Hyaluronic Acid Filler Incidentally Found During Mohs Micrographic Surgery: Observations in 36 Patients Regarding Skin Depth, Degradation Size, and Estimated Persistence Time

BACKGROUND

Although its clinical effect is reported to last up to 2 years, how long hyaluronic acid filler (HAF) histologically persists in the skin is unknown.

OBJECTIVE

To determine the approximate persistence time of HAF in the skin and to correlate persistence time with HAF histological appearance, size, depth, and location.

METHODS

Retrospective review of patient data and available frozen sections from 2003 to 2021 in which HAF was identified in 36 Mohs micrographic surgery patients.

RESULTS

Incidental HAF histologically persisted in the skin for as long as 10.75 years in 1 patient and 3 years or more in 36.8% (7/19) of the patients who remembered the time of implantation. HAF is more apparent in frozen sections stained with toluidine blue than those stained with hematoxylin and eosin. Although HAF volume tended to be less with time, fragmentation was present both early at 3 months and at 3 years or more. There was no correlation of persistence time with anatomic location or depth. In 90.3% of the cases (28/31), HAF was located in the subcutaneous fat. There was no granulomatous or giant cell response at any time period.

CONCLUSION

Hyaluronic acid filler may be seen histopathologically in the skin, usually in the subcutaneous fat, up to 10.75 years after implantation.

S-1 plus irinotecan and oxaliplatin for the first-line treatment of patients with metastatic colorectal cancer: a prospective phase II study and pharmacogenetic analysis

BACKGROUND

S-1 is an oral fluoropyrimidine that mimics infusional 5-fluorouracil. The aim of this phase II trial was to explore the clinical efficacy of the triplet regimen TIROX, which consists of S-1, irinotecan and oxaliplatin.

METHODS

Forty-two chemo-naive patients with metastatic colorectal cancer (mCRC) were planned to be enrolled and be treated with irinotecan 150 mg m(-2) followed by oxaliplatin 85 mg m(-2) on day 1 and S-1 80 mg m(-2) per day from day 1 to 14 every 3 weeks. Polymorphisms in the UGT1A1, UGT1A6, UGT1A7 and CYP2A6 genes were analysed.

RESULTS

Between July 2007 and February 2008, 43 patients were enrolled. An objective response was noted in 29 patients (67.4%, 95% confidence interval: 53.4-81.4), of which 2 achieved durable complete responses. The median progression-free survival was 10.0 months and the median overall survival was 19.2 months. Significant grade 3 or 4 adverse events were neutropenia (45.2%), febrile neutropenia (9.5%), diarrhoea (7.1%) and vomiting (9.5%). Increased gastrointestinal toxicities were associated with the presence of UGT1A6*2 or UGT1A7*3 and an improved tumour response was noted in those without variant alleles of CYP2A6 or UGT1A1*60.

CONCLUSION

The combination of S-1, irinotecan and oxaliplatin showed favourable efficacy and tolerability in untreated patients with mCRC.

Use of eye shields and eye lubricants among oculoplastic and Mohs surgeons: a survey

BACKGROUND

Eye shields and lubricants are recommended for use in the eye during periorbital surgery to prevent injury to the globe. Nonetheless, data regarding their use is sparse, and no study to date has examined the prevalence of their usage and complications.

PURPOSE

To investigate how commonly eye shields and lubricants are used during periorbital surgery and whether there are complications from their use.

METHODS

The authors conducted a survey of oculoplastic and Mohs surgery fellowship directors. The questionnaire investigated the prevalence of use of eye shields and lubricants, complications encountered, and whether the standard of care requires or prohibits their use.

RESULTS

A majority of those surveyed at least sometimes use eye shields in periorbital surgery, particularly to prevent patient injury. Most surgeons believe there are more pros than cons to their use. However, corneal abrasions may be encountered and may be related to the type of lubricant chosen. Surgeons using fat-based lubricants tended to encounter more complications with eye shield use.

CONCLUSION

Eye shield and lubricant use is common among oculoplastic and Mohs surgeons. However, most disagree as to whether the standard of care requires or forbids their use.

The role of oxygen in wound healing: a review of the literature

BACKGROUND

The presence of oxygen is necessary for normal wound healing. Oxygen has been given as a therapeutic modality to assist and speed wound healing.

OBJECTIVE

The objective was to summarize the role of oxygen in wound healing.

MATERIALS AND METHODS

A literature review of clinical and basic science studies regarding oxygen and wound healing was conducted.

RESULTS

Hypoxia appears to jump start wound healing via hypoxia-inducible factor 1alpha and reepithelialization. Nonetheless, oxygen is often required to start or sustain other wound healing processes.

CONCLUSION

Both the absence and the presence of oxygen have effects on wound healing; however, its role is not completely understood. Although hyperbaric oxygen and topical oxygen therapy have been described in aiding wound healing, case-controlled prospective studies are lacking and evidence for their efficacy is inconsistent. The authors have indicated no significant interest with commercial supporters.

