Vascular Postoperative Changes After Facial Flap Repairs: An Opportunity for Early Intervention.

BACKGROUND: Flap repair provides unique advantages in facial reconstruction but still carries the potential for undesirable postoperative cosmetic changes. OBJECTIVE: The aims of this study were to describe postoperative vascular outcomes of patients undergoing flap repairs after Mohs micrographic surgery on facial tumors and to assess associations of baseline characteristics with outcomes. MATERIALS AND METHODS: In this study, 7 dermatologists and 1 physician assistant in dermatology assessed preoperative and postoperative photographs of 57 patients who underwent facial Mohs micrographic surgery, evaluating vascular and pigment outcomes and number of telangiectasias. RESULTS: There was a significant difference in number of telangiectasias according to body location (p = .002), where the number of telangiectasias was highest for nose surgery. CONCLUSION: These data suggest that nasal flap repairs are associated with increased postoperative vascular changes. This highlights an opportunity for improved preoperative patient counseling and possible early laser treatment after nasal Mohs micrographic surgery.

Tri-Site Academic Center Experience with Immunotherapy for Metastatic Skin Cancer in Solid Organ Transplant Patients.

OBJECTIVES: Organ transplant recipients have an increased risk of skin cancer, but treatment options for metastatic skin cancer are limited because of their immunosuppressed state. We sought to qualify the clinical experience and patient safety of immune checkpoint inhibitors (ICIs) for skin cancer treatment in transplant recipients at one large academic institution. METHODS: We conducted a retrospective chart review including patients who had at least one organ transplant, a diagnosis of skin cancer, and received an ICI to treat their skin cancer. RESULTS: Four patients met our criteria. Three received an ICI for metastatic melanoma and died secondary to their cancer. One patient, treated for squamous cell carcinoma, had remission of his cancer with ICI treatment. Only one patient had transplant rejection. CONCLUSIONS: ICIs can be used in organ transplant patients, but the risk of transplant rejection must be carefully discussed because it may be associated with an increased risk of death. A higher risk of rejection exists with anti-programmed cell death 1 and anti-programmed cell death ligand 1 inhibitors.

Indeterminant Cell Histiocytosis in a Patient With Hemophagocytic Lymphohistiocytosis.

ABSTRACT: Indeterminant cell histiocytosis is a rare disorder, which often presents as a benign, papular eruption without age or sex predilection. It is diagnosed based on histologic findings that are similar to those seen in Langerhans cell histiocytosis without the characteristic Birbeck granules. Hemophagocytic lymphohistiocytosis is a potentially life-threatening disease of immune overactivation that may present with severe symptoms and multiorgan involvement. It can develop because of a primary genetic mutation or secondary to a trigger. Despite their widely different clinical manifestations, both diseases originate from the monocyte-macrophage cell lineage. In this article, we describe the unique case of a 2-year-old patient presenting with both of these histiocytic pathologies.

Pediatric necrobiosis lipoidica: case report and review of the literature.

Necrobiosis lipoidica (NL) is a rare, granulomatous disease considered to be associated with diabetes. It is frequently seen in female and middle-aged patients and is rarely observed in children. We present a 14-year-old boy with poorly controlled type 1 diabetes who developed biopsy-proven NL. He had improvement, but not resolution of the plaque with improved glycemic control. Pediatric NL may be associated with diabetes and could be related to poor glycemic control. However, further investigation is warranted in this young population.

Guselkumab in the treatment of concomitant hidradenitis suppurativa, psoriasis, and Crohn's disease.

BACKGROUND: Hidradenitis suppurativa (HS) is a debilitating skin condition whose pathogenesis is poorly understood, although interleukin (IL)-23 may play a role. IL-23 is also implicated in the pathogenesis of Crohn's disease (CD) and psoriasis, both of which can occur in patients with HS. CASE REPORT: We present the case of a 28-year-old woman with HS, psoriasis, and CD, who was successfully treated with guselkumab after failing multiple other biologic agents. CONCLUSION: Guselkumab represents a promising therapeutic option for recalcitrant HS patients with inflammatory comorbidities in which IL-23 plays a role.

Challenges of Teledermatology: Lessons Learned During COVID-19 Pandemic.

The COVID-19 pandemic required a transition to telemedicine to limit viral spread. Dermatology seems particularly well-suited for telemedicine, however, this pandemic transformed teledermatology into the predominant means of delivering care. Providers are limited in their ability to promptly and accurately manage disease without access to in-person tools. This monumental switch to teledermatology may disadvantage certain patient populations, including those with limited technological literacy (such as the elderly) or access to the internet. Dermatologists must acknowledge these limitations and recognize the consequences of severely limited in-person visits over a prolonged period of time.