Cosmetic Defects Research Articles

Modern methods of treatment of complicated forms of pilonidal cyst

There are several theories of the origin of diseases of the epithelial coccygeal tract: empirical, neurogenic, ectodermal and acquired. Most Russian scientists consider this pathology to be congenital, while foreign colleagues believe that it is a consequence of sacrococcygeal area injuries. This pathology is quite common, affecting more than 5 % of the adult population, it also occurs in children and adolescents. This disease decreases the quality of patients` life significantly, affecting all aspects of their life. Conservative methods of treatment do not provide a complete cure, since they do not eliminate the causes of the disease. These include sclerotherapy and obliteration of the cavity with silver nitrate or hydrochloric acid. These methods are not used nowadays. Surgical treatment is the most effective one for this pathology. Surgical intervention, despite its apparent simplicity, turns out to be quite complex, which makes it inaccessible to any general surgeon. Treatment results are often disappointing due to the high incidence of complications after surgery, as well as the long period of activity limitation. Therefore, the resulting rough scar is a cosmetic defect, and the risk of recurrence remains quite high. Studying the literature data, one can see that the authors` opinions concerning surgical tactics for this disease differ. At the moment, there is no single approach and surgical tactic for the treatment of epithelial pilonidal cyst. The problem of creating and introducing new methods of treatment of pilonidal disease remains relevant nowadays.

HIV facial lipodystrophy treatment by polylactic acid – a literature review

Human immunodeficiency virus (HIV) is a disease that negatively affects the immune system, requiring chronic, regular antiretroviral therapy, associated with numerous side effects. Lipodystrophy is one of them and is a serious clinical, psychological and social problem for patients affected by the problem. Volume loss and the formation of deep tissue defects in the facial area are caused by skeletal resorption and the redistribution of fat compartments, which progress with age but are also significantly exacerbated prematurely in the course of HIV and applied antiretroviral therapy. For a large group of patients, this constitutes a significant cosmetic defect, often leading to discontinuation of necessary, antiretroviral treatment. Various forms of treatment for this condition are currently available worldwide, including the implantation of non-permanent tissue fillers, such as hyaluronic acid-based fillers, or autologous fat cell transplants. The use of polylactic acid in the treatment of lipodystrophy is a therapeutic method with proven efficacy, effectiveness and a high safety profile, which will be discussed in this article.

CircRNA_SLC8A1 alleviates hypertrophic scar progression by mediating the Nrf2-ARE pathway.

Hypertrophic scar (HS) is associated with cosmetic defects, mobility, and functional impairments, pruritus, and pain. Previous circRNA microarray analysis identified reduced expression of circRNA_SLC8A1 in HS tissues. Therefore, this study aims to investigate the role of circRNA_SLC8A1 in modulating the abnormal behavior of HS-derived fibroblasts (HSFs) in vitro. RT-qPCR and FISH assays were used to assess the differential expression and localization of circRNA_SLC8A1 in normal and HS tissues. Following modulation of circRNA_SLC8A1 expression, CCK-8, flow cytometry, Transwell, and wound healing assays were employed to evaluate the effects of circRNA_SLC8A1 on the biological behaviors of HSFs. The Starbase database, dual-luciferase reporter assays, and Ago2-RIP assays were utilized to predict and validate the interaction between circRNA_SLC8A1 and downstream miRNAs. CircRNA_SLC8A1 was found to be downregulated in HS tissues and was primarily localized in the cytoplasm. Overexpression of circRNA_SLC8A1 reduced cell viability, cell invasion, wound healing, and the expression of Vimentin, N-cadherin, Col I, and Col III, while enhancing apoptosis and E-cadherin expression in HSFs. CircRNA_SLC8A1 activates the Nrf2-ARE pathway by competitively binding to miRNA-27a-3p. miRNA-27a-3p and Nrf2 exhibited high and low expression, respectively in HS tissues, with an inverse correlation between their levels. Overexpression of miRNA-27a-3p counteracted the effects of circRNA_SLC8A1 in HSF proliferation, apoptosis, migration, EMT, collagen deposition, and Nrf2-ARE pathway activity. CircRNA_SLC8A1 inhibits the proliferation, migration, EMT, and collagen deposition of HSF through competitive binding with miRNA-27a-3p, thereby activating the Nrf2-ARE pathway. The circRNA_SLC8A1/miRNA-27a-3p/Nrf2-ARE axis may offer a promising molecular target for HS therapy.

