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Background and Purpose: After reports that complete lymph node dissection (CLND) did not improve melanoma-specific survival of sentinel lymph node (SLN)-positive patients, the use of CLND has diminished but it is still carried out for selected patients. We sought to assess differences in Health-Related Quality of Life (HRQoL) and tertiary care costs among the Finnish Multicenter Selective Lymphadenectomy Trial (MSLT)-II-patients., Patients/materials and Methods: A total of 52 patients randomized to CLND and 55 to nodal observation completed a modified version of the standardized and validated, RAND-36 questionnaire at baseline, 4 months and annually up to 5 years. Tertiary care costs between the groups were also compared., Results: At 60 months, the mean HRQoL score for the CLND and observation groups for General Health were 77.3 versus 65.0 (p = 0.007, adjusted p = 0.065), for role limitations due to physical health 89.5 versus 72.3 (p = 0.029, adjusted p = 0.203) and for role limitations due to emotional problems 91.4 versus 71.9 (p = 0.006, adjusted p = 0.065) and at 48 months, 92.8 versus 71.3 (p = 0.002, adjusted p = 0.056). Median costs per patient were higher in the CLND group at 4 months but the difference disappeared during follow-up., Interpretation: This study suggests that undergoing CLND after a positive SLN biopsy is not a predictor of worse HRQoL. CLND generates greater costs initially, but there seem to be no major differences in total cost per patient between the two groups.

To analyze the efficacy, safety, and influencing factors of 1064 nm picosecond Nd: YAG laser(PSAL)treatment for Nevus of Ota. From January 2018 to March 2024, 212 patients with Nevus of Ota were treated with 1064 nm picosecond Nd: YAG laser at the Guangzhou Dermatology Hospital. The study analyzed the impact of patient gender, age, Tanino classification of skin lesions, color of skin lesions, Fitzpatrick classification of skin, and number of treatments on efficacy, while also documenting any adverse reactions to the treatment. Overall, out of the 212 patients who underwent 1 to 11 treatment sessions, 80 cases (37.73%) achieved complete clearance, 42 cases (19.81%) showed excellent outcomes, 45 cases (21.22%) had good outcomes, 37 cases (17.45%) saw fair outcomes, and 8 cases (3.77%) had minimal effect, resulting in an overall effective rate of 78.77%. The study revealed a correlation between treatment efficacy, age, and the number of laser treatments (P < 0.05). Multifactorial logistic regression analysis demonstrated a positive association with treatment effectiveness (odds ratio 3.324; 95% confidence interval 2.110-5.238). Other variables such as gender, Tanino classification of skin lesions, color of skin lesions, and Fitzpatrick skin type showed no significant correlation with efficacy (P > 0.05). Among the patients, two experienced temporary post-inflammatory effects, while three exhibited folliculitis. Notably, there were no reported cases of persistent erythema, scarring, or hypopigmentation. The treatment of Nevus of Ota using 1064 nm picosecond Nd: YAG laser has been demonstrated to be both safe and effective, with treatment efficacy impacted by patient age and the number of treatment sessions. Early intervention and higher frequency of treatment sessions are associated with improved treatment outcomes., Competing Interests: Declarations. Ethical approval: Ethics approval was not required for this research. Informed consent: All patients or their guardians were fully informed about the study, and written informed consent. Informed Consent: was obtained before treatment. Conflict of interest: None., (© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Feline Bowenoid in situ carcinoma (BISC) is frequently associated with Felis catus papillomavirus-2 (FcaPV-2). Although surgical excision of BISC is expected to be curative, recurrent lesions are reported and it is not known whether it is a consequence of incomplete surgery or residual viral load., Objectives: To combine colorimetric in situ hybridisation (CISH) and quantitative (q)PCR for the detection of viral DNA, and to correlate the clinical outcome of cats with BISC in which FcaPV-2 DNA is detected at surgical margins., Animals: Twenty-seven cats with a histopathological diagnosis of BISC., Materials and Methods: Sections including core and margins of the lesions were used for histopathological evaluation, qPCR and CISH. After surgical removal of the lesion, clinical follow-up data were recorded for 6 months., Results: Six of 12 cases in which all four histological margins were evaluable were used to correlate the infection status at the margins with the follow-up data. Four showed margin positivity, of which half relapsed as expected and half cured; two cases were negative, of which one cured as expected while the other relapsed. Fifteen cases where only three, two or one of the histological margins were evaluable, were considered to adequately correlate the status of infection with the follow-up data if CISH was positive. Follow-up data were available for three with positive margins: one relapsed while the other two were cured., Conclusions and Clinical Relevance: Wide clinical surgical margins are always recommended for neoplastic conditions, yet there was no evidence that CISH margin examination would be beneficial in predicting recurrence in this viral-induced lesion., (© 2024 ESVD and ACVD.)

Introduction: The management of malignant melanomas often involves performing a sentinel lymph node biopsy (SLNB) aided by imaging with lymphoscintigraphy. Whether lymphoscintigraphy should be performed on the same day as the SLNB operation (SD) or the day before (DB) surgery remains debated. This study aims to summarise existing evidence regarding the impact of the relative timings of lymphoscintigraphy and SLNB on clinical outcomes in melanoma., Methods: A PRISMA-compliant search was conducted from inception to 28th May 2024. Data were collected on SLNB in melanoma patients who underwent either an SD or DB approach. The following outcomes were extracted from the articles: node identification, recurrence rate and survival outcomes. Pooled effects of outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, where applicable., Results: A total of 9 studies met the inclusion criteria. Six studies (n = 10, 216) compared SD and DB approach outcomes, while 3 studies (n = 153) compared SD and DB SLNB within the same patient cohort. In the former, no significant difference was found in positivity rates between SD and DB groups (RR 1.03, 95% CI 0.94-1.13, p = 0.475), and recurrence rates were comparable (RR 0.90, 95% CI 0.75-1.07, p = 0.233). SD approach was associated with significantly shorter hospital stays and lower costs, but conflicting results were observed in survival outcomes. In the latter studies, all 3 reported discrepancies between the results of the SD and DB approaches., Conclusion: Current evidence is insufficient to provide a definitive answer. Further research is warranted to conclusively evaluate the impact of SLNB timing on melanoma outcomes and patient care., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Skin cancer incidence increases globally, requiring effective preventive measures and evidence-based treatment strategies. Current guidelines advocate for surgical excision as a first-line treatment for most early skin cancers. The study investigated practices regarding changing scalpel blades when excising multiple skin lesions in the same patient during the same visit (CSB) and explored how beliefs about iatrogenic seeding influence individual norms of practice., Methods: A multidisciplinary survey was conducted among 173 medical specialists involved in skin cancer care. Participants provided demographic information, years of experience, and practices regarding CSB in four clinical scenarios (first excised tumor: basal cell carcinoma, squamous cell carcinoma, melanoma suspect, and evident melanoma). Practice variations based on specialty, experience, and beliefs about seeding risk were statistically assessed., Results: Surgeons exhibited a significantly higher tendency to change blades compared to non-surgeons across all diagnoses. Iatrogenic seeding (56.52%) and clinical training (18.84%) were the main reasons provided for CSB. Beliefs about seeding risk did not differ significantly between specialties., Conclusions: Although the practice of CSB lacks strong scientific rationale, the approach to this practice significantly varies among different medical specialties. Healthcare professionals should critically evaluate and standardize evidence-based practices to ensure optimal patient care and mitigate potential harm., (© 2024 the International Society of Dermatology.)

