Clinical Versus Histologic Margins for Cutaneous Squamous Cell Carcinoma: Comparing Outcomes for High-Risk Tumors Treated With Mohs Micrographic Surgery.

BACKGROUND: High-risk cutaneous squamous cell carcinoma (cSCC) is associated with poor clinical outcomes. Traditionally, preoperative clinical tumor size ≥2 cm, based on Brigham and Women's Hospital (BWH) staging criteria, is high risk. OBJECTIVE: To compare outcomes of cSCC treated with Mohs micrographic surgery (MMS) with a preoperative size ≥2 cm (clinically ≥2 cm) versus cSCC with preoperative size <2 cm and postoperative defect size ≥2 cm (histologically ≥2 cm). METHODS: Prospective data were collected from January 1, 2014, to December 31, 2020, on MMS cases for cSCC with a preoperative and/or postoperative size ≥2 cm. Clinical outcomes were followed until March 15, 2023. Data were analyzed using multivariate regression. RESULTS: Three hundred thirty cases of MMS for cSCC were included. Cutaneous squamous cell carcinoma clinically ≥2 cm occurred more frequently in elderly patients; cSCC histologically ≥2 cm were more commonly located in the H region, required wider surgical margins, and more MMS stages to achieve clearance. There were no significant differences in rates of recurrence and metastasis between the groups. CONCLUSION: These data suggest that postoperative (histologic) MMS defect size may allow for better risk stratification of high-risk cSCC and improved staging of cSCC.

Lasers for the Treatment of Nonmelanoma Skin Cancer: A Systematic Review of the Literature.

BACKGROUND: Lasers may present an alternative treatment modality for the management of nonmelanoma skin cancer (NMSC). OBJECTIVE: To investigate lasers as a definitive treatment of NMSC. METHODS: A comprehensive search was performed on MEDLINE, the Cochrane Library, and the National Institutes of Health (www.clinicaltrials.gov). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to finalize a list of relevant literature studies evaluating the role of laser therapy for NMSC. Articles published through May 1, 2023, were included. RESULTS: The authors identified 37 studies investigating nonablative and ablative lasers alone and in combination with other lasers, noninvasive imaging, and additional modalities for the treatment of basal cell carcinomas, 10 focusing on squamous cell carcinoma in situ and 3 focusing on the treatment of both basal and squamous cell carcinomas. CONCLUSION: Although surgical management continues to be superior to laser therapy for the management of high-risk and cosmetically sensitive tumors, laser therapy may be an acceptable alternative for low-risk lesions on the trunk and extremities. However, further studies are needed to optimize parameters, determine maximal efficacy, and provide long-term follow-up before the adoption of laser therapy for NMSC into daily clinical practice.

Vaginal Rejuvenation: A Retrospective Review of Lasers and Radiofrequency Devices.

BACKGROUND: Vaginal rejuvenation is a topic of interest to multiple specialties, including dermatologists, plastic and reconstructive surgeons, urologists, and gynecologists. Evidence suggests that minimally invasive, energy-based devices-radiofrequency and laser therapy-are effective at vaginal tightening and decreasing symptoms of genitourinary syndrome of menopause (GSM) and/or vulvovaginal atrophy (VVA). MATERIALS AND METHODS: A systematic review was completed using PubMed in November 2018 with search terms "vaginal" or "vagina" and "rejuvenation" or "tightening" or "laxity" or "radiofrequency" or "laser," as well as "genitourinary syndrome of menopause," "pelvic prolapse," "atrophic vaginitis," "vulvovaginal atrophy," "sexual function," "urinary incontinence," and "radiofrequency" or "laser." Inclusion criteria were articles written in English and clinical trials or case reports/series dealing with human subjects. RESULTS: We identified 59 studies (3,609 women) treated for vaginal rejuvenation using either radiofrequency or fractional ablative laser therapy. Studies report improvement in symptoms of GSM/VVA and sexual function, high patient satisfaction, and minor adverse events, including treatment-associated pain, swelling, or vaginal discharge. CONCLUSION: This review demonstrates radiofrequency and laser are efficacious for the treatment of vaginal laxity and/or atrophy. Further research needs to be completed to determine which specific pathologies can be treated, if maintenance treatment is necessary, and long-term safety concerns.