Metastatic cutaneous squamous cell carcinoma: an update

BACKGROUND

Squamous cell carcinoma (SCC) is the second most common type of skin cancer in the United States. Cutaneous SCC has the potential to metastasize and cause morbidity and mortality.

OBJECTIVE

Our purpose was to review and summarize the literature on metastatic cutaneous SCC, including risk factors for metastasis, data from clinical studies, and current management.

RESULTS

Multiple studies confirm that even well-differentiated and small tumors (<2 cm) may metastasize. Over the past two decades, additional literature on the risk factors for metastatic cutaneous SCC, including immunosuppression, has been published. In addition, new staging systems have been proposed that may influence management of these tumors. Chemotherapy regimens are numerous, but remain limited in ability to improve overall survival.

CONCLUSION

Although we know more about the risk factors, survival for patients with metastatic cutaneous SCC depends on extent of nodal involvement. Therefore, emphasis should remain on prevention and aggressive treatment of cutaneous SCC and vigilant observation for signs and symptoms of metastasis.

Role of Sun Exposure in Melanoma

BACKGROUND

Malignant melanoma is the third most common skin cancer in the United States. It is commonly thought that sun exposure is causative in these tumors. Recently, however, the significance of the role of sun exposure in melanoma has come into question. Some have suggested that other factors, such as genetics, play a larger role, and that sun protection may even be harmful.

OBJECTIVE AND METHODS

To investigate the role of sun exposure in melanoma etiology. An extensive review of basic science and clinical literature on this subject was conducted.

RESULTS

Although exceptions exist, sun exposure likely plays a large role in most melanomas. The pattern of this exposure, however, is not fully known, and controversy exists, especially in the use of sunscreens. Sun exposure may interact with genetic factors to cause melanomas, and sun protective measures appear to be prudent.

CONCLUSIONS

The cause of melanoma is probably variable and multifactorial. Sun exposure may play a primary or supporting role in most melanoma tumors.

Microdermabrasion: a clinical and histopathologic study

BACKGROUND

Microdermabrasion is a widely performed skin rejuvenation procedure. Few studies have examined its efficacy.

OBJECTIVE

To evaluate the clinical and histopathologic effects of microdermabrasion.

METHODS

Fourteen patients underwent microdermabrasion treatments over 12-14 weeks. Self-rated questionnaires were given before and after the treatment series and were evaluated by a paired t-test. Three of the 14 patients were treated for moderate to severe acne scarring. Acute histologic effects were assessed ex vivo on human abdominal skin. Chronic histopathologic effects were examined in three volunteers who underwent skin biopsies before and after a treatment series on the dorsal forearms.

RESULTS

By patient assessment, there was statistically significant improvement in roughness, mottled pigmentation, and overall improvement of skin appearance, but not in rhytides. Acne scarring sometimes improved, but required deeper ablation. Acutely the stratum corneum was homogenized and focally compacted. Chronically there was epidermal hyperplasia, decreased melanization, and some increase in elastin.

CONCLUSION

Microdermabrasion improves some aspects of photoaging and select cases of acne scarring.

A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis

OBJECTIVE

To evaluate whether once-daily gentamicin dosing is as effective as the traditional 8-hour regimen for the treatment of postpartum endometritis.

METHODS

Postpartum women with endometritis were randomized to receive gentamicin 5 mg/kg as a single daily dose or 1.75 mg/kg every 8 hours. All subjects also received clindamycin. Each participant had a peak serum gentamicin level of at least 5.0 micrograms/mL within the first 24 hours. The dosing regimens were compared by analyzing the number of hours that patients were febrile, the length of hospital stay, occurrence of complications, pharmacy costs, and nursing time required to administer the regimens.

RESULTS

The study group (n = 62) and the control group (n = 65) were similar in demographic characteristics and the presence of endometritis risk factors. No differences were found between the groups in the number of patients who completed therapy without complications, required changes in antibiotics, or required readmission for endometritis. The groups did not differ in the number of hours that patients remained febrile after the start of therapy or in the length of hospital stay. No patient in the study group had an initial peak serum concentration less than 5.0 micrograms/mL, whereas 24 patients in the control group had initial peak serum concentrations less than 5.0 micrograms/mL and required dose adjustment, a statistically significant difference (P < .001). Pharmacy costs averaged $16.12 +/- 5.68 for the study group and $41.75 +/- 17.41 for the control group, also a significant difference (P < .001). Nurse tasking time averaged 13.62 +/- 2.56 minutes for the study group and 28.06 +/- 8.77 minutes for the control group (P < .001).

CONCLUSION

In patients with postpartum endometritis, once-daily gentamicin dosing provides consistently high peak serum levels of gentamicin, requires less nurse tasking time, costs less, and is as effective as the 8-hour dosing regimen.