Nasalis-Based V to Y Flap Versus the Bilobed Flap.

BACKGROUND: Reconstructing defects on the nose can be challenging. The bilobed transposition flap and the nasalis-based V to Y (NBVY) flaps can be excellent repair options, each with their own advantages and disadvantages. OBJECTIVE: To compare bilobed and NBVY flap scar appearances, postoperative complications, scar revision rates, flap sizes, and relative costs. MATERIALS AND METHODS: We reviewed 95 cases of Mohs surgery defects on the nose repaired with either a bilobed or a NBVY flap from 2010 to 2018 at our institution. Eleven reviewers judged postoperative scar images using a modified visual analog scale. RESULTS: There were no significant differences in reviewer-rated scar appearances, complication rates, or revision rates between bilobed and NBVY flaps. The NBVY flaps were 50% smaller than bilobed flaps, with significantly lower CPT billing codes. The NBVY flaps yielded better scar appearance scores compared with bilobed flaps on highly sebaceous noses. CONCLUSION: The NBVY and bilobed flaps demonstrated similar scar appearance outcomes, but the NBVY flap has several advantages. Compared with the bilobed flap, the NBVY flap is smaller, less expensive, and may yield better cosmetic outcomes in patients with highly sebaceous noses.

Immune Checkpoint Markers in Superficial Angiosarcomas: PD-L1, PD-1, CD8, LAG-3, and Tumor-Infiltrating Lymphocytes.

ABSTRACT: Cutaneous angiosarcomas may express programmed death ligand-1 (PD-L1) and PD-L1 expression, and the presence of tumor-infiltrating lymphocytes (TILs) correlates with outcome. These observations provide a basis for PD-1/PD-L1 inhibitor therapy. Lymphocyte activation gene 3 (LAG-3) is an inhibitory receptor that interacts with the PD-L1 axis and is considered to be a marker of immune exhaustion. The presence of LAG-3-positive lymphocytes in cutaneous angiosarcoma has not been established. We reviewed 10 cases of treatment naive angiosarcoma of skin and superficial soft tissue and assessed for PD-L1 (ZR3) expression, presence of TILs, and expression of CD8, PD1, and LAG-3 by tumor-associated inflammatory cells by immunohistochemistry. All 10 angiosarcomas were positive for PD-L1: 7 with high expression and 3 with low expression. TILs were present in all tumors: brisk in 7 and nonbrisk in 3. CD8 lymphocytes were present in all tumors with a range of 212-1274 cells per square millimeter (mean 557 CD8 cells/mm2). LAG-3-positive lymphocytes were present in 9 of 10 angiosarcomas with a range of 0-728 cells/mm2 (mean 146 LAG-3 cells cells/mm2). The ratio of LAG-3 lymphocytes to CD8 lymphocytes was 0%-59% (mean 27%). The PD1 cell counts were intermediate between CD8 and LAG3 counts. Cutaneous angiosarcomas frequently express PD-L1, have prominent numbers of CD8 positive, and have smaller numbers of LAG-3-positive and PD-1-positive TILs. Our findings provide further evidence of PD-L1 expression in cutaneous angiosarcoma and the promise for immune checkpoint inhibitor therapy.

Buzzing away the pain: Using an electric toothbrush for vibration anesthesia during painful procedures.

Many dermatologic procedures are painful and traumatic, for both pediatric patients and providers alike. Vibration anesthesia has recently been discussed as an effective method for reducing pain associated with injections, but some vibration machines can be cost prohibitive for providers. We describe how to employ an electric toothbrush as an inexpensive and effective option to provide vibration anesthesia during painful pediatric procedures.