Faculty Bibliography

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/CONCLUSIONS: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.

INTRODUCTION/BACKGROUND:The 595-nm wavelength pulsed dye laser (PDL) is well-established in the treatment of vascular lesions. In June 2023, it received FDA clearance for the treatment of port-wine birthmarks (PWB) and infantile hemangiomas (IH) in the pediatric population. OBJECTIVE:Review the evidence regarding the efficacy, safety, and implications of using PDL for management of pediatric PWB and IH. METHODS:A systematic literature search was performed to identify peer-reviewed articles and clinical trials published between July 2002 and December 2022 in which PDL was used to treat pediatric PWB and IH. RESULTS:After application of criteria, 33 journal articles with 7725 total patients were included. Only 16 (0.8%) of the 2,033 patients with PWB and 11 (0.2%) of the 5692 patients with hemangioma reported permanent adverse effects including scarring, keloids, or permanent pigmentation change, and none reported blindness or other serious injury. Good, excellent, or complete clearance after PDL-on average or in greater than 50% of patients-was reported in 17 of 19 studies (89%) that reported these measures for PWB, and seven of the seven studies (100%) for IH. CONCLUSION/CONCLUSIONS:The 595-nm PDL is an excellent treatment option for early intervention in pediatric patients with PWB or IH.

BACKGROUND:Neck rejuvenation has consistently become a popular cosmetic procedure. While various treatment modalities have been used, a novel fractional thermomechanical skin rejuvenation system was recently developed to create dermal coagulation through direct heat transfer with subsequent neocollagenesis. OBJECTIVE:A prospective clinical trial evaluated the efficacy and safety of a thermomechanical fractional injury device (Tixel 2, Novoxel, Netanya, Israel) for neck rhytides. MATERIALS AND METHODS/METHODS:Subjects with moderate to severe neck rhytides were enrolled for 4 monthly treatments. RESULTS:Twenty-six subjects were enrolled and completed all study visits. The mean age was 58.4 years, and 100.0% were women. Fitzpatrick skin types I to IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), the mean baseline score was 6.3. As per investigator, there was a mean 1.5-grade improvement in FWCS at 1-month follow-up (p < .00001) and 1.4-grade improvement in FWCS at 3-month follow-up (p < .00001). For physician Global Aesthetic Improvement Scale, all subjects (100%) had improvement at both 1- and 3-month follow-up visits. There were no severe adverse events, and subjects experienced minimal pain. CONCLUSION/CONCLUSIONS:A novel thermomechanical fractional injury device is effective and safe for the treatment of neck rhytides.

BACKGROUND:Patients frequently complain about fine lines, wrinkles, dyschromia, and photoaging, for which lasers and energy-based devices can treat each of these. Pairing various devices in a single treatment session can be safe and effective, but different technologies, mechanisms, histologies, parameters, and techniques must be considered. OBJECTIVE:To examine the utility of a paired treatment regimen using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array to improve the clinical appearance of facial wrinkles and photoaging. MATERIALS AND METHODS:A prospective clinical study investigated this paired treatment regimen using 4 monthly sessions. RESULTS:Twenty-five subjects were enrolled, while 18 subjects completed 3-month follow-up. The mean age was 54 years, and 92% were women. Fitzpatrick Skin Types I to IV were represented. Assessments compared baseline with the 3-month follow-up. Two of 3 blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 94.4% of cases. For physician Global Aesthetic Improvement Scale, 100% of subjects had clinical improvement. Overall, 88.9% of subjects were considered to be satisfied with their treatment. No serious or unanticipated adverse events occurred. CONCLUSION:Paired treatment using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array can safely and effectively improve facial wrinkles and photoaging.

BACKGROUND:Dermal microcoring extracts cores of skin that are small enough to allow healing in a scarless fashion. Its use has been reported in the treatment of skin laxity, rhytides, and textural abnormalities. OBJECTIVE:To report the authors' clinical experience using dermal microcoring in a variety of cases. MATERIALS AND METHODS/METHODS:A retrospective chart review was performed looking at dermal microcoring cases for any indication between August 2022 and March 2024. RESULTS:Thirty-eight patients were treated. Overall, 32 (84.2%) patients were women, with median age of 67 years (R: 20-80 years). Fitzpatrick skin types I to V were represented. Among patients with adequate photographs for review, improvements of grade 3 and 4 (good and excellent) were seen in 85.7% (n = 18/21) treated for skin laxity and rhytides, 50.0% (n = 3/6) treated for acne scars, 66.7% (n = 2/3) treated for traumatic or surgical scars, and 100.0% (n = 3/3) treated for foreign material. Six (15.4%) patients experienced erythema or hyperpigmentation lasting more than 4 weeks, and 2 (5.1%) patients experienced temporary focal scarring, which improved with intralesional therapy and laser treatment. No patients experienced permanent dyspigmentation, prolonged edema, or infection. CONCLUSION/CONCLUSIONS:Dermal microcoring has been demonstrated to safely and effectively treat skin laxity, rhytides, scars, and foreign material.

BACKGROUND:Ultrasound energy can successfully treat fine lines and wrinkles, as well as lift the eyebrow and submentum. Ultrasound waves of high intensity induce thermal injury in the dermis with subsequent tissue remodeling. OBJECTIVE:To examine the utility of a novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams to improve the clinical appearance of cellulite on the thighs and buttocks. MATERIALS AND METHODS/METHODS:A prospective, multicenter, clinical study investigated this novel ultrasound device using 2 treatments. RESULTS:Sixty-five subjects completed both treatments. The mean age was 46 years, and 100% were women. Fitzpatrick skin types I to VI were represented. Assessments compared 3-month follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 89.2%. For Cellulite Severity Scale rating, there was significant improvement of 1.61 units ( p < .001). For cellulite Global Aesthetic Improvement Scale (GAIS), 89.2% had improvement, with a mean of 0.87 units ( p < .001). For Laxity Scale rating, there was significant improvement of 0.70 units ( p < .001). For skin laxity GAIS, 89.2% had improvement, with a mean of 0.76 units ( p < .001). No device-related adverse events occurred. CONCLUSION/CONCLUSIONS:A novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams can safely and effectively improve the clinical appearance of cellulite on the thighs and buttocks.