BACKGROUND: Solid organ transplant recipients (SOTRs) face frequent advanced cutaneous malignancies, yet data guiding systemic therapy are limited. MATERIALS AND METHODS: We conducted a Preferred Reporting Items for Syst...BACKGROUND: Solid organ transplant recipients (SOTRs) face frequent advanced cutaneous malignancies, yet data guiding systemic therapy are limited. MATERIALS AND METHODS: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of immune checkpoint inhibitors (ICIs), talimogene laherparepvec (T-VEC), and Sonic Hedgehog Pathway Inhibitors (HPIs) for locally advanced or metastatic cutaneous squamous cell carcinoma, melanoma, Merkel cell carcinoma, and basal cell carcinoma in SOTRs, including a novel case from our institution. Outcomes included tumor response, graft rejection, and graft failure. RESULTS: Among 196 SOTRs treated with ICIs (101 cutaneous squamous cell carcinoma, 83 melanoma, 12 Merkel cell carcinoma), the overall response rate (ORR) was 39.3%, and lack of progression occurred in 58.0%. Graft rejection occurred in 36.9% and graft failure in 22.3%. A higher number of baseline immunosuppressive agents decreased odds of rejection (OR 0.55) and failure (OR 0.38). Tacrolimus was associated with reduced tumor response (OR 0.41), whereas mTOR-based regimens and cemiplimab were associated with fewer transplant rejection. T-VEC was reported in 10 SOTRs with an ORR of 90% and no graft rejection or failure. HPIs in six SOTRs with basal cell carcinoma demonstrated ORR of 83% without graft loss. CONCLUSION: ICIs provide antitumor activity but substantial graft-related risk, while T-VEC and HPIs show high response rates with no reported rejection.
BACKGROUND: Effective intraoperative hemostasis is essential for surgical precision and graft survival in hair transplantation. Although tumescent infiltration is routinely used to control bleeding, the optimal depth of...BACKGROUND: Effective intraoperative hemostasis is essential for surgical precision and graft survival in hair transplantation. Although tumescent infiltration is routinely used to control bleeding, the optimal depth of infiltration has not been clearly defined. OBJECTIVE: To investigate the effect of follicle-length-based tumescent infiltration depths on intraoperative bleeding during recipient site creation in hair transplantation. METHODS: This retrospective, single-center, within-patient comparative observational study included 53 male patients undergoing follicular unit excision hair transplantation. Tumescent solution was infiltrated into three standardized recipient areas at depths corresponding to 30%, 50%, and 70% of the measured hair follicle length. Fifty recipient incisions were created in each area. Intraoperative bleeding was assessed using a semiquantitative surgeon-rated scale. Bleeding scores were analyzed using a linear mixed-effects model adjusted for follicle length, with Bonferroni-corrected pairwise comparisons. RESULTS: Injection depth was significantly associated with bleeding score (F = 39.62, p < .001). After adjustment, the lowest estimated mean bleeding score was observed at 50% infiltration depth (3.21; 95% CI, 2.89-3.52), compared with 30% (3.77; 95% CI, 3.46-4.09) and 70% (4.28; 95% CI, 3.97-4.60). Bleeding at 50% depth was significantly lower than at both 30% and 70% depths (p < .001 for both). CONCLUSION: A follicle-length-based tumescent infiltration strategy targeting approximately 50% of hair follicle length provides optimal intraoperative hemostasis during recipient site creation. This anatomically guided approach may facilitate surgical precision while achieving effective bleeding control with lower epinephrine concentrations.
Schelke L, Harris S, Cerón Bohórquez JM
… +5 more, Lowrey N, Cartier H, Wortsman X, Cotofana S, Velthuis P
Dermatol Surg
· 2026 May · PMID 41990220
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BACKGROUND: Previous ultrasound studies show that unanticipated filler spread can occur during injections. OBJECTIVE: This study investigates filler spread in common facial locations to determine its predictability based...BACKGROUND: Previous ultrasound studies show that unanticipated filler spread can occur during injections. OBJECTIVE: This study investigates filler spread in common facial locations to determine its predictability based on specific anatomical layers. In particular, the authors focused on the direction of filler spread based on the patterns formed by the retinacula superficialis (RS) and retinacula profundus (RP). METHODS: In this observational study, the authors analyzed 440 filler treatments performed on 107 patients by a single injector (primary group) and 22 treatments by 4 additional injectors (reference group). Two filler types were evaluated: (1) 2 volumizing hyaluronic acid fillers and (2) 3 biostimulating fillers. The authors also assessed the feasibility of filler testing at the zygomatic arch. RESULTS: Distinct patterns of filler spread varied by injection site, consistent across both groups. The directional spread was predictable and influenced by the fibrous structures of the RS and RP. In addition, the lengths of the injected bolus varied significantly between the different fillers. CONCLUSION: In uncompromised tissue, filler spread is confined to the injected tissue layer, but follows directions dictated by the RS and RP fibers. While the overall direction of spread is unaffected by filler rheology, the injected length is influenced by the type of filler used.
BACKGROUND: Mohs surgeons operate at close working distances under intense surgical illumination. Ocular symptoms, including eye strain and visual fatigue, are commonly reported, yet quantitative data on eye-level exposu...BACKGROUND: Mohs surgeons operate at close working distances under intense surgical illumination. Ocular symptoms, including eye strain and visual fatigue, are commonly reported, yet quantitative data on eye-level exposure to reflected surgical lighting are limited. OBJECTIVE: To quantify reflected surgical lighting at the Mohs surgeon's eye position and identify modifiable operative factors influencing ocular exposure. MATERIALS AND METHODS: This observational, device-based experimental study was conducted in a Mohs surgical suite using a simulated surgical model. Reflected illuminance was measured with a calibrated digital lux meter positioned at the surgeon's eye level. Overhead light-emitting diode lighting was fixed 40 inches from the surgical field. Measurements were obtained at eye-to-field distances of 14, 20, and 26 inches across 2 lamp orientations, 2 drape colors, and 3 simulated skin tone categories. RESULTS: Reflected illuminance was highest at shorter working distances, measuring approximately 1.5 to 2.0 times higher at 14 inches than at 20 inches and up to 2 to 3 times higher than at 26 inches. White drapes increased reflected illuminance compared with blue drapes, while behind-the-surgeon lamp positioning reduced exposure compared with perpendicular lamp positioning. Skin tone had minimal impact. CONCLUSION: Modifiable operative factors significantly influence ocular light exposure and represent low-cost strategies to reduce exposure without compromising visualization.