BACKGROUND: Skin quality attributes are defined inconsistently in clinical and research settings, which can impede communication between patients and health care professionals (HCPs) and hinder optimization of patient ou...BACKGROUND: Skin quality attributes are defined inconsistently in clinical and research settings, which can impede communication between patients and health care professionals (HCPs) and hinder optimization of patient outcomes. OBJECTIVE: The authors aimed to develop a skin quality vocabulary/lexicon applicable across multiple stakeholders, including aesthetic HCPs, patients, researchers, and regulatory agencies. MATERIALS AND METHODS: The authors convened advisory boards comprising 15 global aesthetic dermatologists to develop consensus definitions for 15 skin quality attributes based on a previously proposed framework. These definitions were used in qualitative patient focus groups ( n = 54) and quantitative online surveys of aesthetic HCPs ( n = 201) and patients ( n = 1,050) to assess preferred terms for each attribute. RESULTS: The advisory board developed definitions with 100% consensus for all 15 attributes after 2 meetings. The quantitative surveys demonstrated substantial agreement in terminology used between HCPs. However, as expected, terminology used by patients and HCPs differed for a number of conditions, including uneven pigmentation, crepiness, and laxity. CONCLUSION: This research identified skin quality attribute terminology/definitions used among HCPs and patients. The authors hope this work will establish a foundation for consistent definitions that will help support patient-HCP communication, optimize outcomes, and bring clarity to the indication for approval by regulators.
BACKGROUND: Postoperative complications from dermatologic surgeries lead to patient morbidity and increased health care costs. Identifying patient-specific risk factors may improve outcomes. OBJECTIVE: Evaluate risk fact...BACKGROUND: Postoperative complications from dermatologic surgeries lead to patient morbidity and increased health care costs. Identifying patient-specific risk factors may improve outcomes. OBJECTIVE: Evaluate risk factors for acute complications of excisional dermatologic surgery while controlling for confounding variables. MATERIALS AND METHODS: This retrospective cohort study used the TriNetX database, which included data from approximately 930,000 patients undergoing excisional dermatologic surgery (Mohs micrographic surgery, malignant excisions, benign excisions). Propensity scoring balanced cohorts on a wide range of conditions and medications. Logistic regressions evaluated patient characteristics and 30-day complication rates. RESULTS: The overall complication rate was low (1.7%). Nicotine use, obesity, anticoagulants (e.g., warfarin, apixaban, heparin), and antiplatelets (e.g., aspirin, clopidogrel, ticagrelor) predicted complications. Vitamin D deficiency and oral corticosteroid use predicted infection and dehiscence. Oral immunosuppressants (methotrexate, azathioprine, mycophenolate, cyclosporine, tacrolimus, sirolimus, and everolimus) showed no association with complications. Poorly controlled DM or HTN were associated with greater odds of complications relative to well-controlled diabetes and hypertension. CONCLUSION: Modifiable risk factors, including nicotine use, obesity, vitamin D deficiency, and poorly controlled diabetes or hypertension, predict complications. Considering these factors preoperatively and postoperatively could improve dermatologic surgery outcomes.
BACKGROUND: The proportion of acral/ungual melanoma varies by ethnicity, with populations of higher Fitzpatrick phototypes (IV-VI) showing frequencies of 15% to 23%. Evidence on tissue-conserving surgical approaches in L...BACKGROUND: The proportion of acral/ungual melanoma varies by ethnicity, with populations of higher Fitzpatrick phototypes (IV-VI) showing frequencies of 15% to 23%. Evidence on tissue-conserving surgical approaches in Latin-American populations remains limited. OBJECTIVE: To describe demographic, clinical, and surgical outcomes of patients with ungual melanoma in situ treated with Mohs micrographic surgery (MMS) and explore the distribution of those variables in a dermatologic center in Bogotá, Colombia. METHODS: Retrospective cross-sectional study including patients with ungual melanoma treated with MMS between 2013 and 2023. Outcomes included histologic clearance, recurrence, surgical margin status, and functional preservation. Multiple correspondence analysis (MCA) identified clusters between the variables. RESULTS: Thirty-six patients were included. All achieved complete histologic clearance with no recurrences or melanoma-related mortality at 5 years (95% confidence interval upper-bound ≈8.3%). Most tumors cleared in a single MMS stage, with final margins <6 mm in 83% of cases. MCA revealed three clusters: nodular/scar lesions in middle-aged women with hand involvement; plaque/papule lesions in men with foot involvement and higher reintervention rates; macular lesions in younger patients with fewer reinterventions. CONCLUSION: MMS provided long-term, function-preserving management of ungual melanoma in situ. MCA identified clinically meaningful subgroups suggesting potential for personalized approaches. Further multicentric validation is needed.
BACKGROUND: Noncultured melanocyte keratinocyte transplantation (MKTP) is an important therapeutic modality for therapy-resistant stable vitiligo. Perigraft halo (PGH) commonly occurs after MKTP but studies tackling PGH...BACKGROUND: Noncultured melanocyte keratinocyte transplantation (MKTP) is an important therapeutic modality for therapy-resistant stable vitiligo. Perigraft halo (PGH) commonly occurs after MKTP but studies tackling PGH are limited. OBJECTIVE: To characterize PGH after MKTP for vitiligo and identify some risk factors. METHODS: This was a retrospective study of patients with stable vitiligo who underwent MKTP. PGH was defined as the presence of white rim at the periphery of the treated lesion 3 months after surgery. Multivariate logistic regression analysis was conducted to identify independent factors associated with PGH. RESULTS: The study included 223 patients. Women were 148 (66.4%) and the mean age was 24.4 ± 8.9 years. PGH was present in 42 patients (18.8%). The head and neck, feet, and lower extremity were the most common sites with PGH. Multivariate logistic regression analysis showed that MKTP performed on the feet significantly increased the odds of PGH (OR 5.856, 95% CI: 2.242-15.292, p value < .001). CONCLUSION: PGH is a relatively frequent complication after MKTP, especially when performed on the feet. The follow-up duration might not have been long enough to show some positive effects of the various post-MKTP interventions. Longer follow-up studies are warranted to evaluate preventive strategies.
