Revisiting the Anchor Flap for Nasal Defects: How It Fits in the Current Reconstruction Paradigm.

The anchor or Peng flap, first described in 1987, has not been comprehensively discussed in the literature since 2008. The anchor flap is worth revisiting as a useful advancement-rotation flap for medium-sized defects of the distal nose. More recent variations to the flap design incorporate medial cheek advancement and allow for versatility in its use for wide defects of the nasal tip, supratip, and dorsum. The anchor flap is a suitable reconstructive option for defects for which the bilobed/trilobed flap, dorsal nasal rotation flap, or interpolated flap would be considered. We review various designs of the anchor flap and discuss how it can be considered in the modern reconstructive paradigm.  J Drugs Dermatol. 2024;23(1):1271-1273.     doi:10.36849/JDD.7532.

The 200-Year Timeline on Botulinum Toxin: From Biologic Poison to Wonder Drug.

The history of botulinum toxin dates back to the late 1700s, when food preparation, storage, and later canning practices led to outbreaks of botulism across Europe and the United States. It is from these initial incidents that the remarkable discovery of botulinum toxin was eventually made, sparking over 200 years of further scientific inquiry and medical innovation. To date, 6 botulinum toxin products have been commercialized in North America with numerous indications across the specialties of ophthalmology, neurology, urology, dermatology, plastic surgery, and otolaryngology. This article traces the key moments and important players in the remarkable journey of this biologic poison and wonder drug. J Drugs Dermatol. 2024;23(1) doi:10.36849/JDD.7288.

Identifying critical quality metrics in Mohs Surgery: A national expert consensus process.

BACKGROUND: Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. OBJECTIVE: The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. METHODS: Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. RESULTS: Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. LIMITATIONS: Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. CONCLUSION: With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.

A Single-Center, Observational Experience With a Bovine Collagen Wound Dressing for Distal Lower Extremity Surgical Defects.

BACKGROUND: Biologic dressings help treat many dermatologic conditions. Their use in dermatologic surgery continues to expand as new dressings are developed. OBJECTIVE: To discuss the authors' experience with a bovine-derived collagen wound dressing in surgical defects on the distal lower extremity. METHODS AND MATERIALS: Over a 9-month period, 24 surgical defects in 20 patients were treated with a bovine-derived collagen wound dressing. All surgical defects were located below the knee. The average defect was 6.9 cm2 (range 1.0-18.0 cm2). The mean duration until healing completion was 117.3 days (range 63-183). RESULTS: The treated surgical defects demonstrated shortened healing time, improved cosmetic outcome, decreased wound drainage, and decreased pain compared with that traditionally seen in second intention healing. Bovine-derived collagen wound dressings should be considered to facilitate the healing of surgical defects on the distal lower extremity that would otherwise be left to heal by the second intention. J Drugs Dermatol. 2023;22(12):1149-1152. doi:10.36849/JDD.5404.

Topical Anesthetic Use in Cosmetic Dermatology.

In today's society, there is growing interest in outpatient cosmetic procedures. Topical anesthetics are commonly used as anesthesia for these procedures. They can be used alone or part of a multi-pronged anesthetic approach. Topical anesthetics have many benefits, but they also have some negatives including risk of toxicity. For this paper, we focused on the role of topical anesthetics in cosmetic dermatology. We surveyed cosmetic dermatologists on the use of topical anesthetics in their practices. We found that the most popular topical anesthetic was benzocaine 20% / lidocaine 6% / tetracaine 4%. When asked for which procedures topical anesthetics are used for anesthesia, the most frequent responses were fractionally ablative lasers and fractionally non-ablative lasers. Though the majority of surveyed dermatologists have not had issues with the topical anesthetic, a portion had experienced adverse events in their patients. Topical anesthetics play an important role in cosmetic dermatology, allowing cosmetic procedures to take place in ways that are both comfortable for patients and allow patients to avoid more involved types of anesthesia. This is a growing area of cosmetic dermatology that requires additional research. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.6978.

