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Jacobsen ES, Hanke CW. Dermatologists Can Treat Ocular Rosacea: An Abbreviated Review of Intense Pulsed Light for Rosacea Eye Disease. Dermatol Surg 2024:00042728-990000000-00751. [PMID: 38595166 DOI: 10.1097/dss.0000000000004192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Dodson JA, Ibrahim SA, Rogers H, Council ML, Nehal KS, Tung R, Leffell DJ, Zeitouni NC, Totonchy MB, Fosko SW, Lee Soon S, Blalock TW, Brodland DG, Billingsley EM, Scott JF, Leach BC, Ratner D, Washington C, Hanke CW, Otley CC, Golda N, Nijhawan RI, Brewer J, Demer A, Fish F, Harmon CB, Zitelli J, Knackstedt T, Singh G, Mollet T, Carr DR, Albertini JG, Moody BR, McDonald M, Bordeaux JS, Massey PR, MacCormack MA, Vidimos A, Arpey CJ, Arron ST, Ibrahimi OA, Jiang SB, Miller CJ, Maher IA, Wysong A, Leshin B, Goldman GD, Kibbi N, Feng H, Collins L. Identifying critical quality metrics in Mohs Surgery: A national expert consensus process. J Am Acad Dermatol 2024; 90:798-805. [PMID: 38081390 DOI: 10.1016/j.jaad.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
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.
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Affiliation(s)
- Joseph A Dodson
- Rush Medical College of Rush University Medical Center, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Howard Rogers
- President, American College of Mohs Surgery, CMO, Advanced Dermatology, Norwich, Connecticut
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Nathalie C Zeitouni
- Division of Dermatology, Department of Internal Medicine, University of Arizona, Phoenix, Arizona
| | | | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, Florida
| | | | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian C Leach
- The Skin Surgery Center of Charleston, Mount Pleasant, South Carolina
| | - Desiree Ratner
- Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Carl Washington
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Partner; Dermatology Associates of Georgia, Decatur, Georgia
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Indianapolis, Indiana; Program Director, ACGME Micrographic Surgery/Dermatologic Oncology Fellowship Training Program, Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Dermatology, University of Iowa-Carver College of Medicine, Iowa City, Iowa
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Golda
- Dermatology and Skin Cancer Centers, Kansas City, Missouri
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Frederick Fish
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - John Zitelli
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina; Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Todd Mollet
- Department of Dermatology, Skin Surgery Center of Oklahoma, Oklahoma City, Oklahoma
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Michel McDonald
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Warren Alpert Medical School at Brown University, Worcester, Massachusetts
| | | | | | - Allison Vidimos
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Omar A Ibrahimi
- Department of Dermatology, Connecticut Skin Institute, Stamford, Connecticut
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Barry Leshin
- Department of Dermatology, Skin Surgery Center, Winston-Salem, North Carolina
| | | | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Lindsey Collins
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Dong J, Hanke CW. Revisiting the Anchor Flap for Nasal Defects: How It Fits in the Current Reconstruction Paradigm. J Drugs Dermatol 2024; 23:1271-1273. [PMID: 38206140 DOI: 10.36849/jdd.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
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.
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Dong J, Helveston EM, Hanke CW. The 200-Year Timeline on Botulinum Toxin: From Biologic Poison to Wonder Drug. J Drugs Dermatol 2024; 23:1357-1359. [PMID: 38206138 DOI: 10.36849/jdd.7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
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.
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Wald J, Shah M, Hanke CW. A Single-Center, Observational Experience With a Bovine Collagen Wound Dressing for Distal Lower Extremity Surgical Defects. J Drugs Dermatol 2023; 22:1149-1152. [PMID: 38051862 DOI: 10.36849/jdd.5404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
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.
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Sutton E, Hanke CW. Topical Anesthetic Use in Cosmetic Dermatology. J Drugs Dermatol 2023; 22:256-259. [PMID: 36877878 DOI: 10.36849/jdd.6978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
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.
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Hanke CW, Asken S, Cook W, Alt T, Bernstein G. Key Moments in the History of Liposuction by Dermatologists. J Drugs Dermatol 2022; 21:997-1000. [PMID: 36074505 DOI: 10.36849/jdd.6952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Hanke CW, Otley C, Bailin P, Stasko T, Olbricht S, Zitelli J. Timeline: The Evolution of Fellowship Training in Micrographic Surgery and Dermatologic Oncology. J Drugs Dermatol 2022; 21:861-863. [DOI: 10.36849/jdd.6933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sutton E, Hanke CW. Microscope Use in Mohs Micrographic Surgery: A Survey of Current and Former Mohs Surgery Fellowship Directors. Dermatol Surg 2022; 48:786-787. [PMID: 35642898 DOI: 10.1097/dss.0000000000003482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Sutton
- Dermatologic Surgery, Ascension St. Vincent Medical Center, Indianapolis, Indiana
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Babalola F, Moattari C, Berman B, Bhatia N, Goldberg L, Gottlieb A, Grada A, Hanke CW, Jagdeo J, Jimenez X, Konnikov N, Martin G, Maytin E, Milane M, Nestor M, Noda A, Rosen T, Shah S, Willey A, Yoo J, Zeitouni N, Siegel D. 2020 IDEOM Annual Meeting: Actinic Keratosis Stakeholders Survey Identifies Gaps in Research and Care. J Drugs Dermatol 2022; 21:128-134. [PMID: 35133114 DOI: 10.36849/jdd.6360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Hanke CW, Dent MS. Comparison of Modern Super Wide Field Microscopy Systems in Mohs Surgery. J Drugs Dermatol 2021; 20:1093-1095. [PMID: 34636510 DOI: 10.36849/jdd.6083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Migden M, Farberg AS, Dummer R, Squittieri N, Hanke CW. A Review of Hedgehog Inhibitors Sonidegib and Vismodegib for Treatment of Advanced Basal Cell Carcinoma. J Drugs Dermatol 2021; 20:156-165. [PMID: 33538567 DOI: 10.36849/jdd.5657] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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
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Berman B, Bukhalo M, Hanke CW, Jarner MF, Larsson T, Siegel DM, Skov T, Szeimies RM. 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. Dermatol Online J 2020. [DOI: 10.5070/d32610050459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Berman B, Bukhalo M, Hanke CW, Jarner MF, Larsson T, Siegel DM, Skov T, Szeimies RM. 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. Dermatol Online J 2020; 26:13030/qt7677c8r4. [PMID: 33147665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023] Open
Abstract
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.
