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1.
Dermatol Surg ; 50(2): 155-159, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38048284

RESUMO

BACKGROUND: Although the onset and duration of local anesthetics are well-defined, how the anatomic site influences the duration of local anesthetics has not been well characterized in dermatology. OBJECTIVE: To define the duration of local anesthesia by anatomic site. MATERIALS AND METHODS: This was a prospective study. Adult healthy volunteers and patients undergoing Mohs micrographic surgery were invited to participate. The nose and the shin were chosen to represent highly and poorly vascularized anatomic sites, respectively. A total of 0.5 mL of buffered 1% lidocaine hydrochloride with 1:100,000 epinephrine was injected subcutaneously into each anatomic site of each participant. A pinprick test was used to assess adequate anesthesia until return of baseline sensation or visit completion. RESULTS: This study enrolled 25 participants. Time to return of sensation was significantly shorter on the nose compared with the shin ( p < .0001). On the nose, there was an association between male sex and shorter time to return of sensation. CONCLUSION: Time to return of sensation is significantly shorter on the nasal ala compared with the shin, suggesting that patients may regain sensation sooner on highly vascularized sites. Defining the duration of local anesthetics based on anatomic regions is important for treatment planning in dermatologic procedures.


Assuntos
Anestésicos Locais , Lidocaína , Adulto , Humanos , Masculino , Anestesia Local , Estudos Prospectivos , Epinefrina , Cirurgia de Mohs , Método Duplo-Cego
2.
Dermatol Surg ; 50(4): 331-336, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38147436

RESUMO

BACKGROUND: There is a paucity of literature describing family planning challenges faced by Mohs fellows. OBJECTIVE: To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows. MATERIALS AND METHODS: A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship. RESULTS: In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female ( n = 81, 69.8%) than male ( n = 35, 30.2%). Most had children before completion of their Mohs training ( n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% ( n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents ( n = 10) who breastfed or pumped did not have a convenient place to do so. CONCLUSION: This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed.


Assuntos
Serviços de Planejamento Familiar , Internato e Residência , Criança , Humanos , Masculino , Feminino , Adulto , Bolsas de Estudo , Educação de Pós-Graduação em Medicina , Pais , Inquéritos e Questionários
3.
J Am Acad Dermatol ; 89(1): 114-118, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36907555

RESUMO

BACKGROUND: Patients awake during staged cutaneous surgery procedures may experience procedure-related pain. OBJECTIVE: To determine whether the level of pain associated with local anesthetic injections prior to each Mohs stage increases with subsequent Mohs stages. METHODS: Multicenter longitudinal cohort study. Patients rated pain (visual analog scale: 1-10) after anesthetic injection preceding each Mohs stage. RESULTS: Two hundred fifty-nine adult patients presenting for Mohs who required multiple Mohs stages at 2 academic medical centers were enrolled; 330 stages were excluded due to complete anesthesia from prior stages, and 511 stages were analyzed. Mean visual analog scale pain ratings were nominally but not significantly different for subsequent stages of Mohs surgery (stage 1: 2.5; stage 2: 2.5; stage 3: 2.7: stage 4:2.8: stage 5: 3.2; P = .770). Between 37% and 44% experienced moderate pain, and 9.5% and 12.5% severe pain, during first as versus subsequent stages (P > .05) LIMITATIONS: Both academic centers were in urban areas. Pain rating is inherently subjective. CONCLUSIONS: Patients did not report significantly increased anesthetic injection pain level during subsequent stages of Mohs.