Background: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery., Patients and Methods: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion., Results: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis., Conclusions: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid., Competing Interests: Conflicts of interest None declared., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery., Patients and Methods: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion., Results: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis., Conclusions: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Solid organ transplant recipients (SOTRs) are at increased risk of developing nonmelanoma skin cancers (NMSC), which may require treatment by Mohs micrographic surgery (MMS). Previous small-scale studies yielded conflicting findings on post-MMS complications in immunosuppressed individuals, and large-scale population-based analyses for SOTRs undergoing MMS are lacking., Objective: The authors investigate postoperative complications after MMS in SOTRs using the TriNetX database of over 106 million patients in the US Collaborative Network., Materials and Methods: Among MMS recipients in this database, a cohort of organ transplant recipients and a cohort of immunocompetent patients were generated. Immunosuppressive medications other than antirejection medications for the SOTR cohort were excluded from both groups. The outcomes for common postoperative complications including infection, wound disruption, graft failure, bleeding, rash, disturbance of skin sensation, and hypertrophic scarring were assessed during a 60-day postoperative window., Results: SOTRs exhibit a twofold increased risk of postoperative infection, 2.5-fold increased risk of surgical wound disruption, and over threefold increased likelihood of swelling within 60 days post-MMS compared with immunocompetent patients. There was no significant difference in bleeding between the cohorts., Conclusion: Given these findings, it may be worth assessing the role of antibiotics and close monitoring for the SOTR population in larger prospective studies to inform future surgical guidelines., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Mohs micrographic surgery is the gold standard treatment for skin cancers in cosmetically sensitive anatomic areas, with a cure rate close to 100%. Managing post-Mohs surgery wounds can pose challenges, particularly in elderly patients. This study evaluates the Cicaglocal drug, a supplement with bromelain, Centella asiatica, hyaluronan, vitamins, and minerals, for enhancing wound healing post-Mohs surgery., Method: This double-blinded, randomized clinical trial conducted at Al-Zahra Hospital in 2023 involved 24 patients aged 50-80 with SCC or BCC undergoing Mohs surgery. Patients were randomized into two groups Cicaglocal and placebo. Treatments were administered postoperatively, and outcomes such as erythema reduction, early healing score (EHS), full recovery, and patient and physician satisfaction levels were evaluated 7 and 14 days after initiation. Data were collected through clinical assessments and standardized wound photographs., Result: Oral Cicaglocal demonstrated significantly improved outcomes compared to their respective placebo groups in terms of erythema score, EHS, full recovery score, and patient and physician satisfaction levels., Conclusion: Cicaglocal can enhance wound healing and lead to improved clinical outcomes following Mohs micrographic surgery., (© 2025 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

This article describes the background and importance of scalp reconstruction. The relevant anatomy and neurovasculature will be discussed. Finally, the entire reconstructive ladder will be examined in its relation to scalp reconstruction and how to optimally reconstruct scalp defects., Competing Interests: Disclosures The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Skin cancers affecting the concha and antihelix are quite common, because of anterior auricular projection from the head and subsequent actinic exposure, leading to the need for effective ear reconstruction post-surgery. Various methods such as skin grafts, free tissue transplantation, and local flaps have been used. This study introduces a refined technique for concha-antihelix defect reconstruction, based on a minimally invasive modification of the revolving-door flap procedure. Here, a fasciocutaneous flap technique involving minimal posterior auricular muscle contribution is used, particularly suitable for anterior skin and cartilage defects. The study included 75 patients with nonmelanocytic skin carcinoma on the ear's anterior surface, in which we evaluated patient's and surgeon's satisfaction with a visual analogue scale and discussed the surgical technique and its advantages and indications. The technique demonstrated excellent cosmetic and functional outcomes, effectively hiding donor-site deformities and ensuring patient and surgeon contentment. This approach allows for one-stage reconstruction under local anesthesia, reducing costs, surgery time, and recovery period. The procedure provides high-quality tissue for reconstruction with low complication risks, making it an optimal choice for wide conchal and antihelix defect repairs due to its proximity to the affected area and the reliable, swift nature of the method., Competing Interests: Declarations of interest None., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: The use of Mohs micrographic surgery (MMS) in melanoma treatment has divided opinion and evidence-based guidelines are lacking., Objectives: This systematic review aimed to analyse clinical outcomes for patients with invasive melanomas treated with Mohs rather than wide local excision (WLE)., Methods: Embase, MEDLINE and Cochrane databases (to 30 August 2023) were searched for studies using Mohs to treat invasive melanoma. Outcomes of interest were local recurrence and death from melanoma., Results: Thirty-five articles involving 41,499 patients with invasive melanoma treated with Mohs were identified. Sixteen studies compared Mohs with WLE and 19 were Mohs-only, non-comparative studies. Patients treated with Mohs differed significantly from those undergoing WLE, in particular Mohs patients were older and had thinner melanomas. Two comparative studies using the same data source reported adjusted hazard ratios for melanoma-specific death and both showed no significant difference between Mohs and WLE-treated patients; 0.87 (95% CI 0.55-1.35) and 1.20 (95% CI 0.71-20.36). There was also no statistically significant difference in local recurrence risk; the unadjusted risk ratio for patients treated with Mohs was 0.46 (95% CI 0.14-1.51 p = 0.20) with moderate heterogeneity (I 2  = 62%). No studies reported multivariable analyses for risk of local recurrence. Many studies generated from relatively few and often overlapping data sets have reported the use of Mohs to treat patients with invasive melanoma. Fewer studies were comparative between Mohs and WLE and these reported substantially different baseline risks of recurrence and death from melanoma between the groups. Mohs has generally been used for thinner melanomas in older patients; therefore, comparisons based on univariable analyses are likely to have been misleading., Conclusions: On the basis of currently available data, it is not possible to reliably assess whether outcomes differ if invasive melanomas with comparable features are treated with Mohs or WLE, and randomized trial evidence will be required for reliable conclusions to be reached., (© 2024 The Author(s). Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Background: Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening. In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap., Patients and Methods: From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed., Results: Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (n = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (n = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months., Conclusions: In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate., (© 2025 The Author(s). Microsurgery published by Wiley Periodicals LLC.)