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Affiliation(s)
- Brian Berman
- Center for Clinical and Cosmetic Research, Aventura, FL.
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McLawhorn JM, Stephany MP, Bruhn WE, Crow LD, Coldiron BM, Hruza GJ, Leach BC, Soon SL, Friedmann DP, Stebbins WG, Blalock TW, Graves MS, Billingsley EM, Knackstedt TJ, Miller SJ, Yob EH, Albertini JG, Zeitouni N, Krathen RA, Bichakjian CK, Jellinek NJ, Hanke CW, Samie FH, Mann MW, Carucci JA, Kakar R, Saylor DK, Fosko SW, Ortiz AE, Henghold WB, Jennings TA, Davis DS, Maloney ME, Curcio NM, Behshad R, Tope WD, McCoppin H, Levin JI, Collins L, Stasko T. An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures. J Am Acad Dermatol 2020; 82:700-708. [DOI: 10.1016/j.jaad.2019.09.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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Tang JC, Hanke CW. Universal Protocol in Mohs Micrographic Surgery: Incorporating a “Time Out” Procedure in Histopathologic Interpretation. J Drugs Dermatol 2020; 19:198. [PMID: 32129971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 1999, the Institute of Medicine’s (IOM) first report, “To Err Is Human”, brought forth the issue of medical error in patient care.1 In this publication, the IOM recognized that mistakes or failures to prevent mistakes were mostly caused by flawed systems, processes, and conditions. It outlined a four-tiered approach to improve safety including: 1) development of leadership, research, tools, and protocols to enhance the knowledge base on safety, 2) a nationwide public mandatory reporting system and encouraging voluntary participation to identify and learn from errors, 3) oversight organizations, professional groups, health care purchasers to raise performance standards and expectations, and 4) implementation of safety systems in the healthcare organization to ensure delivery of safe practice. This was the first roadmap towards a safer health system.
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Hanke CW, Albrecht L, Skov T, Larsson T, Østerdal ML, Spelman L. Efficacy and safety of ingenol mebutate gel in field treatment of actinic keratosis on full face, balding scalp, or approximately 250 cm 2 on the chest: A phase 3 randomized controlled trial. J Am Acad Dermatol 2019; 82:642-650. [PMID: 31374304 DOI: 10.1016/j.jaad.2019.07.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) 0.015% or 0.05% is approved for actinic keratosis (AK) areas of 25 cm2 or less; some patients require treatment of larger fields. OBJECTIVE To determine efficacy and safety of IngMeb 0.027% in areas of AK of up to 250 cm2 during an 8-week initial assessment period and extended 12-month follow-up. METHODS This phase 3, randomized, double-blind, vehicle-controlled trial (NCT02361216) enrolled adult patients with 5 to 20 AK lesions on the face/scalp (25-250 cm2) or chest (approximately 250 cm2). Patients received once-daily IngMeb or vehicle for 3 consecutive days on the full face, full balding scalp, or approximately 250 cm2 on the chest. The primary endpoint was complete AK clearance (AKCLEAR 100; week 8). Additional endpoints included partial AK clearance (AKCLEAR 75), recurrence, patient satisfaction, cosmetic outcome, and safety. RESULTS IngMeb was superior to vehicle for complete AK clearance (21.4% vs 3.4%, P < .001) and AK clearance of 75% or greater (59.4% vs 8.9%, P < .001) at week 8. Probability of sustained clearance during the 12-month follow-up was 22.9% for patients treated with IngMeb. Increased treatment satisfaction and cosmetic outcomes were observed with IngMeb versus vehicle. No unexpected safety signals were identified. LIMITATIONS Localized skin responses hindered maintenance of double-blinding. CONCLUSIONS IngMeb 0.027% was superior to vehicle for treatment of AK areas of up to 250 cm2. The safety profile of IngMeb was as expected.
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Affiliation(s)
| | | | | | | | | | - Lynda Spelman
- Veracity Clinical Research, Brisbane, Queensland, Australia
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Doerfler L, Hanke CW. Treatment of Solitary Keratoacanthoma of the Nose With Intralesional Methotrexate and Review of the Literature. J Drugs Dermatol 2019; 18:693-696. [PMID: 31334929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Keratoacathoma (KA) is a unique clinical pathological entity that is difficult to categorize. Differentiating a KA from a squamous cell carcinoma (SCC) is important for treatment implications but is often challenging. We report a patient with a solitary KA of the skin of the right ala successfully treated with intralesional (IL) injections of methotrexate (MTX). We also provide a review of the literature on IL-MTX as a treatment modality for KA. J Drugs Dermatol. 2019;18(7):693-696.
