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Objective:To investigate the efficacy of tumescent anesthesia combined with skin and soft tissue expansion for the repair of congenital giant melanocytic nevi.Methods:From July 2015 to December 2019, 41 patients with congenital giant melanocytic nevi, including 24 males and 17 females aged 7 - 45 years, were collected from the Department of Dermatology, Xijing Hospital, the Fourth Military Medical University. Skin lesions ranged from 5 cm × 12 cm to 12 cm × 18 cm in size, and were located on the scalp in 13 cases, on the face in 18 cases, as well as on the trunk in 10 cases. Before surgery, the composition of tumescent solution was adjusted according to the body weight, operation duration, skin lesion area, etc., and the total dose and peak plasma concentration of lidocaine should be below 35 mg/kg and 4 mg/L respectively. All the patients received tissue expander placement and second-stage flap transfer under tumescent anesthesia.Results:During surgery, satisfactory effect of tumescent anesthesia was achieved in all the 41 patients, the pain score assessed by a numerical rating scale was 1.82 ± 0.54. In addition, the surgical field and dissection levels were clear with little bleeding and no related complications. Follow-up of 3 - 36 months showed that the skin flaps matched the surrounding skin tissues well, with relatively concealed incision lines and soft flat scars.Conclusion:For the treatment of congenital giant melanocytic nevi, tumescent anesthesia is effective and safe, which combined with skin and soft tissue expansion can effectively reduce the incidence of postoperative complications, and this strategy is worthy of clinical promotion.
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Objective:To assess clinical efficacy of micro-punch combined with electron beam radiation for the treatment of keloids on the lower jaw.Methods:Clinical data were collected from 36 patients with keloids on the lower jaw, who received micro-punch combined with electron beam radiation at Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2018 to January 2019, and analyzed retrospectively. There were 16 males and 20 females, with an average age of 23.80 years and a median disease duration of 32 months. The severity of keloids was evaluated before and 12 months after operation. A paired t test was used to compare keloid severity scores before and after treatment. Results:All of the 36 patients experienced primary wound healing. The keloid severity score was 7.11 ± 1.46 before operation, and significantly decreased to 2.33 ± 0.47 at 12 months after operation ( t=13.85, P=0.008) . Twelve months after the treatment, 15 patients were cured, 17 showed marked improvement, and 4 showed no response or experienced recurrence within 12 months after treatment, with a response rate of 88.89%. Conclusion:Micro-punch combined with electron beam radiation is effective for the treatment of keloids on the lower jaw.
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Objective:To analyze clinicopathological characteristics of trauma-related melanoma and their relationship with the prognosis of patients.Methods:Clinical data were collected from 87 cases of trauma-related melanomas in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from 2009 to 2020, and their clinicopathological characteristics were retrospectively analyzed. Mann-Whitney test was used to analyze the difference in Breslow thickness of tumors between patients of different ages or genders; Spearman rank correlation analysis was used to analyze the correlation between the time from trauma to the notice of melanoma and Breslow thickness, Kaplan-Meier survival analysis and Log-Rank test were employed to analyze the relationship between clinicopathological characteristics of melanoma and the prognosis of patients; Cox regression model was used to analyze risk factors for survival duration of patients with trauma-related melanoma.Results:Among the 87 patients with trauma-related melanoma, 47 (54.02%) were males and 40 (45.98%) were females. Among them, melanoma occurred in 50 (57.47%) cases after sharp injuries, and in 37 (42.53%) after blunt injuries. In addition, 31 (35.63%) cases presented with primary lesions on the hands, and 48 (55.17%) on the feet. The Breslow thickness of the primary tumors was significantly higher in the group aged > 55 years than in the group aged ≤ 55 years ( U= 623.500, P= 0.010) , but there was no significant difference between patients of different genders ( P= 0.138) . The time from trauma to the notice of melanoma was negatively correlated with the Breslow thickness of tumors ( r=-0.203, P= 0.037) . The age of patients, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor significantly affect the survival duration of patients with trauma-related melanoma ( P= 0.011, 0.031, 0.002 and 0.031, respectively) ; the gender, type of trauma and ulceration of tumor mass did not significantly affect the survival duration of patients ( P= 0.618, 0.114 and 0.379, respectively) . Cox regression model analysis showed that the Ki67 proliferation index and Breslow thickness were independent risk factors affecting the prognosis of trauma-related melanoma (risk ratio [ RR] and 95% confidence interval [ CI] were 1.946 (1.234, 4.217) and 1.839 (1.014, 3.332) , P= 0.039 and 0.045, respectively) . Conclusion:The Breslow thickness of trauma-related melanoma is related to the age of patients and time from trauma to the notice of melanoma; the age, Breslow thickness of tumors, Ki67 proliferation index and genetic background of tumor all affect the survival duration of patients with melanoma, and Ki67 proliferation index and Breslow thickness are independent risk factors affecting prognosis.
