Benefit of Mohs Micrographic Surgery Over Wide Local Excision for Melanoma of the Head and Neck: A Rational Approach to Treatment.

BACKGROUND: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma. OBJECTIVE: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE. MATERIALS AND METHODS: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013. RESULTS: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148). CONCLUSION: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.

A Review of the Association Between Parkinson Disease and Malignant Melanoma.

BACKGROUND: An association between melanoma and Parkinson disease (PD) has been hinted at in the neurology and oncology literature since the 1970s after the initiation of levodopa (L-DOPA) therapy for PD. Given that L-DOPA is a substrate in melanin synthesis, there existed a concern that this therapy might cause melanoma. OBJECTIVE: The objective was to research possible etiological links to explain the connection between PD and melanoma. METHODS: A PubMed and Google Scholar literature search was performed using access provided by the University of Minnesota biomedical library. RESULTS: Patients with PD have an overall decreased risk of cancer diagnoses. However, breast cancer and melanoma have an uncharacteristically high rate of co-occurrence with PD. Family history of melanoma and lighter hair and skin color confer a higher risk of developing PD, and having a first-degree relative with either disease conveys a significantly increased risk of developing the other. Other possible connections that have been explored include pigmentation genes in neural-derived cells, pesticides, MC1R polymorphisms, and abnormal cellular autophagy. CONCLUSION: Although a link between PD and melanoma exists, the etiology of this link continues to be elusive. Both PD and melanoma are likely multifactorial diseases involving genetic and environmental risk factors.

Comparative Study of Professional vs Mass Market Topical Products for Treatment of Facial Photodamage.

BACKGROUND: Many over the counter topical products claim to reverse the signs of cutaneous photo-damage. To date, the two most studied ingredients for improving the texture, tone, and pigmentation of the skin are topical retinoids and hydroquinone. OBJECTIVE: This split face study compares a mass market skincare regimen with a prescription skin care regimen for improvement in photo damaged skin. METHODS: Twenty-seven subjects with moderate photo damaged facial skin were enrolled. Each subject was consented and assigned with the mass market anti-aging system (Treatment A) to one side of the face and the prescription anti-aging system (Treatment B or Treatment C) to the other side of the face. Treatment B contained 13 subjects whom did not use 0.025% Retinol cream. Treatment C contained 14 subjects who used a 0.025% Retinol Cream. Subjects had 4 visits over 12 weeks for digital photography and surveys. Photographs were evaluated by blinded physicians. RESULTS: Physician objective analysis showed all three systems to have a statistically significant clinical improvement in photoaged skin seen in as little as 4 weeks of use. Participant's surveys rated the mass market system higher than both of the professional systems for visible skin changes, ease of use, and likelihood to recommend to a friend. Twelve of twenty-seven subjects preferred the mass market system for overall improvement while twelve thought each system gave the same improvement. CONCLUSION: This study demonstrates that a mass marketed skin care system can give similar clinical improvements in photo-aged skin as a professionally dispensed prescription system and the majority of participants preferred the mass-marketed system.

Treatment of Facial Photodamage With Mass Market Topical Products vs Non-ablative Fractional Laser.

METHODS: In this split-face, evaluator-blinded study, 18 subjects were randomly assigned to receive either the SSR or NFL treatments on each side of the face. For the SSR facial sides subjects followed two morning-evening regimens. On the NFL sides subjects were treated 3 times with the 1927-nm laser at 4-week intervals. Three physician evaluators were asked to rate hyperpigmentation, global photoaging, and ne lines and wrinkles for each side of the face at baseline and at 3 months using a 5-point scale. RESULTS: The SSR and NFL treatments provided comparable results for each skin attribute. Improvement from baseline was signi - cant in both treatment programs for each skin attribute. The greatest 3-month improvement for both programs was in hyperpigmen- tation. For global photoaging and ne lines and wrinkles, positive responses were slightly greater in the NFL than in the SSR facial sides. Subject preference for the SSR over the NFL was greatest for ne lines around the eyes, ne lines around the mouth, smooth texture, radiant complexion, and overall improvement while the NFL was preferred for skin rmness and evenness. When the study was completed5 of 18 split-face subjects decided to undergo NFR laser treatment on the non laser treated side along with using the SSR product and 13 of the 18 subjects continued to use the SSR products to their full face after the study. CONCLUSION: The mass market skin care system of the present study provides improvement in hyperpigmentation, global photoaging, and ne lines and wrinkles comparable to that of a series of treatments with a non-ablative fractional laser. J Drugs Dermatol. 2016;15(11):1366-1372..

