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Objective: To review the technique and outcomes of using dermal filler to camouflage forehead osteoma, providing a minimally invasive alternative to surgical excision. Background: Forehead osteoma, commonly known as a forehead bump or bone spur, can be a cosmetic concern. Surgical excision, while effective, carries risks of scarring and postoperative complications. An innovative approach using dermal filler offers a potential solution. Methods: A hyaluronic acid‐based filler is injected into the deep subcutaneous plane over the bony prominence using a cannula. The fanning technique ensures even distribution of the filler. The procedure's safety, patient selection, and communication between the injector and patient are emphasized to achieve optimal results. Results: The technique provides immediate aesthetic improvement with results that can last up to 12 months, depending on the filler used. While generally safe, potential complications include infections, swelling, asymmetry, and lumpiness. Proper technique, patient selection, and good communication between the injector and patient are critical to achieving optimal outcomes. Conclusion: Using dermal filler to camouflage forehead osteoma is a minimally invasive alternative to surgical excision, offering immediate and long‐lasting results with minimal downtime and fewer risks. Further studies are needed to refine the technique and optimize outcomes. [ABSTRACT FROM AUTHOR]

Standard treatment for lentigo maligna (LM) is surgical excision, yet insights into the frequency of and risk factors for incomplete excisions remain limited. The primary objectives were to assess the incomplete excision rate (IER) in primary LM and to explore potential risk factors for incomplete excisions. A retrospective analysis was conducted encompassing consecutive histopathologically confirmed LMs from 2014–2020. Descriptive statistics were used for LM characteristics and IER, while uni- and multivariate analyses were used for calculating risk factors. The study included 395 LMs with an IER of 16.7% (n = 66). Risk factors for higher incomplete excision rates included: head and neck lesions (p = 0.0014), clinical excision margins

Background/Aim. Despite all innovations in medicine, melanoma still has a rising incidence and high mortality and thus represents a significant challenge for the healthcare system. The pandemic of the coronavirus disease 2019 (COVID-19), spanning three years, redirected healthcare resources, suspended preventive programs, and strained the healthcare system, significantly impacting melanoma management. The aim of this study was to assess the influence of the COVID-19 pandemic on the treatment of melanoma patients. Methods. This retrospective study analyzed melanoma patients treated at a single tertiary care center over two distinct three-year periods: pre-COVID period (2017-2020) and the COVID-19 pandemic period (2020-2022). The following data were collected and compared: patient demographics, melanoma characteristics, time intervals from biopsy to surgery, and the share of thin and thick melanoma. Results. During the COVID-19 pandemic period, there was a 3 0% reduction in melanoma patients compared to the pre-COVID-19 period. The decline was most pronounced in 2020 when the state of emergency was introduced in the country. Thin melanoma percentage as a measurement of successful screening programs decreased significantly during the COVID-19 pandemic (11.57% vs. 24.01%), while median Breslow thickness remained stable. The distribution of different histological types was consistent across both periods. The average time from biopsy to surgery remained similar between the two periods, around 40 days. Conclusion. Despite challenges posed by the COVID-19 pandemic, melanoma remains a critical healthcare issue. This study emphasized the significance of prioritizing melanoma care in emergencies, ensuring patient identification and timely treatment in order to optimize survival and minimize treatment costs. [ABSTRACT FROM AUTHOR]

