BACKGROUND: Guidelines and evidence related to antibiotic prophylaxis in dermatologic surgery have evolved since the authors' previously published advisory statement. OBJECTIVE: To provide an updated advisory statement o...BACKGROUND: Guidelines and evidence related to antibiotic prophylaxis in dermatologic surgery have evolved since the authors' previously published advisory statement. OBJECTIVE: To provide an updated advisory statement on antibiotic prophylaxis in dermatologic surgery as guided by updated recommendations from the American Heart Association and the American Dental Association with the American Academy of Orthopaedic Surgeons guidelines. METHODS: A structured literature review was performed. A multidisciplinary team of specialists from dermatologic surgery, infectious diseases, and pharmacy were convened to review up-to-date data and develop updated comprehensive evidence-based recommendations. RESULTS: Consistent with the previous advisory statement, prophylactic antibiotics are recommended for patients with high-risk cardiac or prosthetic joint conditions, when the dermatologic surgical site is infected or if the procedure breaches the mucosa. Significant changes were made for prophylaxis of surgical site infection. Updated recommendations were made regarding antibiotic selection in penicillin-allergic patients and intraoperative use of intraincisional clindamycin in the local anesthetic. LIMITATIONS: Reviewed data are predominantly limited to retrospective data. CONCLUSION: Recommendations regarding antibiotic prophylaxis around dermatologic surgery are evolving as new data and practices are introduced. The 2025 advisory statement provides the latest recommendations for appropriate use of antibiotic prophylaxis in dermatologic surgery.
BACKGROUND: Hypertension (HTN) is common in patients presenting for dermatologic surgery and may be a modifiable risk factor for procedural complications, yet standardized dermatology-specific guidelines on blood pressur...BACKGROUND: Hypertension (HTN) is common in patients presenting for dermatologic surgery and may be a modifiable risk factor for procedural complications, yet standardized dermatology-specific guidelines on blood pressure (BP) management are limited. OBJECTIVE: To synthesize evidence on the impact of HTN on cutaneous surgery and clarify dermatologists' role in BP assessment and management and propose practical clinical guidelines. MATERIALS AND METHODS: The authors conducted a literature search, identified studies relevant to HTN management in dermatologic surgery, comparable office-based surgical specialties, and recent American Heart Association perioperative guidelines. RESULTS: Although HTN may increase perioperative complications, rigid BP cutoffs are not supported by current evidence. Rather, a risk-based framework is supported: surgery may proceed with caution until BP exceeds 200/110 mm Hg without symptoms of acute hypertensive end organ damage. For BP above this threshold, clinicians should attempt to lower BP through rest, anxiolytics, or other calming measures. If BP remains uncontrolled, surgery should be deferred and patients referred for primary care provider management. Dermatologists should measure BP at the initial consultation visit, continue home antihypertensives, maintain adequate analgesia, and use 5-mg diazepam as needed for perioperative anxiety. CONCLUSION: A risk-stratified approach to HTN, combined with adjunct BP management strategies, supports safe and timely dermatologic surgery.
BACKGROUND: Circulating tumor DNA (ctDNA) measures cancer-specific genetic material migrated from a tumor to a patient's bloodstream. Limited research exists aggregating data on ctDNA as a measure of recurrence, treatmen...BACKGROUND: Circulating tumor DNA (ctDNA) measures cancer-specific genetic material migrated from a tumor to a patient's bloodstream. Limited research exists aggregating data on ctDNA as a measure of recurrence, treatment success, and survival in patients with melanoma. OBJECTIVE: The authors aim to evaluate evidence for ctDNA as a measurement of recurrence and survival, and how those results differ by tumor grade and measurement time point in cutaneous melanoma treated with dermatologic surgery. METHODS: An OVID Medline search and manual filtering resulted in six studies meeting the inclusion criteria: evaluating survival and/or disease recurrence by ctDNA measurement in patients with cutaneous melanoma who had undergone dermatologic surgery. RESULTS: Sequencing methods varied: some studies analyzed known gene mutations and others developed individual tumor assays. Individual assays provide more information but are less practical to perform. Significant relationships between postoperative ctDNA level and disease recurrence and survival were found in multiple studies. The most represented stages of melanoma included were II and III. All studies measured postoperative ctDNA, but at unique time points. CONCLUSION: ctDNA measurement may be a useful tool in measuring treatment efficacy and disease recurrence in patients with cutaneous melanoma treated with dermatologic surgery.