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Doerfler L, Hanke CW. Arterial Occlusion and Necrosis Following Hyaluronic Acid Injection and a Review of the Literature. J Drugs Dermatol 2019; 18:587-591. [PMID: 31251553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With the rising popularity of fillers for facial rejuvenation coupled with the paucity of regulations on credentialing of qualified injectors, the number of filler related complications is increasing. Although the majority of complications are mild, vascular occlusion is the most feared and dangerous. Minimizing risk of vascular complications through a comprehensive understanding of vascular anatomy and careful technique is important. Physicians who perform filler injections should also be able to promptly recognize complications and manage them. We report a case of vascular occlusion successfully managed using high dose hyaluronidase and provide a review of the literature including incidence, management, and techniques to prevent vascular complications. J Drugs Dermatol. 2019;18(6):587-591.
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Frost ML, Hrynewycz K, Hanke CW. Is It Time to Rethink What Thickness Really Means as a Prognostic Indicator in Melanoma? Ten Questions We Should Be Asking Ourselves. J Drugs Dermatol 2019; 18:148-151. [PMID: 30794365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Tumor thickness has been a key tool for prognosis of melanoma. However, with the advent of gene expression profile (GEP) assays for melanoma and the discovery of multiple melanoma subtypes, it is time to reassess how we view tumor thickness as a prognostic indicator.Herein we present ten questions for consideration by the shrewd practitioner when considering prognostic factors of melanoma. J Drugs Dermatol. 2019;18(2):148-151.
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Tang JC, Buckel L, Hanke CW. Histopathology of Basal Cell Carcinoma After Treatment With Vismogedib. J Drugs Dermatol 2019; 18:136-138. [PMID: 30794363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: Vismodegib used in the treatment of metastatic basal cell carcinoma (BCC) or locally advanced, recurrent BCC not amenable to surgery or radiation leads to various clinical changes.
Objective: Aim was to elucidate the histopathology that corresponds to tumor involution observed with vismodegib therapy.
Methods: Retrospective case series of patients treated with vismodegib between May 2012 and April 2017 with intra- or post-treatment biopsy.
Results: 42 biopsy specimens and 4 Mohs frozen sections were analyzed. Necrosis, fibrosis, and increased plasma cells were common features.
Limitations: Single center study.
Conclusion: The histologic findings of BCCs treated with vismodegib correlate with clinical response.
J Drugs Dermatol. 2019;18(2):136-138.
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Sarnoff D, Gotkin R, Doerfler L, Gustafson C, Hanke CW. The Safety of Laser Skin Resurfacing With the Microablative Carbon Dioxide Laser and Review of the Literature. J Drugs Dermatol 2018; 17:1157-1162. [PMID: 30481953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE: The aim of this study was to evaluate the incidence of adverse effects following laser skin resurfacing with the microablative carbon dioxide (CO2) laser system (SmartXide DOT; DEKA, Calenzano, Italy). METHODS: A retrospective chart review was performed. Data was collected for DOT laser procedures performed at three clinical centers from 2008-2014. Results: Of the 1,081 DOT laser procedures, there were 13 complications (1.3% of all cases), which included eleven cases of prolonged erythema and two cases of post-inflammatory hyperpigmentation. Of note, there were no cases of scarring. LIMITATIONS: This was a retrospective chart review. Data was collected from laser case logs. However, all patients with complications were evaluated clinically by a physician. CONCLUSION: Microablative fractional resurfacing with the DOT laser enables treatment of a diversity of skin conditions with short post-procedure recovery time and an extremely low incidence of adverse side effects. J Drugs Dermatol. 2018;17(11):1157-1162.
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Wolf DA, Beeson W, Rachel JD, Keller GS, Hanke CW, Waibel J, Leavitt M, Sacopulos M. Mesothelial Stem Cells and Stromal Vascular Fraction for Skin Rejuvenation. Facial Plast Surg Clin North Am 2018; 26:513-532. [PMID: 30213431 DOI: 10.1016/j.fsc.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The use of stem cells in regenerative medicine and specifically facial rejuvenation is thought provoking and controversial. Today there is increased emphasis on tissue engineering and regenerative medicine, which translates into a need for a reliable source of stem cells in addition to biomaterial scaffolds and cytokine growth factors. Adipose tissue is currently recognized as an accessible and abundant source for adult stem cells. Cellular therapies and tissue engineering are still in their infancy, and additional basic science and preclinical studies are needed before cosmetic and reconstructive surgical applications can be routinely undertaken and satisfactory levels of patient safety achieved.
