Porcine xenograft and second intention healing on the lower extremities after Mohs surgery: a descriptive case series.

There is limited data on benefits of healing after Mohs surgery using porcine xenografts (PXs) compared to second intention (SI). This case series sought to describe healing time, scar size, cosmetic outcome, pain, and infection rates in patients treated with PX or SI for wounds on lower extremities. 14 patients were enrolled. Six patients received treatment with SI, and eight patients received PX. 11 patients (4 SI, 7 PX) completed follow-up visit after 3 months (79% follow-up rate) when primary outcome measure was assessed. 64% of patients took > 3 months to heal. 72% of patients healed within 6 months post-surgery. Scars contracted by > 50% in 7/11 patients completing follow-up. In SI group, 3/5 patients self-reported pain level > 1 out of 10 at 1-week post-surgery compared to 3/8 in the PX group. Two patients in each group developed post-operative wound infection and three patients in PX group experienced other adverse events. These results suggest that healing with PX or SI resulted in small scar size, low post-operative pain level, and low rate of adverse events. Both groups had longer healing times than expected.

Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative effectiveness trial.

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .

Dermal suture only versus layered closure: A randomized, split wound comparative effectiveness trial.

BACKGROUND: Layered closure of cutaneous wounds is a commonly used surgical practice. However, there are studies that suggest the additional layer of epidermal sutures might not be necessary. OBJECTIVE: To compare scar outcomes between the single-layer deep-dermal suture technique and the conventional layered suture technique for primary closure of cutaneous wounds. METHODS: A total of 49 patients were enrolled in a prospective, randomized, evaluator-blinded, split scar study to compare the conventional bilayered closure technique with the single-layer deep-dermal suturing technique for primary closure of wounds. The primary outcome measure was mean sum Patient and Observer Scar Assessment Scale (POSAS) score at 3 and 12 months. RESULTS: At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the standard layered closure. However, at the 12-month follow-up, this difference was lost, with the exception of scar color, which was significantly more noticeable on the wound side closed with only dermal sutures. LIMITATION: Single-center study. CONCLUSION: Three months after surgery, the layered closure technique resulted in a slightly better scar outcome than the single-layered closure containing only dermal sutures. At 12-months' follow-up, this difference diminished, with scars for both sides appearing similar.

Desmoplastic intradermal spitz nevi arising within red tattoo ink.

Tattoos present a diagnostic challenge for dermatologists. Various reactions to tattoo have been identified in the literature ranging from allergic, to infectious, to neoplastic. Of the neoplastic cases identified, it is unclear whether the tattoo ink was directly causative, or if the cases were merely coincidence, as the number of cutaneous malignancies has also been on the rise. We present a novel case of two desmoplastic intradermal Spitz nevi arising within red tattoo ink.

Anxiety levels of patients undergoing common dermatologic procedures versus those seeking general dermatologic care.

Patients undergoing Mohs micrographic surgery frequently experience anxiety as a result of multiple potential factors. There is currently no data regarding how this anxiety compares to other common procedures performed in dermatology offices, such as shave biopsy and excision, relative to a general dermatology visit. Herein, we conducted a survey of 471 dermatology patients at an academic medical center, using a validated tool (Visual Analogue Scale from 1 "no anxiety at all" to 10 "extremely anxious").

Single-Staged Tunneled Cheek Interpolation Flap With Cartilage Batten Graft for Repair of Nasal Ala Defect.

Surgical defects located within 5 mm of the nasal alar margin are at risk for alar elevation or collapse of the external nasal valve during wound healing. To reduce the chance of such complications, free cartilage grafts may be used as part of the reconstruction. However, if the defect is large enough so that the free cartilage graft does not fill most of the defect, wound contraction can still lead to alar displacement. In these situations, skin may need to be recruited from either the forehead or cheek in the form of an interpolation flap to cover both the free cartilage graft and the residual cutaneous defect. Typically, such reconstructions require multiple procedures at separate time periods and pose prolonged wound care and an inconvenience to the patient. We describe a case of a 94-year-old male who desired an aesthetic reconstruction of a large nasal alar defect that required only a single operative visit. To simplify the repair into a one-stage procedure, a tunneled cheek interpolation flap was performed over a free cartilage graft.

J Drugs Dermatol. 2017;16(3):288-290.

100% Complete response rate in patients with cutaneous metastatic melanoma treated with intralesional interleukin (IL)-2, imiquimod, and topical retinoid combination therapy: results of a case series.