Angiokeratoma of Fordyce, a localized form of angiokeratoma, is commonly found on the scrotum but rarely affects the vulva. We have documented a case of angiokeratoma of Fordyce in a female patient. She was treated with two sessions of CO2 laser ablation, following which her lesions resolved., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The reconstruction of full-thickness scalp defects with exposed bone can be challenging. A single-stage reconstruction could be the preferred option for patients with multiple comorbidities. We propose using a dermal regeneration template (Matriderm Flex) and full-thickness skin grafts. The approach shown in this case report allows for quick healing, less donor-site discomfort in comparison with dermatome-harvested skin grafts, and very good aesthetic results, matching the surrounding skin thickness., (© 2024 The Author(s). Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Background: The use of Mohs micrographic surgery with melanocytic immunostains (MMS-I) for cutaneous melanoma is increasing., Objective: To assess local recurrence, melanoma-specific death rates in patients with invasive melanoma treated with MMS-I., Materials and Methods: A single-center retrospective review of patients with invasive melanoma treated with MMS-I from January 2008 to December 2018., Results: Three hundred fifty-two patients (359 melanomas) were included. The median age was 71 years; most patients were male (252%; 71.6%). Most tumors were T1a/b (341, 95%), H/N (322; 89.7%), and lentigo maligna subtype (281, 78.3%). At a median follow-up of 4.3 years, local recurrence rates were 1.4% (5) and 0.9% (3) among all-stage and T1a/b tumors, respectively. There were 3 melanoma-related deaths (0.9%)., Conclusion: MMS-I is associated with <1% risk of local recurrence and disease-specific mortality for T1a/b melanomas., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment., Objective: This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment., Methods and Materials: A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution., Results: Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC., Conclusion: The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Cutaneous squamous cell carcinoma (cSCC) is an aggressive tumor with unclear margins. Photodynamic diagnosis (PDD) enables the differentiation of tumor tissue from normal tissue via visible fluorescence. Photodynamic therapy (PDT) is widely used in the treatment of non-melanoma skin tumors. This study aims to illustrate the efficacy and safety of PDD-guided tumor excision combined with ALA-PDT in patients with cSCC., Methods: This study involved 23 cSCC patients, randomly assigned to the PDD group (n = 11) and the non-PDD group (n = 12). Patients in the PDD group underwent tumor excision guided by PDD, while those in the non-PDD group received wide local excision (WLE). Both groups were subjected to frozen section analysis, and PDT was applied during and post-surgery., Results: The negative margin rate in the PDD group was 98.6 %, significantly higher than the 69.2 % observed in the non-PDD group. The PDD group required fewer frozen section analyses and experienced reduced surgical duration., Conclusions: PDD effectively delineates tumor margins in cSCC, guiding the scope of surgical excision. The integration of PDD-guided resection with PDT offers a highly safe and effective therapeutic strategy for cSCC., Competing Interests: Declaration of competing interest The authors have no conflict of interest to report., (Copyright © 2025. Published by Elsevier B.V.)

Mohs micrographic surgery (MMS) is the gold standard for removing basal cell carcinomas (BCCs) due to its ability to guarantee 100% margin evaluation through frozen section histopathology, offering the highest cure rate among current treatments. However, noninvasive imaging technologies have emerged as promising alternatives to clinical assessment for defining presurgical margins. This systematic scoping review examines the efficacy of these imaging modalities, focusing on those approved for clinical use by the United States Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A systematic search of EMBASE, Scopus, PubMed, and the Cochrane Public Library databases identified 11 relevant studies out of 2123 records, encompassing 644 lesions across five imaging techniques. The findings suggest that dermoscopy, high-frequency ultrasound (HFUS), optical coherence tomography (OCT), line-field optical coherence tomography (LC-OCT), and reflectance confocal microscopy (RCM) show potential in detecting BCC margins, which could enhance MMS by providing better preoperative planning, informing patients of expected defect size, aiding in reconstruction decisions, and reducing overall procedure costs. This review discusses the benefits and limitations of each technique, offering insights into how these innovations could influence the future of BCC management. Emerging imaging techniques could enhance MMS by improving BCC margin assessment and reducing costs. Their adoption will depend on price and ease of use., (© 2024 The Author(s). International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Prior studies describe wide local excision and "slow Mohs" outcomes for periocular melanoma. Mohs micrographic surgery (MMS) with immunohistochemistry maximizes tissue preservation and offers same-day comprehensive margin evaluation, which facilitates expedited repair, and coordination of oculoplastic reconstruction when necessary., Objective: To describe oncologic and reconstructive outcomes of invasive periocular cutaneous melanoma treated with immunohistochemistry-assisted MMS., Materials and Methods: Invasive melanoma cases affecting the eyelids or periorbital region treated with MMS between 2008 and 2018 were reviewed. Eyelid tumors and those in adjacent subunits were compared. Main outcome measures were recurrence, melanoma-specific death, and postreconstructive complications., Results: Of 42 cases, 28 were classified as periorbital and 14 as eyelid involving. Most were T1 (37, 88.1%). There was 1 local recurrence in a patient with persistent positive conjunctival margin (2.4%). No local recurrences were observed in cases where negative Mohs margins were achieved, and no melanoma-related deaths occurred. Eyelid tumors were more likely to result in lid margin involving defects and require oculoplastic reconstruction. Eyelid complications developed in 10 cases (23.8%), and 5 (11.9%) required revision surgery., Conclusion: Mohs micrographic surgery for periocular melanoma results in low rates of local recurrence and melanoma-specific death. Initial tumor location can aid in reconstructive planning., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Marjolin's ulcer (MU) is a rare, aggressive skin tumor. There are numerous case reports but large long-term studies are lacking, necessitating further exploration of its treatment. This study aimed to summarize and analyze the characteristics, treatment methods, and prognosis of MU. We retrospectively analyzed the clinical data of 126 patients with MU, treated between January 2013 and January 2023 at the burn center. Demographic data, clinical characteristics, treatment, and prognosis were statistically analyzed. Of the 126 included patients, 104 were followed up for 0.1-10.2 years. The most common cause of the primary injury was flame burn (50.8%). Lesions were commonly observed on the lower limbs (47.6%). The predominant histopathological type was squamous cell carcinoma (92.8%). Among the 126 patients, 35 (27.8%) presented with bone invasion, 37 (29.4%) presented with enlarged lymph nodes, and 9 (7.1%) had lymph node metastasis. Extensive local excision (83.3%) was the most common surgical procedure; the defect was repaired using skin grafting (41.9%), free flaps (37.1%), and local flaps (21.0%). Multivariate analysis revealed that bone invasion and lymph node involvement were risk factors for postoperative recurrence. Survival analysis showed that age, latency period, pathological type, and recurrence were significant risk factors for survival. Extensive local resection is necessary to eradicate tumors, and patient follow-up should be more frequent within 1 year postoperatively. As MU is preventable, it is essential to reach a quick diagnosis and avoid delayed management before the occurrence of deadly metastases., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The epidemiological characteristics and surgical treatment of inpatients with superficial hemangioma in Shandong province were investigated and analyzed. The first-page medical records of hospitalized patients with superficial hemangioma from 2019 to 2020 reported by all secondary and above medical institutions in Shandong province were selected from the National Health Information Platform of Shandong province to analyze their population characteristics and surgical treatment. A total of 3 775 patients with superficial hemangioma were included, with the age of [ M ( Q 1 , Q 3 )] 3.0(0, 33.0)years, including 1 419 males (37.6%) and 2 356 females (62.4%). The head and neck superficial hemangioma accounted for the highest proportion of 37.8% (1 425/3 775), followed by limbs 34.5% (1 302/3 775) and trunk 24.4% (922/3 775). Infants accounted for the highest proportion of 37.2% (1 406/3 775). There were 2 874 (76.1%) patients with superficial hemangioma received surgical treatment, and the proportion of male patients receiving surgery was higher than that of female patients[78.2%(1 110/1 419) vs 74.9%(1 764/2 356), P =0.019]. The proportion of patients receiving surgery increased with age ( P trend < 0.001). In terms of different parts, the proportion of patients with superficial hemangioma in the limbs who received surgery was the highest at 86.2%(1 123/1 302) ( P <0.001). The majority of the surgical operations were secondary surgery (55.8%, 1 110/1 988), elective surgery (91.4%, 1 818/1 988), class Ⅰ incision (53.5%, 1 338/2 501), and general anesthesia (50.9%, 1 219/2 397). The main treatment method was resection (48.1%, 1 816/3 775). The study found that the majority of inpatients with superficial hemangioma in Shandong province were mostly in head and neck, with more females than males, and infants being the main group, and surgical treatment was the main treatment.