Merkel cell carcinoma (MCC) is often treated with surgery and postoperative radiation therapy (PORT). The optimal time to initiate PORT (Time-to-PORT [ttPORT]) is unknown. We assessed if delays in ttPORT were associated with inferior outcomes. Competing risk regression was used to evaluate associations between ttPORT and locoregional recurrence (LRR) for patients with stage I/II MCC in a prospective registry and adjust for covariates. Distant metastasis and death were competing risks. The cohort included 124 patients with median ttPORT of 41 days (range: 8-125 days). Median follow-up was 55 months. 17 (14%) patients experienced a LRR, 14 (82%) of which arose outside the radiation field. LRR at 5 years was increased for ttPORT >8 weeks vs ≤ 8 weeks, 28.0% vs 9.2%, P =.006. There was an increase in the cumulative incidence of MCC-specific death with increasing ttPORT (HR = 1.14 per 1-week increase, P =.016). The relatively low number of LRRs limited the extent of our multivariable analyses. Delay of PORT was associated with increased LRR, usually beyond the radiation field. This is consistent with the tendency of MCC to spread quickly via lymphatics. Initiation of PORT within 8 weeks was associated with improved locoregional control and MCC-specific survival. [ABSTRACT FROM AUTHOR]

To reconstruct a large anterior skin and cartilage defect of the upper half of the external ear in an elderly patient after cancer surgery, different techniques are possible, but single‐stage procedures should be advised. Combining flaps with reliable vascular supply, like the revolving door post‐auricular flap and a mastoid advancement flap, is an attractive single‐stage reconstructive option to rebuild a sturdy auricle. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) has a significant impact on patients' morbidity and aesthetic results. Objective: To identify risk factors for SSI in dermatologic surgery. Patients and Methods: This prospective, single‐centre, observational study was performed between August 2020 and May 2021. Patients that presented for dermatologic surgery were included and monitored for the occurrence of SSI. For statistical analysis, we used a mixed effects logistic regression model. Results: Overall, 767 patients with 1272 surgical wounds were included in the analysis. The incidence of SSI was 6.1%. Significant risk factors for wound infection were defect size over 10cm2 (OR 3.64, 95% confidence interval [CI] 1.80–7.35), surgery of cutaneous malignancy (OR 2.96, CI 1.41–6.24), postoperative bleeding (OR 4.63, CI 1.58–13.53), delayed defect closure by local skin flap (OR 2.67, CI 1.13–6.34) and localisation of surgery to the ear (OR 7.75, CI 2.07–28.99). Wound localisation in the lower extremities showed a trend towards significance (OR 3.16, CI 0.90–11.09). Patient‐related factors, such as gender, age, diabetes, or immunosuppression, did not show a statistically significant association with postoperative infection. Conclusion: Large defects, surgery of cutaneous malignancy, postoperative bleeding, and delayed flap closure increase the risk for SSI. High‐risk locations are the ears and lower extremities. [ABSTRACT FROM AUTHOR]

Reconstruction of a distal nasal defect is challenging due to poor skin mobility and the potential for nasal alar retraction. A trilobed flap can utilize more mobile proximal skin, increase the total rotational arc, and decrease the tension associated with flap transposition. However, the trilobed flap may not be ideal for distal nasal defects because each flap is designed using immobile skin, which may lead to flap immobility and free margin distortion. To overcome these problems, the base and tip of each flap were extended further from the pivot point than those of the conventional trilobed flap. Herein, we report the use of the modified trilobed flap to treat 15 consecutive cases of distal nasal defects that occurred from January 2013 to December 2019. The mean duration of follow‐up was 15.6 months. All flaps survived completely, and satisfactory aesthetic outcomes were achieved. No complications such as wound dehiscence, nasal asymmetry, or hypertrophic scarring were observed. The modified trilobed flap is a simple and reliable treatment for distal nasal defects. [ABSTRACT FROM AUTHOR]

Epidemiology studies on twins have demonstrated that about 58% of melanoma incidence is attributable to genetic variation.[9] Although 10% of individuals with melanoma will have an affected first degree relative,[10] only 10% of those cases will have a strong family history (ie, three or more cases related in the first or second degree).[[11]] Therefore, familial melanoma accounts for a relatively small portion of melanoma heritability. An Australian randomised control trial is currently underway to evaluate the clinical impact and cost effectiveness of using melanoma surveillance photography for those at high risk of melanoma, from a health system perspective, run through melanoma and skin cancer trials (ClinicalTrials.gov, NCT04385732). Keywords: Melanoma; Dermatologic surgical procedures; Skin neoplasms; Early detection of cancer; Dermatology; Surveillance EN Melanoma Dermatologic surgical procedures Skin neoplasms Early detection of cancer Dermatology Surveillance 426 431 6 05/17/23 20230515 NES 230515 Summary Australia has one of the highest rates of cutaneous melanoma in the world. Neoadjuvant therapy represents a new approach to melanoma management and involves administering systemic therapy for a short duration before surgery in patients with resectable stage III disease. [Extracted from the article]

