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Background: For basal cell carcinoma (BCC), only few controlled data have been published so far, which directly compare micrographically controlled surgery with conventional serial section histology. In addition to Mohs surgery, which uses cryostat sections, also three‐dimensional histology (3D‐histology), based on paraffin sections, is available to ensure complete control of the margins and basic sections. Objectives: To investigate the rate of local recurrence (LR) as well as the number of required re‐excisions for basal cell carcinomas with serial section histology vs. 3D‐histology. Methods: We compared serial sections histology with 3D‐histology in a prospective, randomized, controlled blinded trial and analysed 569 BCC of all subtypes up to 30 mm diameter, 287 BCC in the 3D group and 282 BCC in the serial section group. Excisions were performed with adapted primary resection margin according to location and size of the tumour. Surgeons were blinded at the time of surgery as they did not know which histological method will be used. Both methods used paraffin sections. Results: Both groups did not differ regarding patients age, tumour location, tumour diameter, tumour subtypes or primary resection margins. In the serial section group, re‐excisions were required in 21%; 24 tumours (8.4%) recurred after a median of 2.2 years. In the 3D‐histology group, re‐excisions were required in 39%; 10 tumours recurred (3.5%) after a median of 2.8 years. The recurrence rates differed significantly between both groups. Mean follow‐up was 4.5 years. Conclusions: 3D‐histology is a useful technique to detect tumour outgrowths at the excision margins, but required a high rate of re‐excisions. 3D‐histology was associated with a significantly lower LR rate than serial section histology. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with increasing incidence. Severe disease stages are seen as a therapeutic challenge and pose the threat of significant restrictions on patients' life quality. Objectives: We evaluated postoperative outcome after wide local excision for HS as well as postoperative course, cosmetic results, disease recurrence and quality of life. Methods: All patients receiving radical surgical treatment for HS (Hurley III) between 2006 and 2015 were identified and received a letter‐based survey. They were asked about postoperative course, cosmetic results, recurrence and life quality. Results: Two hundred and fifty‐five patients (103 men, 152 women) answered the questionnaire. Ninety‐five percentage of patients reported disease‐specific restrictions on everyday life. Seventy‐five percentage of patients did not experience any postoperative adverse events; however, postoperative pain with need for analgesics was reported in 38%. The majority of patients (80%) were very satisfied or satisfied after surgery, and 85% of patients would recommend surgery to other affected persons. Limitations: The retrospective design of the study was a limitation. Conclusions: The well‐known negative psychological and social effects are a relevant part of HS and emphasize the importance of immediate therapy. As long‐lasting local disease‐control can be achieved, surgery should be considered as first‐line therapy. [ABSTRACT FROM AUTHOR]

Background Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia, many other local anaesthetics do not bare any major risks for infants. Objective In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia ( TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey. Methods Ninety-two infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%). Results Infants were mainly operated for removal of a melanocytic naevus ( n = 54), followed by haemangioma ( n = 23), naevus sebaceous ( n = 6) and other lesions ( n = 9). The lesions were located on the scalp or neck ( n = 31), on the extremities ( n = 31), on the trunk ( n = 21), in the face ( n = 6) or on the buttocks ( n = 3). The median size of excision was 509 mm2 (range: 16 mm2; 3600 mm2). Primary defect closure was performed by intracutaneous ( n = 68) or extracutaneous ( n = 24) suture techniques. No side-effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound-healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%). Conclusions The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side-effects and the benefit of prolonged postoperative analgesia. [ABSTRACT FROM AUTHOR]

Background To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin. Objective To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy. Methods Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI ( DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions. Results Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa ( HS/ AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%). Conclusion Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range. [ABSTRACT FROM AUTHOR]

Complete three-dimensional histology of excised skin tumour margins has a long tradition and, unfortunately, a multitude of names as well. Mohs, who introduced it, called it ‘microscopically controlled surgery’. Others have described it as ‘micrographic surgery’, ‘Mohs’ micrographic surgery’, or simply ‘Mohs’ surgery’. Semantic confusion became truly rampant when variant forms, each useful in its own way for detecting subclinical outgrowths of malignant skin tumours, were later introduced under such names as histographic surgery, systematic histologic control of the tumour bed, histological control of excised tissue margins, the square procedure, the perimeter technique, etc. All of these methods are basically identical in concept. All involve complete, three-dimensional histological visualization and evaluation of excision margins. Their common goal is to detect unseen tumour outgrowths. For greater clarity, the authors of this paper recommend general adoption of ‘3D histology’ as a collective designation for all the above methods. As an added advantage, 3D histology can also be used in other medical disciplines to confirm true R0 resection of, for example, breast cancer or intestinal cancer. [ABSTRACT FROM AUTHOR]

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Local anaesthetics are an integral part of modern surgery since diluted solutions of cocaine were described nearly 150 years before. Tumescent local anaesthesia (TLA) utilizes a mixture of highly diluted local anaesthetics in a carrier solution and is used for skin biopsies, excision of skin tumours and vein surgery.[1] Also, wide excisions for hidradenitis suppurativa, serial excisions of giant congenital nevi (Fig.), Rhinophyma surgery or lymph node dissections are feasible using TLA.[[2]]. [Extracted from the article]

Background: Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive., Objectives: The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia., Methods: Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020., Results: In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1-102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old-old group (≥75-84 years) included 491 patients and the oldest-old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow-up period was 4.9 days (range 1-28 days). 92.0% (719/782) suffered from pre-existing comorbidities. Systemic complications occurred in 10.2% (80/782; old-olds: 8.6%, oldest-olds: 13.1%). Hypertensive crisis (>180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life-threatening complications directly related to tumescent local anaesthesia were found., Conclusions: Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre-existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high-tumescent concentrations or volume quantities., (© 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)