Faculty Bibliography

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.

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine skin cancer with profound but poorly understood resistance to chemotherapy, which poses a significant barrier to clinical MCC treatment. Here we show that ATP-binding cassette member B5 (ABCB5) confers resistance to standard-of-care MCC chemotherapeutic agents and provide proof-of-principle that ABCB5 blockade can inhibit human MCC tumor growth through sensitization to drug-induced cell cytotoxicity. ABCB5 expression was detected in both established MCC lines and clinical MCC specimens at levels significantly higher than those in normal skin. Carboplatin- and etoposide-resistant MCC cell lines exhibited increased expression of ABCB5, along with enhanced ABCB1 and ABCC3 transcript expression. ABCB5-expressing MCC cells in heterogeneous cancers preferentially survived treatment with carboplatin and etoposide in vitro and in human MCC xenograft-bearing mice in vivo. Moreover, patients with MCC also exhibited enhanced ABCB5 positivity after carboplatin- and etoposide-based chemotherapy, pointing to clinical significance of this chemoresistance mechanism. Importantly, ABCB5 blockade reversed MCC drug resistance and impaired tumor growth in xenotransplantation models in vivo. Our results establish ABCB5 as a chemoresistance mechanism in MCC and suggest utility of this molecular target for improved MCC therapy.