Dermatology Research Articles

ACGME Program Requirements for Surgical Specialties: How Do Dermatology and MSDO Stack Up?

Dermatology and micrographic surgery and dermatologic oncology (MSDO) are two areas of medicine where surgical procedures play an important role both in training and practice. We sought to determine how dermatology and MSDO compare to ACGME surgical specialties with regard to surgical curriculum and case log requirements. We found that the surgical curriculums for dermatology and MSDO are similar to those of our surgical colleagues in ophthalmology, obstetrics, and gynecology. They are similar in that none require general surgery rotations, a general surgery postgraduate year 1 is not required, and all surgical experience can be obtained within each respective specialty residency training program. Regarding case log requirements, MSDO was found to have numerical case log requirements comparable to those of ACGME surgical specialties. Dermatology case log requirements were on the low end of the surgical spectrum. In dermatology and MSDO, surgical training is well integrated into the programs and case log requirements. They represent two of the many areas where medicine and surgery combine in the name of patient care. J Drugs Dermatol. 2023;22(1): doi:10.36849/JDD.6886.

How We Do It: Interphalangeal Joint Disarticulation of the Digit.

*Mohs Surgery Unit, Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina †Case Western Reserve University, School of Medicine, Cleveland, Ohio ‡Jacksonville Skin Cancer Specialists, Jacksonville, Florida The authors have indicated no significant interest with commercial supporters.

Reconstruction of a Medial Canthus Defect.

* Both authors are affiliated with the Dell Medical School at the University of Texas at Austin, Division of Dermatology and Dermatologic Surgery, Austin, Texas Address correspondence and reprint requests to: S. Tyler Hollmig, MD, Director, Dermatologic Surgery, The University of Texas at Austin Dell Medical School, Health Transformation Building, 1601 Trinity St #704b, Austin, TX 78701 [email protected] The authors have indicated no significant interest with commercial supporters.

Quantitative and Qualitative Analysis of Skin of Color Images in Dermatologic Surgery Literature From 2019 - 2022.

Diamond, Carrie BA*; Albrecht, Mark MS†; Rundle, Chandler W. MD‡; Stamey, Christopher MD‡ Author Information

4th National Congress of the Bulgarian Society for Dermatologic Surgery, Sofia, 12th March 2022 with main topics: one step melanoma surgery and drug induced melanoma.

Not available

Sustainability in delivering skin surgery training: additional resources consumed andopportunities for environmental gain using the Healthcare Environmental Performance Tool.

Sustainability in delivering skin surgery training: additional resources consumed andopportunities for environmental gain using the Healthcare Environmental Performance Tool.

Complications in dermatologic surgery: A case-control study exploring factors associated with postsurgical infection and wound dehiscence in a large national group practice

To the Editor: Dermatologic surgery is generally considered safe with estimated complication rates of <2%. 1 O'Neill J.L. Lee Y.S. Solomon J.A. et al. Quantifying and characterizing adverse events in dermatologic surgery. Dermatol Surg. 2013; 39: 872-878https://doi.org/10.1111/dsu.12165 Crossref PubMed Scopus (18) Google Scholar , 2 Strickler A.G. Shah P. Bajaj S. et al. Preventing and managing complications in dermatologic surgery: procedural and postsurgical concerns. J Am Acad Dermatol. 2021; 84: 895-903 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Cook J.L. Perone J.B. A prospective evaluation of the incidence of complications associated with mohs micrographic surgery. Arch Dermatol. 2003; 139: 143-152 Crossref PubMed Scopus (148) Google Scholar However, evaluation of the factors that contribute to complications gains merit in the context of the vast numbers of dermatologic procedures performed annually. This retrospective case-control study explores host and procedural variables associated with surgical wound dehiscence (SWD) and infection following dermatologic surgery, factors which are inadequately characterized or limited by small sample sizes in the current dermatology literature. 1 O'Neill J.L. Lee Y.S. Solomon J.A. et al. Quantifying and characterizing adverse events in dermatologic surgery. Dermatol Surg. 2013; 39: 872-878https://doi.org/10.1111/dsu.12165 Crossref PubMed Scopus (18) Google Scholar , 2 Strickler A.G. Shah P. Bajaj S. et al. Preventing and managing complications in dermatologic surgery: procedural and postsurgical concerns. J Am Acad Dermatol. 2021; 84: 895-903 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Cook J.L. Perone J.B. A prospective evaluation of the incidence of complications associated with mohs micrographic surgery. Arch Dermatol. 2003; 139: 143-152 Crossref PubMed Scopus (148) Google Scholar , 4 Delpachitra M. Heal C. Banks J. Charles D. Sriharan S. Buttner P. Risk factors for surgical site infection after minor dermatologic surgery. Adv Skin Wound Care. 2021; 34: 43-48 Crossref Scopus (3) Google Scholar , 5 Balakirski G. Kotliar K. Pauly K.J. et al. Surgical site infections after dermatologic surgery in immunocompromised patients: a single-center experience. Dermatol Surg. 2018; 44: 1525-1536 Crossref Scopus (17) Google Scholar

