A Large Percentage of Excision Specimens Show Residual Basal Cell Carcinoma: A Retrospective Chart Review.

BACKGROUND: Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment. OBJECTIVE: This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment. METHODS AND MATERIALS: A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution. RESULTS: Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC. CONCLUSION: The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC.

Fast absorbing gut sutures in dermatologic surgery: a systematic review and meta-analysis.

INTRODUCTION: Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities. METHODS: A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates. RESULTS: Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01). CONCLUSION: If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.

Most Online Resources for Home Suture Removal are Poor in Quality.

Introduction: At home suture or staple removal can be stressful for patients and may lead some to seek out additional instruction via online resources as an adjunct to what was explained to them by their provider. The purpose of this study was to examine the existing online resources available to patients who may be interested in or have been instructed to remove sutures at home after a simple procedure, such as a skin biopsy or excision. Methods: A systematic search was conducted using internet search engines to identify videos and webpages targeting at home suture removal instruction. The DISCERN instrument was used to evaluate the information quality of each included resource. Results: There was no statistically significant difference between average DISCERN scores for videos and webpage resources, and the majority were rated poor in quality. Conclusions: The online resources for at home suture and staple removal were often not comprehensive and were below the standard quality for written information. Health care providers should consider referring their patients to validated online sources for suture removal to prevent misinformation and improve patient safety.