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Affiliation(s)
- David A Wolf
- Johnson Space Center, Houston, TX, USA; EarthTomorrow, Inc, 1714 Neptune Lane, Houston, TX 77062, USA; Purdue University, West Lafayette, IN, USA
| | - William Beeson
- Facial Plastics, Indianapolis, IN, USA; Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Gregory S Keller
- Facial Plastics, Santa Barbara, CA, USA; Facial Plastics, Los Angeles, CA, USA
| | - C William Hanke
- Dermatology, Indianapolis, IN, USA; Laser and Skin Center of Indiana, 13400 North Meridian Street, Suite 290, Carmel, IN 46032, USA; ACGME Micrographic Surgery, Dermatologic Oncology Fellowship Training Program, St. Vincent Hospital, Indianapolis, IN, USA; University of Iowa-Carver College of Medicine, Iowa City, IA, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jill Waibel
- Dermatology, Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue, Suite B200, Miami, FL 33173, USA; Baptist Hospital of Miami, Miami, FL, USA; Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Matt Leavitt
- Dermatology, Orlando, FL, USA; Advanced Dermatology and Cosmetic Surgery, The Hair Foundation, 260 Lookout Place Suite 103, Maitland, FL 32751, USA; University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA; Nova Southeastern University, 4850 Millenium Boulevard, Orlando, FL 32839, USA
| | - Michael Sacopulos
- Medical Risk Management, Medical Risk Institute, 676 Ohio Street, Terre Haute, IN 47807, USA
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Tang JC, Hanke CW, Caro I. Vismodegib and the Hedgehog Pathway Inhibitors: A Historical Perspective to Current Clinical Application. J Drugs Dermatol 2018; 17:506-508. [PMID: 29742180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Vismodegib (Erivedge, Genentech-Roche) is the first in class of Hedgehog pathway inhibitors approved for treatment of metastatic basal cell carcinoma (BCC), or locally advanced BCC that has recurred after surgery or is not amenable to surgery or radiation. Its path to discovery has been unique and traces its origin to corn lilies, sheep, Drosophila flies, and the Hedgehog signaling pathway. J Drugs Dermatol. 2018;17(5):506-508.
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Hanke CW, Mhatre SK, Oliveri D, Zivkovic M, Caro I, Bergström D, Dawson K, Sima CS. Vismodegib Use in Clinical Practice: Analysis of a United States Medical Claims Database. J Drugs Dermatol 2018; 17:143-148. [PMID: 29462221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Information is limited on the use of vismodegib for treatment of advanced basal cell carcinoma beyond the setting of clinical trials. OBJECTIVE To investigate the treatment patterns and characteristics of patients treated with vismodegib in clinical practice. METHODS A longitudinal, retrospective cohort study was undertaken using data from a US commercial insurance claims (Truven Health Analytics MarketScan) database. Eligible patients were ≥18 years of age, with ≥1 claim for vismodegib from January 2012 to December 2015. RESULTS A total of 321 patients were included in the analysis. Approximately 20% of the patients took 1 or more treatment breaks of ≥ 30 days each before treatment discontinuation. Median duration of vismodegib treatment before the first treatment break and discontinuation was 4.0 and 5.5 months, respectively. Older age ( > 65 years) and absence of Gorlin syndrome were associated with increased risk for treatment interruption or discontinuation. Overall, 47% and 36% of patients underwent surgery or radiotherapy within the 6 months before and after vismodegib initiation, respectively. CONCLUSIONS Real-world evidence indicates that vismodegib is being used in clinical practice as part of combination treatment strategies. J Drugs Dermatol. 2018;17(2):143-148.
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Habbema L, Tang JC, Sattler G, Hanke CW. Liposuction of the Neck: Low Incidence of Nerve Injury and Other Complications in 987 Patients. J Drugs Dermatol 2018; 17:30-34. [PMID: 29320585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
<p>The neck is one of the most common areas treated by liposuction. Neck liposuction decreases fat volume, causes skin contraction, and restores a more youthful appearance. We present a large case series (n=987) performed by three dermatologic surgeons. Five patients developed temporary post-operative marginal mandibular dysfunction, one patient had submandibular gland ptosis and one patient had arterial bleeding. Seroma, skin necrosis, scarring, and hyperpigmentation did not occur following neck liposuction. Neck liposuction performed with tumescent local anesthesia is a safe procedure associated with a low incidence of nerve injury and other complications.</p> <p><em>J Drugs Dermatol. 2018;17(1):30-34.</em></p>.
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Spring LK, Krakowski AC, Alam M, Bhatia A, Brauer J, Cohen J, Del Rosso JQ, Diaz L, Dover J, Eichenfield LF, Gurtner GC, Hanke CW, Jahnke MN, Kelly KM, Khetarpal S, Kinney MA, Levy ML, Leyden J, Longaker MT, Munavalli GS, Ozog DM, Prather H, Shumaker PR, Tanzi E, Torres A, Velez MW, Waldman AB, Yan AC, Zaenglein AL. Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations. JAMA Dermatol 2017; 153:802-809. [PMID: 28658462 DOI: 10.1001/jamadermatol.2017.2077] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Importance The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. Objective To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. Evidence Review A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. Findings Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. Conclusions and Relevance Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
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Affiliation(s)
- Leah K Spring
- Dermatology Department, Naval Hospital Camp Lejeune, Camp Lejeune, North Carolina
| | | | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Ashish Bhatia
- DuPage Medical Group, Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Jeremy Brauer
- Laser and Skin Surgery Center of New York, New York
- Department of Dermatology, New York University School of Medicine, New York
| | - Joel Cohen
- AboutSkin Dermatology, Lone Tree, Colorado
- DermSurgery, Lone Tree, Colorado
| | - James Q Del Rosso
- Dermatology Department, Touro University Nevada College of Health and Human Services, Henderson
| | - Lucia Diaz
- Dell Children's Medical Center, University of Texas Austin Dell Medical School, Austin
| | | | - Lawrence F Eichenfield
- Department of Dermatology, University of California-San Diego
- Rady Children's Hospital, San Diego, California
| | | | | | - Marla N Jahnke
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
- Division of Pediatric Dermatology, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | | | - Moise L Levy
- Dell Children's Medical Center, University of Texas Austin Dell Medical School, Austin
| | | | - Michael T Longaker
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
| | - Girish S Munavalli
- Department of Dermatology, School of Medicine, Wake Forest University, Charlotte, North Carolina
- Dermatology, Laser, and Vein Specialists of the Carolinas, PLLC, Charlotte, North Carolina
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Elizabeth Tanzi
- Dermatology Department, George Washington University School of Medicine, Washington, DC
| | - Abel Torres
- Loma Linda University Medical Center, Loma Linda, California
| | | | | | - Albert C Yan
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics and Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Jackson RF, Dolsky RL, Alexander RW, Crockett CH, Castillo GD, Hanke CW, Lack EB, Tobin HA. Current Practice Standards in Liposuction. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/074880689901600105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jackson RF, Dolsky RL, Alexander RW, Crockett CH, Castillo GD, Hanke CW, Lack EB, Tobin HA. Liposuction: A Practitioner Profile. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/074880689901600104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Dermatology has been one of the major disciplines that has contributed to the rapid advancement of cosmetic surgery. Various cosmetic procedures including chemical peel, dermabrasion, hair transplantation, laser surgery, soft-tissue augmentation, and liposuction have been refined or developed by dermatologists. This article describes the involvement by dermatologists in these cosmetic procedures.