Abstract 11898: Bovine Milk-Derived Extracellular Vesicles as a Novel Injury-Targeting Drug Delivery System Following Cardiac Injury

Introduction: A novel protocol provides large amounts of highly purified small extracellular vesicles (also called exosomes) from bovine milk (Marsh et al, PMID: 34367882). We sought to examine the targeting potential of these pure, highly concentrated bovine milk-derived extracellular vesicles (mEVs) to injured cells and tissues, with the intent of identifying an effective drug delivery platform capable of targeting injured cardiac tissue. Methods: Targeting of mEVs to injured cells and tissues was tested in vitro using a scratch assay on human dermal fibroblast (hDFs) and MDCK cell monolayers, and in vivo, using mouse models of skin wounding and cardiac injury - methods we have previously reported (PMID:34246197; PMID:29351451). mEVs were isolated using our published approach (PMID: 34367882), then fluorescently tagged with Cell Tracker Deep Red (CTDR). Labelled mEVs were then applied to cell cultures at 20 ug/mL for 15 minutes post wound; cells were then rinsed, fixed and stained for cell nuclei with Hoechst. Mice were provided 2 ug/kg loaded mEV’s by oral gavage before skin surgery and induction of cardiac ischemic reperfusion injury. Mice were sacrificed 4 hours post-surgery, fixed by perfusion with 4% paraformaldehyde followed by PBS rinsing, then organs were explanted. Organs were then embedded in O.C.T, sectioned on a cryostat, and stained for nuclei and actin with FITC-Phalloidin. Imaging was performed on a Leica SP8 laser scanning confocal microscope and quantified using mEV uptake normalized to cell nuclei on ImageJ. Results: mEV uptake was significantly increased in scratch wounded cultures of both hDFs and MDCK cells (p&lt;0.001), over uninjured control cells. Similarly, injured heart and skin tissues exhibited significantly increased exosomal uptake (p&lt;0.001), relative to sham injury controls and skin tissues remote from the injury. Conclusions: Our experiments indicate that injured cells and tissues show increased uptake of milk derived exosomes, with in vitro data suggesting that this enhanced uptake occurs, at least in part, in a cell autonomous manner. The data also supports that our isolation protocol provides a novel mEV-based drug delivery system that may preferentially target injured tissues, including ischemic cardiac tissue.

Detection of skin thickness and density in healthy Chinese people by using high-frequency ultrasound.

Due to a recent development of high-frequency ultrasound (HFUS) systems, it is easier to realize high-resolution in vivo imaging of the biological tissues. The object of this study was to map the thickness and echo density of skin layers in healthy Chinese people and assess the influence of gender, age, and region on it. A total of 189 volunteers (85 male, 104 female) with age range of 22-75-year old (mean age of 41.2-year old) were enrolled. The thickness and density of the epidermis and dermis layer were detected by high-frequency (22 or 75MHz) ultrasonography at 13 different anatomical sites, including the forehead, cheeks, flexor and extensor forearms, flexor and extensor upper arms, inner and outer legs, inner and outer thighs, back, and abdomen. The thickness and density of epidermis/dermis between different anatomical sites were statistically significant (p<0.05). The epidermis thickness of the face and trunk were less than that of the limbs, whereas the thicknesses of the dermis were on the contrary. The density of the epidermis/dermis of the face and trunk were less than that of the limbs. The thickness of dermis in most of the sites were higher in male than in female, and the density of epidermis and dermis in most of the sites were less in men than in women. The thicknesses/densities of dermis were lower in older age group in almost all sites, whereas only several sites reached statistical. The difference between the north and south regions showed the environment also influenced the thickness and density of the skin. HFUS provides a simple noninvasive method for evaluating the skin thickness and echo-density, which, reflecting intradermal structure, exhibit systematic regional variation. With the establishment of Chinese phenotypic database of skin thickness and density, it will be helpful for the skin disease assessment, skin surgery, and cosmetology technology.