The first publications regarding aesthetic treatments with polydioxanone threads (PDO) date to 2015 and were preceded by the establishment of this polymer use for surgical sutures as a safe, less inflammatory option that brings superior final aesthetic-functional results.The present article describes a series of five patients that received PDO thread lifting for abdominal periumbilical laxity.

Objective: Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery., Study Design: Randomized controlled trial., Setting: University-affiliated tertiary head and neck oncology center., Methods: Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho., Results: 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01)., Conclusion: EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use., Level of Evidence: Ib., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Longer life expectancy and increasing keratinocyte carcinoma incidence contribute to an increase in geriatric patients presenting for dermatologic surgery. Unique considerations accompany geriatric patients including goals of care, physiologic changes in medication metabolism, cognitive decline, and frailty. Limited geriatric training in dermatology residency has created a knowledge gap and dermatologic surgeons should be familiar with challenges facing older patients to provide interventions more congruent with goals and avoid overtreatment. Frailty assessments including the Geriatric 8 and Karnofsky Performance Scale are efficient tools to identify patients who are at risk for poor outcomes and complications. When frail patients are identified, goals of care discussions can be aided using structured palliative care frameworks including the 4Ms (what matters, medications, mentation, and mobility), REMAP (reframing, expecting emotion, mapping patient goals, aligning patient goals, and proposing a plan), and Serious Illness Conversation Guide. Most geriatric patients will tolerate standard of care treatments including invasive modalities like Mohs surgery and excision. However, for frail patients, nonstandard treatments including topicals, energy-based devices, and intralesional chemotherapy may be appropriate options to limit patient morbidity while offering reasonable disease control., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Pemphigus vegetans is considered a rare clinical variant of Pemphigus vulgaris and is associated with recurrent lesions that can evolve into extensive vegetative plaques that are difficult to resolve. Surgery may be an alternative in the complementary treatment of lesions resistant to classical therapy. There is a shortage of literature that shows the surgical technique and the postoperative results of the approach to pemphigus vegetans, making the communication of this case relevant. We present the case of a patient with the Hallopeau type of pemphigus vegetans successfully treated with tangential exeresis followed by secondary intention healing of large retroauricular projections.

Although onychopapilloma (OP) is a benign tumor of the nail bed and distal matrix, there is nevertheless a demand for treatment in some patients. Classical longitudinal excision (CLEx) with avulsion of the nail plate was the most suitable surgical procedure. However, there may be better ways to produce a pleasing esthetic effect. The aim of this study was to modify CLEx to render it more effective, reduce the rate of recurrence, and achieve better esthetic results. We identified 23 patients with OP in varying clinical manifestations that were treated with CLEx and modified CLEx with or without avulsion of the nail plate. With the procedure of modified CLEx without avulsion of the nail plate, there was no bleeding as a side effect and recovery was faster. The appearance of the nail was nearly unchanged and no patient complained about the cosmetic results. We modified CLEx to treat OP to improve the esthetic effect while maintaining surgical effectiveness. [ABSTRACT FROM AUTHOR]

Development of post-irradiation skin toxicity depends on dose, fractionation, technique, and type of radiotherapy, as well as concurrent treatment and comorbid conditions affecting the skin. Keywords: Dermatologic surgical procedures; Radiotherapy; Skin neoplasms EN Dermatologic surgical procedures Radiotherapy Skin neoplasms 12 14 3 06/30/23 20230701 NES 230701 Clinical record A 62-year-old man with a more than 30-year history of actinic keratoses and keratinocyte carcinomas presented for ongoing management. Post-irradiation skin toxicity limits management options for subsequent skin cancer in the previously irradiated field and increases the risk of surgical complications. [Extracted from the article]

Abstract Background: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging. Objectives: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour. Methods: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used. Results: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p< 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p< 0.05). Study limitations: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice. Conclusions: Primary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.

