Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
3.
Clin Dermatol ; 38(4): 467-476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972605

RESUMO

Basal cell nevus syndrome, also known as Gorlin syndrome, is a hereditary cancer syndrome associated with multiple basal cell carcinomas, congenital defects, and nondermatologic tumors. This disease is autosomal dominant with variable expressivity and is caused by abnormalities in the sonic hedgehog signaling pathway. Management requires a multidisciplinary approach and should include the biopsychosocial needs of patients and their families. Genetic testing is necessary to confirm an unclear diagnosis, evaluate at-risk relatives, and assist with family planning.


Assuntos
Síndrome do Nevo Basocelular/genética , Síndrome do Nevo Basocelular/terapia , Terapia de Alvo Molecular , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/terapia , Adulto , Síndrome do Nevo Basocelular/diagnóstico , Síndrome do Nevo Basocelular/patologia , Feminino , Testes Genéticos , Proteínas Hedgehog/genética , Proteínas Hedgehog/metabolismo , Humanos , Comunicação Interdisciplinar , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/patologia , Receptor Patched-1/genética , Receptor Patched-1/metabolismo , Receptor Patched-2/genética , Receptor Patched-2/metabolismo , Equipe de Assistência ao Paciente , Proteínas Repressoras/genética , Proteínas Repressoras/metabolismo , Transdução de Sinais/genética , Pele/patologia , Adulto Jovem
4.
Dermatol Surg ; 2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32932265

RESUMO

BACKGROUND: Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options. OBJECTIVE: To review the benefits, limitations, and practicality of MMS in patients with DCFIs. METHODS: A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS. RESULTS: Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months. CONCLUSION: Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.

5.
Dermatol Surg ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32897951

RESUMO

BACKGROUND: Antibiotic prescriptions associated with dermatologic surgical visits are increasing and prescribing practices vary among surgeons. OBJECTIVE: To describe dermatologic surgeons' attitudes and practices regarding prophylactic antibiotic use for surgical site infection (SSI), to compare current prescribing practices to those of a 2012 survey, and to determine surgeons' interest in clinical trial data on the utility of prophylactic antibiotics. MATERIALS AND METHODS: This was a cross-sectional online survey of the American College of Mohs Surgery (ACMS) members. Survey items were adapted from a 2012 survey of ACMS members. RESULTS: The survey was initiated by 101 ACMS members. 75.25% (76/101) of surgeons reported routinely prescribing prophylactic antibiotics to reduce SSI risk. The use of prophylactic antibiotics varied with clinical scenario. Most providers (84.21%, 64/76) prescribe postoperative antibiotics, with an average course of 6.56 days. 40.21% (39/97) of respondents were uncertain if prophylaxis prevents SSI, and up to 90.63% (87/96) indicated interest in clinical trial data evaluating the efficacy of oral antibiotics for SSI prevention. CONCLUSION: Dermatologic surgeons continue to report varied attitudes and practices for SSI prophylaxis. Evidence from clinical trials is desired by surgeons to guide clinical practice.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32808822

RESUMO

Background: The natural evolution of facial scars has not been well described. Identifying factors that correlate with optimal scar healing may help patients and physicians during the perioperative period. Methods: A retrospective study of 108 facial skin cancer patient scars was performed. The Patient and Observer Scar Assessment Scale (POSAS) was used to grade scars at two time points (1 week and 3 months postoperatively). Paired two-tailed t-tests identified differences in scar ratings between the time points. Analysis of variance (ANOVA) explored whether POSAS scores differed by anatomic site or reconstruction type. Receiver operating characteristic analysis was performed to identify if 1-week scar appearance correlated with scar appearance at 3 months. Results: Between 1 week and 3 months the total POSAS score improved by 36.3% and overall opinion of the scar improved by 38.6% (p < 0.001). Facial cosmetic units differed in their 1-week and 3-month scores and all anatomic sites demonstrated significant improvement between time points. Differential scoring occurred among reconstruction types. Scar appearance at 1 week was able to predict overall scar appearance at the 3-month visit (area under the curve = 0.7732). Conclusions: Early scar appearance predicts later scar appearance, and scars will improve by nearly 40% 3 months after surgery. These data can be used to assist with perioperative counseling and expectation management.