BACKGROUND: When performing Mohs micrographic and dermatologic surgery for high-risk cutaneous malignancies, particularly aggressive scalp tumors, there may be positive or indeterminate deep margins overlying clinically...BACKGROUND: When performing Mohs micrographic and dermatologic surgery for high-risk cutaneous malignancies, particularly aggressive scalp tumors, there may be positive or indeterminate deep margins overlying clinically uninvolved bony cortex (outer table). OBJECTIVE: To ensure complete tumor extirpation in these situations, the authors performed superficial bone decortication and report their case series. METHODS: Over six consecutive months, superficial bone decortication was performed using a microdrill with rosehead bur after 10 Mohs micrographic surgery cases and one incomplete skin cancer excision. Cases included eight squamous cell carcinomas, two pleomorphic dermal sarcomas, and one basal cell carcinoma. The mean preoperative largest tumor diameter was 37.2 mm, and the mean postoperative largest defect diameter was 49.4 mm. Patients completed mixed-methods questionnaire with a Likert scale, dichotomous, and open-questions. RESULTS: The median pain value was 0 (mean 0.4) during the decortication surgery. All patients receiving Mohs surgery preferred superficial bone decortication under local anesthetic on the day of Mohs rather than referral for another day under general anesthetic.Analysis of open questions determined the procedure was similar to dental drilling -noisy with a vibratory sensation but caused little discomfort. CONCLUSION: Superficial bone decortication is a well-tolerated and safe procedure in an outpatient setting and can be readily performed after Mohs micrographic surgery in clinically uninvolved bone.
BACKGROUND: There is an increasing demand for laser and light-based procedures over larger body surface areas, increasing the risk of encountering nontarget skin areas such as melanocytic nevi and tattoos. Few products e...BACKGROUND: There is an increasing demand for laser and light-based procedures over larger body surface areas, increasing the risk of encountering nontarget skin areas such as melanocytic nevi and tattoos. Few products exist to block light energy transmission to these skin areas during such procedures. OBJECTIVE: To evaluate the effects of four commonly used lasers and intense pulsed light (IPL) on skin shields and other materials aimed for protecting patients. MATERIALS AND METHODS: The authors performed tests with a 532-nm KTP laser, 810-nm diode laser, 1,064-nm Nd:YAG laser, 2,940-nm Er:YAG laser, and IPL. Their effects were evaluated on adhesive skin shields, laser treatment patches, silk and paper white tape, and laser and IPL eye shields using a laser power and energy meter. RESULTS: The skin shields demonstrated the lowest or second lowest energy transmission rates when exposed to the 532-nm KTP laser (3.70%), 810-nm laser (7.18%), 2,940-nm Er:YAG laser (0.04%), and IPL (0.99%-1.49%). Damage was seen on both eye and skin shields when exposed to the 1,064-nm Nd:YAG laser. CONCLUSION: Skin shields were effective in blocking electromagnetic radiation with all tested lasers and IPL, except the 1,064-nm Nd:YAG laser, thus offering a safe, viable option to protect nontarget skin areas.
OBJECTIVE: To compare a novel microscopic suturing technique with conventional laser therapy for facial nevi ≤2 mm. METHODS: A retrospective study of 60 patients with facial nevi ≤2 mm: 30 underwent novel microscopic sut...OBJECTIVE: To compare a novel microscopic suturing technique with conventional laser therapy for facial nevi ≤2 mm. METHODS: A retrospective study of 60 patients with facial nevi ≤2 mm: 30 underwent novel microscopic suturing (observation) and 30 CO2 laser ablation (control). Outcomes: treatment time, intraoperative bleeding, 6-month VSS, satisfaction, and recurrence. RESULTS: Observation group showed better scar scores, satisfaction, and lower recurrence; minimal bleeding versus none in control. CONCLUSION: Despite longer operative time, novel suturing is superior for long-term scarring, satisfaction, and recurrence; worthy of clinical use.
BACKGROUND: After trauma or a variety of nail surgical procedures, there is potential for nail unit epithelium to directly contact dermal connective tissue, putting the nail unit at risk for a bridging scar and resulting...BACKGROUND: After trauma or a variety of nail surgical procedures, there is potential for nail unit epithelium to directly contact dermal connective tissue, putting the nail unit at risk for a bridging scar and resulting dorsal pterygium. To prevent a dorsal pterygium, a variety of materials, including the native nail, have been proposed to splint the proximal nail fold (PNF) and nail matrix (NM). OBJECTIVE: To review the indications, materials, and techniques for intraoperative nail splinting during nail unit surgery. MATERIALS AND METHODS: A comprehensive review of nail splints was conducted in PubMed and OVID Medline. RESULTS: There are a variety of materials that can be utilized to splint the PNF and NM with various securing techniques. Ideally, this is done with the native nail plate; however, if the native nail plate is unavailable, one can utilize a synthetic nail splint. CONCLUSION: If there is trauma or surgery to the nail unit that results in dermal-dermal or dermal-epithelial apposition, it is recommended to splint the sulcus of the PNF from the underlying NM and/or bed during the first 2 to 3 weeks postoperatively. Splinting helps prevent scarring of these opposing tissues and a resulting dorsal pterygium.