Malignant Skin Cancer Excision in Combined Therapy with Electro-Chemotherapy and Dermal Substitute.

Squamous cell carcinoma (SCC) is the second most common malignancy skin cancer. It is characterized by abnormal, accelerated growth of squamous cells (SCs). SCC occurs when DNA damage from exposure to ultraviolet radiation or other damaging agents trigger abnormal changes in the SCs, presenting as painless lesions on areas of high sun exposure, such as the dorsum of the hand and upper extremity. For most skin SCC, the surgical excision alone is standard practice. However, recent efforts in new treatment strategies have involved around adjuvant or concomitant electrochemotherapy (ECT). ECT is a non-thermal tumor ablation modality, safe and effective on any type of solid tumor. An 87-year-old patient affected by hand SCC with invasion of deep structures including tendons was treated with neoadjuvant intra-tumoral ECT sessions followed by a selective surgical removal and reconstruction of the substance loss with collagen dermal template (CDT). Two neoadjuvant intra-tumoral ECT procedures, at distance of 3 months, with the aim to reduce the tumor size before a selective surgery, were performed. This study shows that combined surgical selective excision with ECT and CDT is a valid technique for the extended-deep dorsal hand tumor lesions reconstruction.

Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique.

Hypertrophic and keloid scars result from abnormal wound healing and can have a variable response to a number of available treatment modalities. The evolution of laser treatments in recent years has shown a wide range of clinical applications including their use in the treatment of scars. We investigated the effectiveness of a 1470 nm diode laser using an intralesional optical fibre delivery device in the treatment of hypertrophic and keloid scars. We evaluated its safety and efficacy as a novel and minimally invasive treatment alternative for scar modulation and volume reduction. A prospective cohort study was performed involving 21 patients with hypertrophic scars (HS) (n = 9) and keloids (n = 12) resulting from various aetiology. Patients were treated with one to three treatment sessions. Comprehensive evaluations were performed using the Vancouver Scar Scale, Doppler ultrasound, Cutometer, Mexameter and PeriCam PSI. Scar thickness was reduced by an average of 0.308 ± 0.138 cm (p < 0.001). In particular the two subgroups showed a significant 27.7% and 28.2% reduction in scar thickness of HS and Keloids, respectively. Scar firmness showed a significant improvement of 1.2% (p < 0.05) for HS, though for keloids this was 0.4% (p = 0.26). Keloids had a significant reduction in pigmentation at 21.3%. Blood perfusion had a significant reduction of 29.6% in HS and 22.7% in Keloids. Overall VSS total score improvement of 42% in the HS and at 37.9% in the Keloid subgroup. No adverse events such as hypo/hyperpigmentation, skin infection, or recurrence were reported. This study shows that the intralesional 1470 nm bare-fibre diode laser significantly improved hypertrophic and keloid scars based on both subjective and objective analyses and supports this type of laser therapy as a safe and effective minimally-invasive treatment option.

The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids.

BACKGROUND: Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation. We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars. We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation. METHODS: The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included. Patients took curative effect evaluation before and 1 year after the treatment. The test items included infection frequency in each year; pain, by visual analogue scale (VAS); itch, using VAS; quality of life (QOL), using QOL scale; and blood supply, using PeriCam PSI. RESULTS: A total of 19 patients (mean age 35.21 years, range 11-66) with history of inflamed keloids with episodes of infection or abscess were enrolled. Patients underwent to a 1470 nm laser therapy for average of 1.16 times. After treatment, infection frequency and blood supply in keloids were reduced (p < 0.001). Pain, itching, and QOL were improved (p < 0.001). CONCLUSION: The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation, and a relative stabilization of collagen composition. Therefore, it is an effective minimally invasive scar therapy, but further studies are essential to confirm the present results.

Correction of cicatricial ectropion using non-ablative fractional laser resurfacing.