Knowledge on the effect of different nicotine consumption modalities on dermatologic surgical outcomes is limited, with conflicting conclusions. Cigarette smoking is known to adversely affect outcomes, but the impact of other nicotine consumption modalities like cigars, smokeless tobacco, and nicotine replacement therapy (NRT) is less understood. Our objective was to evaluate the impact of various nicotine consumption modalities on complication rates after Mohs micrographic surgery (MMS). We conducted a prospective cohort study of 404 MMS patients. Variables analyzed included patient age, sex, post-operative complications, and nicotine history via a questionnaire. We found that patients with any history of nicotine use had an 8.5% absolute risk of experiencing complications while the risk for patients without a history of nicotine use was 3.1%, representing a relative risk of 2.75. Cox proportional hazard testing found patient sex and past smoked tobacco use as statistically significant factors for complications. Patients who have smoked tobacco appear to be at a significantly increased risk of experiencing a complication following MMS compared to never-nicotine users. Larger studies are needed to clarify the surgical risks posed by smokeless nicotine products., Competing Interests: Declarations. Ethical approval: This study was approved by Western IRB; tracking number 20220039. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: Consent for the publication of patient nicotine history and surgical outcomes was obtained by the authors. All patients gave consent with the understanding that this information may be publicly available. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Lipomas are benign tumors composed of encapsulated adipocytes. Although relatively common, uncertainty remains about the population-level prevalence, the etiology, and the degree of public interest in lipomas and associated removal procedures., Objective: The spatiotemporal patterns of public interest in lipomas and lipoma removal procedures were characterized., Methods: Google Trends data that report the relative search volume (RSV) of Google queries pertaining to lipomas and their removal procedures at national and international levels were analyzed. To contextualize these trends, the RSV for lipomas was compared to that of several other common dermatological conditions in the United States., Results: In the United States, lipomas have consistently generated lower levels of public interest than other common dermatological conditions, but interest in the condition has been rising since the mid-2010s. Across the world, public interest in lipomas appears to be the highest in pockets of Eastern Europe, whereas in the United States, relative interest has been higher in Midwestern and Southern states. In addition, the interest in lipoma removal procedures has risen steadily from 2004 to the present, with particularly high RSVs coming from Southwestern states., Conclusions: Dermatologists and plastic surgeons should be aware of the increasing public interest in lipomas and lipoma-removal procedures. Clinical awareness is especially important in states with an elevated interest in lipomas and their associated removal procedures., (© Keenan Duggal. Originally published in JMIR Dermatology (http://derma.jmir.org).)

Few studies have examined outcomes for Mohs micrographic surgery (MMS) for cutaneous squamous cell carcinoma (cSCC) in Black versus White patients. We compared time to surgery and defect sizes after MMS between Black versus White patients with cSCC. Patients with biopsy-proven cSCC treated with MMS at the Hospital of the University of Pennsylvania were identified from a prospectively maintained database (2006-2023). Our primary outcomes included time to surgery (days from the diagnostic biopsy to the first MMS) and defect size (final MMS defect surface area). Univariate and multivariate linear regression models were performed to compare outcomes between Black and White patients with adjustments for age, gender, and tumor location. We identified 8445 cSCC, including 8329 (98.2%) in White patients and 116 (1.4%) in Black patients. Mean time to surgery was 31% longer for Black (76 ± 3.9 days) versus White patients (58 ± 0.5 days) [p < 0.001]. Mean post-MMS cSCC defect size was nearly four times larger for Black (18.6 ± 1.2 cm 2 ) versus White patients (4.8 ± 0.1 cm 2 ) [p < 0.0001]. These differences remained significant when adjusted for age, gender, and tumor location [p < 0.0001]. In conclusion, Black patients with cSCC have significantly longer treatment delays and larger MMS defects than White patients. This study highlights the need for earlier diagnosis and more timely access to MMS for Black patients with cSCC., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Basal cell carcinoma is the most common skin malignancy and constitutes a burden for patients and society. Mohs micrographic surgery is a recommended treatment for high-risk basal cell carcinoma, but long-term outcomes of Mohs micrographic surgery in Denmark are unknown. This study aimed to estimate the 5-year recurrence rate of basal cell carcinoma following Mohs micrographic surgery, and to investigate patient and procedure characteristics since the introduction of the procedure in Denmark. The Danish Registry for Mohs Surgery was established and all Mohs micrographic surgery cases nationwide from January 2012 to December 2022 were included. A total of 1,774 patients were included in the cohort, and 2,203 high-risk basal cell carcinomas were treated using Mohs micrographic surgery techniques. The overall 5-year recurrence of basal cell carcinoma following Mohs micrographic surgery was 3.8% (95% CI 2.8-5.0), 3.1% (95% CI 2.1-4.7) for primary basal cell carcinomas, and 5.3% (95% CI 3.6-7.8) for recurrent basal cell carcinomas. The primary basal cell carcinomas showed a tendency towards lower recurrence rates and better surgical outcomes than recurrent basal cell carcinomas, although not significantly. The recurrence rate estimates correspond to international levels, supporting Mohs micrographic surgery as a treatment option for high-risk basal cell carcinomas in Danish dermatological practice. The newly established patient registry serves as a cohort for future research in this field.

Keratinocyte carcinomas (KCs) are commonly located on the scalp and often treated with excision with peripheral and deep en face margin assessment (PDEMA), with Mohs micrographic surgery (MMS) being the most frequently used method. Resection of these malignancies results in wounds with a wide variety of sizes, ranging from small, sub-centimeter defects, to extensive, nearly complete scalp defects. MMS is often the preferred treatment for tumor resection and margin clearance, as it allows for maximal healthy tissue preservation and has the lowest recurrence rates. Multiple local flap reconstruction options exist, and the selection depends on the size and location of the defect. This review highlights the indications, typical locations, potential risks, and advantages of frequently used local flaps on the scalp, accompanied by artistic representations of each flap herein. An exhaustive list of the local scalp flaps discussed in this review includes single, bilateral, and triple rotation flaps, the pinwheel flap, the double hatchet flap, the triple rhomboid flap, both the unilateral and bilateral banner flaps with split thickness skin grafts, A to T flaps, H-plasty flaps, single and double bridge flaps, and the pacman flap. Inelasticity of the scalp inhibits tissue movement so flaps on the scalp must be designed to be much larger than flaps in most other facial locations. One of the greatest benefits of working with local flaps on the scalp is often the presence of hair-bearing skin which provides the reconstructive surgeon the ability to hide significant scars under hair-bearing scalp, and the ability to perform wound repair under local anesthetic immediately following tumor removal by MMS., Competing Interests: Declarations. Patient consent: Not applicable. Competing interests: The authors declare no competing interests. IRB approval: Exempt., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: National Comprehensive Cancer Network guidelines recommend sentinel lymph node biopsy (SLNB) for patients with > 10% risk of positivity, consider SLNB with 5-10% risk, and foregoing with < 5% risk. The integrated 31-gene expression profile (i31-GEP) algorithm combines the 31-GEP with clinicopathologic variables, estimating SLN positivity risk., Methods: The i31-GEP SLNB risk prediction accuracy was assessed in patients with T1-T2 tumors enrolled in the prospective, multicenter DECIDE study (n = 322). To determine if incorporating the i31-GEP into decision-making resulted in fewer SLNBs performed, propensity score-matching was performed to a non-overlapping cohort for whom the 31-GEP was not used for SLNB decision-making., Results: No patients with < 5% i31-GEP predicted risk had a positive SLNB (0/35). Propensity matching demonstrated an 18.5% reduction in SLNBs performed (43.7% vs. 62.2%. p < 0.001). The i31-GEP could have reduced the number of unnecessary biopsies by 25.0% (35/140)., Conclusions: This prospective study confirmed the performance and clinical utility of the i31-GEP for SLNB for improving risk-aligned care and demonstrated a significantly reduced SLNB performance rate when incorporating the i31-GEP into clinical decision-making., Competing Interests: Declarations. Ethics approval and consent to participate: Institutional review board approval was obtained from WCG-IRB and additionally at each participating institution where required by the institution. All participants provided informed consent at visit one. Consent for publication: Not applicable. Competing interests: BJM is an employee and options/shareholder at Castle Biosciences. JMG, AW, and RS are on the speaker’s bureau for Castle Biosciences. All other authors have no conflicts of interest to declare., (© 2024. The Author(s).)