The Utility of Platelet-Rich Plasma for the Treatment of Alopecia.

Importance: Platelet-rich plasma (PRP) is a novel therapy for alopecia. Although the use of PRP remains under investigation, medical practitioners administer PRP for hair regrowth without quantitative evidence of clinical results. Objective: Systematically review literature regarding PRP for alopecia. Evidence Review: PRISMA guidelines were utilized to search the PubMed database in May 2019 with search terms "platelet rich plasma" and "hair", "hair loss", or "alopecia". Manuscripts were included if they were written in English and described PRP treatment in human subjects with alopecia. Findings: Sixty-one articles discussed the use of PRP as monotherapy, or in combination with other medical modalities, for the treatment of androgenetic alopecia (AGA), alopecia areata (AA), and cicatricial alopecia, ranging from level Ib to IV evidence. PRP results in significant increase in hair density and hair shaft width in AGA patients, with high rates of patient satisfaction and minimal adverse events. Data heterogeneity and limited number of well-designed, large-scale clinical trials were limitations of this review. Conclusions and Relevance: Preliminary results regarding the use of PRP for AGA, AA, and cicatricial alopecias are promising. Physicians should be aware that current studies often report qualitative, rather than quantitative, clinical outcomes and should counsel patients regarding PRP treatment efficacy accordingly. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5192.

The Efficacy of Topical Minoxidil for Non-Scarring Alopecia: A Systematic Review

Introduction: Topical minoxidil is the first-line therapy for treating both male and female androgenetic alopecia. Currently there are no comprehensive reviews on the clinical efficacy of minoxidil on hair loss. Method: A literature search was conducted to identify clinically relevant studies regarding the efficacy of topical minoxidil for human subjects for hair loss. Results: Twenty-three pertinent studies were identified for inclusion in this review. Topical minoxidil has been studied in concentrations ranging from 0.01% to 15% for the treatment of AGA resulting in hair growth ranging from 17% to 70%. Concentrations from 3% to 5% have been used to treat alopecia areata, 2% to treat traction alopecia, and 1% to 5% for congenital hair disorders with varying levels of treatment success. Efficacy varies by ethnic groups, but topical minoxidil has been demonstrated to significantly improve quality of life even in the absence of hair regrowth. Conclusion: Topical minoxidil is efficacious for the treatment of hair loss due to male and female androgenic alopecia, alopecia areata, with case-by-case application for traction alopecia, hair transplantation, and congenital hair disorders. Combination therapies using minoxidil with systemic, topical, and injectable therapies demonstrate increased effectiveness over monotherapies. J Drugs Dermatol. 2019;18(2):155-160.

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

Importance: The use of nutraceuticals such as collagen for skincare has been rising, but regulations are lacking on quality, absorption, and efficacy. To address this knowledge gap, clinical studies regarding the potential effects of collagen-based dietary supplements on skin are being completed. Objective: To review the literature and assess available randomized-controlled trials using collagen supplementation for treatment efficacy regarding skin quality, anti-aging benefits, and potential application in medical dermatology. Evidence Review: A literature search was conducted with PubMed using search criteria (collagen) AND (supplement OR food OR nutrition). No lower limit on the year of publication was set. Inclusion criteria were: randomized, placebo-controlled trials using collagen supplementation in human subjects related to dermatology and written in English. Findings: Eleven studies with a total of 805 patients were included for review. Eight studies used collagen hydrolysate, 2.5g/d to 10g/d, for 8 to 24 weeks, for the treatment of pressure ulcers, xerosis, skin aging, and cellulite. Two studies used collagen tripeptide, 3g/d for 4 to 12 weeks, with notable improvement in skin elasticity and hydration. Lastly, one study using collagen dipeptide suggested anti-aging efficacy is proportionate to collagen dipeptide content. Conclusions and Relevance: Preliminary results are promising for the short and long-term use of oral collagen supplements for wound healing and skin aging. Oral collagen supplements also increase skin elasticity, hydration, and dermal collagen density. Collagen supplementation is generally safe with no reported adverse events. Further studies are needed to elucidate medical use in skin barrier diseases such as atopic dermatitis and to determine optimal dosing regimens. J Drugs Dermatol. 2019;18(1):9-16.