ACGME Program Requirements for Surgical Specialties: How Do Dermatology and MSDO Stack Up?

Dermatology and micrographic surgery and dermatologic oncology (MSDO) are two areas of medicine where surgical procedures play an important role both in training and practice. We sought to determine how dermatology and MSDO compare to ACGME surgical specialties with regard to surgical curriculum and case log requirements. We found that the surgical curriculums for dermatology and MSDO are similar to those of our surgical colleagues in ophthalmology, obstetrics, and gynecology. They are similar in that none require general surgery rotations, a general surgery postgraduate year 1 is not required, and all surgical experience can be obtained within each respective specialty residency training program. Regarding case log requirements, MSDO was found to have numerical case log requirements comparable to those of ACGME surgical specialties. Dermatology case log requirements were on the low end of the surgical spectrum. In dermatology and MSDO, surgical training is well integrated into the programs and case log requirements. They represent two of the many areas where medicine and surgery combine in the name of patient care. J Drugs Dermatol. 2023;22(1): doi:10.36849/JDD.6886.

Rate and Characteristics of Incompletely Excised Cutaneous Squamous Cell Carcinoma: A Dermatological Daily Practice Multicenter Prospective Cohort Study.

BACKGROUND: Incomplete excision of squamous cell carcinoma (cSCC) is associated with an increased risk of recurrence, metastasis, and mortality. OBJECTIVE: To determine the rate and characteristics of incompletely excised cSCC in a dermatological daily practice setting. METHODS: Prospective study of all patients who gave informed consent, with a cSCC treated with standard excision (SE) at 1 of 6 Departments of Dermatology in the Netherlands between 2015 and 2017. Pathological reports were screened to detect all incompletely excised cSCCs. RESULTS: A total of 592 patients with 679 cSCCs were included, whereby most cases were low risk cSCC (89%). The rate of incompletely excised cSCC was 4% ( n = 26), and the majority were high-risk cSCCs of which 24 invaded the deep excision margin. CONCLUSION: This prospective study showed that in a dermatological setting, the risk of an incompletely excised cSCC is low (4%) for a cohort that was dominated by low-risk cSCCs. Most incompletely excised cSCCs were of high risk, and incompleteness was almost always at the deep margins. These results suggest that for high-risk cSCC, one should pay attention especially to the deep margin when performing SE, and/or microscopic surgery should be considered.

Key Moments in the History of Liposuction by Dermatologists.

Dermatologists have been pioneers in the development and refinement of liposuction using local anesthesia. Although other specialties routinely use general anesthesia for liposuction, the safety profile of liposuction using local anesthesia is impressive. This article traces the history and development of liposuction by dermatologists in the United States. J Drugs Dermatol. 2022;21(9):997-1000. doi:10.36849/JDD.6952.

Timeline: The Evolution of Fellowship Training in Micrographic Surgery and Dermatologic Oncology.

The Accreditation Council for Graduate Medical Education (ACGME) granted accreditation to the first 5 Procedural Dermatology Fellowship Training Programs in 2004. The name of the training program was changed from Procedural Dermatology to Micrographic Surgery and Dermatologic Oncology by the ACGME/Residency Review Committee for Dermatology in 2014. The American Board of Dermatology/American Board of Medical Specialties conducted the first certification examination in Micrographic Dermatology Surgery in October 2021. This article chronicles the history and development of the subspecialty. J Drugs Dermatol. 2022;21(8):861-863.: doi:10.36849/JDD.6933.

Anatomical Considerations for Injectable Fillers in the Face: How to Reduce Complications and Optimize Aesthetic Results.

The popularity of minimally invasive injectable aesthetic treatments has grown exponentially with over thirteen million neurotoxin and dermal filler injections being performed in 2014. While aesthetic results can be dramatic and convalescence minimal, significant complications including vascular compromise, neuropraxia, and blindness have been reported. Thorough knowledge of the complex anatomy in this area and the use of anatomic landmarks can help the physician obtain improved aesthetic results by deploying fillers in the appropriate anatomic plane and avoiding inadvertent injury to important neurovascular structures in this area. J Drugs Dermatol. 2022;21(4):354-362. doi:10.36849/JDD.6642.