Lower eyelid malposition is the most frequent and severe complication after blepharoplasty and ectropion is observed in 1% of patients after surgery. This article describes a non-surgical method to treat lower eyelid cicatricial ectropion using a non-ablative laser as an alternative to surgery. Twelve patients with unilateral or bilateral lower lid cicatricial ectropion, following surgery or trauma, underwent laser therapy from 2012 to 2016. Laser therapy was performed with a fractional non-ablative laser emitting at a wavelength of 1540 nm. Ten patients had a full correction of their ectropion and two patients had a partial recovery after laser therapy at 6-month follow-up visit. No serious adverse events were reported. Non-ablative fractional laser resurfacing can successfully treat cicatricial ectropion by remodeling the periocular scar tissue and improving the scar texture, and as such may be considered as a valuable alternative to surgery in selected patients.

Efficacy of a Novel Optimized Pulsed Light Source (MaxG) for the Treatment of Facial Vascular Lesions.

BACKGROUND AND OBJECTIVE: Facial vascular malformations can cause a number of functional problems, including difficulties in breathing, eating, speech, and mobility. Psychological problems can also arise due to the possible unpleasant appearance of such lesions. Further, these lesions can lead to a number of complications, including pain, ulceration, infection, and significant bleeding. Many treatments have been proposed in the literature. Laser therapy (and its related treatments by non-coherent light sources) is now considered the gold standard in the treatment of the majority of vascular lesions. METHODS: Here, we present our experience with a novel optimized pulsed light source for the treatment of vascular anomalies. In this prospective study, we evaluate the clinical outcomes of 30 patients treated with this method. RESULTS: Our results confirm the efficacy and safety of this treatment for facial vascular lesions. CONCLUSIONS: Based on our experience and results, we believe this device could be considered as both an alternative monotherapy and a useful adjunctive to the already existing laser instruments.

Severe hidradenitis suppurativa treatment using platelet-rich plasma gel and Hyalomatrix.

Hidradenitis suppurativa (HS) can be a debilitating chronic disease. The underlying cause of the disease is still not clear. HS may be managed through numerous different medical or surgical procedures. Surgical treatment may consist of local excisions and reconstruction using a variety of methods: perforator flaps, skin grafts, local flaps, primary closure or secondary wound healing with vacuum and other devices. This report describes our experience with surgical excision and closure using platelet-rich plasma (PRP) gel and Hyalomatrix PA (HPA) in a patient with severe HS involving most of the body surface. We treated the patient with resection of severe HS of the nuchae and closure with PRP gel prepared with the RegenKit(®) to promote neovascularisation and HPA, a delivery system for hyaluronic acid, to induce a neodermis at the wound bed and to stimulate regeneration in a humid and protected environment. Complete wound healing was achieved after 2 months. The obtained result proved the efficacy of this treatment without complications. No recurrence was observed during the 1 year after the surgical procedure. Severe HS can be safely and effectively managed with wide excision, PRP gel and Hyalomatrix to achieve a successful outcome.

Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face.

BACKGROUND: Actually, autologous fat grafts have many clinical applications in breast surgery, facial rejuvenation, buttock augmentation, and Romberg syndrome as well as a treatment of liposuction sequelae. OBJECTIVE: The aim of this article was to describe the preparation and isolation procedures for stromal vascular fraction (SVF), the preparation of platelet-rich plasma (PRP), and the clinical application in the treatment of the scar on the face. METHODS: Ten patients with burns sequelae (n = 6) and post-traumatic scars (n = 4) were treated with SVF-enhanced autologous fat grafts obtained by the Celution System. Another 10 patients with burns sequelae (n = 5) and post-traumatic scars (n = 5) were treated with fat grafting based on the Coleman technique mixed with 0.5 mL of PRP.To assess the effects of their treatment, the authors compared their results with those of a control group consisting of 10 patients treated with centrifuged fat. RESULTS: In the patients treated with SVF-enhanced autologous fat grafts, we observed a 63% maintenance of contour restoring after 1 year compared with only 39% of the control group (n = 10) treated with centrifuged fat graft (P < 0.0001). In the patients treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring after 1 year compared with that of the control group (n = 10). CONCLUSIONS: Autologous fat grafting is a good method for the correction of scars on the face instead of the traditional scar surgical excision.

