Brow gliding: A new non-surgical concept for almond upturned eyes.

BACKGROUND: The eyes are one of the most prominent features of the face. To date, a vast majority of procedures have been described for periorbital rejuvenation. Among them, non-surgical threading is an alternative and minimally invasive technique. OBJECTIVE: We developed a new non-surgical threading technique to achieve long-lasting almond-shaped upturned eyes with brow lifting that we call "brow gliding". We developed a new non-surgical threading technique to achieve long-lasting almond-shaped upturned eyes with brow lifting that we call "brow gliding". Here, we present details of our procedure and the clinical experience of our patients who have at least a 6-month follow-up period. METHODS AND MATERIALS: We used polydioxanone cog threads in combination with knots to lift the lateral sides of the brows and eyes. By burying these knots in the subcutaneous tissue and extending the threads to the scalp fascia, we were able to spread the load of the threads over multiple stable structures in order to achieve an effective lifting impact. RESULTS: According to the subjective assessment scale, all patients described the improvements as very good or beyond expectations after the procedure. During the follow-up period, 4 of 34 (11.8%) patients stated it was very good and 19 of 34 (55.9%) patients stated that it was still beyond expectations. CONCLUSION: The Brow Gliding technique is a promising office-based cosmetic procedure for periorbital aesthetics with a prominent outcome and minimally invasive fashion.

The role of technology in melanoma screening and diagnosis.

Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.

Molecular risk prediction in cutaneous melanoma: A meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients.

BACKGROUND: Multiple studies have reported on the accuracy of the prognostic 31-gene expression profile test for cutaneous melanoma. Consistency of the test results across studies has not been systematically evaluated. OBJECTIVE: To assess the robustness of the prognostic value of the 31-gene expression profile. METHODS: Raw data were obtained from studies identified from systematic review. A meta-analysis was performed to determine overall effect of the 31-gene expression profile. Clinical outcome metrics for the 31-gene expression profile were compared with American Joint Committee on Cancer staging. RESULTS: Three studies met inclusion criteria; data from a novel cohort of 211 patients were included (n = 1,479). Five-year recurrence-free and distant metastasis-free survival rates were 91.4% and 94.1% for Class 1A patients and 43.6% and 55.5% for Class 2B patients (P < .0001). Meta-analysis results showed that Class 2 was significantly associated with recurrence (hazard ratio 2.90; P < .0001) and distant metastasis (hazard ratio 2.75; P < .0001). The 31-gene expression profile identified American Joint Committee on Cancer stage I to III patient subsets with high likelihood for recurrence and distant metastasis. Sensitivity was 76% (95% confidence interval 71%-80%) and 76% (95% confidence interval 70%-82%) for each end point, respectively. When 31-gene expression profile and sentinel lymph node biopsy results were considered together, sensitivity and negative predictive value for distant metastasis-free survival were both improved. CONCLUSION: The 31-gene expression profile test consistently and accurately identifies melanoma patients at increased risk of metastasis, is independent of other clinicopathologic covariates, and augments current risk stratification by reclassifying patients for heightened surveillance who were previously designated as being at low risk.

Outcomes of Melanoma In Situ Treated With Mohs Micrographic Surgery Compared With Wide Local Excision.