Evaluation of a novel home skin care platform.

The home beauty device market is rapidly growing, having more than tripled in the last four years. This study evaluates several specific attachment heads using a novel home skincare platform (HSP). By incorporating multiple treatment heads for cleansing, skin smoothing, and skin infusion, this device has the potential to address many potential treatment goals. The first subset of this study is a blinded, randomized split-face study evaluating the efficacy of the HSP device with a standard brush head for make-up removal and compares the HSP device to a currently marketed home cleansing device. The results show that the HSP cleansing head was comparable to the leading home skin cleansing device on the market. The HSP's skin smoothing head showed statistically significant improvement in erythema and dryness over baseline levels with significant histologic changes including normalization of epidermal thickness in only 10 days of use. This is comparable to and exceeds many well-studied antiaging treatments after weeks and months of therapy. Finally, the infusion head demonstrated improvement in skin hydration over baseline levels.

Allergic contact dermatitis from formaldehyde textile resins.

Formaldehyde-based resins have been used to create permanent-press finishes on fabrics since the 1920s. These resins have been shown to be potent sensitizers in some patients, leading to allergic contact dermatitis. This review summarizes the history of formaldehyde textile resin use, the diagnosis and management of allergic contact dermatitis from these resins, and current regulation of formaldehyde resins in textiles.

Nonpseudomonal ecthyma gangrenosum.

Ecthyma gangrenosum is a cutaneous infection associated most commonly with pseudomonal sepsis in the patient who is immunocompromised. We describe an 8-month-old girl with acute myelocytic leukemia who developed perineal ecthyma gangrenosum caused by Citrobacter freundii, a gram-negative pathogen that has been rarely associated with cutaneous disease. We also review the literature to categorize the range of pseudomonal and nonpseudomonal pathogens associated with ecthyma gangrenosum.

Annular lichen planus: a case series of 20 patients.

BACKGROUND: Annular lichen planus (ALP) is a long-recognized clinical variant of lichen planus, but is often considered uncommon in occurrence. The typical distribution and presentation of this variant have not been well described. OBJECTIVE: We sought to better define the sites affected and clinical characteristics of the annular variant of lichen planus, along with the age and race of patients affected with this disorder. METHODS: We conducted a retrospective review of 20 patients given a diagnosis of ALP during an 18-year period. The diagnosis was confirmed histologically in all but 3 cases of classic ALP that presented on the glans penis. RESULTS: Patients ranged in age from 24 to 76 years. There were 18 men and 2 women; 15 were Caucasian and 5 were African American. Sites of involvement in order of decreasing frequency included: axilla (35%); penis (25%); extremities (25%); groin (including the inguinal creases and scrotum) (20%); back (15%); buttocks (10%); flanks (5%); neck (5%); and eyelids (5%). None of the patients had oral mucosal, vulval, scalp, or nail lesions. A total of 18 patients had purely annular lesions, whereas 2 of the 20 had a few purple polygonal papules in the vicinity of the annular forms. Some eruptions were macular, whereas the majority had a slightly raised edge with central clearing. In all, 6 patients had solitary lesions whereas only 4 had 10 or greater lesions. None exhibited a linear Koebnerized response or generalized lesions. Most patients were asymptomatic. CONCLUSIONS: ALP commonly involves the male genitalia but also has a predilection for intertriginous areas such as the axilla and groin folds. Eruptions typically consist of a few lesions localized to one or a few sites. Distal aspects of the extremities, and less commonly the trunk, may also be involved. ALP is a subtype of lichen planus that may be more common than is reflected in the literature.