Background: Infection at the surgical site is a frequent complication of office skin procedures, such as electrodesiccation, laser therapy, superficial peelings, curettage, cryotherapy, and incisional or shave biopsies. The use of antibiotic therapy in their prevention is highly controversial due to the raising phenomenon of antibiotic resistance. Italy ranks fifth among high-income countries for resistance to antibiotics, with a rate seven times higher than Scandinavia. In order to raise awareness on this alarming issue, a survey was planned to disclose the misuse of topical antibiotics in the dermatologic practice., Methods: A specifically designed questionnaire aimed at analyzing the topical management of skin lesions following common office skin procedures was distributed nationwide to physicians engaged in the management of small surgical wounds and then collected for statistical data processing and evaluation., Results: A total of 1500 forms were distributed nationwide, 1340 (89.3%) of which were completed by dermatologists. Analysis of the collected data showed that more than 70% of the respondents always use topical antibiotics in the attempt of preventing possible post-procedure superinfections., Conclusions: This survey confirms not only an antibiotic misuse by a large part of the respondents, but above all the widespread erroneous belief that such therapeutic approach can be useful in averting the risk of infections postoperatively. These findings may obviously explain the spread of antibiotic resistance in Italy and confirm that there is an absolute need to raise awareness among dermatologists about the damage caused by the misuse of antibiotics in the management of small wounds.

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

This CME series reviews updated Delphi consensus surface anatomy terminology through the lens of common medical and procedural dermatology scenarios, helping to underscore high-yield points that can be readily integrated into clinical practice to support patient care. Part I of the series reviewed the current state of standardized surface anatomy, provided an illustrative review of consensus terminology, highlighted prominent landmarks that can aid in critical diagnoses, and related the importance of precise terminology to principles of medical management. Part II will utilize consensus terminology to heighten recognition of key landmarks in procedural dermatology to support optimal functional and aesthetic outcomes., Competing Interests: Conflicts of interest Dr Grant-Kels serves as Deputy Editor of JAAD and is Chief Medical Officer and member of the Board of VeraDermics, Inc; Consultant and Advisory Board member for DermaSensor, Inc. She has no relevant conflict of interest in relation to the content of this CME. Dr Feng for full disclosure of all financial interests: Consultant, Soliton Inc; Consultant, Cytrellis Biosystems. He has no relevant conflict of interest in relation to the content of this CME. Dr Sloan for full disclosure of all financial interests: Editor, JAAD Case Reports; Consultant, Medscape. He has no relevant conflict of interest in relation to the content of this CME. Drs Gronbeck, Beltrami, Jain, Hargis, and Cook have no conflicts of interest to declare., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

The reconstruction of nasal defects secondary to non-melanoma skin cancer represents a surgical challenge, especially in the nasal tip, due to its limited local laxity and possible asymmetries.There are multiple techniques to perform this closure, but most are flaps from distant locations that can lead to less aesthetic results. We present two cases of basal cell carcinoma on the nasal tip, where reconstruction with the east-west advancement flap was performed after tumor excision, with a modification of the flap in one of the patients, obtaining a good structural and aesthetic result.

