Multidisciplinary long-term care and modern surgical treatment of congenital melanocytic nevi - recommendations by the CMN surgery network.

In recent years, our knowledge of congenital melanocytic nevi (CMN) has greatly expanded. This has led to a paradigm shift. The present article represents a commentary by an interdisciplinary group of physicians from German-speaking countries with extensive experience in long-term care and surgical treatment of children and adults with CMN (CMN surgery network, "Netzwerk Nävuschirurgie", NNC). The authors address aspects such as the indication for treatment as well as treatment planning and implementation under these new premises. Adequate counseling of parents on conservative and/or surgical management requires an interdisciplinary exchange among physicians and individualized planning of the intervention, which frequently involves a multi-stage procedure. Today, the long-term aesthetic outcome is at the center of any therapeutic endeavor, whereas melanoma prevention plays only a minor role. The premise of "removal at any cost" no longer holds. Potential treatment-related adverse effects (hospitalization, wound healing disorders, and others) must be carefully weighed against the prospects of a beneficial outcome. In this context, the use of dermabrasion in particular must be critically evaluated. At a meeting of the NNC in September 2018, its members agreed on a consensus-based position on dermabrasion, stating that the procedure frequently leads to impaired wound healing and cosmetically unfavorable or hypertrophic scarring. Moreover, dermabrasion is considered to be commonly associated with considerable repigmentation that usually occurs a number of years after the procedure. In addition, the NNC members saw no benefit in terms of melanoma prevention. In the future, physicians should therefore thoroughly caution about the potential risks and often limited cosmetic benefits of dermabrasion.

A retrospective systematic data review on the use of a polihexanide-containing product on burns in children.

BACKGROUND: It is current practice for physicians to use the Prontosan® range of products in children based on their personal clinical experience, despite the lack of safety data in this population. This retrospective data review was designed to obtain information on the safety profile of the Prontosan® range of products in children in routine clinical practice. METHODS: Data from newborns, infants and children with burns treated with the Prontosan® range were collected retrospectively from patient medical records. RESULTS: The majority of children treated for burns (80.1%) were under the age of four. More boys than girls were subject to burn injury (58.1% vs. 41.9%). The majority of burns (74.7%) were partial thickness burn (IIa and IIb). Safety was analysed based on the adverse events/reactions, infections and interactions/symptoms related to Prontosan® reported in the CRFs. AEs were reported in five children after the use of Prontosan® products: itching (3 cases), rash (1 case) and hypergranulating tissue (1 case). No event was severe and all events resolved favourably with good healing results. In addition, 11 patients developed clinical signs of infection during treatment (mainly Staphylococcus aureus). CONCLUSIONS: The Prontosan® range of products is demonstrated as safe and tolerable for use in children as part of burn treatment. Inclusion of this range of products in the protocol of paediatric burn care allows a good healing process starting with appropriate wound cleansing and maintaining moist wound environment.

Vascular congenital dermatofibrosarcoma protuberans: a new histological variant of dermatofibrosarcoma protuberans.

We describe a case of congenital dermatofibrosarcoma protuberans (DFSP) that masqueraded as a vascular tumor both clinically and histologically. Based on the infiltrative growth pattern, presence of capillary-sized vessels, and spindle cell areas with slit-like vascular spaces and numerous thin-walled vessels at the periphery of the tumor, a kaposiform hemangioendothelioma was initially diagnosed. Strong diffuse CD34 positivity and the extension into the subcutaneous fat with a sieve-like effect prompted the fluorescence in situ hybridization analysis, which demonstrated a reciprocal t(17;22) translocation. According to our knowledge, this is the first report of a vascular histological variant of DFSP. This unique variant represents a potential pitfall for dermatopathologists and underlines the importance of cytogenetic diagnostics in unusual cases of DFSP.

[Hand burn injuries in children]. / Thermische Handverletzungen im Kindesalter.

A consistently high proportion of thermal injuries in children are to the hand, and scalds and contact burns are the main causes. While most thermal Injuries to the hand in children can be treated conservatively, deep burns can result in scary contractures and syndactylies that cause functional impairments to the hand. Therefore, thermal injuries to the hand in children should be treated in a specialised centre, thus ensuring a differentiated approach with respect to the localisation and extent of the thermal injury.Besides acute therapy, regular follow-up consultations - including splint and compression treatments -, physiotherapy, ergotherapy and, if necessary, corrective surgical measures are of immense importance. Only adherence to this treatment regime can guarantee optimal functional and aesthetic results and minimise daily restrictions for the young patients. The purpose of this article is to illustrate/outline the essential aspects of this treatment of thermal injuries to the infantile hand.