The recommended treatment for cutaneous squamous cell carcinoma is surgical excision. An initial punch biopsy is often performed as an aid to diagnosis. A retrospective registry-based study was performed to assess histopathological concordance of punch biopsy of cutaneous squamous cell carcinoma and subsequent excision. Analysis of 737 punch biopsies and subsequent matched excisions was performed. In total, 493 (67%) lesions were confirmed as invasive cutaneous squamous cell carcinoma on excision, 76% when excluding "scar" as a final diagnosis. Tumour diameter > 20mm was highly predictive of cutaneous squamous cell carcinoma (positive predictive value 91.1%). Tumours on the scalp were significantly more likely to demonstrate a final diagnosis of cutaneous squamous cell carcinoma than those on the arm (odds ratio 6.11, 95% confidence interval 3.1,12.0). There was moderate concordance between biopsy and excision in grade of histopathological differentiation. This study demonstrates that clinical high-risk features may be of more value in predicting a diagnosis of cutaneous squamous cell carcinoma than partial punch biopsy. Use of clinical and dermoscopic competencies in assessment of cutaneous tumours rather than reliance on biopsies both avoids delay in patient management in the case of high-risk cutaneous squamous cell carcinoma and may also minimize unnecessary surgical excisions if there is a low clinical index of suspicion of cutaneous squamous cell carcinoma.

Background: Superficial leiomyosarcoma is a rare malignant soft tissue tumor arising from smooth muscle cells, accounting for 2-3% of superficial sarcomas, with limited literature available on the subject. It is typically observed in patients aged 50-60 years and affects both men and women equally in the subcutaneous subtype, whereas the cutaneous subtype predominantly affects men., Objective: This study aims to examine the clinicopathological features and therapeutic outcomes of patients with leiomyosarcoma., Method: This is a descriptive retrospective study of 26 cases of cutaneous and subcutaneous leiomyosarcomas, with histological confirmation., Results: We identified 10 (38.5%) subcutaneous leiomyosarcomas and 16 (61.5%) cutaneous leiomyosarcomas. The majority of tumors were located in the lower limbs, accounting for 13 (50%) cases. During follow-up, 6 patients experienced recurrence, and 7 developed metastases, including 2 of the 7 patients who had R0 resection margins. Among these, 3 out of the 6 recurrent cases and 3 out of the 7 metastatic cases were subcutaneous leiomyosarcomas. The average time to recurrence was 6.2 years., Conclusion: The observed risk of metastases and recurrences, despite clear surgical margins, in both cutaneous and subcutaneous leiomyosarcomas, along with the delayed onset of these events, justifies prolonged patient follow-up. The lungs, bones and liver have been identified as the most common site of metastasis., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States., Objective: To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility., Methods and Materials: Medicare claims data were utilized to identify micrographic surgery providers. Surgeon densities were calculated per 100,000 people by county and state. Population changes were analyzed using US census data., Results: Practicing micrographic surgeons were concentrated in metropolitan and nonmetropolitan areas. Overall, 80.4% of counties lacked micrographic surgery providers, with rural areas being the most underserved. Population changes varied among states., Conclusion: Shifts in micrographic surgery certification requirements, US population distribution, and micrographic surgeon location emphasize challenges in accessibility, especially in rural areas across the United States., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Few studies show how dermatologic surgeons manage problems with site identification., Objective: To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question., Methods: Nationwide, prospective, multisite cohort study., Results: Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80 of 98) of initially uncertain sites, with the remaining 18% (18 of 98) postponed. Most postponed surgeries were at non-facial sites., Limitations: Sites were academic centers., Conclusions: When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed., Competing Interests: Conflicts of interest Dr Bolotin reported serving as principal investigator on a clinical trial sponsored by Replimune outside the submitted work. Dr Cohen reported serving as a clinical investigator, consultant, or speaker or trainer for Accure, Allergan, Almirall/Athenex, Avuta, Biofrontera Bioscience, Biopelle, Brickell Biotech, Croma, Elta, Endo Pharmaceuticals, Ferndale, Galderma, InMode, IntraDerm, Lutronic, Merz, Novan, PCA, Pulse Biosciences, Raziel, Recros Medica, Revance, Revision, Sciton, and Sente outside the submitted work. Dr Council reported receiving personal fees from Sanofi-Genzyme Regeneron, AbbVie, and Castle Biosciences outside the submitted work. Dr Schmults reported serving as the National Comprehensive Cancer Network nonmelanoma panel chair, on the American Society for Dermatologic Surgery board of directors, and as International Society for Dermatologic and Esthetic Surgery secretary. Dr Xu serves as the National Comprehensive Cancer Network nonmelanoma panel member. Drs Ahmed, Campbell, Ibrahim, Kang, Aylward, Bari, Cherpelis, Condon, Farhang, Firoz, Garrett, Geronemus, Golda, Humphreys, Hurst, Jiang, Karia, Asadi, Kouba, MacFarlane, Maher, Miller, Moioli, Morrow, Neckman, Pearson, Peterson, Poblete-Lopez, Prather, Ranario, Rubin, Swanson, Urban, Xu, Pearlman, Yoo, Harikumar, Schaeffer, Iyengar, Poon, Cahn and Alam and authors Shi, Koza, Ma, Haq, Nadir, Yi, Dave, Hisham, Lin, Dirr, Bhatti, Helming, Jacobson, and Weil have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Background: Tranexamic acid (TXA) is an antifibrinolytic that has historically been used to treat menorrhagia and bleeding disorders. Exploration of its use in procedures has grown, and it has shown promise in its ability to achieve hemostasis with low risk to patients. Analysis of its use in Mohs micrographic surgery (MMS) is warranted due to its potential superiority to traditional methods of achieving hemostasis (direct pressure, electrocoagulation, and sutures)., Objective: To perform a systematic review of studies which evaluate the efficacy and safety profile of topical application or subcutaneous injection of TXA and analyze as it applies to MMS., Materials and Methods: A comprehensive literature search was conducted using the PubMed database to identify relevant studies using the search terms: "tranexamic acid" OR "TXA." The search was performed up to December 1, 2023., Results: Tranexamic acid has a strong safety profile, and its effectiveness in achieving hemostasis is well-demonstrated. Tranexamic acid has reduced risk of bleeding complications compared with traditional methods of achieving hemostasis., Conclusion: An extensive review of the literature has yielded positive results, suggesting the potential of TXA in improving patient outcomes, reducing surgical time, decreasing intraoperative and postoperative bleeding, and increasing overall patient satisfaction., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Symplastic glomus tumors are a rare subtype of glomus tumor defined by nuclear atypia without additional markers of malignancy such as large size, deep location, or atypical/prevalent mitotic figures. Glomus tumors, including the symplastic subtype, most commonly present in the subungual area with rarer extradigital presentation. To our knowledge, there have been less than 25 cases of symplastic glomus tumors described in the literature. Herein, we present a case of extradigital symplastic glomus tumor with review of the literature., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study aimed to identify factors influencing the completeness of primary and re-excision of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (SCC), and cutaneous carcinoma in situ (CIS) of the head and neck. A retrospective single-center analysis was conducted, encompassing 1513 instances of cutaneous tumors recorded between 2015 and 2022. This dataset comprised 1108 primary excisions and 405 re-excisions, all of which were histologically verified cases of BCC, SCC, and CIS located within the head and neck region. Correlation analyses were performed, considering variables such as patients' gender and age, tumor localization, preoperative suspicion or histological confirmation of skin tumor diagnosis, surgeons' levels of training, and the utilization of magnifying glasses. The primary objective was to assess the impact of these factors on the completeness of both primary and re-excisions of skin tumors. The analysis revealed a significant correlation between the localization of BCC and the completeness of primary excision. Specifically, the nose and ear exhibited a significantly higher rate of incomplete excisions (R1), whereas the cheek demonstrated a substantial reduction in the R1 rate. The utilization of magnifying glasses exhibited a positive correlation with the completeness of primary BCC excision. However, no discernible influencing factors were identified for BCC re-excisions and the combined group of primarily and re-excised cutaneous squamous cell carcinoma (SCC) and carcinoma in situ (CIS). Tumor entity and localization emerged as crucial factors influencing the completeness of skin tumor excisions, with specific anatomical sites exhibiting varying rates of incomplete procedures. Notably, the use of magnifying glasses demonstrated a significant positive correlation with reduced rates of incomplete excisions, re-excisions, and subsequent procedures, suggesting its potential as a valuable tool in enhancing surgical precision and optimizing outcomes., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma with an infiltrative growth pattern that makes it challenging to clear margins. High quality data regarding DFSP natural history, management, and outcomes are limited., Methods: Data were retrospectively collected for adult DFSP patients who underwent resection at 10 institutions in eight countries. Demographics, tumor characteristics, treatment strategies, and outcomes were analyzed., Results: Analysis included 347 patients consisting of young (median, 42 years), White (76.2%), males (54.2%) with truncal lesions (57.3%). The majority (76.8%) were symptomatic at presentation. Preoperative imaging was used in 55.9% of cases. Diagnosis was established with excisional biopsy in 50.9% versus incisional biopsy in 25.0% of cases. Despite planned margins of >1.0 cm in 67.4% of cases, only 69.0% of patients achieved R0 resection. Twenty-two percent of patients underwent at least one re-excision. R0 resection was achieved at a second procedure in 80.2% and a third procedure in 86.2%. Ultimately, R0 resection was feasible in 89.5% of all patients. Fibrosarcomatous transformation (FST) was observed in 12.6%. In total, 6.6% (N = 23) recurred (17 local, six distant). Of the six distant recurrences, 50.0% had FST. With a median follow-up of 47.0 months, disease-specific survival rate was 98.8%. In multivariable analysis, R0 margins at index resection were associated with wider circumferential margins and non-FST histology., Conclusions: In this international, multicenter collaborative, DFSP practice patterns were heterogeneous but achieved favorable recurrence rates and survival. Multiple excisions to clear margins remain commonplace and can inform future efforts to optimize margin selection., (© 2024 American Cancer Society.)

