Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers.

IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

Combined treatment for facial rejuvenation using an optimized pulsed light source followed by a fractional non-ablative laser.

BACKGROUND: Combination laser treatments can potentially increase the effectiveness of treatment without the additional downtime associated with another procedure. OBJECTIVE: To assess the effectiveness and safety of combining non-ablative fractional treatments with optimized intense pulsed light. METHODS AND MATERIALS: Ten subjects (Group A) received full face treatments with a non-ablative fractional either followed or preceded by an optimized intense pulsed light source. Twenty-six subjects (Group B) received only full face treatments with the same non-ablative, fractional laser device. RESULTS: For Group A, the overall average Fitzpatrick Wrinkle Scale for all patients improved from 6.3 ± 1.1 at baseline to 5.9 ± 0.8 one month following one treatment for an average improvement of 0.4 ± 0.6 (P < 0.10 paired t-test n = 9). The average pigment improvement score was 1.8 ± 0.9 on a 4-point scale. In Group B, the average Fitzpatrick Wrinkle Scale improved from 6.0 ± 1.6 at baseline to 5.2 ± 1.4 at 3 months for an average improvement of 0.8 ± 0.7 (P < 0.001, n = 26 paired t-test). The average pigment improvement score was 1.4 ± 1.0 (P < 0.001, t-test, n = 26). Adverse events were similar in the two groups. CONCLUSION: The combination of an optimized intense pulsed light source with a non-ablative fractional laser during the same treatment session is safe and effective.

Nd:YAG laser hair removal in Fitzpatrick skin types IV to VI.

Safe and effective laser treatments are crucial, especially in darker-skinned individuals. Herein, we report our experience treating Fitzpatrick skin types IV to VI with a long-pulsed, 1,064-nm neodymium-doped yttrium aluminum garnet laser. With the right treatment settings, darkly pigmented individuals can undergo laser hair removal effectively.

The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival.

BACKGROUND: Depth of melanoma invasion is critical because it dictates patient treatment and prognosis. Recent reports indicate melanoma transection with initial biopsy does not impact patient survival; however, tumor transection can lead to misdiagnosis and inaccurate staging. OBJECTIVE: This study assessed the rate of melanoma transection with various biopsy techniques and the impact of tumor transection on patient survival. METHODS: We conducted a retrospective review of all melanoma cases at our institution between 2000 and 2008. Of the 490 melanoma cases identified, 479 met inclusion criteria for the study. The transection rates of biopsy techniques were determined. Cases of transected tumors were matched with nontransected cases in a retrospective case-control fashion to evaluate survival. RESULTS: The rate of melanoma transection was 1.5% for excisional biopsies, 4.1% for punch biopsies, and 9.0% for saucerization biopsies. The means of disease-free survival for the control and transected groups were 911 days and 832.7 days, respectively (P value .67). Overall survival for the control group was 1073.7 days versus 1012.4 days for the transected group (P value .72). LIMITATIONS: The study used a select population. The sample size of transected biopsies was limited, in turn limiting the power of the study. Residents performed the majority of biopsies. CONCLUSION: Punch and saucerization biopsies were more likely to transect tumors than excisional biopsies. The transection of melanoma did not affect overall disease-free survival or mortality in the population studied.

Optical coherence tomography and its role in mohs micrographic surgery: a case report.

Optical coherence tomography (OCT) is an imaging technology with the potential to provide high-resolution images of the skin non-invasively. With this device, it is possible to identify a host of skin structures including tumors. In this case report, we demonstrate the use of an OCT device in delineating a lateral tumor margin of an ill-defined basal cell carcinoma prior to Mohs micrographic surgery. Following surgery, the OCT images are compared to histologic sections to confirm their accuracy. OCT technology has the potential to be a vital tool for dermatologists and particularly Mohs surgeons in identifying tumor margins and potentially reducing the number of invasive procedures needed.

Epidermolytic acanthoma of the scrotum: A rare mimicker of condyloma acuminatum.

Epidermolytic acanthoma is a rare benign tumor that is characterized by epidermolytic hyperkeratosis on histopathology. Epidermolytic acanthoma usually presents in adulthood as an asymptomatic tumor less than 1 cm in diameter with a verrucous surface. Whereas the lesions can present in either an isolated solitary, localized, or disseminated form, there tends to be a predilection for the genitoscrotal area.

Biologic drugs for the treatment of hidradenitis suppurativa: an evidence-based review.

There are various treatment options for hidradenitis suppurativa (HS), a recurrent and suppurative disease, but none is wholly satisfactory or effective. There have been many reports on the efficacy of biologic drugs for the treatment of HS; this article is an in-depth review of the published evidence on this topic. Because the current evidence is limited, randomized, double-blinded, placebo-controlled trials are needed to better elucidate the future of these drugs for the treatment of HS.

Transfer contact dermatitis caused by rosin use in bowling.

The diagnosis of allergic contact dermatitis due to colophony may be challenging as this allergen is found in a number of products and used in a variety of settings. Diagnosis becomes more difficult when the distribution of dermatitis does not coincide with typical patterns of use of the allergen. We present a case of transfer contact dermatitis of the face due to rosin use in bowling.

Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.

BACKGROUND: The scalp is the most commonly affected part of the body in patients with psoriasis. Signs and symptoms of scalp psoriasis vary significantly for individual patients. OBJECTIVE: A task force of the National Psoriasis Foundation was convened to evaluate treatment options. Our aim was to achieve a consensus for scalp psoriasis therapy. METHODS: Reports in the medical literature were reviewed regarding scalp psoriasis therapy. LIMITATIONS: There is a paucity of evidence-based and double-blind studies in the treatment of scalp psoriasis particularly for long-term therapy. Many of the studies in scalp psoriasis were designed to attain Food and Drug Administration approval for a medication and not to provide treatment guidance. CONCLUSIONS: The recommended short-term or intermittent therapy for scalp psoriasis is topical corticosteroids. The primary alternatives are topical retinoids, vitamin D analogues, and salicylic acid. Combination therapy has many advantages. The choice of an appropriate vehicle is crucial to increase patient compliance. While scalp psoriasis can often be adequately treated with topical therapy, recalcitrant disease may require more aggressive approaches, including systemic agents.

Self-healing collodion membrane and mild nonbullous congenital ichthyosiform erythroderma due to 2 novel mutations in the ALOX12B gene.

BACKGROUND: Collodion phenotype is a term applied to the condition affecting a newborn involving a parchmentlike membrane covering the whole body surface (collodion membrane). This presentation is common to several different forms of autosomal recessive congenital ichthyoses, including nonbullous congenital ichthyosiform erythroderma (NCIE), lamellar ichthyosis (LI), and harlequin ichthyosis (HI). Recent years have seen considerable advances in our understanding of the molecular basis of autosomal recessive forms of congenital ichthyosis. Several genetic loci have been identified for LI and NCIE. OBSERVATIONS: We describe the clinical and molecular features of 2 cases of self-healing newborns of collodion phenotype developing mild NCIE. A dramatic improvement of the skin was observed in the first few weeks after birth in both cases. The molecular analysis of the ALOX12B gene demonstrated that both patients were compound heterozygous for previously unreported mutations. CONCLUSIONS: Both patients were compound heterozygous for novel ALOX12B mutations, underscoring the concept that mutations in at least 2 different genes, ALOX12B and TGM1, may result in this unusual clinical phenotype.