Faculty Bibliography

There is controversy regarding the optimal surgical modality and ideal recommended margins for treating melanoma in situ (MIS) and invasive melanoma (IM). Although wide local excision is recommended, staged excision offers excellent margin control and low recurrence rates. In this manuscript, we reviewed a 10-year experience of staged excisions for the treatment of MIS and IM. A retrospective review was performed of 130 MIS and 32 IM cases treated with staged excision from April 2012 to April 2022. Staged excision was performed on the head and neck in 102 (79%) MIS and 23 (72%) IM cases. Approximately 10% of cases required surgical margins above the current recommendations (11 (9%) MIS and 6 (19%) IM). Twenty-three (19%) MIS and 7 (22%) IM cases required more than one excision to obtain clearance. Recurrence rates among MIS and IM were 0.0% and 0.6%, respectively. Upstaging occurred in 5 (4%) MIS and 7 (22%) IM cases. Complex repairs were performed on 82 (63%) MIS and 17 (53%) IM cases. Our findings revealed that staged excision provides effective margin control and low recurrence rates. Approximately 10% of patients required margins greater than the current recommendations, leading to larger defects and more complex repairs.

INTRODUCTION/BACKGROUND:Nasal reconstruction has important functional and cosmetic considerations, as proper repair of nasal defects is necessary to maintain function of the nasal airway and to recreate the normal appearance of this central facial structure. Cheek advancement flaps provide matched, mobile and highly vascularized tissue for the reconstruction of nasal defects, allowing for the concealment of incisions within natural creases in a one-stage approach. However, cheek advancement flaps are often underutilized for nasal reconstruction because of their difficulty restoring nasal contour. METHODS:We describe reconstruction of 19 nasal dorsal and sidewall defects 0.8 to 3.0 centimeters (cm) in size. We incorporated a periosteal anchoring suture to maintain/restore nasal contour and additionally removed a half standing cone inferior to the defect to prevent encroachment of the nasal ala or alar crease. All patients were evaluated at least 3 months post-operatively. RESULTS:In all patients, we were able to restore concavity of the nasofacial sulcus, preserve the biconvex nasal tips, prevent alar flaring and retraction and conserve the alar groove. All patients had excellent functional and cosmetic outcomes. CONCLUSION/CONCLUSIONS:We believe this modified cheek advancement flap provides functionally and aesthetically superior results and can be considered as a first-line approach for repair of nasal dorsal and sidewall defects in sub selected patients.

Background: Infundibular cysts, also known as epidermoid or epidermal inclusion cysts, occur most commonly on face, neck, periauricular area and upper trunk. These cysts are thought to arrive from ruptured pilosebaceous follicles or implantation of epithelium beneath the skin as a result of trauma. These cysts are most commonly treated with surgical excision though limited studies have explored the treatment of these cysts with laser therapy. We report a case below of the successful treatment of a 70-year old patient with multiple infundibular cysts with 2940 nm erbium:yttrium aluminum garnet (Er:YAG) laser resulting in notable improvement. Study Design/Materials and Method: A 70-year-old male presented to Dermatology Surgery clinic with complaints of multiple bumps on his face and neck, present for several years. Of note, he had a history of significant chronic sun exposure during his time living in Mexico. On physical exam, there were numerous 2-3 mm skin-colored firm papules on the nose, cheeks, neck and sun exposed areas of the chest. There were no open comedones. Biopsy was performed of a representative lesion, and histopathology revealed an infundibular cyst. He had no pertinent medical history. Due to the widespread involvement of the face, full-face ablative resurfacing with a 2940 nm Er:YAG laser was selected as the best treatment. XXResult(s): The patient underwent a resurfacing procedure with a 2940 nm fully ablative Er:YAG laser. Two passes were performed to the entire face at a depth of 100 microns per pass and each papule was also individually treated with the single spot hand piece set at a depth of 50 microns. Patient reported significant cosmetic improvement with a single treatment. XXConclusion(s): While several reports have demonstrated that carbon dioxide (CO2) fractionally ablative lasers can be effective in the treatment of vellus hair cysts, syringomas, and steatocystomas, there have been limited reports on the use of ablative lasers for epidermal cysts. The first successful treatment of multiple facial epidermal cysts with a CO2 laser was reported by Reynolds and Kenealy in 2002. Feng et al. recently demonstrated that Er:YAG fenestration can be used as an alternative to surgical treatment of epidermal cysts in a series of 25 patients, with 92% reporting good results. To be the best of our knowledge, this is the first study demonstrating treatment of cysts with fully ablative Er:YAG laser.

BACKGROUND:Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation. OBJECTIVE:To evaluate the effectiveness of intraoperative electroabrasion for scar revision. MATERIALS AND METHODS/METHODS:This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery. RESULTS:At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides. CONCLUSION/CONCLUSIONS:Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation.

The detection of melanoma can be challenging. Many patients have clinically equivocal lesions in cosmetically sensitive areas or have multiple suspicious lesions. Epidermal genetic information retrieval is a noninvasive diagnostic method involving the application of adhesive tape onto the skin's surface to recover genomic material from the epidermis. This genomic material can then be used in assays to determine gene expression profiles. Studies have shown the potential of this technology to aid clinicians in differentiating between melanomas and nevi. Although this technology is not meant to replace a biopsy, it can help guide the decision whether to biopsy.