Squamous cell carcinoma developing after CO2 laser resurfacing.

BACKGROUND: Skin resurfacing with the carbon dioxide (CO(2)) laser is currently a popular means of improving rhytides and scars and has been reported useful in the treatment for photodamaged skin, including precancerous and benign skin lesions, as well as superficial benign pigmented lesions. METHODS: We describe a 68-year-old man who developed rapid squamous cell carcinoma (SCC) on the resurfaced areas 3 weeks following CO(2) laser resurfacing. RESULTS: Rapid occurrence of SCC should be considered a rare complication, and we recommend carefully considering CO(2) laser resurfacing after excision of an SCC and surveying any cancer recurrences. CONCLUSIONS: We report a rare complication of CO(2) laser resurfacing. This report suggests that additional work in this area is warranted.

Novel approach with fractional ultrapulse CO2 laser for the treatment of upper eyelid dermatochalasis and periorbital rejuvenation.

Fractional ultrapulse CO2 laser resurfacing improves photodamage, wrinkles, and acne scarring by ablation of damaged tissue with subsequent regeneration and remodeling of collagen. In this study, the authors examined the efficacy and safety of fractional CO2 laser and introduce a novel approach to the treatment of upper eyelid dermatochalasis. We treated 20 patients with low and moderate upper eyelid dermatochalasis. We did photographic analysis of results by measuring distance of upper eyelid fold and lateral eyebrow in vertical axis from a horizontal line joining medial and lateral canthi. All patients underwent UltraPulse CO2 laser (Microxel MX 7000) resurfacing at upper eyelid, superior to eyebrow, and in periorbital area. Measurements were taken before and at 3 and 6 months after the laser treatment. We evaluated results at 3 and 6 months after laser treatment and found that the UltraPulse CO2 laser induced elevation of eyelid crease and brow position (1.62 ± 0.69 and 2.110 ± 0.66 mm at 3 months; 1.63 ± 0.68 and 2.300 ± 0.67 mm at 6 months, respectively) as compared to before the treatment. Side effects were mild, patients reported minor crusting and oozing that resolved within 48 to 72 h, edema (1-2 days), and moderate postoperative erythema resolved within 4 days. These data illustrate the safety and efficacy of fractional ultrapulse CO2 laser in the treatment of low and moderate upper eyelid dermatochalasis with added advantage of nonsurgical brow lift.

Ultrapulsed fractional CO2 laser for the treatment of post-traumatic and pathological scars.

BACKGROUND AND OBJECTIVE: Scar management is a long-term process. A variety of modalities have been employed and, depending on scar type, treatment may be invasive and/or conservative. The purpose of this study was to evaluate a new CO2 laser resurfacing for post-traumatic and pathological scars and to compare this device with classic dermabrasion. The new fractionated ultrapulsed CO2 laser (Ultrapulse Encore, Lumenis Ltd., Santa Clara, CA) is equipped with two types of scanners: the first, ActiveFX, is non-sequential while the second, DeepFX, is sequential and produces microspot. MATERIALS AND METHODS: From September 2008 to November 2008, a study on 60 patients was performed. The patients (average age 47.3 years) enrolled in this study had severely scarred skin and were divided into two groups of 30 people. All patients were Caucasian with skin type II or III. Each scar was photographed and scored by the authors using the Manchester Scar Scale (MSS). Follow-up ranged from 12-15 months. RESULTS: Sixty patients were analyzed in two homogeneous groups. Significant improvement in skin tone, texture and appearance of skin was noted in all patients treated with CO2 laser, lower improvement resulted with dermabrasion. Both subjects and investigators noted similar aesthetic improvement. No major complications were found for both groups and minor complications included transient erythema and edema. CONCLUSION: Fractional ultrapulsed CO2 laser resurfacing has proven to be both safe and effective. The efficacy and favorable side effects profile for this technology, with low incidence of pigmentary changes, make it a viable alternative for the treatment of moderate-to-severe scars.