Assuntos
Anestésicos Locais , Lidocaína , Adulto , Humanos , Anestésicos Locais/efeitos adversos , Lidocaína/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Cirurgia de Mohs/métodos , Estudos Prospectivos , Estudos Longitudinais , Dor/etiologia
4.
Dermatol Surg ; 48(4): 395-400, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35143444

RESUMO

BACKGROUND: Although surgery is the treatment of choice for Bowen disease (BD) and cutaneous squamous cell carcinoma (cSCC), nonsurgical treatments such as photodynamic therapy (PDT) may be preferred for select tumors. Previous meta-analysis have failed to gather strong evidence to recommend PDT. OBJECTIVE: This study evaluates the effectiveness of PDT in the treatment of cSCC and BD for clearance rate (CR) after 1 year. METHODS: A literature search of studies of biopsy-proven BD and cSCC treated with PDT was performed. Pooled CRs were estimated. Subgroup analyses were performed based on follow-up, treatment regimen, lesion size, and site. RESULTS: Forty-three studies were included, enrolling 1943 BD lesions and 282 SCC lesions. Pooled CRs for BD and SCC were 76% (95% CI: 71%-80%; I2 = 78.9%) and 51% (95% CI: 35%-66%; I2 = 85.7%), respectively. CONCLUSION: Our findings support the selective use of PDT for BD; however, patients should be advised of potential for recurrence. Although PDT can be used for certain cases of cSCC, the high rate of treatment failure necessitates close surveillance for residual or recurrent disease. Further studies are needed to justify the usage of PDT in the treatment of BD and cSCC.


Assuntos
Doença de Bowen , Carcinoma de Células Escamosas , Fotoquimioterapia , Neoplasias Cutâneas , Doença de Bowen/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Humanos , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/patologia
5.
J Drugs Dermatol ; 20(12): 1308-1312, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34898154

RESUMO

BACKGROUND: The reconstruction of lower extremity defects can be technically challenging. The keystone island perforator flap is a workhorse reconstructive option for difficult-to-repair regions, including the lower limb. The goal of this study is to evaluate outcomes using the keystone flap in combination with the zinc oxide compression dressing (Unna boot) for repair of lower extremity defects. METHODS: We retrospectively evaluated 96 patients who underwent resection of malignancies or atypical neoplasms on the lower legs. A total of 114 defects were repaired with the keystone flap in combination with the Unna boot. Post-operative outcomes were assessed. RESULTS: The combination of the keystone flap with postoperative Unna boot application led to excellent outcomes. There was no association between complication rates and patient co-morbidities. CONCLUSION: The combination of the keystone flap with the Unna boot is a safe and efficacious approach for reconstruction of lower extremity defects. J Drugs Dermatol. 2021;20(12):1308-1312. doi:10.36849/JDD.5915.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Extremidade Inferior/cirurgia , Estudos Retrospectivos
6.
Facial Plast Surg ; 37(3): 390-394, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33506452

RESUMO

This article determines if patient, defect, and repair factors can be used to predict the use of additional treatments to achieve optimal aesthetic results after repair of facial Mohs defects. An electronic chart review of patients undergoing Mohs excision and reconstruction of facial neoplasms from November 2005 to April 2017 was performed, reviewing patient demographics and history, tumor size, defect size and location, method and service of reconstruction, time between resection and repair, complications, and subsequent treatments. A total of 1,500 cases with basal cell and squamous cell carcinoma were analyzed. The average defect size was 3.09 ± 8.06 cm2; 81.9% of defects were less than 4 cm2 in size. Advancement flaps were used to repair 44.3% of defects. Complications and undesired sequelae (CUS) were noted in 15.9% of cases; scar hypertrophy or keloid (10.8%) was most common. Postoperative ancillary procedures were performed in less than one-quarter (23.4%) of patients to enhance the postrepair appearance; the most common procedures were intralesional corticosteroid injections and pulse dye laser treatments. CUS were more likely in females (19.6%), defects on the lips (28.7%) and on the nose (27.3%) (p < 0.001 for each). Females (22.7% vs. 12.7%), lip repairs (40.2% vs. 18.3%), transposition flaps (39.2% vs. 14.8%), and repairs performed by a dermatologist (17.9% vs. 11.2%) (p < 0.001 for each) were more likely to be treated with postoperative corticosteroid injections. Females (14.5% vs. 7.4%), patients under the age of 60 years (13.9% vs. 8.8%), and patients whose repair was performed by a dermatologist (11.9% vs. 2.9%) (p < 0.001 for each) were more likely to receive postoperative pulsed dye laser treatments. CUS and ancillary procedures after repair of facial Mohs defects are uncommon. Awareness of individual risk factors and defect characteristics allows the surgeon to choose the most appropriate repair technique while anticipating the potential need for ancillary procedures.


