Mohs Micrographic Surgery as the Standard of Care for Nail Unit Squamous Cell Carcinoma.

BACKGROUND: There is no established standard of care for treatment of nail unit squamous cell carcinoma (SCC). OBJECTIVE: The aim of the study is to further characterize the clinical characteristics and diagnostic considerations of nail unit SCC and to examine the outcomes of patients with nail unit SCC treated with Mohs micrographic surgery (MMS). MATERIALS AND METHODS: A retrospective review was conducted of patients treated for nail unit SCC with MMS from January 1, 2006, to December 30, 2016. Demographic data were collected along with lesion characteristics, treatment characteristics, and follow-up results. RESULTS: Forty-two cases of nail unit SCC were treated with MMS. Recurrences were observed in 3 patients (7.1%). Recurrent cases were treated with MMS. There were no cases of distant metastases, subsequent recurrence, or death. Two of 3 recurrences occurred in patients with histologic features of verruca vulgaris. CONCLUSION: Mohs micrographic surgery provides an excellent cure rate for the treatment of nail unit SCC. This technique offers the greatest ability to achieve histological clearance while maximizing tissue sparing, thereby reducing unnecessary amputations and patient morbidity.

Suction blister grafting for vitiligo: efficacy and clinical predictive factors.

BACKGROUND: Suction blister epidermal grafting (SBEG) is a well-established treatment modality for vitiligo, but predictive factors for outcomes are not well characterized. OBJECTIVE: To determine the efficacy and predictive variables for response to SBEG in patients with vitiligo. MATERIALS AND METHODS: A retrospective single-center review of all cases treated with SBEG was performed. Repigmentation was assessed by 2 independent reviewers by assessing pigment spread of grafts during the postoperative period. Repigmentation rates were then compared with patient demographics and transplant location. RESULTS: A total of 28 patients were enrolled in this study. The total number of grafts was 129, of which 86.8% (112/129) survived. Highest rate of graft survival was seen in patients younger than 20 years (100%) and the lowest in patients older than 40 years (75%-78%). Repigmentation was seen in 68% of patients. The highest degree of pigment spread was on the neck (283%) and face (231%), whereas the hands and feet had the least response (119%). CONCLUSION: Blister grafting is successful in most patients with vitiligo, with a high graft survival rate; however, the degree of pigment spread is variable and depends on clinical characteristics of the patient and graft site.

A chimeric Cfh transgene leads to increased retinal oxidative stress, inflammation, and accumulation of activated subretinal microglia in mice.

PURPOSE: Variants of complement factor H (Cfh) affecting short consensus repeats (SCRs) 6 to 8 increase the risk of age-related macular degeneration. Our aim was to explore the effect of expressing a Cfh variant on the in vivo susceptibility of the retina and RPE to oxidative stress and inflammation, using chimeric Cfh transgenic mice (chCfhTg). METHODS: The chCfhTg and age-matched C57BL/6J (B6) mice were subjected to oxidative stress by either normal aging, or by exposure to a combination of oral hydroquinone (0.8% HQ) and increased light. Eyes were collected for immunohistochemistry of RPE-choroid flat mounts and of retinal sections, ELISA, electron microscopy, and RPE/microglia gene expression analysis. RESULTS: Aging mice to 2 years led to an increased accumulation of basal laminar deposits, subretinal microglia/macrophages (MG/MΦ) staining for CD16 and for malondialdehyde (MDA), and MDA-modified proteins in the retina in chCfhTg compared to B6 mice. The chCfhTg mice maintained on HQ diet and increased light showed greater deposition of basal laminar deposits, more accumulation of fundus spots suggestive of MG/MΦ, and increased deposition of C3d in the sub-RPE space, compared to controls. In addition, chCfhTg mice demonstrated upregulation of NLRP3, IP-10, CD68, and TREM-2 in the RNA isolates from RPE/MG/MΦ. CONCLUSIONS: Expression of a Cfh transgene introducing a variant in SCRs 6 to 8 was sufficient to lead to increased retinal/RPE susceptibility to oxidative stress, a proinflammatory MG/MΦ phenotype, and a proinflammatory RPE/MG/MΦ gene expression profile in a transgenic mouse model. Our data suggest that altered interactions of Cfh with MDA-modified proteins may be relevant in explaining the effects of the Cfh variant.