Nail surgery: the effect of clinical and psychological characteristics on post-surgical quality of life and pain severity

Nail disease and nail surgery are commonly perceived as painful and distressful experiences that can significantly affect patient health-related quality of life. A comprehensive management of patients undergoing dermatological surgery could improve their emotional experience, influence quality of life and, hopefully, improve their adaptation to the intervention. This study aimed to investigate whether patient psychological characteristics may relate to nail intervention procedures and influence post-surgical quality of life and pain severity. This prospective observational monocentric cohort study was conducted in the Dermatology Nail Unit of Bologna. Patient candidates for nail surgery, meeting the inclusion criteria, were invited to participate in the study which consisted of completion of a self-report questionnaire before (Time 1) and one month after (Time 2) surgery. Nail surgery was performed for 102 patients: 46 underwent highly invasive and 56 mildly invasive nail procedures. In total, 46 nail tumours were excised which were shown to be benign in 36 cases and malignant in 10 cases. Patients with a high level of pain sensitivity and trait of anxiety reported significantly lower levels of quality of life and high levels of pain intensity one month after surgery (p < 0.001). Our findings highlight the need for clinicians to consider the psychological characteristics of patients following dermatological surgery care in order to balance the negative impact of trait anxiety, pain sensitivity and negative treatment expectations regarding post-surgery quality of life and pain severity.

Eruptive Non-melanoma Skin Cancers/Squamous Atypia Following Skin Surgery. Report of Two New Cases, Concise Review of the Literature With Special Emphasis on Treatment Options.

Eruptive cutaneous squamous cell carcinomas (ESCC), eruptive squamous atypia (ESA) and eruptive keratoacanthomas (EKA) are different terms used to describe the occurrence of multiple cutaneous squamous neoplasms after skin surgery, laser treatment, traumas, such as tattoos, and local or systemic medical treatments. ESCC have been reported to arise at the sites of skin surgery, including the area affected by the primary tumor and split thickness skin graft (STSG) donor and recipient sites. The aim of this study is to report 2 additional cases of ESCC after skin surgery and make a critical revision of the literature, analyzing the clinical, histological features and outcomes of ESCC after cutaneous surgery. Up to August 2021, according to our systematic review of the literature, we have collected 19 published articles and a total of 34 patients, including our 2 cases. The results of this review highlight five red flags that clinicians should consider: (i) lower and upper limbs represent the cutaneous site with the highest risk, representing 83,78% of the cases in the literature; (ii) the median time to onset of ESCC is approximately 6 weeks; (iii) primary cutaneous squamous cell carcinomas were completely excised with free margins on histologic examination in the totality of the cases of the literature, and therefore ESCC should not be considered recurrences; (iv) any surgical technique involves a risk to promote ESCC; (v) treatment of ESCC includes medical treatment, surgery or combined surgical and medical treatment. This review highlights 5 red flags which could support clinicians in the diagnosis and management of ESCC after skin surgery.

Mondor disease: an uncommon complication in dermatological surgery.

We present an unusual case of Mondor disease (MD) occurring secondary to elliptical excision of a naevus on the chest wall. MD is a rare superficial thrombophlebitis classically occurring on the anterolateral thoracoabdominal wall. It can be idiopathic, can be due to trauma, breast malignancy, hypercoagulable states or can be iatrogenic, most commonly arising from breast surgery. The condition is generally self-resolving within weeks.

