Assuntos
Pele , Cicatrização , Humanos , Microcirculação , Procedimentos Cirúrgicos Dermatológicos , Suturas , Técnicas de SuturaRESUMO
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.
Assuntos
Cicatriz/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Técnicas de Sutura , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
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.
Assuntos
Nevo de Células Epitelioides e Fusiformes/diagnóstico , Nevo Intradérmico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Tatuagem , Adulto , Feminino , Humanos , Tinta , Nevo de Células Epitelioides e Fusiformes/patologia , Nevo de Células Epitelioides e Fusiformes/cirurgia , Nevo Intradérmico/patologia , Nevo Intradérmico/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
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.
.Assuntos
Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/efeitos adversos , Cartilagens Nasais/transplante , Neoplasias Nasais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/patologia , Bochecha , Estética , Humanos , Masculino , Neoplasias Nasais/patologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Neoplasias Cutâneas/patologia , Retalhos Cirúrgicos , CicatrizaçãoRESUMO
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").
Assuntos
Ansiedade , Procedimentos Cirúrgicos Dermatológicos/psicologia , Pacientes/psicologia , Biópsia/psicologia , Humanos , Cirurgia de Mohs/psicologia , Visita a Consultório MédicoAssuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos , California , Estudos Transversais , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Cirurgia de Mohs/educação , Qualidade da Assistência à Saúde , Pele/patologia , Neoplasias Cutâneas/patologia , Estados Unidos , United States Department of Veterans Affairs/organização & administraçãoRESUMO
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.
Assuntos
Aminoquinolinas/administração & dosagem , Interleucina-2/administração & dosagem , Melanoma/tratamento farmacológico , Retinoides/administração & dosagem , Neoplasias Cutâneas/tratamento farmacológico , Administração Tópica , Estudos de Coortes , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Imiquimode , Injeções Intralesionais , Masculino , Melanoma/secundário , Invasividade Neoplásica/patologia , Metástase Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Melanoma Maligno CutâneoRESUMO
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.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Célula de Merkel/terapia , Imunoterapia , Neoplasias Cutâneas/terapia , Anticorpos Monoclonais/uso terapêutico , Benzamidas/uso terapêutico , Biomarcadores/análise , Antígeno CD56/imunologia , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/virologia , Eletroquimioterapia , Receptor Celular 2 do Vírus da Hepatite A , Humanos , Mesilato de Imatinib , Imunoterapia Adotiva , Indazóis , Proteínas Inibidoras de Apoptose/metabolismo , Interferons/uso terapêutico , Interleucina-12/genética , Interleucina-2/uso terapêutico , Ipilimumab , Metástase Linfática , Proteínas de Membrana/antagonistas & inibidores , Poliomavírus das Células de Merkel , Oligonucleotídeos Antissenso , Piperazinas/uso terapêutico , Infecções por Polyomavirus/virologia , Prognóstico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Pirimidinas/uso terapêutico , Receptores de Somatomedina/antagonistas & inibidores , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/virologia , Somatostatina/análogos & derivados , Sulfonamidas/uso terapêutico , Survivina , Serina-Treonina Quinases TOR/antagonistas & inibidores , Tionucleotídeos/uso terapêuticoRESUMO
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.
Assuntos
Inibidores de Calcineurina/efeitos adversos , Dermatite Atópica/tratamento farmacológico , Lentigo/induzido quimicamente , Doenças Labiais/induzido quimicamente , Tacrolimo/análogos & derivados , Administração Cutânea , Adulto , Biópsia , Inibidores de Calcineurina/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Lentigo/patologia , Doenças Labiais/patologia , Peptidilprolil Isomerase/antagonistas & inibidores , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversosRESUMO
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.
Assuntos
Cicatriz , Cirurgia de Mohs , Animais , Suínos , Humanos , Cicatriz/etiologia , Cicatriz/patologia , Cirurgia de Mohs/efeitos adversos , Xenoenxertos , Intenção , Extremidade Inferior/cirurgia , Extremidade Inferior/patologia , Dor/etiologiaRESUMO
Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.