Objectives: Glomangiomas are benign vascular malformations that exist within the spectrum of glomuvenous malformations which consist of varying amounts of glomus cells, vascular spaces, and smooth muscle. Glomangiomas are often treated due to associated pain, particularly when located on pressure areas such as the back or extensor surfaces, which can cause difficulty with certain activities and occupational functions. Histologically glomangiomas consist of prominent dilated vascular spaces lined by glomus cells typically situated in the deep-dermis to subcutaneous fat which limits treatment to modalities capable of reaching the depth of the tumor including excision, sclerotherapy, and laser therapy. To our knowledge laser treatment of glomangiomas has been reported with Nd:YAG (neodymium-doped yttrium aluminum garnet), long-pulsed KTP (potassium-titanyl-phosphate), and PDL (pulsed-dye laser). The objective of our case is to compare the clinical and histologic treatment response of glomangiomas to the 595 nm PDL, 755 nm Alexandrite, and 1064 nm Nd:YAG lasers., Materials and Methods: Two different laser sessions were performed consisting of PDL (Vbeam Prima Pulsed Dye Laser, Candela), Nd: YAG and Alexandrite (GentleMax Pro, Candela) laser pulses. The GentleMax Pro was utilized for both Nd:YAG and Alexandrite laser pulses as it is capable of functioning in both modalities to deliver 1064 nm and 755 nm wavelengths, respectively. Settings were selected to minimize any risk of potential scarring. Punch biopsies were performed following the second session to assess the histologic response to each laser modality., Results: Treatment response, as measured by clinical flattening, clearance of obvious blue-red vascular coloration, and resolution of pain, was noted to be most effective for the Alexandrite and Nd:YAG lasers. Procedural and post-procedural pain was noted to be the lowest with Alexandrite. Anatomically, greatest degree of clinical flattening, color normalization with surrounding skin, and sustained clearance was noted for glomangiomas located on acral sites and the trunk., Conlusions: Optimal treatment of glomulovenous malformation while minimizing patient discomfort may best be achieved with Alexandrite. The exception would be palmar glomangiomas which appeared to respond better to Nd:YAG., (© 2024 Wiley Periodicals LLC.)

Objectives: This study aimed to evaluate the efficacy and safety of nanosecond laser treatment of pigmented lesions in silico using a model of melanosome disruption threshold fluence (MDTF) based on skin optical properties., Methods: Particle size analysis and scanning electron microscopy were performed to determine the threshold fluence for melanosome disruption using a nanosecond laser. By inputting the obtained threshold fluence into the MDTF model and considering the variability in skin optical properties, irradiation parameters were calculated and compared with the results from clinical studies., Results: The threshold fluences for 532 and 755 nm nanosecond laser irradiation were determined to be 3.0 and 15.0 J/cm 2 , respectively. In silico analysis showed that the incident fluence for moderately pigmented skin should be 1.2 times that for lightly pigmented skin, whereas it should be 50% lower than that for lightly pigmented skin to achieve the same level of energy deposition. Clinically applied fluences for moderately pigmented skin are at the low end of the calculated range of values, suggesting that the clinical fluence is chosen to minimize energy deposition in normal tissues., Conclusions: Our results showed that the MDTF model can be used to evaluate nanosecond laser treatments and provide clinical guidance on fluence settings based on laser-tissue interactions in moderately pigmented skin. The in silico method can, therefore, provide a robust and quantitative retrospective evaluation of the treatment effects that accounts for variation in irradiation parameters among patients by combining the MDTF model with the in vivo optical properties of individual skin types., (© 2024 Wiley Periodicals LLC.)