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Affiliation(s)
- C. William Hanke
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - William P. Coleman
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lisa A. Francis
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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Affiliation(s)
- C. William Hanke
- Laser & Skin Surgery Center of Indiana, and Indiana University School of Medicine, Indianapolis, Indiana, USA
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Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW, Jellinek N, Maibach HI, Tanner JW, Vashi N, Gross KG, Adamson T, Begolka WS, Moyano JV. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol 2016; 74:1201-19. [PMID: 26951939 DOI: 10.1016/j.jaad.2016.01.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/19/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.
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Affiliation(s)
- David J Kouba
- Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
| | - Matteo C LoPiccolo
- Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio; Department of Dermatology, Henry Ford Health System, Detroit, Michigan; Dermatology Specialists of Shelby, Shelby, Michigan
| | - Murad Alam
- Department of Dermatology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Bernard Cohen
- Department of Dermatology-Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana PC, Carmel, Indiana
| | - Nathaniel Jellinek
- Department of Dermatology, Brown University, East Greenwich, Rhode Island
| | - Howard I Maibach
- Department of Dermatology, UCSF School of Medicine, San Francisco, California
| | - Jonathan W Tanner
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neelam Vashi
- Department of Dermatology and Center for Ethnic Skin, Boston University School of Medicine, Boston, Massachusetts
| | | | - Trudy Adamson
- Department of Nursing, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Wendy Smith Begolka
- Department of Science, Quality and Practice, American Academy of Dermatology, Schaumburg, Illinois
| | - Jose V Moyano
- Department of Science, Quality and Practice, American Academy of Dermatology, Schaumburg, Illinois.
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Gustafson CJ, Woodard M, Hanke CW. A Unique Case of Herpes Zoster Within One Week of Varicella Zoster Vaccination. J Drugs Dermatol 2016; 15:241-243. [PMID: 26885795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a unique case of herpes zoster that developed shortly after Varicella Zoster vaccination.
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Viscusi KS, Hanke CW. Vismodegib for Locally Advanced Basal Cell Carcinoma: Descriptive Analysis of a Case Series and Comparison to the Literature. J Drugs Dermatol 2015; 14:956-962. [PMID: 26355613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This case series explores the use of vismodegib to treat locally advanced basal cell carcinoma (laBCC), with a focus on tolerability, efficacy, and outcomes after treatment cessation. METHODS Data from patients who underwent vismodegib treatment for laBCC at a single institution from 3/6/2012 through 3/15/2015 was utilized in this study. For all included cases, treatment responses as recorded at the first follow-up after treatment cessation were assessed and are reported as complete clinical response (CCR), partial clinical response (PCR), stable disease, or progressive disease. In cases of CCR, clinical disease free survival (DFS) was calculated as the time from cessation of vismodegib until last available follow-up, death, or recurrence. Data pertaining to side effects and adverse events was also recorded, and results are presented using descriptive statistics. RESULTS A total of 24 patients and 31 tumors met inclusion criteria. CCR was observed in 17 of 31 tumors (55%), and 13 of 31 tumors (42%) demonstrated PCR. Stable disease was seen in one patient (one tumor) (3%). No cases demonstrated clinical tumor progression during treatment. The mean clinical DFS at time of data cut off for all cases of CCR was 9.3 months (range 2-21 months). In cases of PCR, the mean reduction in tumor size was 52% (range, 11%-80%). Only two patients (8%) discontinued treatment secondary to side effects. CONCLUSION Each patient and each tumor responds uniquely to vismodegib treatment, including variable tumor responses and a wide range of side effects and tolerability. This study highlights important unique observations, and our data as a whole adds to previously published studies, leading to thought provoking questions. Overall, the FDA approval of vismodegib for advanced basal cell carcinoma has markedly improved the prognosis and care of affected patients.