Common warts (verrucae vulgares) are the most common complaint in routine dermatological practice. Warts can be painful on pressure and are often an aesthetic problem, but they are not a major threat to the person’s general health. Treatment options are symptomatic and do not eradicate the causative agent. Dermatological surgery procedures such as cryotherapy, electrocauterization and excochleation can be painful, with common recurrences. These are the most important reasons for revival of the treatment procedures and remedies based on traditional medicine. Traditional medicine is still commonly practiced as a form of self-healing. This paper presents the most commonly used wart remedies of plant, animal and mineral origin, along with various magic practices. We emphasize that this paper is written from the viewpoint of physicians, practitioners of dermatology, not as a study in the history or culture. The main objective of the study was to explore various substances and methods people use as home remedies for warts. We performed a case study survey among the general population by interviewing 147 adult participants using a simple preliminary questionnaire inquiring about preferred treatment and knowledge about common warts.

Healthcare is a potent emitter of greenhouse gases amounting up to 7% of total estimated greenhouse gas emissions (CO2e) for Australia. Australia has one of the highest incidences of skin cancer in the world but there is a paucity of data on the ecological impact of skin cancer excision/dermatologic surgery. The authors reviewed the various impact inventories in order to perform a life cycle assessment of skin cancer excision. A total of 8641 tonnes of estimated CO2e are produced from dermatologic surgery annually in Australia (6751 tonnes from private clinical rooms and 1890 tonnes from hospitals) and the waste generated contributes significantly to terrestrial ecotoxicity and acidification of land and water. Various means can be carried out to reduce this impact, ranging from simple behavioural changes to larger, policy changes. [ABSTRACT FROM AUTHOR]

Objective: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds., Method: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure., Results: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm 2 . Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain., Conclusion: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease., Declaration of Interest: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

Background: With the increasing demand for surgical procedures in dermatology, resident education in surgical dermatology has become important for delivering high-quality treatment. However, it remains unclear if a sufficient number of residency programs with quality standards exist, as there has been little research on this subject in South Korea., Objective: To identify the status of surgical dermatology education among residents and assess dermatologists' perceptions of the subject., Methods: A 35-question survey was developed and distributed to all resident training hospitals and local clinics listed by the Korean Society of Dermatologic Surgery. Only third- and fourth-year residents were included and board-certified specialists from training hospitals and local clinics responded to the surveys., Results: Survey participants included 88 residents and 120 specialists of whom one-quarter of the residents attended regular monthly educational sessions. Most residents (93%) participated in cosmetic procedures, and many performed laser therapy. However, the opportunity for toxin or filler injection was rare, with only 12% of the residents having experience with filler injections. In response, 49% of residents and 32% of specialists said that more cosmetic training was required, whereas 28% of residents and 50% of specialists said that more training for both cosmetic and conventional surgeries was necessary., Conclusion: The survey demonstrated a need for more training programs in surgical dermatology during residency and a perception gap between residents and specialists. Therefore, developing educational residency programs that focus on basic dermatologic surgery principles and their applications in cosmetic procedures is essential., Competing Interests: The authors have nothing to disclose., (© 2024 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Competing Interests: Conflicts of interest None disclosed.

Objective: Family physicians (FPs) in Canada routinely perform in-office cutaneous surgery. There is strong evidence to support a moist wound healing environment, resulting in faster healing times and improved cosmesis. However, the wound care practices of FPs have not been previously studied. We aimed to examine the postoperative wound care practices of FPs after in-office cutaneous surgery., Method: An online survey was distributed to Canadian FPs to determine post-surgical wound care practices. The survey examined moist versus dry wound healing and the reasons for these recommendations were explored. Additional wound care practices were also studied. Appropriate statistical analyses were undertaken., Results: A total of 573 (91.5%) FPs completed the survey. Just under half (49.2%) of FPs recommended moist wound healing to their patients, while the remaining respondents (50.8%) recommended dry wound healing. The most endorsed reason for both moist and dry wound care recommendations was prior training (63.1% and 65.3%, respectively). Most physicians (57.2%) recommended the use of a cream or ointment postoperatively. While there appeared to be consensus on recommending sun avoidance after cutaneous surgery (77.7%), additional wound care practices varied, including: the use of dressings; cleansing practices; smoking cessation; reduction in physical activity; photoprotection; water exposure; and scar treatment/cosmetic use., Conclusion: Almost half of FPs in Canada responding to the survey did not recommend moist wound healing despite strong evidence to support this practice. We also noted a diverse range of postoperative wound care practices after in-office cutaneous surgery. Therefore, these results highlight a critical need for consistent wound care recommendations following cutaneous surgery for FPs in Canada.

