Publications by authors named "Daniel B Eisen"

105 Publications

Response to "Comment on 'Guidelines of care for the management of actinic keratosis'".

J Am Acad Dermatol 2022 Jun 17. Epub 2022 Jun 17.

American Academy of Dermatology, Rosemont, Illinois. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2022.06.023DOI Listing
June 2022

Interrupted subcuticular suture spacing during linear wound closures and the effect on wound cosmesis: a randomized evaluator-blinded split-wound comparative effectiveness trial.

Br J Dermatol 2022 Apr 27. Epub 2022 Apr 27.

Department of Dermatology, UC Davis, Davis, CA, USA.

Background: Surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial cuticular layer. Some surgeons feel the need to place many deep sutures in order to reduce tension on cuticular sutures, as they believe this may decrease incidence of track marks and dehiscence, and lead to better cosmetic outcomes. However, others feel that a higher number of subcuticular sutures increases the risk of a suture reaction, which leads to patient anxiety and poorer wound cosmesis. To our knowledge, there are no studies published on the effect of subcuticular suture spacing on wound cosmesis.

Objectives: To determine whether suturing with 1-cm interval subcuticular sutures results in better cosmetic outcomes than suturing with 2-cm interval subcuticular sutures.

Methods: Fifty patients were enrolled in a randomized clinical trial using a split-wound model, where half of the wound was repaired with sutures spaced 2 cm apart and the other half was repaired with sutures spaced 1 cm apart (ClinicalTrials.gov identifier NCT03327922). Both the evaluators and patients were blinded as to which side received which treatment. The scar was evaluated 3 months post-surgery by two blinded observers and the patients themselves using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment instrument.

Results: The total mean POSAS score for observers for the sides that received 1-cm interval subcuticular sutures and the sides that received 2-cm interval subcuticular sutures did not differ significantly at 3 months (P = 0·34). There was also no significant difference in the patient assessment scale score between the two sides at 3 months (P = 0·084).

Conclusions: We found that 1-cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2-cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval. What is already known about this topic? Surgeons have differing opinions on the ideal frequency of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions. The effect of subcuticular suture spacing on wound cosmesis has not been previously explored in the literature. What does this study add? There was no significant difference in cosmetic outcome between 1-cm suture spacing and 2-cm suture spacing when evaluated by blinded observers and patients. Dermatology surgeons can use 2-cm suture spacing for increased efficiency, without significantly different cosmetic outcomes, detected by blinded observers and patients.
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http://dx.doi.org/10.1111/bjd.21625DOI Listing
April 2022

Focused update: Guidelines of care for the management of actinic keratosis.

J Am Acad Dermatol 2022 08 18;87(2):373-374.e5. Epub 2022 Apr 18.

Department of Dermatology, University of California, Davis, Sacramento, California.

Background: Actinic keratoses (AKs) are rough scaly patches that arise on chronically UV-exposed skin and can progress to keratinocyte carcinoma.

Objective: In 2021, the American Academy of Dermatology published guidelines to assist in clinical decision-making for the management of AK. The purpose of this focused guideline update is to incorporate recently available evidence on the use of topical tirbanibulin to treat AK.

Methods: A multidisciplinary work group conducted a systematic review to evaluate data on the use of tirbanibulin for AK and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading a clinical recommendation. The graded recommendation was voted on to achieve consensus.

Results: Two trials were identified, and analysis of the evidence resulted in 1 recommendation.

Limitations: This analysis is based on the best available evidence at the time it was conducted. Long-term efficacy and safety data are not currently available.

Conclusions: A strong recommendation for the use of topical tirbanibulin to join the currently recommended list of topical therapies for AK was made on the basis of the available evidence.
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http://dx.doi.org/10.1016/j.jaad.2022.04.013DOI Listing
August 2022

Merkel cell carcinoma treatment with Mohs micrographic surgery versus wide local excision: A retrospective cohort survival analysis.

J Am Acad Dermatol 2022 Jan 29. Epub 2022 Jan 29.

Department of Dermatology, University of California, Davis, Sacramento, California. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2022.01.025DOI Listing
January 2022

Evidence-Based Clinical Practice Guidelines for Extramammary Paget Disease.