Orbital dirofilariasis (case report)

Ocular Dirofilariasis is one of the frequent manifestations of this disease. The primary manifestations of dirofilariasis of the visual organ (soreness, redness, itching in the eyelid area) may be nonspecific and weakly expressed at the beginning of the disease. The peculiarity of this disease is that if earlier most cases of human infection with Dirofilaria repens were registered in southern countries and southern regions of the Russian Federation, recently there has been a tendency for this disease to spread to northern regions. Diagnosis of this disease based on the data of instrumental methods of investigation is difficult, although cases of detection of the parasite at the preoperative stage have been described in the literature. This publication presents a clinical case of the orbital form of dirofilariasis, which was diagnosed at the intraoperative stage using transconjunctival access. This access is sufficient for complete removal of the neoplasm, and the rehabilitation of patients after surgery with such an access is short and without the formation of a cosmetic defect. Surgical intervention is the main and only treatment tactic and does not require additional specific antiparasitic treatment.

The state of hand rub dispensers in healthcare settings – a multicenter assessment in 19 German healthcare facilities

BackgroundHand hygiene is one of the most important hygiene measures to prevent healthcare-associated infections. Well-functioning hand rub dispensers are the foundation of hand hygiene but are often overlooked in research. As the point of origin for hand hygiene, dispensers not only promote compliance through ease of use, but also strongly influence the amount of hand rub used per disinfection. This work investigates how dispenser types and conditions affect dispensed volumes and usability.MethodsData from 5,014 wall-mounted or point-of-care dispensers was collected from 19 German healthcare facilities during installation of an electronic hand hygiene monitoring system, including dispenser type and dispensed hand rub volumes. Of these dispensers, 56.2% were metal dispensers, and the majority (89.5%) were wall-mounted. For one hospital, 946 wall-mounted dispensers were analyzed in detail regarding pump material, damages, functionality, cleanliness, and filling levels.ResultsDispensed volumes varied across and within dispenser types, ranging from 0.4 mL to 4.4 mL per full actuation, with the largest volumes generally dispensed by plastic dispensers with a preset of 1.0 to 3.0 mL per actuation. In general, most dispensers dispense more hand rub per full actuation than specified by the manufacturer. When different types of dispensers are used within a healthcare facility, vastly different volumes can be dispensed, making reliable and reproducible disinfection difficult for healthcare workers. In the detailed analysis of 946 dispensers, 27.1% had cosmetic defects, reduced performance, or were unusable, with empty disinfectant being the most common reason. Only 19.7% of working dispensers delivered their maximum volume on the first full actuation.ConclusionEven though several studies addressed the variability in dispensed volumes of hand hygiene dispensers, studies dealing with dispenser types and functionality are lacking, promoting the common but false assumption that different dispensers may be equivalent and interchangeable. Variability in dispensed volumes, coupled with frequent dispenser defects and maintenance issues, can be a major barrier to hand hygiene compliance. To support healthcare workers, more attention should be paid to ‘dispenser compliance’, selecting dispensers with similar volume ranges and proper maintenance.

Description of a clinical case of bullous scleroderma in a somatically impaired patient

Bullous scleroderma is a rare variant of localized scleroderma characterized by the formation of subepidermal tense blisters. At the moment, the etiology and pathogenesis of dermatosis is not fully understood, but a number of authors consider the pathology of the endocrine system as a trigger for the development of localized and systemic scleroderma. Untimely or erroneous diagnosis of bullous scleroderma leads to the risk of developing a systemic process, irreversible cosmetic defects and even disability. Treatment of bullous scleroderma should be complex and multicourse with the inclusion of systemic glucocorticoids, antibacterial and cytostatic drugs, agents that improve microcirculation, as well as topical glucocorticoids of the 3-4th class of activity, regenerating agents. Physiotherapeutic methods of treatment such as PUVA and UVA therapy are widely used; there are reports on the successful use of a combination of immunosuppressive mycophenolate mofetil and extracorporeal photopheresis, as well as intravenous infusions of N-acetylcysteine. In addition to traditional drug and physiotherapy therapies, the use of biological therapies is currently being considered. The article presents a rare case of scleroderma bullosa on the background of pronounced chronic endocrine pathology. The interest of this clinical case lies not only in the rare form of the disease and the progressive nature of the course of dermatosis, but also in the probable association of dermatosis with the patient's endocrine gland diseases in the form of panhypopituitarism due to adenohypophysis macroadenoma with the development of secondary hypothyroidism and adrenal insufficiency. In our observation, the steady negative dynamics of the skin process — from localised plaque scleroderma with subsequent transformation into the bullous form, and further into a probable systemic process — drew attention. Taking into account the severity of the disease course, the presence of concomitant chronic endocrinopathy, as well as positive specific serological reactions for the systemic form of scleroderma, in the presented clinical case the patient needs an interdisciplinary approach and constant dispensary observation.

