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Resume La cicatrisation est la reponse de la peau a toute incision, blessure, ou perte de substance. Elle s’effectue par un systeme de reparation naturel complexe en 4 etapes : vasculaire, inflammatoire, proliferative, de remodelage et d’apoptose cellulaire. Ce systeme de reparation incroyable est parfois imprevisible et aleatoire en raison des differences individuelles multifactorielles. La cicatrice reste le critere objectif de reussite d’une chirurgie cutanee oncologique pour le patient et le praticien. Il est donc crucial d’etablir avec le patient lors de la consultation preoperatoire, la taille et le positionnement de la cicatrice attendue, compte tenu des contraintes carcinologiques, anatomiques, et chirurgicales. Elle peut idealement se confondre avec la peau mais peut aussi donner lieu a diverses anomalies cicatricielles. Celles ci peuvent etre prevenues par la maitrise de l’inflammation initiale qui peut induire une hyperpigmentation post inflammatoire et une hypertrophie cicatricielle. Cela repose sur des massages precoces utilisant un topique anti-inflammatoire cortisone ou cosmetique et une photoprotection en particulier chez les patients a risque. L’alea cicatriciel peut etre minimise par un accompagnement cicatriciel dynamique et personnalise.

Background: Dermatosurgery (DS) is a growing sector in dermatology. Performance measurement is organized worldwide to improve the quality of health care. Clinical audit relies on self-assessment, comparison with guidelines, frames of references and implementation of improvement actions. Objective: To assess the efficiency of our DS department. Methods: A clinical audit focusing on the organization of the DS unit, patient routing, continuing medical education and training for students was conducted by two external auditors. After an initial evaluation, improvements were implemented and reassessed 1 year later by the same auditors. Results: The audit resulted in the implementation of preoperative consultation, improved pre- and postoperative information leaflets for patients, standardizing of surgery reports, earmarking of funds for materials, and patient satisfaction survey. The training of residents was organized. Conclusion: This audit was a driving force for communication among the medical and paramedical teams and helped improve patient care and training of residents in DS. It also highlighted areas needing further improvement.

The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.

Summary Background Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. Objectives The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. Methods Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. Results A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. Conclusions This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.

Cutaneous infections due to Mycobacterium marinum seems to be frequent. We report two cases with different clinical forms : nodular and sporotrichoid. Treatment is based upon tetracyclines or rifampicin plus ethambutol.

Cutaneous involvement by Hodgkin's disease (HD) is rarely the presenting feature. However, non specific lesions occur in 15–50 % of cases and result often from pruritus. The association vasculitis and hematological disease is uncommon. We report two cases of leukocytoclastic vasculitis preceeding and revealing Hodgkin's disease.