Assuntos
Neoplasias Faciais , Procedimentos de Cirurgia Plástica , Neoplasias Cutâneas , Estética Dentária , Neoplasias Faciais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Cirurgia de Mohs/efeitos adversos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos
7.
J Drugs Dermatol ; 19(3): 264-270, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32550697

RESUMO

BACKGROUND: Cosmetic concerns following Mohs Micrographic surgery (MMS) are significant and may require adjunctive treatments for unsatisfactory appearance. OBJECTIVE: To determine factors associated with adjunctive cosmetic intervention for facial defects following MMS. METHODS AND MATERIALS: A retrospective review of 699 patients undergoing repair of facial defects after MMS from 2008-2018 was performed. Tumor types, defect sizes, patient demographics, repair methods, complications, and post-operative cosmetic interventions were examined. RESULTS: 666 Mohs cases and resultant defects were analyzed. The most common method of repair following MMS was primary closure (52.3%), and the most common post-operative intervention was steroid injection (18.3%). The lip subunit was more than twice as likely as other locations to be treated with steroid injections (P<.001). The lip subunit also had the highest frequency of scar revision (13%; P<0.001). Patients who had primary closure were less likely to require scar revision (P=0.003) or dermabrasion (P=0.042), and there was no significant association between skin graft repair and cosmetic intervention. CONCLUSIONS: Both defect subunit and closure type were independently associated with adjunctive cosmetic intervention following MMS. Defect size was not significantly associated with an adjunctive intervention in our study. Understanding the factors affecting the need for adjunctive cosmetic interventions may improve patient counseling prior to Mohs repair. J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4701.


Assuntos
Cicatriz/cirurgia , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Idoso , Face , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos
8.
Lancet Oncol ; 20(12): e699-e714, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31797796

RESUMO

Sebaceous carcinoma usually occurs in adults older than 60 years, on the eyelid, head and neck, and trunk. In this Review, we present clinical care recommendations for sebaceous carcinoma, which were developed as a result of an expert panel evaluation of the findings of a systematic review. Key conclusions were drawn and recommendations made for diagnosis, first-line treatment, radiotherapy, and post-treatment care. For diagnosis, we concluded that deep biopsy is often required; furthermore, differential diagnoses that mimic the condition can be excluded with special histological stains. For treatment, the recommended first-line therapy is surgical removal, followed by margin assessment of the peripheral and deep tissue edges; conjunctival mapping biopsies can facilitate surgical planning. Radiotherapy can be considered for cases with nerve or lymph node involvement, and as the primary treatment in patients who are ineligible for surgery. Post-treatment clinical examination should occur every 6 months for at least 3 years. No specific systemic therapies for advanced disease can be recommended, but targeted therapies and immunotherapies are being developed.


Assuntos
Adenocarcinoma Sebáceo/terapia , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Neoplasias das Glândulas Sebáceas/terapia , Humanos , Prognóstico
19.
J Am Acad Dermatol ; 75(2): 265-84, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27444069

RESUMO

While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to systemic reactions, high energy systems, and trauma are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of surgical emergencies can mitigate any associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue.


Assuntos
Anafilaxia/etiologia , Anestésicos Locais/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Traumatismos Oculares/etiologia , Terapia a Laser/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Anafilaxia/diagnóstico , Anafilaxia/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Emergências , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/terapia , Incêndios , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/terapia , Humanos , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/terapia , Fatores de Risco
20.
J Am Acad Dermatol ; 75(2): 243-62, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27444068

RESUMO

While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to vascular occlusion, hypertension, and hypotension are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of these emergencies can mitigate or forestall associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/terapia , Emergências , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Hipotensão/etiologia , Hipotensão/terapia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
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