Neurofibromatosis type 1: short review and clinical case

Neurofibromatosis type 1 (NF1) is acommon (1/3000) autosomal dominant disorder associated with amutation in the NF1 gene, located on the long arm of chromosome 17 (17q11.2). NF1 is diagnosed using well-known clinical criteria: café au lait spots, axillary and inguinal freckles, cutaneous and subcutaneous neurofibromas, optic pathway gliomas, and specific bone abnormalities. The pathognomonic feature of the disease is plexiform neurofibroma (PN), which is abenign peripheral nerve sheath tumor that occurs in 30-50% of patients with NF1. In addition to awide range of clinical manifestations, such as pain, motor, respiratory disorders, neurological deficits, cosmetic defects, etc., there is about a15% risk for the development of malignant peripheral nerve sheath tumors (MPNST). And it should be noted that the treatment of PN is acomplex task that does not have one standard solution. Thus, surgical treatment, which was the “gold standard” and remains one of the main methods of therapy, carries significant risks, such as postoperative neurological deficit, ahigh risk of intraoperative bleeding and is accompanied by ahigh percentage of relapses. Therefore, the emergence of targeted therapy and its use in the Russian Federation since 2021 has made asignificant contribution to the treatment of symptomatic inoperable plexiform neurofibromas.

The possibilities of improving the effectiveness of acne therapy

Acne is one of the most urgent problems of dermatology, since this dermatosis is widespread, often occurs during puberty, is accompanied by cosmetic defects, causes increased anxiety, dysmorphic phobia and depressive states. As a result, the quality of life and the possibility of social adaptation decrease in patients. Therefore, it is necessary to optimize the treatment of this disease with the inclusion of modern highly effective drugs. When prescribing treatment, it is necessary to take into account all links in the pathogenesis of acne, and also remember that inflammation plays an important role in the development of dermatosis (especially severe course). With mild acne, it is recommended to prescribe only external therapy, with medium – external therapy and, if necessary, systemic, with severe systemic therapy is used as the main one. The appointment of antibiotics for this dermatosis is dictated by the presence of bacterial flora. Clindamycin is one of the antibiotics that effectively reduce colonization of C. аcnes. To ensure the high efficiency and safety of topical therapy, as well as the prevention of the development of resistance of microorganisms, there is a need to use a combination of at least two drugs. Thus, the combination of clindamycin with benzoyl peroxide makes it possible to increase the effectiveness of therapy due to bactericidal, bacteriostatic, anti-inflammatory and keratolytic actions. The convenient mode of use and the rapid therapeutic effect make it possible to include this combination in the group of priority drugs for the treatment of acne. Comedonolytic, anti-inflammatory and bactericidal effects are also observed in azelaic acid, and therefore drugs containing this component show a high pathogenetic effect in acne.

Acellular Dermal Matrix: Imaging Features With Histopathology Correlation.

Acellular dermal matrix (ADM) is an immunologically inert graft, typically from cadaveric skin, often used in postmastectomy breast reconstruction. Created from decellularized dermal tissues that have been treated to remove DNA and antigenic donor cells (leaving extracellular matrix), ADM is often used as a structural scaffold or sling to reinforce and support the structure and position of a breast implant during postoperative integration in implant-based breast reconstruction; ADM can also be used to fill cosmetic defects. Advantages of ADM use include improved cosmesis and reduced capsular contracture rates. On US, ADM can be seen as a subtle band with variable echogenicity adjacent to the implant. When folded on itself or redundant, ADM may present as a palpable oval mass with indistinct or circumscribed margins and variable echogenicity. On mammography, ADM can be seen as a circumscribed oval equal density mass when redundant and folded on itself; a layered appearance may be evident on tomosynthesis. On MRI, presence and absence of enhancement have been documented. Imaging findings likely vary depending on the degree of host tissue remodeling and incorporation, and when biopsied, histopathologically, ADM may be difficult to distinguish from scarring. Successful imaging diagnosis of ADM is aided by clinical knowledge of the intraoperative use and configuration of ADM, which may help differentiate ADM from new or recurrent malignancy and avoid unnecessary biopsy.