The role of sustainability education within dermatological surgery in the United Kingdom

Sustainability recognises the limited planetary resources and is characterised by being able to sufficiently meet the needs of the current population without compromising future generations. The most recent iteration of the General Medical Council (United Kingdom) ‘Outcome for Graduates’ document required newly qualified doctors to have knowledge of sustainable healthcare (General Medical Council, 2018). Medical education is a key pillar in empowering the medical workforce to recognise the sustainability of the health services they provide and build competencies to reconfigure services and care pathways that will be resilient to the effects of climate change. This correspondence discusses the role of sustainability education within dermatological surgery in the United Kingdom.

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospital.

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospital.

Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques.

A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect. Current evidence suggests that buffering and warming of LA fluid, along with cooling, pinching and administering vibrations to the skin are effective at reducing pain during administration. In this review, no significant difference in pain reduction was found between cooling and administering vibrations to the skin. Studies demonstrate that, overall, LA injection into distal sites is safe. However, the evidence specific to dermatological surgery is limited with regard to ways to reduce pain during LA injection and in determining the safety of LA for distal sites with confidence. Further high-quality research in the form of multicentre randomized controlled trials is required.

Reverse-Grip Technique of Scissors in Dermatologic Surgery: Tips to Improve Undermining Efficiency.

Undermining in difficult-to-reach positions often requires a shift in body position or stretching over the surgical field to obtain adequate reach. We propose a technique of reversing the grip on undermining scissors that improves efficiency without sacrificing technique.

Young boy with a head wound.

Journal of Paediatrics and Child HealthVolume 58, Issue 10 p. 1907-1907 Image of the Month Young boy with a head wound First published: 01 October 2022 https://doi.org/10.1111/jpc.1_15803Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume58, Issue10October 2022Pages 1907-1907 RelatedInformation RecommendedDelayed Wound Healing with Adhesive Wound DressingsJOHN A. ZITELLI M.D., The Journal of Dermatologic Surgery and OncologyWound Healing and DressingsRapid Perioperative Care, [1]

Skin Biopsy in the Pediatric Age Group

Abstract Skin biopsy has a crucial place in arriving at a definitive diagnosis in many pediatric dermatologic conditions. The need to perform a skin biopsy on a child may provoke apprehension in the parents/caregivers, which can be alleviated by establishing a good rapport with them. The details of the procedure, including benefits and risks involved, and the expected result should be communicated to the parents in an easy-to-understand language to have an informed decision. In this review, literature search was done across the PubMed database from January 1992 to January 2022 using the following keywords “skin biopsy in children,” “skin biopsy in pediatric age group,” “pediatric dermatopathology,” “dermatologic surgery in children,” “dermatologic surgery in pediatric age group,” “pediatric dermatologic surgery,” and “procedures in pediatric dermatology.” Articles not written in the English language were excluded.

Self-assembled surgical headlights in dermatologic procedures

Adequate lighting including surgical lighting systems and pedestal examination lights are essential in dermatological procedures and surgeries. However, these overhead fixed lighting systems are expensive, limited in mobility, and in need of continuous electrical power supply. Surgical headlights on the other hand, are portable with adjustable light-emitting diode that can illuminate areas of the surgical field, unreachable by overhead lighting, which increases procedural precision. Unfortunately, some pitfalls of surgical headlights include high cost, high maintenance fee, heavyweight, requiring additional battery cartridges, and low accessibility in resource-poor or developing countries.

Topically Applied Resiquimod versus Imiquimod as a Potential Adjuvant in Melanoma Treatment.

Melanoma is the most lethal form of skin cancer and surgery remains the preferred and most effective treatment. Nevertheless, there are cases where surgery is not a viable method and alternative treatments are therefore adopted. One such treatment that has been tested is topical 5% imiquimod (IMQ) cream, which, although showing promise as a treatment for melanoma, has been found to have undesirable off-target effects. Resiquimod (RSQ) is an immunomodulatory molecule that can activate immune responses by binding to Toll-like receptors (TLR) 7 and 8 and may be more effective than IMQ in the context of melanoma treatment. RSQ can cross the stratum corneum (SC) easily without requiring pretreatment of the skin. In a gel formulation, RSQ has been studied as a monotherapy and adjuvant for melanoma treatment in pre-clinical studies and as an adjuvant in clinical settings. Although side effects of RSQ in gel formulation were also reported, they were never severe enough for the treatment to be suspended. In this review, we discuss the potential use of RSQ as an adjuvant for melanoma treatment.