Assuntos
Dermatologia , Internato e Residência , Humanos , Dermatologia/educação , Assistência ao Paciente , Sociedades MédicasRESUMO
Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.
Assuntos
Dermatologia , Internato e Residência , Humanos , Dermatologia/educação , Currículo , Inquéritos e QuestionáriosRESUMO
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 .
Assuntos
Cicatriz , Lesões dos Tecidos Moles , Idoso , Cicatriz/etiologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Feminino , Humanos , Masculino , Pele/patologia , Lesões dos Tecidos Moles/complicações , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , CicatrizaçãoRESUMO
PURPOSE: Carcinoembryonic antigen (CEA) is a tumor-associated protein expressed on a variety of adenocarcinomas. To develop an immunotherapy for patients with cancers that overexpress CEA, we isolated and genetically modified a T-cell receptors (TCRs) that specifically bound a CEA peptide on human cancer cells. EXPERIMENTAL DESIGN: HLA-A2.1 transgenic mice were immunized with CEA:691-699. A CEA-reactive TCR was isolated from splenocytes of these mice and was genetically introduced into human peripheral blood lymphocytes via RNA electroporation or retroviral transduction. Amino acid substitutions were introduced throughout the complementarity determining regions (CDR1, CDR2, and CDR3) of both TCR alpha and beta chains to improve recognition of CEA. RESULTS: Murine lymphocytes bearing the CEA-reactive TCR specifically recognized peptide-loaded T2 cells and HLA-A2.1(+) CEA(+) human colon cancer cells. Both CD8(+) and CD4(+) human lymphocytes expressing the murine TCR specifically recognized peptide-loaded T2 cells. However, only gene-modified CD8(+) lymphocytes specifically recognized HLA-A2.1(+) CEA(+) colon cancer cell lines, and tumor cell recognition was weak and variable. We identified two substitutions in the CDR3 of the alpha chain that significantly influenced tumor cell recognition by human peripheral blood lymphocytes. One substitution, T for S at position 112 (S112T), enhanced tumor cell recognition by CD8(+) lymphocytes, and a second dually substituted receptor (S112T L110F) enhanced tumor cell recognition by CD4(+) T cells. CONCLUSIONS: The modified CEA-reactive TCRs are good candidates for future gene therapy clinical trials and show the power of selected amino acid substitutions in the antigen-binding regions of the TCR to enhance desired reactivities.
Assuntos
Antígeno Carcinoembrionário/imunologia , Neoplasias Colorretais/imunologia , Antígeno HLA-A2 , Peptídeos , Receptores de Antígenos de Linfócitos T/genética , Animais , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Antígeno Carcinoembrionário/química , Linhagem Celular Tumoral , Eletroporação , Humanos , Ativação Linfocitária , Camundongos , Camundongos Transgênicos , Receptores de Antígenos de Linfócitos T/imunologia , Linfócitos T Citotóxicos/imunologiaAssuntos
Escroto/patologia , Xantomatose/patologia , Xantomatose/terapia , Biópsia , Terapia Combinada , Humanos , Lasers de Gás , Masculino , Pessoa de Meia-IdadeRESUMO
Recent studies using murine models of human squamous cell carcinoma (SCCA) have revealed a significant improvement in survival and cure rate of animals transplanted with human SCCA when treated with a combination of intratumor injections of chemotherapy and laser induced thermal therapy (LITT). These preliminary results suggest that this novel combination therapy may lead to improved clinical response compared to either treatment modality alone. Using a murine model of human SCCA we investigated two different modes of intratumor injection of cisplatin: a sustained-release cisplatin gel implant (CDDP/gel) versus cisplatin in solution (CDDP) at varying doses (range 1-3 mg/ml). In addition, we tested CDDP/gel combined with LITT. Results showed optimal drug concentration (30-300 nM) at tumor margins up to 4 h after injection of CDDP/gel implant compared to 3 nM at 5 min after injection with CDDP solution. Combined CDDP/gel and laser therapy significantly decreased tumor volume (P<0.05), with recurrence in only 25% of animals tested, compared to 78% tumor regrowth after LITT alone. These results suggest that laser chemotherapy may be an effective treatment for head and neck SCCA.