Oral donor site evaluation in the early and late postoperative periods for augmentation and replacement urethroplasty

Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials & methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

Definitive Radiation Therapy is a Viable Treatment for Locally Advanced Basal Cell Carcinoma Otherwise Requiring Radical or Disfiguring Resection

BackgroundStandard treatment for basal cell carcinoma (BCC) is surgical resection. However, a subset of locally advanced BCCs may be unresectable, or surgery would result in unacceptable functional or cosmetic defects. Outcomes after definitive radiotherapy for locally advanced BCC in the contemporary era are not well established. ObjectiveWe sought to determine locoregional control and disease specific survival after definitive radiotherapy for locally advanced BCC. MethodsPatients with locally advanced BCC treated with definitive radiotherapy between 2005-2020 from 4 academic tertiary care institutions were included. Locally advanced BCCs were defined as patients with unresectable disease, or locations where margin negative resection would lead to unacceptable cosmetic or functional deficit. Additionally, a set of 5 risk factors (size ≥4 cm, the presence of bone invasion, PNI, immunocompromised patient, and recurrent disease) was separately defined and outcomes were investigated. Results608 locally advanced BCC cases were identified, of which 140 were treated with definitive radiotherapy. Median follow up was 22.9 months (1.5-207.2 months). 101 (72.1%) tumors were treated with upfront definitive radiotherapy, while 39 (27.9%) were treated for a recurrence. 5-year Kaplan-Meier estimated locoregional control was 78%. The majority of locoregional failures were local recurrences (95.5%). Larger tumor diameter was a risk factor for locoregional failure (p=0.045), while recurrent disease was not (p=0.29). Cumulative incidence of BCC related mortality at 5 years was 9.5%. Patients with 0 risk factors had a 5-year FF-LRF of 92.4%, whereas those with 1+ risk factors had a 5-year FF-LRF of 68.5% (p=0.004). ConclusionDefinitive radiotherapy for locally advanced BCC has excellent locoregional control, with tumor size representing the only risk factor for recurrence in this study.

High-Frequency Ultrasound in the Assessment of Cellulite-Correlation between Ultrasound-Derived Measurements, Clinical Assessment, and Nürnberger-Müller Scale Scores.

Cellulite is a cosmetic defect of multifactorial etiology that affects over 90% of women worldwide. Cellulite-induced skin changes are undesirable and negatively affect self-esteem. Despite a plethora of cellulite-reducing treatments, we still lack objective tools to enable accurate diagnosis and treatment efficacy assessment. The aim of this study was to determine whether high-frequency ultrasound can be helpful in assessing cellulite and whether there is an association between ultrasound-derived measurements, parameters ascertained clinically, and cellulite assessment scale scores. The study group consisted of 114 women with cellulite in their posterior thighs, assessed using the Nürnberger-Müller scale. Two types of ultrasound devices were used in this study: a conventional scanner with a linear transducer and a skin-dedicated scanner equipped with a mechanical transducer. We used high-frequency ultrasonography to determine epidermal thickness, dermal thickness, the surface area of fat protrusions at the dermal subcutaneous junction, and the thickness and stiffness of the subcutaneous tissue (ultrasound elastography). There was a correlation between cellulite severity and subcutaneous tissue thickness (r = 0.63), the surface area of fat protrusions at the dermal subcutaneous junction (r = 0.64), and the elastographic strain ratio (r = 0.51). An association was also demonstrated between thigh circumference and subcutaneous tissue thickness (r = 0.48). There was a significant difference in the assessed parameters between the subgroups identified by cellulite severity scores. Ultrasound-determined surface area of fat protrusions at the dermal subcutaneous junction as well as the thickness and stiffness of the subcutaneous tissue seem useful in cellulite assessment. Thus, ultrasonography has the potential to become a common tool in aesthetic medicine and cosmetology.