BACKGROUND: Patients with cutaneous melanoma metastases have experienced excellent responses to intralesional interleukin (IL)-2. This has led to its recent inclusion into the US National Comprehensive Cancer Network guidelines for management of cutaneous melanoma metastases. Despite this, intralesional IL-2 has not been highlighted in the US literature nor have US physicians adopted it. OBJECTIVE: We sought to evaluate the effectiveness of intralesional IL-2 combined with topical imiquimod and retinoid for treatment of cutaneous metastatic melanoma. METHODS: A retrospective case series of 11 patients with cutaneous metastatic melanoma were treated with intralesional IL-2 combined with topical imiquimod and retinoid. RESULTS: A 100% complete local response rate with long-term follow-up (average of 24 months) was seen in all 11 patients treated with this proposed regimen. Biopsy specimens of treated sites confirmed absence of malignant cells. The most common treatment-related adverse event was rigors. LIMITATIONS: Small number of patients, retrospective review of charts, and lack of a comparison group were limitations. CONCLUSION: Intralesional IL-2 administered concomitantly with topical imiquimod and a retinoid cream is a promising therapeutic option for managing cutaneous melanoma metastases. The regimen was well tolerated and should be considered as a reasonable alternative to surgical excision.

Merkel cell carcinoma: current status of targeted and future potential for immunotherapies.

Merkel cell carcinoma is an aggressive neuroendocrine tumor with a high incidence of local recurrence, regional nodal and distant metastasis, and a high mortality rate. It has been linked to a polyomavirus in addition to immune suppression. Traditionally, treatment options have been limited to surgery and radiation therapy. Better understanding of the molecular pathways of infection and carcinogenesis has provided potential molecular targets and potential immunotherapies which are discussed in this review.

Multiple labial melanotic macules occurring after topical application of calcineurin inhibitors.

Topical calcineurin inhibitors are widely used to treat inflammatory dermatoses for their steroid-sparing advantage. Herein, we report a patient with chronic lip dermatitis who developed multiple labial melanotic macules after application of tacrolimus 0.1% ointment and pimecrolimus 1% cream. Prior and current reports raise concerns for potential development of pigmented lesions associated with topical calcineurin inhibitor use. These reports highlight the need for careful risk-benefit assessment when prescribing topical calcineurin inhibitors for inflammatory dermatoses, especially when used on sun-exposed sites.

Update on laser photochemotherapy: an alternative for cancer treatment.

Although major progress has been made in surgery, radiation, and chemotherapy for the treatment of malignancy during the last 20 years, there has been little improvement in the survival of patients with recurrent or advanced head and neck cancer. Because of the ease and accessibility for surgery and their loco-regional biological behavior, head and neck cancers serve as an ideal model to test combined laser energy delivered via interstitial fiberoptics and chemotherapeutic agents activated by photo-thermal energy as an alternative, less invasive treatment for cancer. A number of investigators have shown that anthracyclines and cisplatin are likely candidates for light or heat activation in cancer cells. Maximum tolerated dose followed by photochemical and thermal activation via laser fiberoptics can improve treatment by sensitizing tumor response. The higher intratumor drug levels compared to systemic drug administration along with laser activation should also reduce systemic toxicity. In this article the authors analyze the concept of combining anti-cancer drugs and laser therapy and review the clinical application. In summary, the literature available suggests photochemotherapy with currently approved drugs and lasers may soon become an attractive alternative for cancer treatment.

Outcomes of laser thermal therapy for recurrent head and neck cancer.

OBJECTIVE: To review the outcomes of a phase II study using laser-induced thermal therapy (LITT) as a palliative treatment for 106 patients with recurrent head and neck tumors. STUDY DESIGN: Retrospective study. SETTING: Tertiary hospital in the United States. SUBJECTS AND METHODS: The primary endpoints were tumor response and survival. Prognostic values were assessed by the Kaplan-Meier method. RESULTS: The best results were seen in oral cavity tumors, in which mean survival was 29.1 months, as compared to neck tumors (mean 14.4 +/- 6.9 months; range 7.5-20.7 months; with a 95% confidence interval). Further analysis showed that clinical factors such as gender, smoking, and alcohol use were not indicators of poor prognosis, whereas neck disease and tumor stage at first treatment were relevant factors. CONCLUSION: In this study, 40 out of 106 patients treated by LITT remained alive at the end of our follow-up, and a complete response was seen in 24 (22.6%) patients. The highest response rate was seen in oral cavity tumors, which suggests that tumor location at this site may be a predictor of favorable outcome with LITT.

Laser-induced thermal therapy and cisplatin for recurrent head and neck cancer: a case characterized by an unusually long disease-free survival.

Recurrent squamous cell carcinoma after major surgery and microvascular reconstruction with a free-flap transfer is difficult to handle via conventional treatment methods. Based on our experience with laser-induced thermal therapy for recurrent head and neck tumors, we explored an aggressive treatment protocol using laser thermal ablation with concurrent cisplatin chemotherapy as a minimally invasive option for the treatment of a patient with recurrent squamous cell carcinoma of the neck who had previously undergone a reconstructive free-flap transfer. Because of the very favorable outcome we observed in this patient with this combined treatment modality, we report this case, and we review some aspects of the treatment proposed. The remarkable survival of this patient suggests that the combination of laser-induced thermal therapy and chemotherapy warrants further investigation as an alternate treatment for patients with recurrent head and neck cancer.