Background: Nasal cutaneous tumors impact appearance and function, affecting the patients' well-being. This study compares the outcomes of second intention healing, where wounds heal naturally, with flap transfer in nasal defect repair after tumor resection to evaluate its viability as an alternative., Methods: In this multi-center study, 80 patients who underwent second intention healing and 70 patients who received flap transfer after nasal tumor resection between July 2018 and June 2023 were included. Patient demographics, tumor characteristics, operative details, and wound healing time were collected. Scar outcomes were evaluated at 6 months postoperation using the Vancouver scar scale and visual analog scale., Results: The second intention healing group showed significantly better outcomes compared to the flap transfer group. The Vancouver scar scale score was lower in the second intention group (3.51 ± 0.22 vs. 3.98 ± 0.68, P = 0.02), indicating better scar quality. Superior outcomes were observed in vascularity, pigmentation, and pliability on the observer patient and observer scar assessment scale (POSAS) scale. Patients reported better color, irregularity, and higher satisfaction with wound care experience. The overall patient satisfaction score was significantly higher in the second intention group (7.59 ± 0.24 vs. 7.16 ± 0.10, P = 0.02)., Conclusion: This cohort study suggests that second intention healing is associated with higher patient satisfaction in nasal cutaneous tumor surgery compared to flap transfer. These findings support the possibility of using second intention healing as an alternative in nasal cutaneous tumor treatment. Further research is needed to validate these results., Competing Interests: Conflict of interest No competing interests were declared., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2 cm) and medium-sized (size around 2-4 cm) cutaneous defects of the face even for the oldest and/or emaciated patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background: Nasal defects after skin cancer excision can often be healed by second intention in certain circumstances., Objective: We aim to demonstrate the utility of bovine collagen xenografts in supplementing second-intention healing of a variety of nose surgical defects., Results: Thirty-nine patients underwent Mohs micrographic surgery of the nasal tip (33%), ala (23%), dorsum (31%), sidewall (10%), and root (3%) with the application of bovine collagen xenograft. The average defect size was 1.89 cm2 (0.36 - 7.5 cm2 ). The average time to re-epithelialization was 33 days (range, 11 - 60 days) at a rate of 19.4 days to healing per cm2 of defect size, which represented an improved time to reepithelialization of over 40% compared to historical controls of second intention healing. Cosmetic outcomes were outstanding or acceptable in 77% of the cases., Conclusion: Bovine collagen xenografting is a safe and effective method to enhance the second intention of healing Mohs excision defects of the nose, with overall excellent cosmetic results. J Drugs Dermatol. 2025;24(1):96-99. doi:10.36849/JDD.8634.

Background: Flap repair provides unique advantages in facial reconstruction but still carries the potential for undesirable postoperative cosmetic changes., Objective: The aims of this study were to describe postoperative vascular outcomes of patients undergoing flap repairs after Mohs micrographic surgery on facial tumors and to assess associations of baseline characteristics with outcomes., Materials and Methods: In this study, 7 dermatologists and 1 physician assistant in dermatology assessed preoperative and postoperative photographs of 57 patients who underwent facial Mohs micrographic surgery, evaluating vascular and pigment outcomes and number of telangiectasias., Results: There was a significant difference in number of telangiectasias according to body location ( p = .002), where the number of telangiectasias was highest for nose surgery., Conclusion: These data suggest that nasal flap repairs are associated with increased postoperative vascular changes. This highlights an opportunity for improved preoperative patient counseling and possible early laser treatment after nasal Mohs micrographic surgery., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Tissue expansion for treating giant congenital melanocytic nevi (GCMN) is a commonly used surgical method. However, the procedure's efficacy is often hindered by anatomical and histologic characteristics and blood supply, particularly in the extremities and trunk. Enhancing expansion efficiency while reducing complications is thus a topic to be investigated, especially for pediatric patients undergoing rapid physical and psychological development with higher risks of noncompliance to medical instructions. The purpose of this study was to explore the effectiveness of expansion in extremities and trunk by immobilizing the acellular dermal matrix (ADM) in the gravitational force zone of inflating expanders., Methods: All patients involved in this research underwent ADM-assisted tissue expansion in either the extremities or trunk. ADM was fully flattened, securely fixed to the lower pole of the expander, and subsequently attached to the inner surface of the expanding flap., Results: From 2021 to 2023, a total of 9 pediatric patients with GCMN underwent ADM-assisted tissue expansion. All patients achieved the desired expansion volume without experiencing petechiae, ecchymosis, or skin ulceration in the ADM-covered area. The process was well tolerated by all patients, with no reports of itching, pain, allergic reaction, or fever. During the flap transfer, the ADM was observed to be firmly adhered to the expanding flap with discernible capillary network., Conclusions: ADM-assisted tissue expansion demonstrates promise in augmenting expansion efficiency and reducing the time needed for surgical intervention in the extremities and trunk, thereby presenting significant clinical value for pediatric patients with GCMN., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

