Role of Retinoic Acid Receptor-γ in DNA Damage-Induced Necroptosis.

DNA-damaging compounds, commonly used as chemotherapeutic drugs, are known to trigger cells to undergo programmed cell death such as apoptosis and necroptosis. However, the molecular mechanism of DNA damage-induced cell death is not fully understood. Here, we report that RARγ has a critical role in DNA damage-induced programmed cell death, specifically in necroptosis. The loss of RARγ abolishes the necroptosis induced by DNA damage. In addition, cells that lack RARγ are less susceptible to extrinsic apoptotic pathway activated by DNA-damaging agents whereas the intrinsic apoptotic pathway is not affected. We demonstrate that RARγ is essential for the formation of RIPK1/RIPK3 death complex, known as Ripoptosome, in response to DNA damage. Furthermore, we show that RARγ plays a role in skin cancer development by using RARγ1 knockout mice and human squamous cell carcinoma biopsies. Hence, our study reveals that RARγ is a critical component of DNA damage-induced cell death.

The Transposition Flap for the Reconstruction of Lower Cutaneous Lip Defects.

The lower cutaneous lip is a highly visible and functionally sensitive unit, and numerous factors must be considered when deciding on the optimal repair for defects in this area. The transposition flap represents an excellent option in the reconstruction of larger lower cutaneous lip defects. We describe the use of random pattern transposition flaps for the repair of lower lateral cutaneous lip defects.

J Drugs Dermatol. 2017;16(4):385-387.

Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers.

IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

Color-specific enhancement of digital photographs for identification of the extent of cutaneous malignancy.

OBJECTIVES: To introduce the concept of active digital imaging to the literature and to support further investigation by showing the utility of photochromatography in the identification of cutaneous cancer margins METHODS: Digital color images of 10 cutaneous basal cell carcinomas were digitally enhanced to highlight color change in and around each lesion. After the most intense area of tumor coloration was located and sampled, the color was digitally changed to a sharply contrasting color across the entire region, thereby highlighting abnormal areas not readily seen by the unaided eye. The enhanced areas of predicted tumor extent were compared with digital images of the resulting defect after treatment with Mohs micrographic surgery. RESULTS: The extent of tumor was predicted with good accuracy in 5 cases and with fair accuracy in 2 cases and was not determinable in the remaining 2 cases. In no case did photochromatography overestimate the extent of the lesion. CONCLUSIONS: Digital highlighting of color change not readily seen by the unaided eye (photochromatography) can improve identification and localization of cutaneous tumor. Our findings justify further investigation into algorithms for photographic color detection and enhancement in the evaluation of tissue change.

Use of a deep polypropylene suture during earlobe repair: a method to provide permanent reinforcement in the prevention of recurrent earlobe tract elongation.

BACKGROUND: Cosmetic repair of elongated or lacerated earlobe tracts is a commonly encountered dermatologic procedure. For esthetic purposes, patients may choose to repierce the repaired lobe over the original site. Subsequent piercing within a scarred area potentially increases the risk of recurrent tract elongation secondary to the reduced tensile strength of the scar. OBJECTIVE: To strengthen a damaged earlobe by incorporating a nonabsorbable, dermal polypropylene suture during earlobe METHODS: The technique is described within the text. RESULTS: A deep polypropylene suture placed within a repaired earlobe tract provides a permanent barrier above which repiercing can be performed. CONCLUSION: Permanent reinforcement of the repaired earlobe serves to reduce the possibility of recurrent elongation of the earlobe tract. The technique is relevant when repeat piercing is desired over the original site.

Successful treatment of a cosmetic tattoo using a combination of lasers.

BACKGROUND: Cosmetic tattoos are becoming more popular and are often composed of several colors. Tattoo pigments containing ferric oxide and titanium dioxide can change to a blue-black color after exposure to Q-switched lasers that can be permanent. OBJECTIVE: Using a patient who presented with rouge tattoos on the cheeks as an example, we describe a useful approach to laser treatment of cosmetic tattoos. METHODS: Test areas were done with the Q-switched Nd:YAG at both 532 and 1064 nm and with the pulsed-dye laser at 595 nm. RESULTS: Although an immediate blue-black color change occurred after treatment with the Nd:YAG at 532 and 1064 nm, sequential treatments at 1064 nm produced a near complete clearance of the tattoos. The pulsed-dye laser was used to remove subtle pink tones. CONCLUSION: Performing small test areas before complete treatment and using several laser wavelengths throughout the course of therapy are essential to the successful treatment of cosmetic tattoos.

Revisiting the purse-string closure: some new methods and modifications.

BACKGROUND: Surgical wounds resulting from the extirpation of cutaneous malignancies can be repaired in a number of ways. One alternative, which has been used extensively in our practice, is the purse-string closure. This method of closure offers distinct advantages in the proper setting over traditional methods of closure. OBJECTIVE: Over the years, our approach to this procedure has evolved, and we have integrated a number of new modifications that are presented later here. METHODS: A report of three illustrative cases is given. RESULTS: Three cases are presented that illustrate some new modifications to the purse-string closure. CONCLUSION: The purse-string closure, which uses circumferential tissue advancement, can be used to close a wide range of surgical wounds. This method also frequently offers the advantage of an excellent cosmetic outcome.

Pigmentary changes after alexandrite laser hair removal.

BACKGROUND: Postinflammatory pigmentary changes are a frequently encountered problem with numerous dermatologic procedures. Limited literature is available that documents this complication with laser hair removal. OBJECTIVE: It is important for all physicians performing laser hair removal to be aware of this potential complication. We present our experience with postinflammatory pigmentary change and discuss some potential etiologic factors. METHODS: Seven patients who experienced postinflammatory complications after alexandrite laser hair removal are presented. These are all the patients who developed this complication in our office over the past 2.5 years. RESULTS: The patients who we describe in this article all developed a similar pattern of initial hyperpigmented rings, later developing into a thin wafer-like crust followed by hypopigmentation with gradual return to their normal skin color. CONCLUSION: In general, the alexandrite laser is both safe and effective for hair removal in patients of varying skin types. Complication rates will increase as skin pigment increases and as the power used increases. However, even in light-skinned individuals without recent pretreatment or posttreatment sun exposure, with proper treatment parameters, complications, and side effects can arise. We have found this to be especially true when treating areas other than the face.