A New Hydrocellular Wound Dressing Used After Dermatologic Surgery: Dermatologic Surgeons' and Patients' Perceptions.

BACKGROUND: Optimum postsurgical healing requires appropriate dressing use. OBJECTIVE: This study assessed effectiveness and tolerance of a novel, hydrocellular dressing in dermatologic surgery using validated tools, describing its use in clinical practice, and comparing surgeons' and patients' perceptions of scar evolution. METHODS: This study examined direct suture closures of surgical excisions of small- to medium-sized skin lesions on the extremities or trunk. Dressings were changed 3 times/week. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS) were used to assess outcomes. Data were collected at Day 0 (D0, FLC application), Day 15 to 21 (D15-21, suture removal), and Day 45 (D45) postprocedure by the surgeon and the patient. RESULTS: There were 128 patients (mean age: 55.1 years, 56.1% women). Mean length and width of the excisions were 3.5 × 1.65 cm and the most common FLC applied was 8 × 8 cm (67.7%). Most scars had normal pigmentation, pliability, and height at D15 to 21 and D45, as reported by patients and surgeons using VSS. Patient scores on visual analog scale (VAS) were high (>8/10) and global satisfaction measured by POSAS was generally high (>7/10 at D15-21; >8/10 at D45). CONCLUSION: These dressings were effective in managing surgical excisions, as assessed by VSS, VAS, and POSAS. Further controlled studies investigating various dressings in wound repair are needed.

Diabetes and Blood Glucose Disorders Under Anti-PD1.

Acute type 1 diabetes (AD1) is a rare but definitive immune-related adverse event associated with anti-PD1. Most of the reported cases are close to what has been described as "fulminant type 1 diabetes." We sought to determine whether anti-PD1 could impair glycoregulation and whether occurrence of AD1 could be anticipated by prior glycemic changes. Fasting glycemia collected before, under, and after treatment in melanoma patients treated with anti-PD1 over a period of 36 months were retrospectively analyzed. Glycemic trend analyses were performed using linear regression analysis. In total, 1470 glucose values were monitored in 163 patients treated for a mean duration of 5.96 months. Three patients developed an AD1 (1, 84%). Two other cases were observed in the same period in a still-blinded trial of anti-PD1 versus ipilimumab. All cases of AD1 occurred in patients with a normal pretreatment glycemia, and there was no detectable drift of glycemia before ketoacidosis onset. In 4 of 5 cases of AD1, the HLA subgroups were DRB01* 03 or 04, known to increase type 1 diabetes risk in the general population. In the 28 patients with preexisting type 2 diabetes, there was a slight trend for glycemia increase with anti-PD1 infusions (0.05 mmol/L/infusion P=0.004). In the 132 patients with normal pretreatment glycemia, there was a slight trend for a decrease of glycemia with anti-PD1 infusions (-0.012/mmol/L/infusion P=0.026). These data suggest that the monitoring of glycemia under anti-PD1 cannot help to anticipate AD1, and there is no general tendency to glycemic disorder. HLA genotyping before treatment may help to focus surveillance in patients with the HLA DRB1*03/04 group.

[Chordoma cutis, an unusual clinical presentation of a rare neoplasm: Chordoma]. / Chordoma cutis, un tableau clinique rare d'une tumeur inhabituelle : le chordome.

Chordoma cutis represents an unusual clinical presentation of a rare neoplasm. The involvement of skin or sub-cutaneous soft tissues can be the consequence of local infiltration or metastasis; the latter may occur several years following the initial diagnosis of chordoma and therefore, may pose a diagnosis challenge when the clinical history of the patient is unknown. The clinical forms, morphology, immuno-histochemical profile and the main differential diagnoses of chordoma cutis are presented here through an anatomoclinical case.