[Smartphone apps for self-diagnosis of skin cancer]. / Smartphone-apps voor zelfdiagnostiek van huidkanker.

Smartphone applications are increasingly used in medicine, including for the detection of skin cancer. In essence, these applications use artificial intelligence to analyse photographs of skin lesions. When reviewing the literature, only one app (SkinVision) has been evaluated in multiple clinical studies, with a pooled sensitivity of 88% (95%-CI: 70-98%) and specificity of 79% (95%-CI: 70-86%). When used in an unselected adult population, this translates to negative and positive predictive values of > 99% and 1.9%, respectively. This means that a high proportion of app users will be falsely warned of possible skin cancer and recommended to seek medical care. We believe that prior to making this technology available for unrestricted use in a community-based setting, further study is warranted to evaluate the ramifications of this application on health care usage, possible benefits (such as time to diagnosis compared with usual care), as well as unwanted side effects, such as medicalization and anxiety.

2020 IDEOM Annual Meeting: Actinic Keratosis Stakeholders Survey Identifies Gaps in Research and Care.

This is a report of the survey results from the International Dermatology Outcome Measures (IDEOM) actinic keratosis (AK) workgroup. The purpose of the survey was to compile a list of gaps within AK care and management that require refinement. The results were discussed at the IDEOM annual meeting held virtually on October 23–24, 2020. This built a framework with which the AK workgroup, which consisted of physicians, patients, and pharmaceutical scientists, discussed at length in their breakout session at the meeting. The electronic survey was distributed to patients, pharmaceutical scientists, and leading physician experts in the field via email on September 22, 2020, with a deadline of October 2, 2020. The survey consisted of three open-ended prompts concerning key gaps and/or unmet needs in (1) the care of AKs, (2) outcome measurement of AKs in clinical trials and, (3) the measurement of AKs in clinical practice. The results were qualitative, with a response rate of 47%. Responses included reform of outcome measures for clinical trials, a methodology for evaluating the efficacy of preventative measures, and a comparison of treatments to establish a treatment protocol, among other efforts. This paper will also provide a brief overview of the current state of the AK outcome measures, emphasizing the heterogeneity of the measures and detailing the AK workgroup's future efforts to create a reliable and applicable core outcome measure set. J Drugs Dermatol. 2022;21(2):128-134. doi:10.36849/JDD.6360.

Beyond Liposuction: Evolving Applications for Tumescent Anesthesia.

Tumescent anesthesia was initially developed as a safer and more effective alternative to general anesthesia in performing liposuction. Today, it is used extensively for a wide variety of surgical procedures performed by various specialties. As more surgeons have become exposed to tumescent anesthesia with its associated advantages over general anesthesia, the number of applications for this unique form of local anesthesia has skyrocketed. In this article, we will briefly discuss the basics of tumescent anesthesia, followed by a discussion of the many applications that are now being performed by various specialties. J Drugs Dermatol. 2022;21(1):86-89. doi:10.36849/JDD.6279.

Tumescent Anesthesia: A Brief History Regarding the Evolution of Tumescent Solution.

Tumescent anesthesia, initially developed as a safer and more effective alternative to general anesthesia in performing liposuction, is used extensively today for a wide array of surgical procedures performed by various specialties. The make-up of the tumescent solution is variable, and it has evolved significantly over the past 40+ years. Even prior to Jefferey Klein’s tumescent solution recorded in his article from 1987, “The Tumescent Technique for Lipo-Suction Surgery,” there were significant contributions paving the way to modern formulations.1 In this article, we attempt to provide the most comprehensive history and timeline documenting the evolution of tumescent solution to date. J Drugs Dermatol. 2021;20(12):1283-1287. doi:10.36849/JDD.6212.

Comparison of Modern Super Wide Field Microscopy Systems in Mohs Surgery.

