Vitamin D and Cutaneous Melanoma Risk: An Umbrella Review of Systematic Reviews and Meta-Analyses.

Background: Vitamin D (VitD) properties can impact cancer cells. Despite the documented link between VitD levels and prevalence of several cancer types, conflicting findings have been reported for cutaneous melanoma (CM). Objective: This overview aims to compile the evidence from existing systematic reviews and meta-analyses, emphasizing the relationships between VitD serum levels, intake, receptor (VDR) gene polymorphisms, and CM risk. Methods: A literature search in electronic databases was conducted, based on certain inclusion criteria. Results: Twenty-one studies were included. Conflicting evidence between high VitD serum levels, dietary/supplementary intake, and CM risk is highlighted. VDR polymorphisms may play a role in the intricate CM pathogenesis. Also, high serum levels of VitD are associated with improved CM prognosis. Conclusions: This overview showed that the impact of VitD on CM is not clear, and thus further research is suggested to explore its true effect size on CM risk.

The Association of Vitamin D with Non-Melanoma Skin Cancer Risk: An Umbrella Review of Systematic Reviews and Meta-Analyses.

Background and Objectives: Previous studies revealed the anti-angiogenic, antiproliferative, and anti-inflammatory effects of Vitamin D (VitD) on cancer cells. Although this body of evidence supported the correlation of high VitD levels with reduced incidence rates for various malignancies, contradictory results were reported regarding non-melanoma skin cancer (NMSC). The aim of this overview was to summarize the available evidence from the existing pool of systematic reviews and meta-analyses, focusing on VitD serum status, dietary intake, and VitD receptor (VDR) polymorphisms in correlation to NMSC incidence. Materials and Methods: A literature search in electronic databases was conducted from inception to January 2023. The inclusion criteria were systematic reviews and meta-analyses published in peer-reviewed journals, evaluating VitD serum levels, dietary and/or supplementary intake, or VDR gene polymorphisms, and reporting data on NMSC. Results: A total of 10 studies were included in the data analysis models. A positive association between VitD serum levels and NMSC is highlighted. However, dietary/supplementation of VitD does not exhibit a likewise strong linkage to NMSC. Despite the contradictory findings, VDR polymorphisms may play a crucial role in the intricate NMSC pathogenesis. Conclusions: This umbrella review shows that high VitD levels are associated with increased NMSC incidence, potentially due to its direct correlation with increased sun exposure. Further research on VDR polymorphisms is suggested to explore their true effect size on NMSC risk.

Concomitant Reconstruction of Multiple Scalp Defects With One Rotational Flap.

The cornerstones of scalp reconstruction are provisions of adequate skin paired with a satisfactory cosmetic outcome without hairline distortion. Several techniques have been described over the years to reconstruct sizable defects. Currently, an individualized approach, based on the patient's medical status and needs, the defect characteristics, and the local tissue quality and availability, should be considered for an optimal outcome. The reconstruction of multiple scalp defects, by means of a well-planned rotational flap, is proposed as a viable option with many advantages. It enables concurrent reconstruction of the defects, obviates further surgical incisions, and elaborates surgical maneuvers, minimizing operative time and complications risk. A satisfactory esthetic outcome can be achieved.

Antibiotic Prophylaxis in Reduction Mammaplasty: A Network Meta-Analysis.

BACKGROUND: Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network meta-analysis is to evaluate the effectiveness of different antibiotic regimens in the prophylaxis from surgical site infections and delayed wound healing (DWH) following breast reduction. METHODS: A network meta-analysis was conducted using a predetermined protocol after searching the electronic databases MEDLINE, Scopus, the Cochrane Library and US National Institutes of Health Ongoing Trials Register from inception to July 2022. The included studies had to examine breast reduction in females with at least 1-month follow-up, receiving antibiotics in an intervention arm compared to a control arm. The quality of studies was assessed using the Cochrane risk of bias tool. A frequentist Mantel-Haenszel approach was adopted for the reported SSI rates while an inverse variance random effects model was used for the DWH rates. RESULTS: A total of 10 studies was included in the analysis involving 1331 patients. All but one study controlled for major risk factors, and no differences were observed in patients' baseline characteristics. Antibiotic administration significantly reduced the SSI rate after breast reduction, with the prolonged antibiotic regimen being the most efficacious (odds ratio [OR]: 0.36 [95%CI: 0.15-0.85]). No statistically significant reduction in delayed wound healing rate was revealed among the regimens. CONCLUSIONS: Antibiotics mitigate the SSI rate after breast reduction. This meta-analysis provides an evidence-based strategy to optimize antibiotic administration. Further research is needed though to examine antibiotic prophylaxis on delayed wound healing. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis.

