Hyaluronic Acid Filler Incidentally Found During Mohs Micrographic Surgery: Observations in 36 Patients Regarding Skin Depth, Degradation Size, and Estimated Persistence Time.

BACKGROUND: Although its clinical effect is reported to last up to 2 years, how long hyaluronic acid filler (HAF) histologically persists in the skin is unknown. OBJECTIVE: To determine the approximate persistence time of HAF in the skin and to correlate persistence time with HAF histological appearance, size, depth, and location. METHODS: Retrospective review of patient data and available frozen sections from 2003 to 2021 in which HAF was identified in 36 Mohs micrographic surgery patients. RESULTS: Incidental HAF histologically persisted in the skin for as long as 10.75 years in 1 patient and 3 years or more in 36.8% (7/19) of the patients who remembered the time of implantation. HAF is more apparent in frozen sections stained with toluidine blue than those stained with hematoxylin and eosin. Although HAF volume tended to be less with time, fragmentation was present both early at 3 months and at 3 years or more. There was no correlation of persistence time with anatomic location or depth. In 90.3% of the cases (28/31), HAF was located in the subcutaneous fat. There was no granulomatous or giant cell response at any time period. CONCLUSION: Hyaluronic acid filler may be seen histopathologically in the skin, usually in the subcutaneous fat, up to 10.75 years after implantation.

Treatment of fibroelastolytic papulosis with fractionated carbon dioxide laser.

Fibroelastolytic papulosis (FEP) is an acquired elastic tissue disorder that presents as white-to-yellow papules and plaques usually occurring on the neck. Although the lesions are often asymptomatic, their appearance may be distressing to patients. FEP has been treated with topical tretinoin in one case report ( 1 ). Other reports have not mentioned treatment for this rare disorder ( 1-6 ). We present a case of FEP successfully treated with a fractionated carbon dioxide (CO2) laser.

Use of eye shields and eye lubricants among oculoplastic and Mohs surgeons: a survey.

BACKGROUND: Eye shields and lubricants are recommended for use in the eye during periorbital surgery to prevent injury to the globe. Nonetheless, data regarding their use is sparse, and no study to date has examined the prevalence of their usage and complications. PURPOSE: To investigate how commonly eye shields and lubricants are used during periorbital surgery and whether there are complications from their use. METHODS: The authors conducted a survey of oculoplastic and Mohs surgery fellowship directors. The questionnaire investigated the prevalence of use of eye shields and lubricants, complications encountered, and whether the standard of care requires or prohibits their use. RESULTS: A majority of those surveyed at least sometimes use eye shields in periorbital surgery, particularly to prevent patient injury. Most surgeons believe there are more pros than cons to their use. However, corneal abrasions may be encountered and may be related to the type of lubricant chosen. Surgeons using fat-based lubricants tended to encounter more complications with eye shield use. CONCLUSION: Eye shield and lubricant use is common among oculoplastic and Mohs surgeons. However, most disagree as to whether the standard of care requires or forbids their use.

The role of oxygen in wound healing: a review of the literature.

BACKGROUND: The presence of oxygen is necessary for normal wound healing. Oxygen has been given as a therapeutic modality to assist and speed wound healing. OBJECTIVE: The objective was to summarize the role of oxygen in wound healing. MATERIALS AND METHODS: A literature review of clinical and basic science studies regarding oxygen and wound healing was conducted. RESULTS: Hypoxia appears to jump start wound healing via hypoxia-inducible factor 1alpha and reepithelialization. Nonetheless, oxygen is often required to start or sustain other wound healing processes. CONCLUSION: Both the absence and the presence of oxygen have effects on wound healing; however, its role is not completely understood. Although hyperbaric oxygen and topical oxygen therapy have been described in aiding wound healing, case-controlled prospective studies are lacking and evidence for their efficacy is inconsistent. The authors have indicated no significant interest with commercial supporters.

Metastatic cutaneous squamous cell carcinoma: an update.

BACKGROUND: Squamous cell carcinoma (SCC) is the second most common type of skin cancer in the United States. Cutaneous SCC has the potential to metastasize and cause morbidity and mortality. OBJECTIVE: Our purpose was to review and summarize the literature on metastatic cutaneous SCC, including risk factors for metastasis, data from clinical studies, and current management. RESULTS: Multiple studies confirm that even well-differentiated and small tumors (<2 cm) may metastasize. Over the past two decades, additional literature on the risk factors for metastatic cutaneous SCC, including immunosuppression, has been published. In addition, new staging systems have been proposed that may influence management of these tumors. Chemotherapy regimens are numerous, but remain limited in ability to improve overall survival. CONCLUSION: Although we know more about the risk factors, survival for patients with metastatic cutaneous SCC depends on extent of nodal involvement. Therefore, emphasis should remain on prevention and aggressive treatment of cutaneous SCC and vigilant observation for signs and symptoms of metastasis.

Role of sun exposure in melanoma.

BACKGROUND: Malignant melanoma is the third most common skin cancer in the United States. It is commonly thought that sun exposure is causative in these tumors. Recently, however, the significance of the role of sun exposure in melanoma has come into question. Some have suggested that other factors, such as genetics, play a larger role, and that sun protection may even be harmful. OBJECTIVE AND METHODS: To investigate the role of sun exposure in melanoma etiology. An extensive review of basic science and clinical literature on this subject was conducted. RESULTS: Although exceptions exist, sun exposure likely plays a large role in most melanomas. The pattern of this exposure, however, is not fully known, and controversy exists, especially in the use of sunscreens. Sun exposure may interact with genetic factors to cause melanomas, and sun protective measures appear to be prudent. CONCLUSIONS: The cause of melanoma is probably variable and multifactorial. Sun exposure may play a primary or supporting role in most melanoma tumors.