Tissue regeneration in loss of substance on the lower limbs through use of platelet-rich plasma, stem cells from adipose tissue, and hyaluronic acid.

BACKGROUND: Platelet-rich plasma (PRP) induces wound regeneration and tissue repair through cell proliferation and differentiation, promoting tissue healing and also acting as an autologous scaffold. With a small quantity of blood, it is possible to obtain the necessary optimal volume of PRP to treat the loss of substance in the lower limb. It has been demonstrated that mesenchymal stem cells are present in the adipose tissue (thus accelerating the effect of the PRP). METHODS: The analysis involved 30 patients with lesions ranging from ulcerative, dystrophic, with substance loss, with differentiating etiopathogenesis all localized on the inferior limb, and to those treated with PRP and autologous fat grafts. The wounds were covered with a 3-dimensional, polymerized hyaluronic acid medicated biologic dressing. The authors' protocol consists of a general checkup; wound examination; instrumental, microbiological, and immunohistochemical diagnostic examinations; and acquisition of photographic images with follow-up at 0, 1, 2, and 3 weeks; 1, 3, and 6 months; and 1 year. RESULTS: The results show an improvement from minor to moderate in 100% of patients after 3 weeks, healing in less than 6 weeks in 47% of patients, and complete wound healing in 57% of patients within 3 months. CONCLUSIONS: The authors' data demonstrate the ability of the combination of PRP and autologous adipose graft to regenerate tissue and epithelialization with wound closure, with a significant healing-time reduction. Furthermore, the minimally invasive technique is well accepted by patients, with a noteworthy improvement of the quality of life along with cost reduction due to the fewer number of medications.

Treatment of stable vitiligo by ReCell system.

The aim of our study was to analyze the results obtained with the ReCell system for surgical treatment of stable vitiligo. At Department of Plastic and Reconstructive surgery, University of Tor Vergata in Rome, we treated 15 patients with stable vitiligo during a 2-year period. The stability of vitiligo lesions varied between 1 and 4 years. The mean stability was 2.25. The disease activity according to Vitiligo Disease Activity Score (VIDA) was 0 in all cases, which means that all patients had a stability of greater than or equal to 1 year. Three (20%) patients had vitiligo vulgaris, seven (46.6%) segmental vitiligo and five (33.3%) focal vitiligo. Repigmentation was assessed using the Vitiligo Area Scoring Index (VASI). The extent of pigmentation was scored as excellent, good, fair, and poor depending on the percentage of repigmentation in the previously depigmented site. The color of the repigmented area was compared with the adjacent normally pigmented area: excellent color match was present in ten (66.6%) and good in five (33.3%) cases. There was no fair or poor outcome. Repigmentation greater than 75% was recorded in 12 (80%) and 25% to 50% repigmentation in three (20%) of 15 patients treated. ReCell is a feasible, simple and safe technique. The method that uses noncultured autologous epidermal suspension is simpler, less expensive, less time consuming, and does not require sophisticated laboratory facilities as compared with the methods employing cultured melanocytes.

Bipolar radiofrequency in the treatment of dermatologic imperfections: clinicopathological and immunohistochemical aspects.

