Photographic assessment of postsurgical facial scars epidermally sutured with rapidly absorbable polyglactin 910 or nylon: A randomized clinical trial.

BACKGROUND: Surgeons use absorbable and nonabsorbable sutures for epidermal wound closure. No large, randomized studies have compared the effect of these suture types on facial scar appearance. OBJECTIVE: To assess postsurgical facial scar appearance using either rapidly absorbable polyglactin 910 or nylon for epidermal closure. METHODS: Randomized, blinded, split-scar clinical trial. A total of 105 patients with facial wounds resulting from Mohs micrographic surgery excisions were randomly assigned for epidermal closure with rapidly absorbable 5-0 polyglactin 910 (Vicryl Rapide) on one half of the repair and 5-0 nylon (Ethilon) on the other half. Two physicians (1 dermatologist and 1 plastic surgeon), unaware of the original suture location, examined photographs of each healed wound at 6 months after surgery and graded the appearance of each half of the scar using the visual analog scale, wound evaluation scale, and Stony Brook Scar Evaluation Scale. RESULTS: At 6 months, there was no significant difference in the combined mean (standard deviation) visual analog scale scores (83.1 [14.2] and 83.0 [13.7]), Stony Brook Scar Evaluation Scale scores (4.3 [0.9] and 4.4 [0.9]), or wound evaluation scale scores (5.3 [1.1] and 5.2 [1.1]) for rapidly absorbable polyglactin 910 versus nylon (P = .72, .57, and .21, respectively). LIMITATIONS: Single institution. CONCLUSIONS: Both rapidly absorbable polyglactin 910 and nylon sutures placed through the epidermis resulted in an equivalent photographic appearance of facial scars at 6 months after surgery.

Patient Indications for Mohs Micrographic Surgery: A Systematic Review.

The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.

Quantitative label-free mass spectrometry analysis of formalin-fixed, paraffin-embedded tissue representing the invasive cutaneous malignant melanoma proteome.

Understanding the events at a protein level that govern the progression from melanoma in situ to invasive melanoma are important areas of current research to be developed. Recent advances in the analysis of formalin-fixed, paraffin-embedded tissue by proteomics, particularly using the filter-aided sample preparation protocol, has opened up the possibility of studying vast archives of clinical material and associated medical records. In the present study, quantitative protein profiling was performed using tandem mass spectrometry, and the proteome differences between melanoma in situ and invasive melanoma were compared. Biological pathway analyses revealed several signalling pathways differing between melanoma in situ and invasive melanoma, including metabolic pathways and the phosphoinositide 3-kinase-Akt signalling pathway. Selected proteins of interest (14-3-3ε and fatty acid synthase) were subsequently investigated using immunohistochemical analysis of tissue microarrays. Identifying the key proteins that play significant roles in the establishment of a more invasive phenotype in melanoma may ultimately aid diagnosis and treatment decisions.

Haploinsufficiency for AAGAB causes clinically heterogeneous forms of punctate palmoplantar keratoderma.

Palmoplantar keratodermas (PPKs) are a group of disorders that are diagnostically and therapeutically problematic in dermatogenetics. Punctate PPKs are characterized by circumscribed hyperkeratotic lesions on the palms and soles with considerable heterogeneity. In 18 families with autosomal dominant punctate PPK, we report heterozygous loss-of-function mutations in AAGAB, encoding α- and γ-adaptin-binding protein p34, located at a previously linked locus at 15q22. α- and γ-adaptin-binding protein p34, a cytosolic protein with a Rab-like GTPase domain, was shown to bind both clathrin adaptor protein complexes, indicating a role in membrane trafficking. Ultrastructurally, lesional epidermis showed abnormalities in intracellular vesicle biology. Immunohistochemistry showed hyperproliferation within the punctate lesions. Knockdown of AAGAB in keratinocytes led to increased cell division, which was linked to greatly elevated epidermal growth factor receptor (EGFR) protein expression and tyrosine phosphorylation. We hypothesize that p34 deficiency may impair endocytic recycling of growth factor receptors such as EGFR, leading to increased signaling and cellular proliferation.

Knowledge of local anesthetic use among dermatologists.

BACKGROUND: Local anesthesia is widely used in general dermatology practices. The onus is on the practitioner to have a sound knowledge of the pharmacology and dosing of any drug used, including local anesthesia. The dermatologist should also be aware of the signs, symptoms, and management of toxicity of local anesthetic use. The level of knowledge of dermatologists on this topic has not been previously assessed. OBJECTIVE: To assess levels of knowledge of local anesthetic pharmacology, local anesthetic systemic toxicity (LAST), and the management of the latter of dermatologists. METHODS: A survey designed to test knowledge of absolute dosing limits; calculation of patient-specific dosing using clinical vignettes; and awareness of the signs, symptoms, and management of LAST was distributed electronically to the membership of three professional dermatological organizations in the United Kingdom and Ireland, including one specialist dermatologic surgery group. RESULTS: Knowledge of local anesthetic use of dermatologists was comprehensive enough to practice safely, without necessarily being entirely accurate. Awareness of the signs and symptoms of local anesthetic toxicity was good, but awareness of the specific agent now recommended for the management of LAST in official guidelines was poor. CONCLUSIONS: Knowledge of local anesthetic dosing and toxicity is reasonable among dermatologists. Awareness of the guidelines for management of LAST, released by the American and Great Britain and Ireland associations of anesthetists, and in particular the use of lipid emulsion in this setting, could be improved.

The effect of narrowband UV-B treatment for psoriasis on vitamin D status during wintertime in Ireland.

OBJECTIVES: To determine whether narrowband UV-B (NB-UV-B) may mediate its beneficial effect on psoriasis by increasing vitamin D levels, and to assess the effect of NB-UV-B on vitamin D status in patients with psoriasis in wintertime. DESIGN: A prospective controlled study from October 2008 to February 2009. SETTING: A dermatology outpatient department at a university teaching hospital. PATIENTS: Thirty consecutive patients with psoriasis treated with NB-UV-B and 30 control patients with psoriasis were recruited. Control patients were recruited within 1 week of treated patients to control for seasonal variation of serum 25-hydroxyvitamin D [25(OH)D] levels. One patient with photo aggravated psoriasis was withdrawn from the study. INTERVENTION: Narrowband UV-B was administered 3 times per week. MAIN OUTCOME MEASURE: Serum 25(OH)D was measured at baseline, after 4 weeks and at completion of treatment. RESULTS: Levels of serum 25(OH)D increased significantly(P< .001) from a median (range) of 23 (9-46)ng/mL at baseline to 51 [rather than 59, as given in the originally published article] (32-112) ng/mL at the end of NB­UV-B treatment compared with no change in the control group [corrected]. The change in serum 25(OH)D level correlated with the number of exposures of NB-UV-B (r = 0.61; P < .001) and cumulative UV-B dose (r = 0.47; P = .01) but not with treatment response. At the end of the study, all patients in the treatment group were vitamin D sufficient, but 75% of the control group had vitamin D insufficiency [serum 25(OH)D level <20 ng/mL]. In a multiple regression model, prior phototherapy was the sole predictor of baseline serum 25(OH)D level (r(2) = 0.13; P = .006), whereas the number of exposures of NB-UV-B predicted change in serum 25(OH)D level (r(2) = 0.38; P = .001). CONCLUSIONS: Narrowband UV-B effectively increases serum 25(OH)D level while clearing psoriasis. Up to 75% of Irish patients with psoriasis were shown to be vitamin D insufficient during wintertime.