Dermatologic Surgery

A New Hydrocellular Wound Dressing Used After Dermatologic Surgery: Dermatologic Surgeons' and Patients' Perceptions BACKGROUND Optimum postsurgical healing requires appropriate dressing use. OBJECTIVE This study assessed effectiveness and tolerance of a novel, hydrocellular dressing in dermatologic surgery using validated tools, describing its use in clinical practice, and comparing surgeons' and patients' perceptions of scar evolution. METHODS This study examined direct suture closures of surgical excisions of small- to medium-sized skin lesions on the extremities or trunk. Dressings were changed 3 times/week. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS) were used to assess outcomes. Data were collected at Day 0 (D0, FLC application), Day 15 to 21 (D15–21, suture removal), and Day 45 (D45) postprocedure by the surgeon and the patient. RESULTS There were 128 patients (mean age: 55.1 years, 56.1% women). Mean length and width of the excisions were 3.5 × 1.65 cm and the most common FLC applied was 8 × 8 cm (67.7%). Most scars had normal pigmentation, pliability, and height at D15 to 21 and D45, as reported by patients and surgeons using VSS. Patient scores on visual analog scale (VAS) were high (>8/10) and global satisfaction measured by POSAS was generally high (>7/10 at D15–21; >8/10 at D45). CONCLUSION These dressings were effective in managing surgical excisions, as assessed by VSS, VAS, and POSAS. Further controlled studies investigating various dressings in wound repair are needed. Address correspondence and reprint requests to: Vincent Orlandini, MD, Bordeaux University Hospital, Hospital Saint-André, 1 Rue Jean Burguet, Bordeaux 33000, or e-mail: vincento.derm@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). Supported by ConvaTec. All authors participating in this study fulfilled authorship requirement. The authors have indicated no significant interest with commercial supporters. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Squamous Cell Carcinoma of the Hand: A Retrospective Study in Immunosuppressed and Immunocompetent Individuals BACKGROUND Cutaneous squamous cell carcinoma (SCC) of the hand presents a treatment challenge because of the anatomical complexity of this location. Immunosuppressed patients are disproportionately affected by cutaneous SCC. Existing data on SCC of the hand are primarily presented in the orthopedic literature, and may thus be affected by referral bias. OBJECTIVE Characterization of epidemiology and treatment outcomes for hand versus nonhand cutaneous SCC in immunosuppressed versus immunocompetent patients, across all clinical departments. MATERIALS AND METHODS Single-institution retrospective cohort study of cutaneous SCC evaluated over 3 years and hand SCC over an additional 5 years. RESULTS A cohort of 522 hand SCC cases (1,746 total SCC) was ascertained among 1,064 patients, of whom 175 were immunosuppressed. Occurrence on the hand was more common for SCC arising in immunosuppressed versus immunocompetent patients (38% vs 24% of cases respectively). Hand SCC cases demonstrated balanced laterality and comparable spectra of differentiation regardless of immunosuppression. No cases of hand SCC metastasis were observed over greater than 2 years' mean follow-up, and digital amputation was only required in approximately 1% of hand SCCs. CONCLUSION In our cohort, assessment of hand SCC across all clinical departments suggests more favorable prognosis than reflected in the previous literature. Address correspondence and reprint requests to: M. Laurin Council, MD, Division of Dermatology, Washington University School of Medicine in St. Louis, Center for Dermatologic and Cosmetic Surgery, 969 N. Mason Road, Suite 200, St. Louis, MO 63141, or e-mail: mcouncil@wustl.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). M.L. Council has served as a consultant for Sanofi-Genzyme/Regeneron. The remaining authors have indicated no significant interest with commercial supporters. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