The assessment of the impact of carboxytherapy and selected chemical peels on cosmetic defects and signs of aging of skin around eyes

ABSTRACT Objective The purpose of this study was to assess changes in skin elasticity and other skin defects related to the aging of skin around eyes following the use of combination treatment carboxytherapy and chemical peels (ferulic acid combined with ascorbic acid, lactobionic acid). Material and methods A total of 39 Caucasian patients were subjected to a series of five combination carboxytherapy and chemical peels treatments at weekly intervals. The Cutometer device was used to objectively measure skin elasticity. The assessment was supplemented by photographic documentation. Results A statistically significant improvement in skin elasticity assessed on the basis of R2 and R7 parameters (p < .0001, p = .001, respectively) was demonstrated after a series of five sessions of carboxytherapy combined with chemical peels. The improvement in the R2 parameter was observed in 82.1%, while R7 in 76.9% of study participants. It observed that the number of participants who benefited from treatment with ferulic acid and ascorbic acid was statistically higher compared with the second group (p = .036). Improved R2 values were reported in 100% of participants undergoing carboxytherapy combined with ferulic and ascorbic acid. Conclusion Carboxytherapy in combination with chemical peels improved skin elasticity and can be used to reduce other skin defects.

Novel approaches to psoriatic onychopathy diagnostics and treatment

Psoriasis is one of the most important problems in the clinical practice of a dermatovenereologist. In addition to damage of the skin and joints, the nail involvement is often seen in psoriatic patients. Despite its wide prevalence and significant impact on the quality of life, psoriatic onychopathy is discussed relatively rare. A change in the nails may indicate early alterations in the small joints of the palms, еthat foster to suspect psoriatic arthritis at an earlier time. Besides, the severity of nails lesions determined on the base of the NAPSI index correlates directly with the severity of pain in enthesitis. Nails damage in psoriasis does not entail persistent functional disorders, but significantly affects the patient’s quality of life due to a visible cosmetic defect. In addition, psoriatic onychopathy is difficult to treat. The use of topical agents is impractical, and systemic therapy gives a weak clinical response over a longer period. Even in the absence of a pathological process on the skin, nail psoriasis may persist much longer, which causes significant discomfort to patients. The study of pathomorphological aspects and mechanisms of nail psoriasis development will allow to disover a new methods for the effective treatment of psoriatic onychopathy.

Surgical Anatomy of Endoscopic Endonasal Approaches to the Anterior Cranial Fossa

Lesions of the anterior cranial fossa (ACF) are challenging to treat. Historically, to obviate retraction on the frontal lobes and access the entire lesion, extensive craniofacial and skull base approaches were employed, often leading to significant cosmetic defects and morbidity. With the advent of expanded endonasal approaches, select lesions involving the ACF are treated with endoscopic endonasal approaches (EEAs). Consequently, for the contemporary skull base neurosurgeon, understanding the anatomy of EEAs to ACF lesions is vital. Thus, in this article we detail the surgical anatomy of EEAs to the ACF.

To assess the effectiveness of treatment methods for patients of different age groups with basal cell cancer of the skin of the nose and ears

The relevance of the problems of diagnosis and treatment of skin cancer is currently determined not only by the high incidence rate, but by the existing difficulties in differential diagnosis and treatment with traditional methods. For localizations of basal cell skin cancer (BCSC) that are "inconvenient" for treatment, such as the external auditory canal, auricle, and wing of the nose, treatment is associated with certain difficulties and the possible appearance of a cosmetic defect, therefore, when choosing a treatment method, the anatomical features of these organs are taken into account. It has been determined that the effectiveness of treatment for primary BCSC of the nose and auricles is higher than recurrent one, and among the various treatment methods, the most effective and radical is the surgical method. The immediate results of treatment of BCSC in the form of PR by surgical method were 86.7%, which is statistically significant compared with other types of treatment (p < 0.05). Long-term treatment results with the surgical method are also higher (77%) compared to other methods, which is also statistically significant (p < 0.05).