Competing Interests: Conflicts of interest Author Kim is a paid consultant at Verve Therapeutics and SeQure Dx, unrelated to this research. Author Kim’s interests were reviewed and are managed by Mass General Brigham in accordance with their conflict-of-interest policies. Author Shiau, Author Young, Author Baker, and Dr Bae have no conflicts of interest to declare.

At the 2024 American Academy of Dermatology annual meeting in San Diego, California, attendees explored the latest advancements in clinical and surgical dermatology and physician well-being. Key takeaways for residents included enhancing surgical experiences, adapting ergonomic practices, and prioritizing both patient and physician well-being. The meeting underscored the importance of combining technical proficiency with compassionate patient care and continuous learning in dermatology.

Competing Interests: Conflicts of interest None disclosed.

Introduction: Basal cell carcinomas are mostly treated surgically, mostly by surgery with postoperative histopathologic margin evaluation (“conventional surgery”), but large long-term data regarding recurrence by completeness of excisions is limited. Methods: Retrospective cohort study of basal cell carcinomas treated by conventional surgery at different medical specialties in a large tertiary centre, between 2008 and 2014. Survival analysis with a Cox proportional-hazards was performed, stratified by completeness of excision (complete excision/incomplete excision) and adjusted to several potentially confounding covariates. Results: A total of 2876 basal cell carcinomas were identified, of which 2306 (2100 primary, 206 recurrent) were considered eligible for analysis. During the 5-years of follow-up, there were 80 (4%) recurrences among 1980 complete excisions (16/1000 cases-year) and 83 (23.9%) recurrences among 348 incomplete excisions (100/1000 cases-year). Survival analysis was performed with multivariable adjustment. In the final adjusted model, we identified an association between relapse and re-intervention on recurrent tumors [adjusted Hazard Ratio (HR) 2.20 (95% Confidence interval (IC), 1.26-3.84), p=0.006], a wrong preoperative clinical diagnosis/surgery devoid of preoperative biopsy [adjusted HR 2.75 (95% CI, 1.68-4.5), p

Abstract is missing (Short communication)

Background Skin grafting is a commonly performed operation in plastic and reconstructive surgery. The tie-over dressing is an effective technique to secure the grafted skin by delivering persistent downward pressure. However, if an additional dressing is required due to incomplete graft healing, the process of re-implementing the tie-over dressing may be frustrating for both patients and surgeons. Therefore, we introduce the double tie-over dressing, which readily allows for an additional tie-over dressing after the first dressing, and we present a comparison of its effectiveness with that of the simpler bolster dressing.

Objective: Rare disease Background: Primary cutaneous cribriform apocrine carcinoma is a histopathological variant of apocrine adenocarcinoma (AA) of the skin, which is a rare, low-grade malignancy. While low-grade in nature, cutaneous cribriform apocrine carcinoma can mimic a metastatic manifestation of a visceral or breast malignancy, and is important to distinguish as primary through clinical history, histology, and immunohistochemical studies, if indicated. Case Report: A 56-year-old man with past medical history remarkable for basal cell carcinoma and hypertension presented with a 12-month history of a slowly enlarging, asymptomatic nodule on his right anterior medial lower leg. Physical examination revealed a 12×9 mm indurated and erythematous nodule with no other masses or lymphadenopathy detected. Histology demonstrated a well-circumscribed proliferation of epithelial cells in fibrosing granulation tissue-like stroma having the delicate cross-bridging of a cribriform carcinoma. Immunohistochemical studies were significant for positive high-molecular-weight keratin and cytokeratin, focal positivity for carcinoembryonic antigen (CEA) and S100, with negative results for prostate-specific antigen (PSA) and cytokeratin 20. Conclusions: Clinicians should maintain a high index of suspicion for metastasis when cutaneous cribriform apocrine carcinoma is diagnosed. The use of clinical history and appropriate laboratory workup with parameters such as age and sex can guide workup. After a wider excision with clear margins, follow-up for evidence of recurrence or metastasis is recommended, as the limited number of reported cases suggests that this assumption cannot be made with certainty. [ABSTRACT FROM AUTHOR]

Abstract: Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.