JAMA Oncol 2022 04;8(4):618-628

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: Extramammary Paget disease (EMPD) is a frequently recurring malignant neoplasm with metastatic potential that presents in older adults on the genital, perianal, and axillary skin. Extramammary Paget disease can precede or occur along with internal malignant neoplasms.

Objective: To develop recommendations for the care of adults with EMPD.

Evidence Review: A systematic review of the literature on EMPD from January 1990 to September 18, 2019, was conducted using MEDLINE, Embase, Web of Science Core Collection, and Cochrane Libraries. Analysis included 483 studies. A multidisciplinary expert panel evaluation of the findings led to the development of clinical care recommendations for EMPD.

Findings: The key findings were as follows: (1) Multiple skin biopsies, including those of any nodular areas, are critical for diagnosis. (2) Malignant neoplasm screening appropriate for age and anatomical site should be performed at baseline to distinguish between primary and secondary EMPD. (3) Routine use of sentinel lymph node biopsy or lymph node dissection is not recommended. (4) For intraepidermal EMPD, surgical and nonsurgical treatments may be used depending on patient and tumor characteristics, although cure rates may be superior with surgical approaches. For invasive EMPD, surgical resection with curative intent is preferred. (5) Patients with unresectable intraepidermal EMPD or patients who are medically unable to undergo surgery may receive nonsurgical treatments, including radiotherapy, imiquimod, photodynamic therapy, carbon dioxide laser therapy, or other modalities. (6) Distant metastatic disease may be treated with chemotherapy or individualized targeted approaches. (7) Close follow-up to monitor for recurrence is recommended for at least the first 5 years.

Conclusions And Relevance: Clinical practice guidelines for EMPD provide guidance regarding recommended diagnostic approaches, differentiation between invasive and noninvasive disease, and use of surgical vs nonsurgical treatments. Prospective registries may further improve our understanding of the natural history of the disease in primary vs secondary EMPD, clarify features of high-risk tumors, and identify superior management approaches.
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http://dx.doi.org/10.1001/jamaoncol.2021.7148DOI Listing
April 2022

Aesthetic outcome of simple cuticular suture distance from the wound edge on the closure of linear wounds on the head and neck: A randomized evaluator blinded split-wound comparative effect trial.

J Am Acad Dermatol 2022 04 29;86(4):863-867. Epub 2021 Oct 29.

Keck School of Medicine at University of Southern California, Los Angeles, Department of Dermatology, Los Angeles, California.

Background: Little data support the optimal distance of cuticular suture placement from the wound edge to achieve the most cosmetically appealing scar.

Objective: To compare Patient and Observer Scar Assessment Scale (POSAS) scores for cutaneous sutures spaced 2 mm versus 5 mm from the wound edge in head and neck defects repaired via linear closure.

Methods: Fifty patients were enrolled in this randomized, evaluator blinded, split-scar study. Surgical wounds were repaired with cuticular sutures 2 mm from the wound edge on one side and 5 mm on the other. POSAS scores and scar width were compared 3 months postoperatively.

Results: The sum observer POSAS score for this study had a mean (SD) of 16.06 (6.49) on the 2-mm side and 15.82 (6.83) on the 5-mm side (P = .807). Similarly, no difference was seen between scar width with a mean (SD) of 0.100 cm (0.058 cm) on the 2-mm side and with mean (SD) 0.100 cm (0.076 cm) on the 5-mm side (P = .967).

Limitations: Linear repairs were studied on head and neck defects after extirpation of cutaneous malignancies, resulting in a homogeneous elderly white patient population.

Conclusion: Cuticular sutures placed 2 or 5 mm from the wound edge did not result in different cosmetic outcomes in linear closures on the head and neck.
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http://dx.doi.org/10.1016/j.jaad.2021.10.036DOI Listing
April 2022

Buried dermal set-back suture placement: Considerations for optimizing long-term outcomes.

J Am Acad Dermatol 2022 02 24;86(2):e85. Epub 2021 Sep 24.

Private practice, Media, Pennsylvania.