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Augustin M, Tu JH, Knudsen KM, Erntoft S, Larsson T, Hanke CW. Ingenol mebutate gel for actinic keratosis: the link between quality of life, treatment satisfaction, and clinical outcomes. J Am Acad Dermatol 2015; 72:816-21. [PMID: 25770879 DOI: 10.1016/j.jaad.2015.01.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Actinic keratosis therapy can elicit unsightly and painful local skin responses; assessment of treatment satisfaction and health-related quality of life (QoL) is important. Ingenol mebutate gel is a novel topical field therapy for actinic keratosis. OBJECTIVE Post-hoc analyses were performed based on patient-reported outcomes from phase-III trials (n = 1005) to assess the effects of ingenol mebutate on QoL and the relationship between both QoL and treatment satisfaction, and degree of lesion clearance. METHODS Patients received ingenol mebutate or vehicle for self-application to a 25-cm(2) contiguous area: 0.015% once daily for 3 consecutive days (face/scalp) or 0.05% once daily for 2 consecutive days (trunk/extremities). QoL (Skindex-16) and Treatment Satisfaction Questionnaire for Medication data were recorded. RESULTS Significant, positive associations between Treatment Satisfaction Questionnaire for Medication score and degree of clearance were identified for patients in the face/scalp (effectiveness P < .0001 and global satisfaction P = .0002) and trunk/extremities (P < .0001 and P = .0014, respectively) groups. There was a significant association between Skindex-16 score and clearance for patients in the face/scalp group for change in symptoms (P = .0218), emotions (P = .0002), and overall Skindex-16 score (P = .0006) from baseline. LIMITATIONS Clinical trial population findings may not be generalizable to clinical practice. CONCLUSION Ingenol mebutate significantly improved patients' QoL and treatment satisfaction. Improvements were associated with higher degrees of actinic keratosis lesion clearance.
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Affiliation(s)
- Matthias Augustin
- German Center for Health Services Research in Dermatology, University Medical Center, Hamburg, Germany.
| | - John H Tu
- Dermatology Associates of Rochester, Rochester, New York; Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | | | - C William Hanke
- Indiana University School of Medicine, Indianapolis, Indiana
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Goldsberry A, Hanke CW, Countryman NB. A comparison of super wide field microscopy systems in mohs surgery. J Drugs Dermatol 2014; 13:1463-1465. [PMID: 25607789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microscopic frozen section interpretation is one of the cornerstones of Mohs surgery. The recent development of super wide field (SWF) microscopy can improve accuracy and efficiency while reading microscope sections, and also decrease the physician's musculoskeletal and ocular strain. Super wide field microscopy systems increase viewable field area (VA) by combining low magnification objectives, eg, 1x or 2x (Figure 1), with eyepieces that have a higher field number. This article reviews 3 SWF microscopy systems: Leica DM2000 (Leica Microsystems, Wetzlar, Germany), Nikon Eclipse Ni (Nikon Instruments Inc., Melville, NY), and Olympus BX43 (Olympus, Center Valley, PA). The Leica DM2000's 1.25x objective results in a VA of 314.16 mm2. The Nikon Eclipse Ni's 1x objective results in a VA of 490.87 mm2. The Olympus BX43's 1.25x objective results in a VA of 352.99 mm2. The maximum VA at the lowest objective for Nikon is nearly 40% greater than for the Olympus and over 50% greater than for the Leica. The Nikon Eclipse Ni has a significantly higher maximum VA than the other 2 systems.
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Goldsberry A, Hanke CW, Hanke KE. VISIA system: a possible tool in the cosmetic practice. J Drugs Dermatol 2014; 13:1312-1314. [PMID: 25607694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Dyspigmentation is a common complaint in the dermatology office. OBJECTIVE We also sought to evaluate whether the VISIA Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ) could be a tool to help patients better understand their skin complaints. METHODS Twenty-one consecutive women were recruited for VISIA analysis. Each subject underwent VISIA analysis and completed a follow up survey. RESULTS 86% of respondents reported that the VISIA analysis helped them understand their initial concern. 86% noted that the VISIA brought other skin problems to their attention. 100% of the subjects responded that they would recommend VISIA analysis to others. 62% of subjects responded that they would prefer to go to a practice with a VISIA system in comparison to a practice without VISIA. CONCLUSION The VISIA Complexion Analysis System is a beneficial tool for dermatology and aesthetic practices with the potential to aid in patient education.
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Hanke CW. Response to 'Current status of surgery in dermatology'. J Am Acad Dermatol 2014; 71:391. [PMID: 25037789 DOI: 10.1016/j.jaad.2014.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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Berman B, Goldenberg G, Hanke CW, Tyring SK, Werschler WP, Knudsen KM, Larsson T, Swanson N. Efficacy and safety of ingenol mebutate 0.015% gel after cryosurgery of actinic keratosis: 12-month results. J Drugs Dermatol 2014; 13:741-747. [PMID: 24918567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Recurrence rates of actinic keratosis (AK) lesions after cryosurgery are high, and this treatment does not address field cancerization. We investigated the efficacy and safety of field treatment of AKs with ingenol mebutate gel following cryosurgery. METHODS In this phase 3, randomized, double-blind, vehicle-controlled study (NCT01541553), patients ≥18 years with four to eight clinically typical, visible, discrete AKs within a contiguous 25-cm2 treatment area on the face or scalp underwent cryosurgery followed 3 weeks later by once-daily ingenol mebutate 0.015% or vehicle gel for 3 consecutive days. Endpoints included complete clearance at week 11 and safety and efficacy over 12 months. RESULTS In 329 randomized patients, complete clearance rates were greater with ingenol mebutate than vehicle (week 11: 60.5% vs 49.4%; P=.04; month 12: 30.5% vs 18.5%; P=.01). Fewer patients experienced the emergence of new lesions with ingenol mebutate than with vehicle (38.9% vs 51.9%; P =.02). At month 12, mean percentage reduction of AKs was higher with ingenol mebutate than with vehicle (68.2% vs 54.1%; P =.002). The probability of remaining free of lesions was sustained longer with ingenol mebutate compared with vehicle gel: 78% vs 68% at 6 months; 64% vs 57% at 9 months; 55% vs 40% at month 12, respectively. Ingenol mebutate 0.015% gel was well tolerated and no unexpected adverse events occurred; all adverse events resolved within 2 weeks of starting treatment. CONCLUSIONS Field treatment with ingenol mebutate 0.015% gel following cryosurgery significantly enhanced clearance of baseline lesions, and was well tolerated. Furthermore, ingenol mebutate 0.015% gel following cryosurgery reduced development of new lesions in the treated field.