Treatment of breast cysts with ozone-oxygen mixture using ultrasonic guidance

Objective. To evaluate the effectiveness of treatment of breast cysts with an ozone-oxygen mixture using ultrasound guidance. Materials and methods. The methodology included a retrospective analysis of the ultrasound-guided treatment of breast cysts. Treatment was carried out according to clinical recommendations using a conservative method and involved outpatient ultrasound-guided removal of cystic content without sclerosant and with introduction of ozone-oxygen mixture. Results. 445 patients with fibrocystic mastopathy were treated. The age of the patients ranged from 18 to 55 years. The detected cysts up to 2 cm represented regular-shaped, rounded anechoic masses with clear even contours and homogeneous structure. Cysts larger than 2 cm were sometimes irregular in shape with anechoic, homogeneous content. In most cases, the multilocular cysts had an irregular shape with anechoic contents, without intracavitary parietal inclusions. The average size of the cysts comprised 2.8±0.9 cm. The analysis showed the effectiveness of the treatment methods. The best effect was obtained with the use of an ozone-oxygen mixture. Complications of the procedure were observed in 6 (2%) patients (hematoma and recurrence). Conclusion. The findings of the study showed that treatment of breast cysts with an ozone-oxygen mixture using ultrasound guidance proved to be a highly effective, low-traumatic, and safe method. This technique is performed on outpatient basis, does not require the administration of anesthetics, is well tolerated by patients, has a selective effect, has no serious complications and risk of cosmetic defects.

Photodynamic therapy in treatment of squamous cell carcinoma of oral cavity with chlorine e6 photosensitizer with long-term follow up

Photodynamic therapy is an effective method for treating superficial forms of malignant neoplasms, characterized by a minimal risk of damage to normal tissues. In this study, we presented our experience of treating cancer of the oral mucosa using photodynamic therapy, and analyzed the immediate and long-term results of treatment. 38 patients with squamous cell carcinoma of oral cavity mucosa, with a depth of invasion no more than 7 mm, were included in the study. All patients underwent photodynamic therapy with chlorine e6 based photosensitizer. Photosensitizers were administered intravenously 3 hours before irradiation, at a dosage of 1 mg/kg of the patient’s weight. Photodynamic therapy was performed with the following parameters: P – 1.0 W, Ps – 0.31 W/cm2, E – 300 J/cm2. The area of one irradiation field ranged 1.0-2.0 cm2. Treatment effect was evaluated by RECIST 1.1. Overall survival, cancer-specific survival, and disease-free survival were calculated using Kaplan-Meier curves. Evaluation of adverse events was made by .TCAE 5.0 criteria. At 35 (92.1%) out of 38 cases, complete regression was observed after photodynamic therapy. Among them in 3 out of 35 patients relapse was diagnosed in 11.5 to 43.2 months. The total number of patients who didn’t respond to treatment was 6 (15.8%). Follow-up period was 4.2-87.3 months. (mean 42.9). 34 (89.5%) out of 38 patients are alive, 1 (2.6%) died from progression, and three died from other causes. The 5-year overall survival rate was 82.1%, cancer-specific survival rate was 97.0%, and disease-free survival rate was 81.1%. Among the factors significantly (p &lt; 0.05) influencing relapse-free survival: depth of invasion &lt; 5 mm (p – 0.013) and the presence of leukoplakia (p – 0.007). When assessing cancer-specific survival, factors worsening the prognosis were: age &gt;70 years (p – 0.034) and the presence of leukoplakia (p – 0.007). Photodynamic therapy is an alternative treatment method of oral cancer superficial lesions, in case of proper assessment of primary lesion and in case of possibility of full irradiation of the tumor. Moreover, after using photodynamic therapy, the underlying connective-muscular structures are preserved, which promotes rapid healing with minimal scarring, the functions of the affected organ remain intact, and cosmetic defects do not form.