Background: The Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), published in 2017, demonstrated equivalent melanoma-specific survival between nodal surveillance and completion lymph node dissection (CLND) for sentinel lymph node (SLN) positive melanoma. This study evaluated outcomes of nodal surveillance in an early post-MSLT-II institutional cohort., Methods: Included patients received nodal surveillance from 2017 to 2023. Primary outcomes were nodal basin and any site recurrence. Kaplan Meier curves and Cox proportional hazard models were used to evaluate recurrence-free survial and associated factors., Results: This 212 patient cohort (median age 61 years, 57.7 ​% male, 96.7 ​% white) had median primary tumor depth of 1.9 ​mm and one positive SLN. Sixty-three patients (29.7 ​%) recurred at 23 month median follow-up. Sixty percent received adjuvant therapy. Any site and nodal basin recurrence-free survival were 58.3 ​% and 80.9 ​% at 3 years. On adjusted analysis, older age and head/neck primary site were associated with worse recurrence-free survival., Conclusion: Long-term outcomes at a single institution were comparable to clinical trial findings. Nodal surveillance remains a feasible management strategy for SLN ​+ ​melanoma., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kristy Broman reports a relationship with National Institutes of Health that includes: funding grants. Kristy Broman reports a relationship with American College of Surgeons that includes: funding grants. Kristy Broman reports a relationship with American Society of Clinical Oncology that includes: funding grants. Kelsey Montgomery reports a relationship with Agency for Healthcare Research and Quality that includes: funding grants. Victoria Jiminez reports a relationship with American Skin Association that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Malignant adnexal tumors of the skin are a rare group of tumors that can be locally aggressive and require surgical excision with strict margin control to achieve clearance. Given the rarity of these tumors, there is a limited understanding within the medical community regarding optimal treatment approaches., Objective: To examine surgical management trends and outcomes for patients diagnosed with cutaneous adnexal tumors from 2000 to 2020., Materials and Methods: The Surveillance, Epidemiology, and End Results database was queried to identify biopsy-proven cases of cutaneous adnexal tumors between 2000 and 2020. Clinical and disease characteristics were examined, and disease-specific survivals were compared between surgical approaches using Kaplan-Meier curves and Cox proportional hazards models., Results: Mohs surgery demonstrated a significant increase in utilization from 2000 to 2020 (+447.1%) and improvements in disease-specific survival (mean 231.7 months; p < .001) compared with no surgery; wide local excision exhibited no improved disease-specific survival (227.7 months; p = .070). Multivariable Cox regression further highlighted that only Mohs surgery exhibited a reduced disease-specific mortality risk compared with no surgery (adjusted HR 0.49; p = .011)., Conclusion: Given the enhanced disease-specific survival coupled with tissue preservation strategies, Mohs surgery emerges as a promising surgical approach for the treatment of malignant adnexal tumors of the skin., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Laser capture microdissection (LCM) of formalin-fixed, paraffin-embedded sections is a way to analyze gene expression of morphologically distinct areas of tissue, as microscopically visualized with stained tissue sections. Herein, I describe a method for laser dissecting lymphoid aggregates in canine cutaneous and subcutaneous sarcomas and their adjacent sarcoma tissue to determine the differential expression of RNA as determined by NanoString ® nCounter technology. Canine soft tissue sarcomas (STS) are diversely derived mesenchymal neoplasms that, regardless of exact histogenesis, behave similarly and thus have been grouped together as a diagnostic entity. The risk of recurrence and/or metastasis depends on the extent of surgical excision and histologic grade. Lymphoid aggregates are described in these tumors but have not been characterized. In humans, lymphoid aggregates characterized as tertiary lymphoid structures (TLS) improve the prognosis of several tumors, including sarcomas. We sought to determine if RNA expressed by lymphoid aggregates in canine sarcomas was compatible with TLS RNA expression. This chapter describes tissue preparation, staining, laser capture microdissection, and RNA isolation in preparation for digital RNA counting., (© 2025. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins., Methods: Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins., Results: Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (P < 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (P < 0.001) but only the latter predicted worse overall (P = 0.013) and recurrence-free survival (P = 0.009). Kaplan-Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (P = 0.006) and recurrence-free survival (P = 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes., Conclusions: Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame., Competing Interests: Disclosure: Carolyn Nessim has received honoraria from the following companies, but they are not relevant to this paper: Merck, Sanofi, Novartis, EMD Sorono, Astra Zeneca, and Boehringer-Ingelheim Medical. Alex Lee, Boaz Wong, Heidi Li, Elysia Grose, Olivier Brandts-Longtin, Katherine Aw, Rebecca Lau, Ahmad Abed, James Stevenson, Rahat Sheikh, Richard Chen, Clara Goulet, and Stephanie Johnson-Obaseki have no conflicts of interest to declare that may be relevant to the contents of this article., (© 2024. Society of Surgical Oncology.)

Background Nail unit squamous cell carcinoma (nSCC) is a malignant subungual tumour. Although it has a low risk of metastasis and mortality, the tumour has a significant local recurrence rate. There is insufficient data to determine whether functional surgery is less effective than amputation for nSCC that does not involve the bone. Objectives We aimed to investigate existing data on the outcomes of functional surgery and amputation for nSCC without bone invasion. Materials and Methods We carried out an extensive search in PubMed, Embase, Cochrane Library, Web of Science, and Scopus for appropriate English-language academic papers, starting with the creation of individual resources until February 23, 2023. The main outcome was local recurrence. Initially, 2191 studies related to nSCC were selected. Information from every research study was retrieved and subdivided, comprising the year of publication, period, number of patients, age, gender distribution, tumour stage, type of intervention, number of recurrences, and follow-up period. Results Ten independent studies (319 lesions) were finally selected. Mohs micrographic surgery was the most reported surgical modality, followed by wide surgical excision and amputation. Local recurrence rates between Mohs micrographic surgery, wide surgical excision and amputation treatment were nearly identical. Other surgical methods included limited surgical excision, partial ablation, and limited excision until the clearing of margins, with recurrence rates up to 50%. Conclusions Given the functional impairment and psychological distress associated with phalanx amputation, functional surgery, including Mohs micrographic surgery and wide surgical excision , should be the preferred therapy for nSCC without bone involvement. Amputation should remain the preferred therapy for nSCC that involves the bone. Partial excision should be avoided. Further studies on whether Mohs micrographic surgery or wide surgical excision is a better option for nSCC not involving the bone are required.

Purpose: Mohs micrographic surgery with immunohistochemistry allows for same-day comprehensive margin assessment of melanoma in situ prior to subspecialty reconstruction. This study describes the oncologic and reconstructive outcomes of eyelid and periorbital melanoma in situ and identifies risk factors for complex reconstructive demands., Methods: Retrospective case series of all patients treated with Mohs micrographic surgery with immunohistochemistry for melanoma in situ affecting the eyelids or periorbital region from 2008 to 2018 at a single institution. Tumors were assigned to the eyelid group if the clinically visible tumor involved the skin inside the orbital rim. Reconstructive variables were compared between the eyelid and periorbital cohorts., Results: There were 24 eyelid and 141 periorbital tumors included. The initial surgical margin for all tumors was 5.34 ± 1.54 mm and multiple Mohs stages were required in 24.2% of cases. Eyelid tumors included more recurrences ( p = 0.003), and the average defect size was larger (14.0 ± 13.3 cm 2 vs. 7.7 ± 5.4 cm 2 , p = 0.03). Risk factors for complex reconstruction included: initial tumor diameter >2 cm (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 1.95-7.57) and eyelid involved by initial tumor (OR: 4.88, 95% CI: 1.94-12.28). At an average follow-up of 4.8 years, there were no melanoma-related deaths and 1 local recurrence (0.6% recurrence rate)., Conclusions: Mohs micrographic surgery with immunohistochemistry achieves excellent local control rates for periocular melanoma in situ. An initial surgical margin of 5 mm is frequently insufficient to achieve clear margins. The resulting defects are large, and the complexity of reconstruction can be predicted by tumor size and clinical involvement of eyelid skin., Competing Interests: The authors have no financial or conflicts of interest to disclose, (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

The rapid aging of the population has led to an increase in the number of cutaneous squamous cell carcinoma (cSCC) cases among the older population. However, the characteristics of these cases remain unclear. In this study, we aimed to identify the problem by analyzing the clinical characteristics of patients with cSCC aged 90 years and over. In this retrospective study, we analyzed the characteristics of patients aged >90 years with regard to gender, risk factors for cSCC, and disease course, using data from 316 patients with cSCC who underwent surgery at the Kagoshima Medical Centre between October 2014 and September 2022. Patients were separated into two groups based on age: those aged ≥90 years (104 patients) and those aged <90 years (212 patients). Regarding the National Comprehensive Cancer Network risk classification, there was no difference between groups. Univariate, multivariate, and Cox analyses of relapse-free survival of patients in both groups indicated that the recurrence risk was significantly high among those aged ≥90 years. Patients aged ≥90 years were at higher risk for recurrence, suggesting a need for closer follow-up than that for patients aged <90 years., (© 2024 Japanese Dermatological Association.)