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Ibelli TJ, Bauer B, Kleinman EP, Kuruvilla A, Mendiratta D, Scope A, Seyidova N, Taub PJ. Surgery or Not? A Systematic Review of Facial Congenital Melanocytic Nevi Treatment Patterns and Outcomes. Ann Plast Surg 2024; 92:120-132. [PMID: 37856246 DOI: 10.1097/sap.0000000000003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Treatment management for congenital melanocytic nevi (CMN) on the face (FCMN) is highly variable and requires a thorough assessment of multiple factors. To date, a systematic review of FCMN treatment is lacking. The purpose of the present study was to elucidate the frequency, variety, and outcomes of treatment modalities for FCMN with different levels of complexity. METHODS A comprehensive review of Pubmed, Embase, and Google Scholar databases from 1950 to 2022 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles reporting on FCMN treatment approaches, outcomes, and associated complications were screened and data were extracted according to inclusion criteria. Data were tabulated for thematic analysis of FCMN treatment types, anatomic locations, outcomes, and complications. RESULTS Of the 561 studies retrieved, 34 met inclusion criteria including 19 surgical treatments, 14 nonsurgical treatments, and one combined surgical and nonsurgical treatment study, totaling 356 patients. The majority of treated FCMN were small-to-medium-sized (56%). Facial CMN treated conservatively were mostly located on the cheek (27%) and/or perinasal region (21%), whereas FCMN treated with surgery were primarily located in the periorbital region (44%) and/or the cheek (17%). Across all treatment cohorts, 22% of patients experienced at least one complication, with 12% of complications experienced by patients treated by surgery. CONCLUSIONS There is a greater need for standardized FCMN nomenclature that encompasses nevi pattern, dimensions, anatomical coverage, and quantitative measurements of treatment outcome. Future studies should focus on identifying anatomic locations of FCMN that are more prone to complications and determine which treatment approach optimizes outcomes.
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Affiliation(s)
| | - Bruce Bauer
- Department of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Elana P Kleinman
- From the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annet Kuruvilla
- Division of Plastic and Reconstructive Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Dhruv Mendiratta
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Yamanaka H, Sawaragi E, Nakano T, Katayama Y, Ito T, Tada H, Hidaka Y, Morita S, Funakoshi C, Kinoshita A, Watanabe M, Tsuge I, Katsube M, Sakamoto M, Yamaoka T, Morimoto N. A high-hydrostatic pressure device for nevus tissue inactivation and dermal regeneration for reconstructing skin defects after giant congenital melanocytic nevus excision: a clinical trial. Regen Ther 2023; 24:167-173. [PMID: 37448852 PMCID: PMC10338193 DOI: 10.1016/j.reth.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Background A novel treatment has been developed to reconstruct large skin defects caused by the excision of giant congenital melanocytic nevi. It involves the reimplantation of high-hydrostatic pressurized nevus tissue as a cell-inactivated autologous scaffold for dermal regeneration, followed by the implantation of cultured epithelial autografts on the regenerated dermis. Because this treatment has shown promise in a first-in-human clinical trial which used a prototype pressure machine, a novel pressure device was specifically designed for clinical use. Methods In a prospective investigator-initiated clinical trial involving three patients, we evaluated the safety and efficacy of the skin regeneration treatment using a pressure device. All three patients underwent surgical excision of the nevus tissue, primary reimplantation of the inactivated nevus tissue, and secondary implantation of cultured epithelial autografts. Results Engraftment of inactivated nevus tissue and cultured epithelial autografts was successful in all three cases, with over 90% epithelialization at 8 weeks post-surgery. No serious adverse events or device malfunction were observed during the trial. Conclusion The novel pressure device safely and effectively enabled dermal regeneration using the nevus tissue as an autologous scaffold. This innovative approach offers several advantages, including reduced invasiveness due to minimal sacrifice of normal skin for skin grafting and high curative potential resulting from full-thickness removal of the nevus tissue.
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Affiliation(s)
- Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Eiichi Sawaragi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Nakano
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasuhiro Katayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuya Ito
- Regulatory Science and Pharmaceutical Informatics, School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Nanabancho, Wakayama, Wakayama Prefecture 640-8156, Japan
| | - Harue Tada
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yu Hidaka
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Satoshi Morita
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Chihiro Funakoshi
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akemi Kinoshita
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mieko Watanabe
- Department of Clinical Trial Science, Translational Research Center, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Motoki Katsube
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shinmachi, Suita, Osaka 564-8565, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Akasaka K, Maeno A. Proteins in Wonderland: The Magical World of Pressure. BIOLOGY 2021; 11:6. [PMID: 35053003 PMCID: PMC8772990 DOI: 10.3390/biology11010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/03/2023]
Abstract
Admitting the "Native", "Unfolded" and "Fibril" states as the three basic generic states of proteins in nature, each of which is characterized with its partial molar volume, here we predict that the interconversion among these generic states N, U, F may be performed simply by making a temporal excursion into the so called "the high-pressure regime", created artificially by putting the system under sufficiently high hydrostatic pressure, where we convert N to U and F to U, and then back to "the low-pressure regime" (the "Anfinsen regime"), where we convert U back to N (U→N). Provided that the solution conditions (temperature, pH, etc.) remain largely the same, the idea provides a general method for choosing N, U, or F of a protein, to a great extent at will, assisted by the proper use of the external perturbation pressure. A successful experiment is demonstrated for the case of hen lysozyme, for which the amyloid fibril state F prepared at 1 bar is turned almost fully back into its original native state N at 1 bar by going through the "the high-pressure regime". The outstanding simplicity and effectiveness of pressure in controlling the conformational state of a protein are expected to have a wide variety of applications both in basic and applied bioscience in the future.
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Affiliation(s)
- Kazuyuki Akasaka
- Keihanna Academy of Science & Culture, Kansai Science City, Keihanna Interaction Plaza, Lab. Wing, Kyoto 619-0237, Japan
| | - Akihiro Maeno
- Lab of Medical Chemistry, Kansai Medical University, 2-5-1 Shin-machi, Osaka 573-1010, Japan;
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