BACKGROUND: Although abdominoplasty is growing in popularity, it still results in considerable postoperative pain, which prolongs recovery. OBJECTIVES: The aim of this network meta-analysis was to combine evidence about different regional nerve blocks to examine their effectiveness in the management of postoperative pain sequelae and recovery following abdominoplasty. METHODS: An electronic literature search in the MEDLINE (PubMed; National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), Cochrane Library (London, UK) and US National Institutes of Health Ongoing Trials Register electronic databases (Bethesda, MD) was conducted from inception to July 2022. Inclusion criteria were the presence of intervention and control groups; data derived from controlled studies evaluating nerve blocks after abdominoplasty, in terms of analgesia needs, complications, and patient satisfaction; and publication in peer-reviewed journals. The quality of studies was assessed via Cochrane's risk-of-bias tool. A frequentist random-effects network meta-analysis was conducted for all outcomes of interest. RESULTS: A total of 12 studies, containing 543 patients with no differences in age, sex, BMI, and comorbidities, met the inclusion criteria. Transversus abdominis plane blocks have been found to reduce 24-hour and 48-hour opioid consumption (-3.70 and -5.01 weighted mean difference, respectively). In addition, the nerve blocks reviewed effectively prolonged the time to first rescue analgesia request, were safe in terms of complications, and were associated with high satisfaction rates. CONCLUSIONS: Nerve blocks emerge as an effective and safe adjunct for adequate pain management following abdominoplasty. This meta-analysis provides an evidence-based strategy to optimize the current analgesia regimens following abdominoplasty.

A Meta-Analysis on the Impact of the COVID-19 Pandemic on Cutaneous Melanoma Diagnosis in Europe.

The COVID-19 pandemic has been the epicenter of healthcare attention globally for the past two years, and large-scale adaptations in healthcare provision have been required. This study aimed to investigate the impact of the pandemic and the resulting lockdowns on cutaneous melanoma diagnosis and tumor burdens in Europe. A relevant literature search in electronic databases was conducted from inception to September 2022. The inclusion criteria were: controlled studies published in a peer-reviewed journal evaluating cutaneous melanoma in Europe and reporting data on melanoma characteristics from diagnoses. The quality of studies was evaluated using the Cochrane ROBINS-I tool for assessing bias in non-randomized studies. Meta-analysis was conducted utilizing a random effects model to synthesize the data. A total of 25 studies involving 32,231 patients were included in the data analysis models. Statistically significant increases in mean Breslow thickness (0.29 mm (0.03-0.55 mm)), ulceration rates (OR = 1.66 (1.29-2.13)), and resultant tumor staging were observed in the PostCovid group, with subgroup analysis revealing that lockdown-derived data were responsible for this trend. This meta-analysis reported on the impact of COVID-19 restrictions on melanoma diagnosis in Europe, emphasizing the higher tumor burden and disease progression state provoked by healthcare adaptations in the pandemic period.

An Algorithmic Approach for the Reconstruction of Extended Upper-Third Auricular Soft Tissue Defects.

ABSTRACT: Auricular defects are demanding to reconstruct due to the complex anatomy and the three-dimensional shape of the ear. The functional perspective needs to be addressed without neglecting aesthetic outcomes though, given that it is a prominent facial landmark. In this report the reconstruction of a sizable soft tissue defect of the helical crus and upper third of the right auricle, following surgical excision of a skin tumor, is presented. A variety of treatment options is explored, and a relevant algorithm is proposed. This defect was reconstructed using a transposition flap from the postauricular area, accomplishing single-stage full defect coverage combined with optimal postoperative aesthetic results. High patient satisfaction levels were achieved, avoiding more complicated and prolonged procedures. This case exemplifies the proposed algorithmic approach of upper-third auricular defects, addressing these defects in a systematic and logical manner.

Eccrine Porocarcinoma of the Face is a Great Imitator With Aggressive Behavior.

Introduction: Eccrine porocarcinoma (EPC) is a rare subtype of non-melanoma skin cancer developing in the intraepithelial portion of eccrine sweat glands. It is branded with a highly metastatic potential and increased rate of local recurrence after treatment. EPC showcased a trend of developing on the extremities, with presentation on the face sparse. Objectives: Aim of the study was to evaluate the frequency, clinical features, and course of this malignancy presented on the face. Methods: A retrospective review of the skin cancers excised between January 2010 and June 2021 was conducted in the plastic surgery department of a tertiary hospital. Patients were included in the study if EPC on the face was histologically confirmed. A prospectively maintained clinic database and the pathological reports were used to collect data. Results: 4 EPC cases on the face out of 3984 confirmed skin cancers were identified. None of the cases was suspected clinically, but the diagnosis was established following the histopathologic examination. An aggressive postoperative behavior was confirmed in 2 cases. Conclusions: The variance in the clinical presentation and the non-specific characteristics are perplexing clinical diagnosis, with the histopathologic examination representing the current standard for confirmation. Early diagnosis and adequate surgical resection are recommended as treatment cornerstones. Clinical awareness ought to be raised and a definitive treatment protocol be established for optimized results.