Video recording surgical procedures is one of the most valuable tools for teaching and self-assessment in Dermatologic Surgery. A number of recording systems have been described in the literature. Nevertheless, they’re usually expensive (~500€) and time-consuming to prepare, the latter being a major disadvantage for a busy surgical speciality such as Dermatology. The authors describe a simple and inexpensive technique for surgical video capture in Dermatologic Surgery. For this setup, the surgeon needs only a smartphone with a camera (which is nowadays ubiquitous), a bike phone holder (10€ to 30€), an adjustable intravenous pole and, optionally, a powerbank. With the patient in position for the surgical intervention (seated or lying on his back on the surgical table, depending on the procedure), the bike phone holder should be attached to the vertically adjustable intravenous pole. The smartphone must be then set on the bike phone holder, with its “recording mode” already started. Optionally, a powerbank can also be attached to the intravenous pole to provide extra charge for longer procedures. The height of the intravenous pole, as well as its position and distance to the surgical table, should be adjusted accordingly before the intervention, in order to provide the best recording definition. The authors describe a simple, easy to setup, inexpensive system to record videos in Dermatologic Surgery.

Aim: Since use of major cutaneous surgeries/reconstructions among patients with cutaneous squamous cell carcinoma (CSCC) is not well described, we sought to quantify major cutaneous surgeries/reconstructions among patients with CSCC who were newly diagnosed and for those treated with systemic therapy, stratified by immune status. Methods: We used the Optum ® Clinformatics ® Data Mart database (2013-2020) and Kaplan-Meier estimators to assess risk of surgeries/reconstructions. Results: 450,803 patients were identified with an incident CSCC diagnosis, including 4111 patients with CSCC who initiated systemic therapy. The respective 7-year risks of major cutaneous surgeries/reconstructions were 10.9% (95% CI: 10.7-11.0) and 21.8% (95% CI: 17.6-25.8). Overall risk of major cutaneous surgeries/reconstructions was higher in patients who were immunocompromised than those who were immunocompetent. Conclusion: Approximately one in nine patients with CSCC will undergo ≥1 major cutaneous surgeries/reconstructions within 7 years of diagnosis; the risk increases in patients who initiate systemic therapy and among those who are immunocompromised.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest The authors declare no conflicts of interest.

Background: Cervical necrotizing fasciitis (CNF) is a rare, aggressive form of deep neck space infection with significant morbidity and mortality rates. Serial surgical debridement acts as the cornerstone of CNF treatment; however, it often results in defects requiring complex reconstructions., Case Summary: We report two cases in which the keystone flap (KF) was used for CNF defect coverage: Case 1, an 85-year-old patient with CNF in the anterior neck, and Case 2, a 54-year-old patient with CNF in the posterior neck. Both patients received empirical intravenous antibiotic therapy and underwent serial debridement, enabling adequate wound preparation and stabilization. The final defect size measured 5.5 cm × 12 cm in Case 1 and 6 cm × 11 cm in Case 2. For defect coverage, we employed an 8 cm × 19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm × 18 cm type II KF based on perforators from the transverse cervical artery in Case 2. Both flaps showed complete survival. No postoperative complications occurred in both cases, and favorable outcomes were observed at 7- and 6-month follow-ups in case 1 and 2, respectively., Conclusion: We effectively treated CNF-associated defects using the KF technique; KF is viable for covering CNF defects in carefully selected cases., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.