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Alam M, Lee A, Ibrahimi OA, Kim N, Bordeaux J, Chen K, Dinehart S, Goldberg DJ, Hanke CW, Hruza GJ, Nehal KS, Olbricht SM, Orringer J, Rohrer TE, Scheinfeld NS, Schmults CD, Strasswimmer JM, Taylor JS, Yoo S, Nodzenski M, Poon E, Cartee T. A Multistep Approach to Improving Biopsy Site Identification in Dermatology. JAMA Dermatol 2014; 150:550-8. [DOI: 10.1001/jamadermatol.2013.9804] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, No
| | - Andy Lee
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Natalie Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeremy Bordeaux
- Department of Dermatology, Case Western Reserve School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Karen Chen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - C. William Hanke
- Department of Dermatology, Indiana University School of Medicine, Indianapolis
| | - George J. Hruza
- Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri
| | - Kishwer S. Nehal
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Suzanne M. Olbricht
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jeffrey Orringer
- Department of Dermatology, University of Michigan Medical School, University of Michigan, Ann Arbor
| | - Thomas E. Rohrer
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island
| | - Noah S. Scheinfeld
- Department of Dermatology, Columbia University Medical Center, Columbia University, New York, New York
| | - Chrysalyne D. Schmults
- Mohs Micrographic Surgery Unit, Brigham & Women’s Faulkner Hospital, Boston, Massachusetts
| | | | - James S. Taylor
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Nodzenski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd Cartee
- Department of Dermatology, Penn State Hershey Medical Center, Penn State University, Hershey
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Vleggaar D, Fitzgerald R, Lorenc ZP, Andrews JT, Butterwick K, Comstock J, Hanke CW, O'Daniel TG, Palm MD, Roberts WE, Sadick N, Teller CF. Consensus recommendations on the use of injectable poly-L-lactic acid for facial and nonfacial volumization. J Drugs Dermatol 2014; 13:s44-s51. [PMID: 24719078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Poly-L-lactic acid (PLLA) was approved for use in Europe in 1999. In the United States, it was approved by the Food and Drug Administration in 2004 for the treatment of facial lipoatrophy associated with human immunodeficiency virus, and in 2009 for cosmetic indications in immune-competent patients. The need for consistent, effective PLLA usage recommendations is heightened by an increased consumer demand for soft tissue augmentation and a shift toward a younger demographic. Over the past 14 years, considerable experience has been gained with this agent, and we have come to better understand the clinical, technical, and mechanistic aspects of PLLA use that need to be considered to optimize patient outcomes. These consensus recommendations regarding patient selection, proper preparation and storage, optimal injection techniques, and other practical considerations reflect the body of evidence in the medical literature, as well as the collective experience of this author group.
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Goldsberry A, Dinner A, Hanke CW. Thanaka: traditional Burmese sun protection. J Drugs Dermatol 2014; 13:306-307. [PMID: 24595576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Limonia acidissima or Hesperethusa crenulata is a common tree in Southeast Asia. It is indigenous to the Republic of Myanmar (formerly Burma) as well as India, Sri Lanka, Java, and Pakistan. In English, the common names for Limonia acidissima are sandalwood, wood-apple, elephant-apple, monkey fruit, and curd fruit tree. The plant has a number of different names in different languages including bal or bael in Assamese, bael in Bengali, kaitha in Hindi, belingai in Malaysia, and thanaka in Burmese. Unique to the Burmese people, thanaka has been used as a cosmetic product for over 2000 years. Mention of thanaka has been traced back to ancient Burmese lyrics, and relics of equipment used by ancient royalty to grind thanaka can be found in museums.
