Nonablative Fractional Laser Treatment Is Associated With a Decreased Risk of Subsequent Facial Keratinocyte Carcinoma Development.

BACKGROUND: Keratinocyte carcinoma (KC) is the most common type of nonmelanoma skin cancer. Currently, prophylactic treatment options are limited. Nonablative fractional lasers (NAFL) have received the Food and Drug Administration approval for the treatment of actinic damage; however, their role in KC prophylaxis is not known. OBJECTIVE: The aim of this study is to determine whether NAFL treatment is associated with a decrease in subsequent facial KC development. MATERIALS AND METHODS: A retrospective cohort study of patients with a history of facial KC treated at the Massachusetts General Hospital Dermatology Laser and Cosmetic Center between 2005 and 2021 was conducted. RESULTS: Forty-three NAFL-treated patients with a history of facial KC and 52 matched control subjects were included in the study. The rate of subsequent facial KC development was 20.9% in NAFL-treated patients and 40.4% in control subjects (RR 0.52, p = .049). Control subjects developed new facial KC significantly sooner than NAFL-treated patients (p = .033). When controlling for age, gender, and skin type, control subjects were more likely to develop new facial KC than NAFL-treated patients (hazard ratio 2.65, p = .0169). CONCLUSION: NAFL treatment was associated with a decreased risk of subsequent facial KC development and may have a benefit for KC prophylaxis.

The Effect of Forearm Tattoos on Flap Choice in Transmasculine Phalloplasty Patients.

Purpose. The radial forearm free flap (RFFF) is considered the gold standard for gender affirming phalloplasty. Ideally, a nondominant forearm flap is used to minimize the risk of functional morbidity. However, many transmasculine individuals have tattooed forearms, which can affect decision making. The purpose of this study was to understand the prevalence of forearm tattoos among transmasculine patients seeking phalloplasty and how and whether tattoos affected decision making about flap source. Methods. Participants were 50, consecutive, adult, transmasculine patients seeking phalloplasty. The presence and location of tattoos were assessed using consult notes in the electronic medical record. A one-tailed test of proportions was used to test whether forearm tattoos increased the likelihood of alternative flap choice. Results. More than half of patients (56%) had tattoos on either one or both forearms (n = 28), 75% on their nondominant arm (n = 21). Among the patients with forearm tattoos, the presence of tattoos affected the flap site decision for 46% of patients (n = 13). For the patients that chose an alternative flap site, 46% chose a dominant forearm RFFF (n = 6) and 54% an anterolateral thigh flap (n = 7). The percentage of patients whose records indicated that they were planning on using an alternative flap due to a tattoo on their nondominant forearm was significantly higher than the percentage of patients without such tattoos, indicating the desire for an alternate flap (P < 0.01). Conclusion. Many transmasculine patients seeking phalloplasty have tattoos on either one or both of their forearms. Because of this, a substantial fraction of patients may choose flap donor sites that are less ideal. Providers from all disciplines may wish to educate young transmasculine patients about how tattoo placement may affect surgical options earlier during transition.

Associations Between Transgender Exclusion Prohibitions and Insurance Coverage of Gender-Affirming Surgery.

Purpose: This investigation examined how coverage of gender-affirming surgery differs between states that do and do not have prohibitions against explicit transgender exclusions in private insurance. Methods: Insurance policies for gender-affirming surgery were obtained from the three largest insurers, by market share, in each state. Policies were reviewed manually between May and August of 2019. The number of major gender-affirming surgical services covered by each policy was recorded. This investigation examined coverage of facial feminization/masculinization, augmentation mammoplasty, mastectomy, phalloplasty, vaginoplasty, thyroid chondroplasty, and hair removal. Descriptive statistics were calculated to compare the number of services covered in states that do and do not prohibit transgender exclusions in private insurance. Results: The total number of gender-affirming surgical services covered by insurance policies ranged from zero to seven. The mean number of services covered in states prohibiting transgender exclusions in private insurance was 4.52, whereas the mean in states without prohibitions against transgender exclusions was 3.83. The mean difference was 0.69 (95% confidence interval = 0.17-1.21, p = 0.004). Although almost all policies covered phalloplasty, vaginoplasty, and mastectomy, the policies of the top insurers in states without prohibitions against transgender exclusions were significantly less likely to cover hair removal (p = 0.03), thyroid chondroplasty (p = 0.0008), and facial feminization/masculinization (p = 0.01). Conclusion: Insurers in states prohibiting transgender exclusions in private insurance offered coverage of a small but significant number of additional gender-affirming surgical services compared with states allowing transgender exclusions. Although a core group of services was covered almost universally, insurers based in states allowing transgender exclusions were much less likely to cover services that are sometimes thought of as less central to transgender care.

A 63-Year-Old Male with AIDS and Diffuse Violaceous Plaques.

Hyperkeratotic Kaposi's sarcoma (KS) is a rare clinicopathologic variant of AIDS-related KS that typically presents with chronic lymphedema and diffuse hyperkeratotic plaques of the lower extremities. Histopathologically, this variant is defined by epidermal hyperplasia, thickened lymphatic walls, and increased numbers of dermal fibroblasts and vascular spaces. Herein, we report the case of a 63-year-old HIV-positive male who presented with this rare hyperkeratotic variant of AIDS-related KS.