Extracellular Vesicles as Novel Diagnostic and Therapeutic Agents for Non-Melanoma Skin Cancer: A Systematic Review.

Standard non-melanoma skin cancer (NMSC) treatment involves surgery, recently combined with chemotherapy or immunotherapy in cases of advanced tumors. EVs, including exosomes, are integral to carcinogenesis, and are found in NMSC releasing mediators impacting tumor progression. Nevertheless, the precise intercellular signaling role of NMSC-derived EVs remains unclear. This review aims to elucidate their potential role in NMSC diagnosis and treatment. This systematic review encompassed literature searches in electronic databases from inception to September 2023, based on certain inclusion and exclusion criteria, addressing NMSC-derived EVs, their molecular cargo, and their implications in the diagnosis, prognosis, and treatment of NMSC. Key components were identified. Extracellular vesicle (EV) proteins and RNA have emerged as diagnostic biomarkers in EV-based liquid biopsy. Circular RNA CYP24A1, known for its molecular stability, holds promise as a diagnostic biomarker. Long noncoding RNAs (lincRNA-PICSAR) and Desmoglein 2 (DSg2) are linked to drug resistance, serving as prognostic biomarkers. EV mediators are being actively investigated for their potential role as drug delivery agents. In conclusion, this systematic review showed that NMSC-derived EVs display promise as therapeutic targets and diagnostic biomarkers. Further research is imperative to fully comprehend EV mechanisms and explore their potential in cancer diagnosis and treatment.

The 'Facelift' Flap Revisited.

The reconstruction of facial defects focuses on the preservation of function without compromising facial symmetry and esthetics. The aim of the study is to describe and evaluate a revised 'facelift' flap technique to reconstruct large defects of the cheek, temple, frontotemporal area, and zygomatic arch. A prospective, observational study of facial defect reconstruction by means of a 'facelift' flap was conducted from January 2019 to January 2022. The revised 'facelift' flap technique, based on the defect location and characteristics, is described. The postoperative outcomes and patient satisfaction were evaluated. The flap was applied to 34 patients with defect diameters ranging from 3 cm to 9 cm. The mean operation time was 67±17 minutes and the mean hospital stay was 1 day. No major postoperative complications were encountered; reoperation was not needed. High patient satisfaction rates were reported (9.6±0.5). The revised facelift flap is a reliable and safe method for the reconstruction of large defects of the cheek, temple, frontotemporal area, and zygomatic arch, based on local tissue availability that ensures satisfactory esthetic outcomes with undetectable scars.

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case-Control Study.

BACKGROUND: The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. METHODS: Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. RESULTS: All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. CONCLUSIONS: WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

The impact of treatment delay on skin cancer in COVID-19 era: a case-control study.

BACKGROUND: The outbreak of COVID-19 pandemic led to a 2-month lockdown in Europe. Elective surgeries, including skin cancer excisions, were postponed. The purpose of this prospective case-control study was to assess the impact of the treatment delay on patients with non-melanoma skin cancer (NMSC) or melanoma operated in the first post-lockdown period. METHODS: A comparative study of skin cancer operations performed in a 4-month period either in 2020 or in 2019 was conducted. All data were collected from a prospectively maintained clinic database and the pathological reports. Continuous variables were compared with t test or Mann-Whitney U test according to their distribution. Categorical variables were compared with Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) was used to assess the risk of excising high-risk NMSC in 2020 compared with 2019. RESULTS: Skin cancer excision was performed in 158 cases in 2020 compared to 125 cases in 2019 (26.4% increase). Significantly, more SCC were excised in 2020 (p = 0.024). No significant difference for several clinical parameters regarding BCC, SCC, and melanoma was identified. However, the reconstructive method applied, following NMSC excision, was significantly different, requiring frequently either skin grafting or a flap. CONCLUSION: These results indicate that skin cancer treatment delay, due to COVID-19 pandemic, is related to an increased incidence of SCC and more complicated methods of reconstruction. Considering the relapsing COVID-19 waves, significant skin cancer treatment delays should be avoided. TRIAL REGISTRATION: The study adhered to the STROBE statement for case-control studies.