Examining the Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine in Correcting Volume Loss of the Jawline-A Pilot Study.

BACKGROUND: Patients seek 3-dimensional volume restoration of the jawline to obtain a "defined" line. Injection of filler into the jawline is not approved by the Food and Drug Administration; however, dermatologists have injected this area with positive results, minimal adverse events, and high patient satisfaction. OBJECTIVE: This study explores the efficacy of premixed calcium hydroxylapatite filler with integral lidocaine [CaHA(+)] to correct volume defects of the jawline. It examines the longevity, safety, and patient satisfaction (up to 12 months) of CaHA(+) for jawline volume loss correction. MATERIALS AND METHODS: This is a single-investigator, nonblinded study. Twenty subjects received CaHA(+) filler injection in the jawline, with follow-up evaluations conducted at 14 days, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA(+) injection in the jawline results in statistically significant restoration in volume and improvement in appearance lasting up to 12 months. Overall, subjects report "moderate" improvement on the Global Aesthetic Improvement Scale. CONCLUSION: It is important for cosmetic surgeons and dermatologists to have access to data on the efficacy and safety of injectables. The data obtained in this study show that CaHA(+) is an effective and safe option to correct jawline volume loss and is associated with high patient satisfaction.

Pilot Study Examining the Safety and Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine Over a 12-Month Period to Correct Temporal Fossa Volume Loss.

BACKGROUND: Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. OBJECTIVE: This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. MATERIALS AND METHODS: This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. CONCLUSION: As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.

Recall erythema phenomenon following Er:YAG laser treatment: two case studies and literature review.

Recall erythema is a phenomenon occurring when an area of epidermis treated with laser is later exposed to a trigger, most often sunlight or hot water, causing erythema in the zone of laser treatment after post-treatment erythema has already resolved. Radiation recall dermatitis is a more specific subtype of recall erythema in which an area treated with radiation is subjected to another exposure causing erythema in the area of previous radiation. Cases of recall dermatitis after laser treatment are extremely rare and have only been reported with diode neodymium-doped yttrium aluminum garnet lasers. We report two cases of recall dermatitis following erbium-doped yttrium aluminum garnet resurfacing laser triggered by exposure to either hot water or direct sunlight, and in one case, radioablation of the thyroid gland. We will also provide a brief literature review of recall dermatitis in the setting of laser surgery.

The Kinetics of Reversible Hyaluronic Acid Filler Injection Treated With Hyaluronidase.

BACKGROUND: Hyaluronidase is an enzyme capable of dissolution of hyaluronic acid (HA). There is a lack of evidence-based research defining time- and concentration-dependent reversal of HA filler using hyaluronidase. OBJECTIVE: To explore the efficacy of different concentrations of hyaluronidase in digesting commercially available HA-based reversible fillers-Belotero Balance (BEL), Juvederm Ultra XC (JUVXC), Juvederm Ultra Plus (JUVX+), Juvederm Voluma XC (JUVV), Restylane-L (RESL), Restylane Silk (RESS), and Perlane/Restylane Lyft (RESLYFT). MATERIALS AND METHODS: This was a blinded randomized study involving 15 participants. Participants received HA filler injection into their back, followed by no secondary injection, or injection with normal saline, 20 or 40 units of hyaluronidase. Using a 5-point palpation scale, the degradation of HA filler was monitored over 14 days. RESULTS: In the authors' study, there is a significant decrease in HA filler degradation using 20 and 40 units of hyaluronidase compared with no secondary injection or normal saline. There is no significant difference in HA filler dissolution when comparing 20 to 40 units of hyaluronidase. CONCLUSION: Lower concentrations of hyaluronidase may be just as effective as higher concentrations to degrade HA filler in situations where the reversal of cutaneous augmentation with HA filler arises.