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Although the incidence of melanoma is increasing rapidly, its proportion is relatively low among all the malignant tumors in China, and oncologists commonly pay little attention. The first consultation place for melanoma patients is mainly the department of dermatology. Dermatologists have unique advantages in the diagnosis and treatment of melanoma since they can comprehensively integrate clinical diagnosis, pathological diagnosis, surgical treatment and drug treatment. In recent years, Chinese scholars have made great progress in melanoma research, such as regulation of cell death, epigenetic modification, resistance to targeted drugs, tumor microenvironment and tumor immune regulation. Interferon α-1b, a unique new drug in China, not only can be used for adjuvant treatment of high-risk stage Ⅱ and Ⅲ melanoma, but also shows good efficacy in the treatment of stage Ⅳ melanoma, and adverse reactions to it are far less than those to interferon α-2b. Unlike the White population, the common subtypes of melanoma are acral and mucosal melanomas in the Asian population. The combination of interferon α-1b with programmed death receptor-ligand 1 inhibitor, targeted drugs or angiogenesis inhibitors is bringing hope for patients with stage IV melanoma.
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Objective:To explore surgical treatment strategies and prognosis of early-stage nail apparatus melanoma.Methods:A total of 115 patients with early-stage nail apparatus melanoma receiving surgical treatment were collected from Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from July 2011 to December 2019, and surgical treatment strategies and outcomes were analyzed retrospectively.Results:According to the modified ABCDEF criteria and clinical manifestations (such as deformation of the nail plate, ulcers, nodules) , 73 patients with early-stage nail apparatus melanoma received extended surgical resection based on the resection principles of melanoma in situ, 22 based on the resection principles of stage I and II melanoma, 20 based on the resection principles of stage I and II melanoma with invasion risks. During the follow-up period of 6 months to 9 years, there was no recurrence of the primary tumors in any patients; no abnormalities were observed by the ultrasound examination of lymph nodes in 101 patients; metastases occurred in 2 patients receiving finger amputation, 1 of whom died; 12 patients were lost to follow-up. Conclusion:To select extended surgical resection strategies for early-stage nail apparatus melanoma based on clinical manifestations, can ensure adequate treatment and preserve the normal function of the extremities to the greatest extent without recurrence of the primary tumors.
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Objective:To compare clinical efficacy and safety of microwave thermotherapy versus microneedling in the treatment of axillary bromhidrosis.Methods:From May 2018 to March 2019, 116 patients with different degrees of axillary bromhidrosis were collected from Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, including 56 treated with microwave thermotherapy by using a miraDry device, and 60 treated with microneedling by using a BodyTite device. These patients were followed up for 12 months after treatment, and clinical efficacy, complications and recurrence rate were evaluated.Results:After 12 months of follow-up, no significant difference in the response and recurrence rates were observed between the microwave group (94.64%[53 cases], 5.36%[3 cases], respectively) and microneedling group (93.33%[56 cases], 6.67%[4 cases], respectively; both χ2=0.088, P=0.767) . However, the incidence of postoperative complications was significantly lower in the microwave group (0) than in the microneedling group (6.67%, including 2 cases of skin burns and 2 cases of scars; χ2=3.867, P=0.049) . Conclusion:In the treatment of axillary bromhidrosis, microwave thermotherapy showed equivalent clinical efficacy with lower incidence of complications compared with microneedling.