Microscopic interpretation of frozen tissue sections is fundamental to Mohs micrographic surgery. Mohs surgeons spend a significant portion of their day at the microscope. Eye strain and fatigue, in addition to musculoskeletal strain, may increase the risk of interpretation errors as well as musculoskeletal injury.3,4,5,7 Advances in microscope systems have allowed for more efficient and reliable reading of slides as well as decreased physical strain. In particular, the advent of super wide field (SWF) microscopy, which includes lower power objective lenses as well as wider eyepieces, allows for a much larger area to be viewed, decreasing eye strain.2,5 Also, more ergonomically designed systems help to decrease musculoskeletal fatigue and injury.7 In an update to an article from Goldsberry et al, that compared older SWF microscope systems,1 we review three newer systems for comparison: Leica DM2500, Nikon Ci-L, and Olympus Bx53 (Figure 1.) Each system reviewed demonstrates ergonomic design and super wide fields of view, allowing for efficient interpretation of tissue and decreased eye strain and musculoskeletal strain compared to older systems. The Nikon Ci-L had the largest possible VFA at 490.87 mm2, 40% more area than the Olympus and 56% more area than the Leica. J Drugs Dermatol. 2021;20(10):1093-1095, doi:10.36849/JDD.6083.

A Review of Hedgehog Inhibitors Sonidegib and Vismodegib for Treatment of Advanced Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is the most common malignancy in fair-skinned populations. Most cases are successfully treated with surgery, but in advanced BCC—including locally advanced BCC and metastatic BCC—surgery is likely to result in substantial morbidity or unlikely to be effective. In those patients, the systemic Hedgehog inhibitors (HHIs) sonidegib and vismodegib are the only approved pharmacologic treatment option. Although a number of clinical studies highlight the similarities and differences between the two HHIs, no head-to-head clinical comparison is available. Results from the pivotal BOLT and ERIVANCE clinical studies for sonidegib and vismodegib, respectively, demonstrate similar efficacy measured by objective response rate, complete response rate, and histologic tumor subtype. Safety results for both studies are comparable with similar common adverse events reported for muscle spasms, alopecia, and dysgeusia. A notable difference between sonidegib and vismodegib is their respective pharmacokinetic profiles with sonidegib reaching peak concentration in plasma within 2–4 hours of dosing and steady state in plasma achieved by week 17 of treatment, while vismodegib reaches peak plasma concentration approximately 2 days after a single dose and steady state within 21 days of repeated dosing. This review compares efficacy, safety, and pharmacokinetics of sonidegib and vismodegib based on published literature to date. J Drugs Dermatol. 2021;20(2):156-165. doi:10.36849/JDD.5657 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Efficacy and safety of ingenol disoxate gel in field treatment of actinic keratosis on full face, scalp or large area (250 cm2) on the chest: results of four phase 3 randomized controlled trials.

INTRODUCTION: Actinic keratosis (AK) is a skin condition arising from chronic exposure to ultraviolet light and may lead to the development of malignancies. This trial aimed to evaluate efficacy and safety of ingenol disoxate gel (IngDsx, 0.018% for face/chest [FC]; 0.037% for scalp [S]), versus vehicle. METHODS: Four identical phase 3 trials in patients with AK on the full face/up to 250cm2 of chest or full balding scalp, with an initial 8-week period and 12-month follow-up, were conducted. FC and S trials were pooled for analysis. The primary endpoint was complete clearance at Week 8. RESULTS: Across trials, 616 patients were randomized to FC and 626 to S, with 410 and 420 assigned to receive IngDsx, respectively. In the FC and S trials, 25.9% and 24.5% of patients in the IngDsx group, respectively, achieved the primary endpoint. IngDsx was relatively well tolerated. During extended follow-up, there were more identified non-melanoma skin malignancies in the IngDsx group than vehicle group; HR: 2.38 (95% CI: 1.28, 4.41). CONCLUSION: Treatment with IngDsx was superior to vehicle on all clinical endpoints, patient-reported and cosmetic outcomes. During the 12-month follow-up, slightly increased skin malignancies in the treatment area were identified, potentially due to unintentional detection bias.