7.
JAMA Dermatol ; 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32845319

RESUMO

Importance: Defining which populations are affected by basal cell carcinoma (BCC) vs cutaneous squamous cell carcinoma (cSCC) may inform targeted public health strategies. Incidence of BCC and cSCC is not reported to national cancer registries, but claims data for the treatment of BCC and cSCC provide insights into the epidemiology of keratinocyte carcinoma. Objective: To define differences in the ratio of BCC to cSCC in adults (age, ≥18 years) in a large database of patients with commercial insurance and Medicare Advantage coverage. Design, Setting, and Participants: This cross-sectional analysis used deidentified data derived from the Optum Clinformatics Data Mart to perform a retrospective evaluation of a large commercially insured cohort based on treatment claims from January 1, 2012, to December 31, 2016. Patients with a diagnosed and treated BCC or cSCC as determined by codes from the International Classification of Diseases, Ninth Revision, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology were included. Data were analyzed from November 30, 2019, to March 20, 2020. Exposure: Diagnosis and treatment of BCC or cSCC. Main Outcomes and Measures: The ratio of BCC to cSCC based on age, sex, race, and geographic location. Multivariable logistic regression was used to assess how demographics were associated with the odds of a treated keratinocyte carcinoma being a BCC. Results: Among the 985 317 claims for patients included in the analysis (61.59% for men; mean [SD] age, 69.82 [12.58] years), BCCs were 1.69 (95% CI, 1.6899-1.6901) times more likely than cSCCs to be treated in the United States from 2012 to 2016. Basal cell carcinomas were significantly more prevalent than cSCCs in younger patients (18-39 years, 9.63 [95% CI, 9.6088-9.6574] BCCs per cSCC; 40-64 years, 2.92 [95% CI, 2.9171-2.9187] BCCs per cSCC; and ≥65 years, 1.33 [95% CI, 1.3289-1.3291] BCCs per cSCC; P < .001). Basal cell carcinomas were significantly more prevalent than cSCCs in women vs men, except in adults 65 years or older (odds ratios [ORs], 0.98 [95% CI, 0.97-0.99] vs 1.67 [95% CI, 1.47-1.88] for those aged 18-39 and 1.15 [95% CI, 1.12-1.19] for those aged 40-64 years; P < .001). The difference in BCC:cSCC ratios between men and women diminished with increasing age (OR, 1.67 for 18-39 years, 1.15 for 40-64 years, and 0.98 for 65 years or older). Basal cell carcinoma was more prevalent than cSCC in all races, including Black patients (BCC:SCC ratios, 1.60 for Asian patients, 1.45 for Black patients, 2.00 for Hispanic patients, and 1.69 for White patients of all ages). The BCC:cSCC ratio varied based on geography, with the highest ratio in the West North Central census division (2.12) and the lowest ratio in the South Atlantic census division (1.35). Conclusions and Relevance: In the absence of a national registry, claims data can improve our understanding of the epidemiology of keratinocyte carcinomas. In this cross-sectional study, basal cell carcinomas were more common than cSCCs for all demographics, including in Black patients. In populations younger than 40 years, BCCs were 12.6 times more likely for women and 7.2 times more likely for men. These demographic groups may benefit from public health education focused on the presentation and management of BCCs.

9.
J Drugs Dermatol ; 19(5): 493-497, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32484626

RESUMO

BACKGROUND: Mohs micrographic surgery is a safe procedure with low rates of infection. OBJECTIVE: To establish current antibiotic prescribing practices amongst Mohs surgeons. METHODS AND MATERIALS: 16-question survey sent to American College of Mohs Surgery members. RESULTS: 305 respondents with collectively 7,634+ years of experience. The majority performed outpatient surgery (95.0%) and avoided oral or topical antibiotics for routine cases (67.7% and 62.8%, respectively). Prophylactic antibiotics were routinely prescribed for artificial cardiac valves (69.4%), anogenital surgery (53.0%), wedge excision (42.2%), artificial joints (41.0%), extensive inflammatory skin disease (40.1%), immunosuppression (38.9%), skin grafts (36.4%), leg surgery (34.2%), and nasal flaps (30.1%). A minority consistently swabbed the nares to check for staphylococcus aureus carriage (26.7%) and decolonized carriers prior to surgery (28.0%). CONCLUSION: Disparity exists in antibiotic prescribing practices amongst Mohs surgeons. There may be under-prescription of antibiotics for high risk factors like nasal flaps, wedge excisions, skin grafts, anogenital/lower extremity site, and extensive inflammatory disease. Conversely, there may be over-prescription for prosthetic joints or cardiac valves. Increased guideline awareness may reduce post-operative infections and costs/side effects from antibiotic over-prescription. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4695.