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Objective To explore the application of radiofrequency lipolysis combined with line-ar lifting in fine lipolysis ,facial rejuvenation and treatment of common complications .Methods From February 2016 to October 2018 ,237 patients were treated by radiofrequency lipolysis combined with linear lifting .According to the patient's face shape ,skin laxity and fat accumulation ,the thickness of fat was measured by B-mode ultrasonography before operation ,and the operative plan was formulated after sufficient communication with the patients .Then ,we marked the range of lipolysis ,the orienta-tion of serrated line and the position of puncture point ,followed by the adjustment of the treatment parameters .Subsequently ,we placed FaceTite handle after swelling anesthesia ,moving slowly and fixing the treatment point ,as well as monitoring the temperature and swelling status of the skin .Im-mediately after the completion of lipolysis ,the treatment area of skin was ice compressed ,with the trocar needles inserted and serrated lines introduced for linear lifting operation .Neck-jaw sleeves were put on after operation .Results 237 patients had different degrees of post-operative edema ,of which the period ranged from 2 to 7 days .168 patients were followed up for 6 to 24 months ,and 8 patients had subcutaneous sclerosis that then gradually disappeared within 2 months after operation .Folliculitis occurred in 5 cases of scalp puncture ,and recovered after topical antibiotics .Facial skin relaxation and sagging ,fat accumulation ,facial shape ,pouch and wrinkles of 160 patients were improved in varying degrees ,and the outcomes of facial rejuvenation were obvious .However ,the self-reported treatment outcomes of 7 patients were not obvious .One patient was reported that the sagging of the skin after sacrificial lipolysis was worse than before ;48 patients underwent autologous fat transplantation ,botu-linum toxin injection ,hot pull ,E-light ,and water-light injection during the follow-up period ,and were not included in the evaluation of efficacy ;21 patients were lost to follow-up .Conclusions Radio-frequency lipolysis combined with linear lifting is an effective method for facial rejuvenation ,and it has obvious effect in fining lipolysis and facial rejuvenation by avoiding the disadvantage of single approach . Post-operative edema should be controlled and avoided to improve patients'satisfaction .
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Objective To observe the effect of Bacillus coagulans tablets Combined with minus Xiaoyao powder, Nifuratel nystatin soft capsule in treatment of VVC. Methods A total of 108 cases of VVC. patients were randomly divided into 2 groups:observation group and control group. In the observation group (n=54), patients were given vaginal placement of Nifuratel nystatin soft capsule, 1 capsule daily, for 6 days;oral administration of minus Xiaoyao powder, 1 agent daily, for 7 days; and oral administration of Bacillus coagulans tablets, 3 tablets one time, 3 times a day, for 14 days, double dose at first. In control group (54 cases), patients were given vaginal placement of Nifuratel nystatin soft capsule, 1 capsule daily, for 6 days;and oral placement of vitamin C tablet, 1 tablet one time, 3 times a day,for 14 days. The short-term effect and the long-term recurrence of were observed 3-7 days, 1 months, 3 months, 6 months after stopping drug treatment. Results 3 days after stopping drugs, the effective rate in the observation group and the control group was 92.59%and 81.48%, respectively, the difference between the two groups was statistically significant (P<0.05) . 6 months after stopping drugs, the recurrence rate was 9.26% in the observation group, and 20.37% in the control group, the difference was statistically significant (P<0.05) . Conclusion For Vaginal candidiasis, on the basis of antifungal therapy, giving Bacillus coagulans tablets for regulation of intestinal micro ecological environment, and traditional Chinese medicine minus Xiaoyao powder for clearing heat and removing dampness, soothing the liver, can significantly improve the short term and long term curative effects,and reduce the recurrence rate.