagliptin-induced BP. Māori patients were over-represented in this subgroup. The mean time to BP onset after vildagliptin initiation was 388 days. Non-vildagliptin BP was more likely to require systemic immunosuppression. Vildagliptin-induced BP represents a common and under-recognised clinical entity in New Zealand.

Complications from intense pulsed light treatments are often attributed to the use of broad wavelength light and insufficient operator skill. This case series reviews four patients who experienced intense pulsed light (IPL) treat-induced complications at cosmetic clinics across Melbourne, Australia. The findings aim to educate both clinicians and consumers about the common complications seen with IPL treatment, the potential severity of these complications and to offer recommendations to enhance the safety of IPL treatments for individuals with skin of colour.

This case series outlines a proposed simplified and cost-effective alternative to expensive laboratory-based autologous non-cultured epidermal suspension (NCES). In all five adult participants, 75%-100% repigmentation was observed at 6 months, with one participant experiencing unsatisfactory colour mismatch and one participant experiencing hypertrophic scarring. Larger, randomised controlled trials with extended follow-up are needed to determine the long-term efficacy and safety profile of our clinical NCES protocol.

Background/objectives: Studies on factors that predict the number of stages in Mohs micrographic surgery (MMS) have been published previously. To date, no studies have analysed the predictors for the number of sections during MMS.

Methods: A retrospective case-control study of patients treated for keratinocyte cancer (KC) between 2013 and 2017 was conducted to identify predictive factors for 13 or more MMS sections. Patient, tumour, management and practitioner-related factors were analysed with univariate logistic regression and a multivariate predictive model. Surface area for tumours and defects was studied in cases and controls as a secondary outcome.

Results: Out of 10,132 tumours, a total of 195 cases representing 1.9% of all MMS procedures for the study period required more than 13 MMS sections. A control group with 213 tumours was also randomly selected. Largest preoperative tumour diameter, mixed histology, tumour recurrence and age were significant predictors for 13 or more MMS sections in a multivariate model (AUC 88.4%, sensitivity 77.2% and specificity 87.0%). Significantly larger defects were also found in our cases compared to the control group (median tumour to defect ratio 3.94 vs. 2.43; p < 0.0001).

Conclusion: Identifying factors that predict 13 or more sections prior to surgery could assist the Mohs practitioner in informing patients and allocating time and resources accordingly.