A Split-Scar Study Investigating the Effectiveness of Early Intervention With Electroabrasion on Improving the Cosmetic Appearance of Postsurgical Scars BACKGROUND Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation. OBJECTIVE To evaluate the effectiveness of intraoperative electroabrasion for scar revision. MATERIALS AND METHODS This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery. RESULTS At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides. CONCLUSION Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation. Address correspondence and reprint requests to: Swati Kannan, MD, 4122 Spectrum, Irvine, CA 92618, or e-mail: swatikannan@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). The authors have indicated no significant interest with commercial supporters. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Mucosa Does Not Matter: Successful Secondary Intention Healing of the Lip and Vermilion Border in Mohs Surgery Patients No abstract available

Advantages of A Hairline Incision for the Excision of Forehead Lipomas BACKGROUND Direct incision (DI) for forehead lipoma removal has a considerable risk of damaging the vertical vessels and leaving a visible scar. OBJECTIVE To evaluate the usefulness of the hairline incision (HI) in minimizing scars and neurovascular damage. PATIENTS AND METHODS Retrospective analysis was done for 30 patients with forehead lipomas who underwent excision between 2011 and 2019 at the Severance Hospital of the Yonsei University Health System, Seoul, Korea. Fourteen patients underwent DI, and 16 underwent HI. Comparison of the cosmetic outcomes, complications, and patient's subjective satisfaction was performed. RESULTS In the HI group, superior cosmetic outcomes, including patients' subjective satisfaction and photographic assessment findings, were observed. In the DI group, there were 2 cases of skin necrosis with scarring change and 3 cases of recurrence. Periorbital edema was the most common complication in the HI group, which spontaneously resolved within 1 week. CONCLUSION Hairline incision using a loupe should be considered as a first-line treatment in the removal of forehead lipomas, because it enables complete removal of lipoma with few complications and minimal scarring. Validation of our treatment algorithm requires further exploration. Address correspondence and reprint requests to: Byung Ho Oh, MD, PhD, Department of Dermatology, Yonsei University College of Medicine, Seoul 03722, Korea, or e-mail: obh505@yuhs.ac Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). The authors have indicated no significant interest with commercial supporters. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Comparison of Cell Suspension Transplantation Prepared From Plucked Hair Shafts, Excised Hair Follicles, and Epidermal Shave Biopsies in Vitiligo Patients: A Randomized Study No abstract available

Hyaluronic Acid Soft Tissue Filler for the Treatment of The Hypoplastic Chin: An Observational Study BACKGROUND The hypoplastic chin is associated with facial unattractiveness. OBJECTIVE To evaluate safety and efficacy of JUVÉDERM Voluma XC Injectable Gel (hyaluronic acid filler, HAF) for treatment of hypoplastic chin. METHODS This was a one-year, open-label, single-center study. RESULTS Thirty subjects received HAF injections of which 24 subjects (80%) completed the study. Mean facial angle significantly improved at all time points compared with baseline, improving by 1.83° (95% confidence interval, 0.91, 2.75; p < .001) at 12 months. Subject satisfaction with lower face and jawline increased significantly for all FACE-Q questions and time points compared with baseline (p < .05). Subject satisfaction with overall facial appearance, and percentage of subjects “not bothered” by area under chin increased significantly for most FACE-Q questions and time points compared with baseline (p < .05). The Global Aesthetic Improvement Scale (GAIS) rating of “much improved” significantly increased at all time points compared with baseline (p < .001). Sixteen subjects (53.3%) experienced 27 treatment-related adverse events (TRAEs), 2 subjects (6.7%) experienced device-related TRAEs, and 2 subjects (6.7%) experienced 6 serious adverse events unrelated to device or procedure. CONCLUSION In this completed one-year study, HAF injection for hypoplastic chin was safe and accompanied by significant improvement in facial angle, measures of subject satisfaction, and GAIS. Address correspondence and reprint requests to: Kenneth R. Beer, MD, PA, 1500 North Dixie Hwy, Suite 305, West Palm Beach, FL 33401, or e-mail: mdunn@beerdermatology.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). K. Beer and Monica Dunn are employees of the K. R. Beer, MD, PA. K. Beer is a speaker and consultant for Allergan, Galderma, and Valeant; an investor in Theraplex; and a principal investigator for Leo, Revance, Allergan, Galderma, and Brickell and he received a grant to support and conduct this study from Allergan, Inc. Anthony Stonehouse is an employee of Watson & Stonehouse Enterprises LLC, and received a grant funding from Allergan, Inc. The remaining author has no conflict of interest to disclose. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Chronic Osteomyelitis of the Calvaria Discovered During Mohs Micrographic Surgery No abstract available

