Intravascular Basal Cell Carcinoma Hiding under a Keratoacanthoma.

A 79-year-old male presented for removal of what was proven to be a keratoacanthoma. Additional tissue removed deep to the initial lesion revealed intravascular basal cell carcinoma (BCC). Intravascular BCC is exceedingly rare with only 8 cases previously reported in the literature. Intravascular BCC may be associated with more aggressive subtypes. Intravascular infiltration is more common in metastatic BCC, but this finding may not imply causality. More data are required in order to determine prognostic implications of intravascular BCC and to develop a protocol for managing patients with this unique finding.

The Adjunct Use of Platelet-Rich Plasma in Split-Thickness Skin Grafts: A Systematic Review.

OBJECTIVE: To summarize the available literature on platelet-rich plasma (PRP) as an adjunct to split-thickness skin graft (STSG) in an organized and easy-to-read format. These data may encourage surgeons to integrate PRP into their skin graft protocol. DATA SOURCES: The authors conducted a systematic search using the PubMed, Cochrane, and ClinicalTrials.gov databases for articles published from their respective inceptions to October 1, 2019, to identify relevant studies. STUDY SELECTION: A total of 629 articles were reviewed, and 5 were identified for inclusion in this study. The population of all studies was patients receiving an STSG to close a skin defect. DATA EXTRACTION: Articles were screened for the following outcome measures: graft take rates, edema or hematoma formation, instant adhesion of graft, healing time, length of hospital stay, scar hypertrophy, and frequency of dressing changes. DATA SYNTHESIS: The data were organized into two tables describing the studies and the selected outcome measures. CONCLUSIONS: The data suggest that PRP in STSG reduces healing time, length of hospital stay, and scarring and that it eliminates the need for sutures/staples. Further, these benefits may correlate with a decrease in overall expenditure. This systematic review suggests that further research on PRP and skin grafts is warranted.

Multiple Facial Lesions of Recalcitrant Pyoderma Gangrenosum Successfully Treated with Adalimumab.

Pyoderma gangrenosum (PG) is a rare, ulcerative, inflammatory skin disease that most commonly presents on the lower legs. Development of PG on the head and neck is exceedingly rare. We present the case of a 52-year-old man with no known history of underlying systemic disease who developed multiple facial lesions of PG that were refractory to both standard and alternative treatment modalities. Clearance of disease was ultimately achieved using adalimumab.

The Use of Botulinum Neurotoxin Type A in Aesthetics: Key Clinical Postulates.

BACKGROUND: The most common aesthetic procedure performed worldwide is the injection of botulinum neurotoxin Type A (BoNT-A). Aesthetic providers must fully comprehend the objective scientific data, theoretical mechanisms of action, and differences between brands of BoNT-A. OBJECTIVE: To determine and review the relevant clinical postulates for the use of botulinum toxin in aesthetics. MATERIALS AND METHODS: The BoNT-A clinical postulates presented here discuss how each brand of BoNT-A acts identically, how the molecular potency may vary between the different products, how patient age, gender, genetics, and muscle mass cause variation in toxin receptor number and density, and how both practitioner and patient can affect toxin distribution. RESULTS: A total of 8 clinical postulates have been identified that are key to understanding the use of botulinum toxin in aesthetics and to obtaining the best clinical results. CONCLUSION: All of these factors affect the potential efficacy of the injected toxin and hence the aesthetic results obtained.

A treatment algorithm to identify therapeutic approaches for leg ulcers in patients with sickle cell disease.

Sickle cell leg ulcers (SCLUs) are a common complication of sickle cell disease (SCD). Patients who develop ulcers appear to have a more severe haemolysis-associated vasculopathy than individuals who do not develop them, and manifest other complications such as priapism and pulmonary hypertension. SCLUs are slow to heal and often recur, affecting both the emotional and physical well-being of patients. Here we summarise what is known about the pathophysiology of SCLUs, describe available treatment options and propose a treatment algorithm.

Use of buckets as tools by Western lowland gorillas.

While all great apes have been documented to use tools, gorillas are arguably the least proficient tool users. In 2009, a Western lowland gorilla (Gorilla gorilla gorilla) at the Buffalo Zoo was observed using a bucket, which had been provided as part of normal enrichment, as a tool to collect water. We conducted a brief, ad libitum investigation to confirm the validity of the initial observation. We then carried out a systematic investigation of the behavior in 2010. We collected 72 hr of videotaped data and tested the null hypothesis that the gorillas did not differ in their prevalence of engaging in bucket-use behaviors. We documented that all four adult gorillas in the group used buckets as drinking tools; however, there was significant individual variation in frequency and type of use of buckets. Four of the eight behaviors showed significant variation among individuals. The silverback male and the youngest adult female contacted and held the bucket significantly more than the remaining two adult females. The young female carried and drank from the bucket significantly more than any other individual. Furthermore, she was observed to fill the bucket with water four of the six times during which this behavior was observed. These data provide evidence of the ability of gorillas to utilize tools, given the appropriate environmental conditions. We continue to explore the abilities of gorillas to recognize the functionality of buckets as tools.