10.
Dermatol Surg ; 46(4): 514-518, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31592922

RESUMO

BACKGROUND: Postoperative concerns after Mohs micrographic surgery (MMS) are not well characterized. OBJECTIVE: To better define patient concerns and contributing characteristics in the immediate postoperative period after MMS. MATERIALS AND METHODS: A standardized telephone encounter template was implemented to better assess patient concerns in the 24-hour postoperative period. A review was then performed of patients undergoing MMS from October 2016 to July 2017 to assess for the most common patient concerns and association with clinical characteristics. RESULTS: We included 307 patients. Overall, 60.6% of patients reported a concern. Fifty-four percent of patients reported pain. Most pain was characterized as "a little" (67.7%). On univariate analysis, flap repairs, location on the upper extremities, and swelling were associated with higher mean postoperative pain. Tumor type was not associated with increased pain. On multivariate analyses, patients with larger defects and associated edema were statistically significantly associated with higher degrees of pain. CONCLUSION: Over half of patients experience postoperative concerns after MMS, most commonly pain. The immediate postoperative period may be an optimal time to identify patient concerns allowing for reassurance or early intervention when necessary.


Assuntos
Assistência ao Convalescente/métodos , Cirurgia de Mohs/efeitos adversos , Dor Pós-Operatória/epidemiologia , Cuidados Pós-Operatórios/métodos , Neoplasias Cutâneas/cirurgia , Adulto , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/normas , Cuidados Pós-Operatórios/estatística & dados numéricos , Período Pós-Operatório , Estudos Retrospectivos , Inquéritos e Questionários/normas , Inquéritos e Questionários/estatística & dados numéricos , Telefone
14.
J Cutan Med Surg ; 23(6): 617-623, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31422679

RESUMO

BACKGROUND: Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions. OBJECTIVE: To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size. MATERIALS AND METHODS: One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary. RESULTS: Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas. CONCLUSION: Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.


Assuntos
Curetagem , Cuidados Pré-Operatórios , Neoplasias Cutâneas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento
15.
J Am Acad Dermatol ; 80(2): 321-339, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29782901

RESUMO

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.


Assuntos
Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/terapia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Idoso , Anilidas/uso terapêutico , Biópsia por Agulha , Carcinoma Basocelular/prevenção & controle , Dermoscopia/métodos , Detecção Precoce de Câncer , Educação Médica Continuada , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Prognóstico , Piridinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Neoplasias Cutâneas/prevenção & controle , Tomografia de Coerência Óptica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
J Am Acad Dermatol ; 76(6): 1013-1024, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28522038

RESUMO

Botulinum toxin is a potentially deadly anaerobic bacterial toxin that acts by inhibiting release of acetylcholine at the neuromuscular junction, thereby inhibiting contraction of the exposed striated muscle. There are currently 4 botulinum toxin preparations approved by the US Food and Drug Administration (FDA): onabotulinumtoxin, abobotulinumtoxin, incobotulinumtoxin and rimabotulinumtoxin. While significant overlap exists, each product has unique properties and specifications, including dosing, diffusion, and storage. Extensive physician knowledge of facial anatomy, coupled with key differences of the various neurotoxin types, is essential for safe and successful treatments. The first article in this continuing medical education series reviews key characteristics of each neurotoxin, including new and upcoming agents, and provides an anatomic overview of the most commonly injected cosmetic sites.


Assuntos
Toxinas Botulínicas/administração & dosagem , Neurotoxinas/administração & dosagem , Administração Tópica , Toxinas Botulínicas/uso terapêutico , Técnicas Cosméticas , Dermatologia/métodos , Músculos Faciais/anatomia & histologia , Humanos , Injeções , Neurotoxinas/uso terapêutico
17.
J Am Acad Dermatol ; 76(6): 1027-1042, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28522039

RESUMO

The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.


