Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications.

BACKGROUND: Few prospective studies have evaluated the safety of dermatologic surgery. OBJECTIVE: We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. METHODS: Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. RESULTS: Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. LIMITATIONS: The study was limited to one academic dermatology practice. CONCLUSION: The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events.

Verrucous carcinoma of the scalp.

Verrucous carcinoma is a distinctive form of low-grade squamous cell carcinoma. It typically involves the oral cavity, larynx, esophagus, and skin. Cutaneous lesions typically arise in the genitocrural area and plantar surface of the foot, with rare case reports of verrucous carcinoma arising elsewhere on the body. Human papillomaviruses, predominately types 6 and 11, have been associated with some case reports. We present a case of verrucous carcinoma arising on the scalp with negative human papillomavirus testing in a relatively young patient.

Keratoacanthoma developing in sites of previous trauma: a report of two cases and review of the literature.

Keratoacanthoma is a common benign squamous neoplasm that only rarely progresses to metastatic carcinoma. The cause of keratoacanthoma is unclear; however, suspected causes include ultraviolet light, genetic factors, immunosuppression, chemical carcinogens, viruses, and trauma. Keratoacanthomas have been reported only rarely to arise in sites of previous trauma. We report 2 cases of keratoacanthomas arising shortly after episodes of cutaneous trauma and provide a review of the literature of similar cases previously reported. It is likely that an interaction exists between a variety of factors in the development of keratoacanthomas; however, it appears that a predilection exists for these lesions to arise in trauma sites.