BACKGROUND: Rapid progress in the technology for skin rejuvenation has allowed for shorter post-treatment times than ever before. An example of such technology is the radiofrequency (RF) device, which offers nonablative skin rejuvenation, particularly for skin tightening and wrinkle reduction. OBJECTIVE: Medical devices that emit RF energy produce a change in the electrical charges of the treated skin creating an electron movement, and the resistance of the tissue to the electron movement generates heat. This article examines the mechanism of action of a new bipolar RF device, which emits RF energy through a handpiece with a bipolar electrode configuration, and assesses the clinical histological and immunohistochemical results on a sample group of patients who underwent a cycle of sessions with this device. METHODS AND MATERIALS: Thirty patients affected with periocular wrinkles, glabellar wrinkles, slackness of the cheeks with accentuation of the nasogenian furrow, striae distensae at the scapulohumeral joint, abdomen, and gluteal-trochanteric areas, or acne scars were included. These patients underwent a cycle of 6 to 8 sessions with 2-week intervals with the new bipolar RF device undergoing photographic monitoring before treatment and at the end of the cycle of sessions. In addition, 15 patients from the sample group were subjected to 2 biopsies, one at the start of treatment and the other 3 months after the last treatment. RESULTS: All the patients showed improvement in treated imperfections from the second session onward, and they expressed their satisfaction at the end of the treatment cycle. The most notable clinical, histological, and immunohistochemical results were observed in the patients with abdominal striae distensae. In most cases, the temporary side effects observed consisted of rashes and ecchymosis. Two patients reported the formation of blisters on the treated area caused by excessively high RF settings. CONCLUSION: The new bipolar RF device proved to be effective, noninvasive, and easy to use. The improvement in the treated areas is progressive and continues to be apparent several months after the last session. The duration of the results achieved still remains to be accurately determined.

Giant meta-typical carcinoma: an unusual tumor.

Meta-typical carcinoma (MTC) or basosquamous carcinoma is a remarkable malignancy with features of both basal and squamous cell carcinoma. It is typically located on the back and face, often with clinical features of basal cell carcinoma but tending to be more aggressive with enhanced prospects of lymph node or distant metastases. Our report describes a huge neglected MTC of the back of ten-year duration, a giant ulcero-vegetative tumor measuring 20 x 25 cm. Histologic examination of specimens from the margins and periphery revealed aspects of both basal and squamous cell carcinoma, while the ulcerated center showed sclerotic tissue without tumor. Radical excision and reconstruction by grafts were performed. No metastases were observed after two years. There are many controversies surrounding the histologic definition and biologic behavior of MTC, including its metastasizing potential. The MTC we describe exhibited benign biologic behavior. This may have been related to an intense inflammatory host response with elimination of neoplastic tissue and consequent local sclerosis evident in the central tumor-free portion. This central tumor regression is to our knowledge a unique finding in MTC.

Cutaneous implantation metastasis of cholangiocarcinoma after percutaneous transhepatic biliary drainage.

Percutaneous transhepatic biliary decompression is a preoperative surgical adjunct in patients with obstructive jaundice that has been in use since 1973. It is recommended that this procedure be adopted for both palliative treatment in unresectable patients and as a preoperative means of lowering serum bilirubin in patients with potentially resectable malignancies of the pancreas or biliary tract. Metastatic tumor seeding along the transhepatic biliary catheter is an unusual complication resulting from this procedure but there have been a few cases reported in the literature. Below is a report on a 59-year-old woman in whom the percutaneous transhepatic catheter drainage of the biliary tree, performed before surgical resection of a cholangiocarcinoma, caused cutaneous tumor implantation at the catheter site 3 months later. The clinical aspect was morphea-like and histopathologic examination revealed typical features of a dermal metastasis of adenocarcinoma. Immunohistochemistry revealed cytoplasmic positivity for cytokeratin 7-19, specific for the biliary tract epithelium. A review of the literature available led us to conclude that port-site metastasis in patients with obstructive jaundice treated with percutaneous transhepatic biliary decompression was an unusual but possible complication. In fact, many catheter-tract metastatic deposits in the liver parenchyma, detected at autopsy or on operation, are mistakenly identified as hematogenous or lymphatic metastasis and are not attributed to a catheter-related process. We also report on this case because of the atypical morphea-like aspect of the skin metastasis.