Sequential Treatment of Superficial Basal Cell Carcinomas With Topical Methyl Aminolevulinate Photodynamic Therapy and Imiquimod 5% Cream: A Retrospective Study of Clinical and Cosmetic Outcomes BACKGROUND Topical photodynamic therapy (PDT) and imiquimod 5% (IMQ) cream are established treatments for superficial basal cell carcinoma (sBCC). Both have high initial response rates and recurrence rates of up to 37%. Recent studies demonstrate that PDT and imiquimod may act on sBCCs via synergistic immunomodulatory pathways. OBJECTIVE To describe the sequential use of MAL-PDT and imiquimod 5% cream in the treatment of sBCCs and report treatment tolerability, cosmetic outcomes, and efficacy. MATERIALS AND METHODS This is a retrospective case series of patients presenting over a 2-year period with primary sBCC who underwent 2 cycles of topical MAL-PDT, followed by 6 weeks of imiquimod 5% cream. Outcome measures were resolution of the index lesion at 3 months, side effects, cosmetic outcome, and long-term recurrence (LTR). RESULTS A total of 17 consecutive patients (n = 17) with a combined 21 sBCCs (n = 21) were included. The median length of follow-up was 72 months (range 24–95 months). Long-term recurrence occurred in 2/21 lesions (10%). CONCLUSION Sequential use of PDT and imiquimod was well tolerated with good cosmetic outcomes. The 10% LTR rate is at the lower end of the range reported for single modality treatment; however, larger samples are required to evaluate efficacy differences. Address correspondence and reprint requests to: Ian T. Logan, BM, MRCGP, MRCP, Dermatology Department, Ealing Hospital, London North West University Healthcare NHS Trust, London, United Kingdom, UB1 3HW or e-mail: i.logan@nhs.net The authors have indicated no significant interest with commercial supporters. E. Kulakov Joint first author. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Effect of Different Methods of Trypsinization on Cell Viability and Clinical Outcome in Vitiligo Patients Undergoing Noncultured Epidermal Cellular Suspension BACKGROUND Noncultured Epidermal Cell Suspension (NCECS) is a surgical modality used in treating stable vitiligo. Trypsinization of the epidermis may be done either at 4°C overnight (cold) or at 37°C for 30 to 50 minutes (warm). Recently, trypsinization was done at room temperature (25°C) in an in vitro trial. OBJECTIVE To compare different trypsinization techniques in NCECS regarding cell viability and clinical outcome. METHODS This comparative multicenter study was conducted on 20 patients with stable nonsegmental vitiligo. In each patient, 3, nonacral vitiligo lesions were randomly assigned for treatment by NCECS prepared by warm, room temperature, and cold trypsinization techniques, respectively. A perilesional biopsy was taken from each of the 3 treated lesions as an objective measure of disease stability. After transplantation, all patients received narrow-band ultraviolet B twice weekly for 6 months. Cell viability was assessed in each technique, as well as clinical outcome in all treated lesions. RESULTS Warm and room temperature trypsinization techniques were comparable with each other. Both were significantly better than the cold technique regarding viability and repigmentation. CONCLUSION Room temperature trypsinization can be used as a convenient substitute to warm trypsinization. Cold trypsinization is not recommended because of its poor results and poor patient satisfaction. Address correspondence and reprint requests to: Heba I. Gawdat, MD, Dermatology Department, Faculty of Medicine, Cairo University, 59 Street 104, Maadi Gardens, Cairo, Egypt 11431, or e-mail: heba.gawdat@yahoo.com. The authors have indicated no significant interest with commercial supporters. All authors have substantially contributed in the current work and satisfied authorship criteria. © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.