The Two Faces of Fractionated Photodynamic Therapy: Increasing Efficacy With Light Fractionation or Adjuvant Use of Fractional Laser Technology.

"Fractionated photodynamic therapy (PDT)" is a new term being used by dermatologists to describe advances in PDT technology including fractionated light or the adjuvant use of fractional lasers. Although dermatologists have used PDT since the early 1990s for the treatment of photodamage and precancerous lesions, newer developments in technology have allowed for the treatment of non-melanoma skin cancers (NMSCs), in ammatory disorders, and even uses in the eld of anti-aging. Recent developments in fractionated light therapy have allowed for PDT with dark intervals and two-fold illumination schemes to increase cellular damage and apoptosis. Combining PDT with fractional laser technology has allowed for enhanced dermal penetration of topical photosensitizers including 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL), as well as increased ef cacy of treatment. These advances in PDT technology will allow for increased convenience, decreased treatment time, only one application of topical photosensitizer, and decreased cost to the patient and dermatologist. J Drugs Dermatol. 2016;15(11):1324-1328..

Systematic review of vismodegib toxicity profile in the treatment of advanced basal cell carcinomas compared to other systemic therapies in dermatology.

Vismodegib is a first-in-class, hedgehog-signal inhibitor that is FDA-approved for use with advanced basal cell carcinomas (BCCs) that cannot be removed by either surgical resection or treated with radiation. Release of the drug was fast-tracked because of need for this type of drug, and its overall efficacy in clinical trial by producing either regression or even resolution of advanced BCCs. Compared to placebo, patients using vismodegib have arrested BCC progression, reduced size of BCC, and decreased recurrence of BCC. Unfortunately, vismodegib has notable adverse effects (especially those of alopecia, gastrointestinal, muscle spasms, and dysguesia) that make dermatologists reluctant to prescribe the drug and patients unwilling to undergo therapy. In this article, we tackle this dilemma by comparing the toxicity profile of vismodegib to the adverse effect profiles of other dermatologic chemotherapeutics, immunomodulators, retinoids, and biologics. Considering that many of these drugs carry their own risks and those drugs used to treat advanced melanoma have similar toxicity profiles to that of vismodegib, we hope dermatologists and patients alike will be more willing to try vismodegib as a treatment option for advanced BCCs in the future.

A systematic review on the lipid composition of human hair.

Hair lipid composition varies by ethnic hair type and by hair layer. Lipids in the cuticle, cortex, and medulla of the hair shaft provide a protective barrier to environmental and chemical damage, prevent hair breakage and desorption, and affect the elastic and tensile properties of hair. The aim of this systematic review is to provide an overview of the lipid composition and ethnic differences of human hair, effects of external damage on lipid content and properties, and changes in hair lipid composition associated with disease states. PubMed/MEDLINE was searched up to March 2021 according to PRISMA guidelines for articles discussing the lipid content of human hair and effects of physical, chemical, or environmental damage, and disease. Fifty-nine articles investigating the lipid content of hair were included for review. Lipids affect fluid permeability, hydration, strength, and texture of ethnic hair fibers. Lipid loss is accelerated by hair-damaging treatments such as bleach, dye, perm, straightening, and surfactant use, and sun and aging processes, leading to dehydrated, breakable, disordered, and dull hair. Diseases including acne, alopecia, and breast, gastric, prostate, lung, and rectal cancers display elevated hair lipid levels. Lipids are vital in protection against damage and maintenance of healthy hair. Further studies are needed to investigate the effects of lipids on the structural properties of ethnic hair, and changes in hair lipid composition with various dermatologic and systemic diseases.

