Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets.

BACKGROUND: Bleeding is an unavoidable risk of dermatologic surgery. The risk may be higher in patients taking agents that affect hemostasis. OBJECTIVE: The aim of this study was to provide an updated review of current anticoagulant and antiplatelet therapy available in the market and their associated risk of bleeding complications in cutaneous surgery. MATERIALS AND METHODS: A review of PubMed and MEDLINE was performed to review the English-language medical literature. RESULTS: Many anticoagulant and antiplatelet therapies exist. Several studies recommend the continued use of antiplatelet and anticoagulant medications in the perioperative period. Combination regimens and novel oral anticoagulants may be associated with an increased risk of bleeding. CONCLUSION: An updated understanding of antiplatelet and anticoagulant agents is critical for the surgeon. Current evidence does not support the discontinuation of antiplatelet and anticoagulant agents in the perioperative period under most circumstances. However, relevant data on novel oral anticoagulant agents are still sparse, suggesting that a precautionary approach is warranted.

Update and Review of Bleeding Considerations in Dermatologic Surgery: Hemostatic Techniques and Treatment Strategies for Bleeding Complications.

BACKGROUND: There are many intraoperative and postoperative techniques to aid hemostasis in dermatologic procedures. An updated understanding is critical for the surgeon. OBJECTIVE: To provide an updated review of methods for hemostasis and therapies for postprocedural purpura and ecchymosis applicable to dermatology. MATERIALS AND METHODS: A review of Ovid MEDLINE was performed to review the English-language medical literature of hemostatic options and their use in cutaneous surgery. All available publication years were included from 1946 to present. RESULTS: A comprehensive and current list of hemostatic options used in the intraoperative and postoperative period is provided along with traditional and emerging therapies for postprocedural purpura and ecchymosis. CONCLUSION: A myriad of options exist for minimizing and treating bleeding complications. The appropriate use and updated knowledge of hemostatic options is provided.

What's New in Photoprotection: A Review of New Concepts and Controversies.

Cumulative ultraviolet exposure plays a critical role in photodamage. Recent advancements in photomedicine have resulted in a more thorough understanding of these mechanisms. Despite this, the adoption of routine sun protective practices is commonly not undertaken regularly by a large proportion of the public. Various obstacles exist that contribute to the public's nonadherence to these practices. Sunscreens, which are an integral component in all photoprotective regimens, have been questioned recently in terms of their safety. The aim of this article is to provide an overview of new concepts in photoprotection and also address current controversies pertaining to sunscreens.

Reflectance confocal microscopy as a first-line diagnostic technique for mycosis fungoides.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma and is a diagnostic challenge in its early stages. It often can be misdiagnosed as chronic contact dermatitis, atopic dermatitis, psoriasis, or other common dermatoses. Histologic diagnosis remains the gold standard for MF; however, in many cases repeat biopsies may be needed over time, especially in early patch stages of MF. Reflectance confocal microscopy (RCM) is a quick and noninvasive diagnostic tool that may be useful to determine an appropriate area to biopsy. We present the case of a 60-year-old man with plaque and tumor lesions clinically suspicious for MF that had originally been misdiagnosed as psoriasis. Reflectance confocal microscopy was used to evaluate for findings specific to MF and to select an appropriate biopsy site. The features noted on RCM were consistent with MF, and subsequent biopsy revealed tumor-stage disease. This article describes a unique case in which RCM was used for initial primary diagnosis of tumor-stage MF in a clinical setting. As in prior studies, our evaluation failed to identify unique RCM features specific to tumor-stage MF when compared to plaque- or patch-stage disease. Nonetheless, RCM may be useful in providing a quick noninvasive diagnosis when the clinical presentation of MF is ambiguous, especially in early lesions.