BACKGROUND: Squamous cell carcinomas (SCCs) of the penis are often treated with partial or total penectomy. Although penectomy has low recurrence rates, it often leads to psychosocial distress and disfigurement. Mohs mic...BACKGROUND: Squamous cell carcinomas (SCCs) of the penis are often treated with partial or total penectomy. Although penectomy has low recurrence rates, it often leads to psychosocial distress and disfigurement. Mohs micrographic surgery (MMS) is a tissue-preserving treatment modality, but data on recurrence rates are limited and the National Comprehensive Cancer Network (NCCN) guidelines recommend it only for in situ and stage T1 tumors in select cases, based on the American Joint Committee on Cancer (AJCC) eighth edition staging criteria. OBJECTIVE: This study systematically reviews clinical studies on MMS for penile SCC, summarizing disease outcomes and surgical complications. METHODS: A systematic review was conducted using Ovid MEDLINE, Embase, Cochrane, CINAHL, and Web of Science for studies published through October 23, 2024. RESULTS: Nineteen studies with 329 penile SCCs met inclusion criteria. Local recurrence (n = 15, 5%), nodal metastasis (n = 8, 3%), distant metastasis (n = 1, 0.3%) and disease-specific death (n = 3, 1%) were rare. Urologic Surgery collaboration was utilized in 27% of cases, performing procedures including urethrectomy, meatotomy, and reconstruction. Complications occurred in 9%, including poor wound healing (n = 11, 3%), urethral stricture (n = 11, 3%), wound infection (n = 3, 1%), and bleeding (n = 2, 1%). Patients with advanced-stage (T2/T3) tumors had higher rates of local recurrence (8% vs 1%), and similar rates of nodal (2% vs 1%) and distant metastasis (0% vs 1%), compared to patients with early-stage tumors (Tis/T1). CONCLUSION: Mohs micrographic surgery is a penis-sparing surgical approach with low recurrence rates in low-stage tumors. Multidisciplinary collaboration with Urology is recommended in cases of advanced-stage tumors, anticipated reconstruction, or urethral involvement. Further research is needed, as the level of evidence was low in this systematic review.
BACKGROUND: Red and blue light have beneficial, complementary effects on acne. OBJECTIVE: To evaluate the efficacy and safety of at-home treatment of mild-to-moderate inflammatory acne with an investigational combination...BACKGROUND: Red and blue light have beneficial, complementary effects on acne. OBJECTIVE: To evaluate the efficacy and safety of at-home treatment of mild-to-moderate inflammatory acne with an investigational combination 660-nm red/415-nm blue light-emitting diode device (RBL) compared with a commercially available 415-nm blue light-emitting diode device (BL). MATERIALS AND METHODS: This was an open-label randomized-controlled trial with a 30-subject goal ( n = 20 RBL, n = 10 BL). Subjects performed once-daily at-home treatments for 8 weeks, with 4-week (4W) and 8-week (8W) follow-ups. RESULTS: Twenty-three subjects completed the study ( n = 14 RBL, n = 9 BL). Total lesions were significantly reduced at 4W ( p = .028) and 8W ( p = .015) with RBL but at neither timepoint with BL. Inflammatory lesions were significantly reduced at 4W ( p = .010 and p = .008) and 8W ( p = .005 and p = .02) with both RBL and BL, respectively. Noninflammatory lesion reduction was not significant in either group. No significant between-group difference in total, inflammatory, or noninflammatory lesion reduction occurred at any timepoint. Median investigator static global assessment was significantly lower with RBL at 8W ( p = .015). CONCLUSION: Daily at-home treatment with RBL led to significantly reduced inflammatory and total acne lesions at 4W and 8W. Although equivalent to BL in most outcomes, RBL demonstrated a significantly greater reduction in median ISGA.