Microneedling for the Treatment of Scars: An Update for Clinicians.

BACKGROUND: Microneedling (MN) is used for the treatment of scars, amongst other indications. Although used in Asia and the Middle East for decades, related to the supposed lack of post-procedure pigmentary alterations even in darker skin types, MN only recently gained attention in the United States as an effective, well-tolerated aesthetic treatment. MATERIALS AND METHODS: A systematic review of the Medline database was completed using search terms "microneedle" or "microneedling" or "micro needle" or "micro needling" and "scar". Included articles were written in English and discussed the use of MN for the treatment of scars in human subjects. RESULTS: Fifty-eight studies were included for review, with a total of 1845 patients treated for acne scarring, hypertrophic or keloid scars, and those resulting from surgery, trauma, varicella or smallpox. MN and its counterpart fractional radiofrequency MN (FRF-MN) were used as monotherapy or in combination with topical, surgical or systemic modalities. MN and FRF-MN treatment resulted in clinical improvement of scar appearance from baseline. No serious adverse events occurred. CONCLUSION: MN is a well-tolerated, minimally invasive procedure that can be used for the treatment of scars with a high level of patient satisfaction. Further clinical studies are needed to develop standardized treatment protocols.

The use of phosphodiesterase inhibitors for the treatment of alopecia.

Background: Hair loss encompasses a group of scarring and nonscarring diseases with limited treatment options. Understanding the pathogenesis of alopecias has led to the experimental use of phosphodiesterase inhibitors (PDEi).Objective: To perform a systematic review of literature surrounding the use of PDEi for alopecia.Materials and methods: A search was conducted using PubMed in February 2019 on PDEi and alopecia. Inclusion criteria were clinical trials, prospective or retrospective studies, case series and case reports written in English, using PDEi in human subjects for the treatment of alopecia.Results: Fifteen articles were included for review - eight discussing the use of topical caffeine 0.2%-2.5% for the treatment of androgenetic alopecia (AGA) and telogen effluvium (TE), one using injectable caffeine for AGA, one using topical sildenafil for pediatric alopecia areata (AA), and five using oral apremilast for adult AA.Conclusions: Preliminary results using topical caffeine for AGA or TE are promising with minimal adverse events. However, these studies are primarily single-center trials with few patients. Studies using topical or systemic PDEi for AA demonstrate limited success. Current research using PDEi for alopecia is limited, however new clinical trials are being conducted.

Identifying and characterizing basal cell carcinomas in persons with albinism.

BACKGROUND: Historically, persons with albinism (PWA) were thought to develop squamous cell carcinoma (SCC) more frequently than basal cell carcinoma (BCC). Recent evidence suggests BCCs in PWA are more common than initially hypothesized. OBJECTIVE: To characterize the presentation of BCC in PWA. METHODS: Fifty-four PWA with lesions suspicious for non-melanoma skin cancer sought care at Tanzanian dermatologic clinics from 2017 to 2019. Demographic and clinical presentation data were recorded. Histologic analysis of each sample was completed. RESULTS: The majority of PWA were female (53.7%), with a mean age of 34.6 ± 14.9 years and a mean duration of disease of 0.70 ± 0.73 years. Physician description of histologically proven BCC included ulceration (41.7%), erythema (16.7%), and scale (16.7%). Lesions were most commonly located on the trunk (47.1%) and face (41.2%). Histologic analysis demonstrated 30.2% of lesions were BCC, 26.4% SCC, and 17% Bowen's disease. LIMITATIONS: Patient population was limited to those visiting clinics, and data were limited by accuracy of the medical record. CONCLUSIONS: Basal cell carcinoma occurs at a higher rate than SCC in our population, suggesting BCC in PWA is underdiagnosed. It is important to recognize BCC early in PWA to avoid large disease burden and high rates of morbidity and mortality.