Importance: Melanoma in situ (MIS) is increasing in incidence, and expert consensus opinion recommends surgical excision for therapeutic management. Currently, wide local excision (WLE) is the standard of care. However, Mohs micrographic surgery (MMS) is now used to treat a growing subset of individuals with MIS. During MMS, unlike WLE, the entire cutaneous surgical margin is evaluated intraoperatively for tumor cells. Objective: To assess the outcomes of patients with MIS treated with MMS compared with those treated with WLE. Design, Setting, and Participants: Retrospective review of a prospective database. The study cohort consisted of 662 patients with MIS treated with MMS or WLE per standard of care in dermatology and surgery (general surgery, otolaryngology, plastics, oculoplastics, surgical oncology) at an academic tertiary care referral center from January 1, 1978, to December 31, 2013, with follow-up through 2015. Exposure: Mohs micrographic surgery or WLE. Main Outcomes and Measures: Recurrence, overall survival, and melanoma-specific survival. Results: There were 277 patients treated with MMS (mean [SD] age, 64.0 [13.1] years; 62.1% male) and 385 treated with WLE (mean [SD] age, 58.5 [15.6] years; P < .001 for age; 54.8% male). Median follow-up was 8.6 (range, 0.2-37) years. Compared with WLE, MMS was used more frequently on the face (222 [80.2%] vs 141 [36.7%]) and scalp and neck (23 [8.3%] vs 26 [6.8%]; P < .001). The median (range) year of diagnosis was 2008 (1986-2013) for the MMS group vs 2003 (1978-2013) for the WLE group (P < .001). Overall recurrence rates were 5 (1.8%) in the MMS group and 22 (5.7%) in the WLE group (P = .07). Mean (SD) time to recurrence after MMS was 3.91 (4.4) years, and after WLE, 4.45 (2.7) years (P = .73). The 5-year recurrence rate was 1.1% in the MMS group and 4.1% in the WLE group (P = .07). For WLE-treated tumors, the surgical margin taken was greater for tumors that recurred compared with tumors that did not recur (P = .003). Five-year overall survival for MMS was 92% and for WLE was 94% (P = .28). Melanoma-specific mortality for the MMS group was 2 vs 13 patients for the WLE group, with mean (SD) survival of 6.5 (4.8) and 6.1 (0.8) years, respectively (P = .77). Conclusions and Relevance: No significant differences were found in the recurrence rate, overall survival, or melanoma-specific survival of patients with MIS treated with MMS compared with WLE.

Pulse methylprednisolone therapy for the treatment of extensive alopecia areata.

BACKGROUND: Since the mainstay of pathogenesis depends on autoimmune process, systemic steroids are widely used in the treatment of alopecia with various side effects. To avoid side effects of long-term steroid treatment, pulse methylprednisolone therapy appears to be a safe treatment option. OBJECTIVE: The aim was to determine the effect of pulse methylprednisolone therapy for the treatment of adult alopecia areata. METHODS: Demographical features of all patients were recorded before the treatment. Patients received methylprednisolone 500 mg intravenously for 3 consecutive days every month for 3 months. Patients were followed up for 3 months. Treatment responses were defined by complete regrowth (100%), significant regrowth (>50%) and minimal regrowth (<50%). RESULTS: Totally 15 patients were enrolled in this study. At the end of the study, two patients had significant regrowth and one patient had minimal regrowth in multifocal alopecia areata (n = 4); one patient had significant regrowth and one patient had minimal regrowth in alopecia universalis (n = 8); three patients had no regrowth in alopecia totalis (n = 3). CONCLUSIONS: The study suggests that pulse methylprednisolone therapy might be a therapeutic option for severe multifocal alopecia areata. However, in alopecia totalis or universalis, treatment results are unsatisfactory.

The effect of oral cyclosporine in the treatment of severe alopecia areata.

CONTEXT: Alopecia areata (AA) is a common non-scarring hair loss condition with an unpredictable and relapsing disease course. T-cell mediated autoimmune process is mainstay of the pathogenesis of AA, therefore immunosuppressive therapies are widely used in the treatment of AA. OBJECTIVE: The aim of the study was to evaluate efficacy of oral cyclosporine therapy and reveal effects of prognostic factors in the treatment of severe AA. MATERIALS AND METHODS: We evaluated case histories of patients who were admitted to our department between December 2004 and September 2011 for the treatment of severe AA. A total of 25 patients were included in the study. Patients' data that included sex, age, alopecia type, alopecia duration, family history, atopic history, previous treatments, treatment dosage, treatment duration, adverse events and clinical response were retrieved from patients' records. Twelve patients had multifocal AA, nine patients had alopecia universalis and four patients had alopecia totalis. Patients were treated with 2.5-6 mg/kg/d doses of oral cyclosporine for 2-12 months. RESULTS: The mean age of patients was 21.92 ± 3.56 (range: 19-34) years. All patients were male. The mean duration of disease was 8.3 ± 6.48 (range: 0.5-21) years. Four patients had positive family history and three patients had atopy history. Three of 25 (16%) patients discontinued treatment due to adverse events. Of remaining 22 patients, significant hair growth was observed in 10 (45.4%) patients; five patients with multifocal AA, three patients with alopecia universalis and two patients with alopecia totalis. In addition to this, six of nine patients with less than four years disease duration showed significant hair growth. But in patients with more than four years disease duration, only 4 of 13 patients showed significant hair growth. CONCLUSION: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.