Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery.

BACKGROUND: The temporal branch of the facial nerve is at risk of damage during Mohs micrographic surgery (MMS). This complication leads to motor deficit in the ipsilateral upper face with resultant functional and cosmetic impairment. OBJECTIVE: To identify patient, tumor, and surgical risk factors associated with temporal nerve damage. MATERIALS AND METHODS: A single-institution, retrospective review of MMS cases involving anatomic sites within the temporal nerve danger zone was performed. Risk factors were compared between cases with and without nerve damage. RESULTS: Of 616 cases within the danger zone, 28 (4.5%) had postoperative nerve dysfunction. Variables significantly associated with dysfunction included patient immunosuppression, tumor size, aggressive tumor histology, recurrent tumors, high degree of subclinical spread, and greater average number of Mohs stages. Preoperative tumor size and postoperative defect size of ≥3 cm resulted in a ×37 and ×40 increased odds of nerve damage, respectively. Sex, age, and basal versus squamous cell carcinoma were not significantly associated with temporal nerve damage. No patients with a postoperative defect size measuring <2 cm had nerve damage. CONCLUSION: The overall risk of damage to the temporal nerve during MMS is low, but there are certain risk factors that warrant increased counseling about this potential complication.

Self-Resolving Eruptive Keratoacanthomas After Full-Field Erbium Laser Resurfacing.

Keratoacanthoma (KA) is a subtype of squamous cell carcinoma whose development has been linked to excessive sun exposure, immunosuppression, and trauma. Given the rapidly expanding therapeutic armamentarium for anti-aging modalities in dermatology, reports of KA secondary to invasive cosmetic procedures are on the rise. We present a case of eruptive KAs after full- eld ablative Erbium:YAG 2940 nm laser resurfacing of the face that resolved with minimal intervention. This case demonstrates the potential for a rare yet signi cant laser complication that may warrant discussion during the consenting process. J Drugs Dermatol. 2016;15(11):1453-1455..