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Alam M, Ibrahim O, Nodzenski M, Strasswimmer JM, Jiang SIB, Cohen JL, Albano BJ, Batra P, Behshad R, Benedetto AV, Chan CS, Chilukuri S, Crocker C, Crystal HW, Dhir A, Faulconer VA, Goldberg LH, Goodman C, Greenbaum SS, Hale EK, Hanke CW, Hruza GJ, Jacobson L, Jones J, Kimyai-Asadi A, Kouba D, Lahti J, Macias K, Miller SJ, Monk E, Nguyen TH, Oganesyan G, Pennie M, Pontius K, Posten W, Reichel JL, Rohrer TE, Rooney JA, Tran HT, Poon E, Bolotin D, Dubina M, Pace N, Kim N, Disphanurat W, Kathawalla U, Kakar R, West DP, Veledar E, Yoo S. Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers. JAMA Dermatol 2014; 149:1378-85. [PMID: 24080866 DOI: 10.1001/jamadermatol.2013.6255] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Omer Ibrahim
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael Nodzenski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Shang I Brian Jiang
- Division of Dermatology, Department of Medicine, University of California, San Diego
| | - Joel L Cohen
- AboutSkin Dermatology and Dermsurgery, Englewood, Colorado
| | - Brian J Albano
- Dermatology Associates, PA, of the Palm Beaches, Delray Beach, Florida
| | - Priya Batra
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts
| | - Ramona Behshad
- Laser and Dermatologic Surgery Center, Chesterfield, Missouri
| | - Anthony V Benedetto
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania12Dermatologic SurgiCenter, Philadelphia, Pennsylvania
| | - C Stanley Chan
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts
| | - Suneel Chilukuri
- Bellaire Dermatology Associates, Houston, Texas14Department of Dermatology, Baylor University College of Medicine, Houston, Texas15Memorial Hermann Family Practice Residency Program, Columbia University College of Surgeons and Physicians, Manhattan, New York
| | | | | | - Anir Dhir
- Dermatology Associates of Kentucky, PSC, Lexington
| | | | | | | | - Steven S Greenbaum
- Skin and Laser Surgery Center of Pennsylvania, Philadelphia21Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania22Department of Dermatology, Division of Dermatologic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth K Hale
- New York University School of Medicine, New York, New York24Laser and Skin Surgery Center of New York, New York, New York
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Carmel26Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - George J Hruza
- Laser and Dermatologic Surgery Center, Chesterfield, Missouri27Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri
| | - Laurie Jacobson
- Pacific Dermatology and Cosmetic Center, Seattle, Washington
| | - Jason Jones
- AboutSkin Dermatology and Dermsurgery, Englewood, Colorado
| | | | - David Kouba
- The Toledo Clinic Dermasurgery and Laser Center, Toledo, Ohio
| | - James Lahti
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois30DPNS Surgical Center, Northbrook, Illinois
| | | | | | - Edward Monk
- Wesmed Medical Group, New Rochelle, New York
| | - Tri H Nguyen
- Northwest Diagnostic Clinic, Houston, Texas32Department of Dermatology, MD Anderson Cancer Center, The University of Texas, Houston
| | - Gagik Oganesyan
- Division of Dermatology, Department of Medicine, University of California, San Diego
| | - Michelle Pennie
- Department of Dermatology, University of Florida College of Medicine, Gainesville34Pennie Dermatology & Skin Surgery Center, Englewood, Florida
| | | | | | | | - Thomas E Rohrer
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts36Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island
| | | | - Hien T Tran
- Seaside Dermatology and Skin Cancer Center, Irvine, California
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Diana Bolotin
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Meghan Dubina
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Natalie Pace
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Natalie Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wareeporn Disphanurat
- Dermatology Unit, Department of Medicine, Thammasat University, Patumthani, Thailand
| | - Ummul Kathawalla
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rohit Kakar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Emir Veledar
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Berman B, Goldenberg G, Hanke CW, Tyring SK, Werschler WP, Knudsen KM, Goncalves J, Larsson T, Skov T, Swanson N. Efficacy and safety of ingenol mebutate 0.015% gel 3 weeks after cryosurgery of actinic keratosis: 11-week results. J Drugs Dermatol 2014; 13:154-160. [PMID: 24509965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Cryosurgery is the most common treatment for actinic keratosis (AK) in the United States. Efficacy with cryosurgery is variable, and is a modality for treating individual, visible lesions while failing to treat subclinical lesions. METHODS FIELD Study 1 (NCT01541553) is a phase 3, multicenter, randomized, double-blind study that evaluated the short- (11-week) and long- (12-month) term efficacy and safety of sequential AK treatment using cryosurgery with liquid nitrogen followed by ingenol mebutate gel, versus cryosurgery followed by vehicle. RESULTS Overall, 329 patients were randomized to ingenol mebutate 0.015% gel (n=167) or vehicle (n=162) 3 weeks after cryosurgery. Baseline characteristics were balanced across groups. At week 11, complete clearance rate (100%) in the treatment area was higher for ingenol mebutate gel compared with vehicle (60.5% vs 49.4%, respectively; P=.04). Mean percentage reduction in number of AKs versus baseline was also numerically higher for ingenol mebutate gel (82.7% vs 75.6%). A general reduction from baseline lesion count was observed 3 weeks after cryosurgery. Treatment after cryosurgery was well tolerated. CONCLUSIONS Short-term (11-week) AK clearance rates on the face or scalp with ingenol mebutate gel after cryosurgery were higher than with cryosurgery alone.
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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Krueger N, Luebberding S, Sattler G, Hanke CW, Alexiades-Armenakas M, Sadick N. The history of aesthetic medicine and surgery. J Drugs Dermatol 2013; 12:737-742. [PMID: 23884484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The history of beauty is as old as mankind itself--throughout history people have tried to improve their attractiveness and to enhance their beauty. The technical basis for many of nowadays procedures like lipoplasty, breast augmentation or rhinoplasty was thereby initiated more than a hundred years ago and evolved to the modern standards of today. The aim of this article is to recall the early days of aesthetic medicine and show the swift progress up to the highly specialized medical discipline of our modern time. Combining the past, present and future of aesthetic medicine, allows to incorporate this perspective and ultimately to delivery better patient care.
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Affiliation(s)
- Nils Krueger
- Division of Cosmetic Science, University of Hamburg, Germany.
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Countryman NB, Levy RM, Hanke CW. An update on super wide field microscopy in dermatologic surgery. J Drugs Dermatol 2013; 12:668-671. [PMID: 23839184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Microscopic interpretation represents the central tenet for diagnosis and eradication of cutaneous tumors. Standard microscopes are limited by relatively high-powered objectives and smaller viewable diameter. Newer equipment offers optional lower powered objectives including 1X and 2X objectives and can be combined with super widefield eyepieces to greatly enhance the viewable area during pathologic interpretation of slides. Mohs micrographic surgery represents one of the most useful areas in which the dermatologic surgeon gleans multiple efficiencies from these microscope systems. One such system that was recently trialed, the Nikon 80i microscope, proved to be incredibly easy to use and multiple efficiencies were quickly realized.
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