Assuntos
Toxinas Botulínicas/administração & dosagem , Neurotoxinas/administração & dosagem , Administração Tópica , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/uso terapêutico , Técnicas Cosméticas , Dermatologia/métodos , Humanos , Injeções , Neurotoxinas/efeitos adversos , Neurotoxinas/uso terapêutico
18.
J Am Acad Dermatol ; 75(5): 855-870, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27745641

RESUMO

Hereditary photodermatoses are a spectrum of rare photosensitive disorders that are often caused by genetic deficiency or malfunction of various components of the DNA repair pathway. This results clinically in extreme photosensitivity, with many syndromes exhibiting an increased risk of cutaneous malignancies. This review will focus specifically on the syndromes with malignant potential, including xeroderma pigmentosum, Bloom syndrome, and Rothmund-Thomson syndrome. The typical phenotypic findings of each disorder will be examined and contrasted, including noncutaneous identifiers to aid in diagnosis. The management of these patients will also be discussed. At this time, the mainstay of therapy remains strict photoprotection; however, genetic therapies are under investigation.


Assuntos
Distúrbios no Reparo do DNA/genética , Síndromes Neoplásicas Hereditárias/genética , Transtornos de Fotossensibilidade/genética , Neoplasias Cutâneas/genética , Síndrome de Bloom/enzimologia , Síndrome de Bloom/epidemiologia , Síndrome de Bloom/genética , Síndrome de Bloom/terapia , Reparo do DNA , Enzimas Reparadoras do DNA/deficiência , Enzimas Reparadoras do DNA/genética , Distúrbios no Reparo do DNA/epidemiologia , Genes Recessivos , Predisposição Genética para Doença , Humanos , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/genética , Síndromes Neoplásicas Hereditárias/epidemiologia , Fenótipo , Antígeno Nuclear de Célula em Proliferação/genética , Síndrome de Rothmund-Thomson/enzimologia , Síndrome de Rothmund-Thomson/epidemiologia , Síndrome de Rothmund-Thomson/genética , Síndrome de Rothmund-Thomson/terapia , Neoplasias Cutâneas/etiologia , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos , Xeroderma Pigmentoso/enzimologia , Xeroderma Pigmentoso/epidemiologia , Xeroderma Pigmentoso/genética , Xeroderma Pigmentoso/terapia
19.
J Am Acad Dermatol ; 75(5): 873-882, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27745642

RESUMO

Photodermatoses associated with defective DNA repair are a group of photosensitive hereditary skin disorders. In this review, we focus on diseases and syndromes with defective nucleotide excision repair that are not accompanied by an increased risk of cutaneous malignancies despite having photosensitivity. Specifically, the gene mutations and transcription defects, epidemiology, and clinical features of Cockayne syndrome, cerebro-oculo-facial-skeletal syndrome, ultraviolet-sensitive syndrome, and trichothiodystrophy will be discussed. These conditions may also have other extracutaneous involvement affecting the neurologic system and growth and development. Rigorous photoprotection remains an important component of the management of these inherited DNA repair-deficiency photodermatoses.


Assuntos
Distúrbios no Reparo do DNA/genética , Transtornos de Fotossensibilidade/genética , Síndrome de Cockayne/epidemiologia , Síndrome de Cockayne/genética , Síndrome de Cockayne/terapia , Adutos de DNA , Distúrbios no Reparo do DNA/epidemiologia , Gerenciamento Clínico , Predisposição Genética para Doença , Humanos , Mutagênese , Fenótipo , RNA Polimerase II/metabolismo , Tolerância a Radiação/genética , Transcrição Genética , Síndromes de Tricotiodistrofia/epidemiologia , Síndromes de Tricotiodistrofia/genética , Síndromes de Tricotiodistrofia/terapia , Raios Ultravioleta/efeitos adversos , Xeroderma Pigmentoso/genética
20.
Semin Cutan Med Surg ; 34(1): 7-12, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25922951

RESUMO

Fractional ablative lasers have recently proven to be an effective modality for improving the clinical appearance and minimizing the morbidity associated with restrictivetype scars. Their tolerable safety profile on nonfacial sites and darker Fitzpatrick skin types provides an advantage over its fully ablative counterpart in treating facial rhytides, photodamaged skin, and acne scars. However, despite its increasing usage in clinical practice, the mechanism behind the observed clinical benefit remains complex and has yet to be fully elucidated. This paper reviews the work on the histological mechanism of action of ablative fractional lasers, and the molecular changes that occur posttreatment on restrictive scars, with an emphasis on mature burn and postsurgical scars. As the majority of research has been on the carbon dioxide laser, a natural focus on this wavelength is presented.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...