Abstract PO2-07-04: Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity

Abstract Background: Traditionally, multi-focal breast cancer results in mastectomy. The Alliance Trial offers a paradigm shift in surgical options available for multi-focal breast cancer patients in the context of adjuvant chemotherapy. In the trial, patients with multi-focal disease (&amp;lt; 3 tumors) who underwent breast conservation surgery (BCS) were found to have similar outcomes to patients undergoing mastectomy. BCS for large volume tumors ( &amp;gt;30%) has been cited as having a high potential for cosmetic defect, and hence represents a typical upper limit for potential tissue removal in BCS. Here, we evaluated a patient cohort to better understand the economic impact of the Alliance trial and further categorize patients that would most benefit without suffering cosmetic impact. We employed a novel computational technology to quantify the ratio of tumor size to breast tissue volume. Methods: Using a publicly available, single site cohort (n=243, DUMC) of breast cancer patients that underwent mastectomy, we segmented the tumors using our TumorSight Viz software platform. This platform uses artificial intelligence to segment the tumor and surrounding tissues and allows for a volumetric and morphologic assessment in 3D space. We then applied relevant inclusion/exclusion criteria from the Alliance Trial to the cohort (Saha et al, 2018). In trial eligible patients, we used TumorSight Viz to create a convex hull (CH) around the multi-focal disease using dilations of 1 cm and 2 cm. The volume of the CH, corresponding to proposed surgical extirpation, and the overall breast volume (BV) were then computationally assessed in 3D. The ratio of CH to BV (CH:BV) was calculated and a cutoff of 30% (high potential for cosmetic deformity) was applied. A cost analysis was then carried out. We determined the aggregate per annum savings that could potentially be realized by transforming a subset of mastectomies to BCS by tabulating total costs of mastectomy+reconstruction vs. BCS+WBI (whole-breast irradiation), as well as adjusted for relative rates of adjuvant therapy (~80%) across the nationwide patient population. Results: We found that 19.3% of adjuvant mastectomy patients were eligible for BCS based on Alliance Trial criteria. Of those, 68% had tumor CH:BV &amp;lt; 30% when using a 1 cm dilation around the tumor. When using a 2 cm dilation, 56% had tumor CH:BV &amp;lt; 30%. Together, these results indicate that of all adjuvant mastectomy patients, an estimated 10.8-13.1% are eligible for BCS based on volumetric measures of cosmetically acceptable breast tissue removal. Our economic analysis of BCS vs. mastectomy revealed an estimated $28,500 cost savings for patients with private insurance, suggesting that both decreased costs and improved quality-of-life (QOL) can be mutually aligned. By assessing the nationwide number of patients receiving adjuvant therapy for breast cancer, alongside the percentage potentially eligible for BCS using the above cosmetic defect analysis, we estimate that BCS conversion from mastectomy offers to provide a net savings of $300-350 million annually. Conclusion: The Alliance Trial guidelines unveiled the potential option of BCS in ~20% of patients with multi-focal disease in our cohort, demonstrating considerable cost-savings. Computational tools can further differentiate individuals who may not be best candidates for BCS in this setting, ensuring high QOL and informed decision-making. Citation Format: John Pfeiffer, Matthew Biancalana, Dorys Lopez-Ramos, Bradley Feiger, Anuja Antony. Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-04.

QUINQUAUD’S DISEASE IN THE SPECTRUM OF CONCOMITANT DERMATOLOGIC PATHOLOGY

Cicatrical alopecia is one of the acute issues of modern dermatology due to a permanent cosmetic defect in the form of bald areas with non-recoverable loss of hair follicles. Interrelation of cicatrical alopecia with other dermatoses and somatic diseases is also topical. The article presents a clinical case of development of Quinquaud’s disease of the scalp combined with parapsoriasis lichenoides and multiple seborrheic keratosis on the top of already administered targeted therapy in connection with previously removed skin melanoma. Among the features of this pathology, we noted: appearance of rashes after a past oncological disease, erythema diffusely spreading throughout the entire scalp, multiple follicular pustules and rapid formation of cicatricial atrophy, severe itching and soreness, resistance to the ongoing therapy, as well as multiple rashes on the skin of body and extremities in the form of lichenoid papules and plaques. For differential diagnostics, multifocal biopsic examination of the skin was carried out, which showed presence of histologic signs of three dermatoses, which make up a spectrum of the concomitant pathology in the patient. Taking into account the important role of staphylococcal infection in the pathogenesis of Quinquaud’s disease and parapsoriasis lichenoides, we can assume similar pathogenetic mechanisms for the development of these diseases in the patient, associated with disorders of cutaneous microbiome. It is possible that a history of the oncological pathology and targeted therapy could lead to a decrease in resistance and suppression of the immune system, which was also a factor contributing to the development of concomitant dermatoses. Appearance of multiple eruptive seborrheic keratomas on skin of the body and extremities may be an indicator of a paraneoplastic process and require oncological screening. Understanding the causes and common factors of formation of dermatoses comorbid with cicatricial alopecia is extremely important for a dermatologist, because it allows performing early diagnostics in a timely manner, assigning treatment and preventing development of the permanent cosmetic defect leading to a decrease in the quality of life.