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http://dx.doi.org/10.1016/j.jaad.2021.09.034DOI Listing
February 2022

Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative effectiveness trial.

Arch Dermatol Res 2022 Sep 21;314(7):697-703. Epub 2021 Sep 21.

Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA.

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .
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http://dx.doi.org/10.1007/s00403-021-02280-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307554PMC
September 2022

Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Nasal Ala: A Systematic Review.

Dermatol Surg 2021 09;47(9):1205-1213

Department of Dermatology, University of California Davis, Sacramento, California.

Background: Despite numerous options for nasal ala reconstruction, advantages and disadvantages of each method are unclear.

Objective: To summarize reported outcomes of local flaps without the use of grafts for nasal ala oncologic reconstructive surgery.

Methods: A nasal ala-specific protocol was adapted from a previous head- and neck-specific PROSPERO submission (CRD42017071596). The search was conducted in MEDLINE, EMBASE, and CENTRAL on December 23, 2017 and updated on May 10, 2019. Two reviewers screened 9,313 results from head and neck literature. Study bias was evaluated with the ROBINS-I tool.

Results: Subunit-based categorization of included studies identified 12 nasal ala-specific publications. Complications (flap necrosis, hematoma, wound infections, trapdoor deformities, and dehiscence), functional (nasal valve or respiratory dysfunction), and cosmetic (alar rim distortion/asymmetry/notching, secondary/revisionary procedures, and patient satisfaction) outcomes were extracted.

Conclusion: Generally favorable outcomes are seen in all flaps. Careful consideration of donor sites for interpolation flaps is needed for optimal cosmetic outcomes. Transposition flaps, including laterally based bilobed and trilobed flaps, created good outcomes, although melolabial transposition flaps may produce poorer outcomes compared with melolabial island pedicle advancement flaps. Caution is needed for rotation flaps to prevent nasal valve/respiratory dysfunction due to alar crease contracture or ridge elevation. Further research is needed.
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http://dx.doi.org/10.1097/DSS.0000000000003100DOI Listing
September 2021

The effect of rate and temperature on patient-reported pain during local anesthesia injection: A single-blinded, randomized, controlled trial.

J Am Acad Dermatol 2022 07 31;87(1):211-214. Epub 2021 Jul 31.

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.07.041DOI Listing
July 2022

Guidelines of care for the management of actinic keratosis: Executive summary.

J Am Acad Dermatol 2021 10 7;85(4):945-955. Epub 2021 Jun 7.

Dermatology & Laser Center of Charleston, Clinical Research Center of the Carolinas, Charleston, South Carolina.

Background: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. Treatment options for AK include topical medications, photodynamic therapy, cryosurgery, and laser ablation.

Objective: This executive summary provides a synopsis of the 18 evidence-based recommendations for the treatment of AK detailed in the Guidelines of Care for the Management of Actinic Keratosis.

Methods: A multidisciplinary workgroup conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations Assessment, Development and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.

Results: Analysis of the evidence resulted in 18 recommendations, suggesting there are several effective treatments available for AK.

Limitations: The analysis informing the recommendations was based on the best available evidence at the time it was conducted. The results of future studies may necessitate a revision of current recommendations.

Conclusions: Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are presented for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
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http://dx.doi.org/10.1016/j.jaad.2021.05.056DOI Listing
October 2021

Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment.

Dermatol Surg 2021 09;47(9):1214-1219

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood.

Objective: To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions.

Materials And Methods: Multi-center, prospective discrete choice experiment (DCE).

Results: Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics.

Conclusion: Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.
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http://dx.doi.org/10.1097/DSS.0000000000003113DOI Listing
September 2021

Anogenital warts and relationship to child sexual abuse: Systematic review and meta-analysis.

Pediatr Dermatol 2021 Jul 1;38(4):842-850. Epub 2021 Jun 1.

Department of Dermatology, University of California Davis, Sacramento, CA, USA.

Background/objectives: In children, distinguishing anogenital warts (AGW) acquired innocently from those acquired by child sexual abuse (CSA) is challenging. High-quality studies examining this relationship are sparse. Here, we sought to evaluate the association between AGW and sexual abuse in children 12 years of age and younger with respect to wart location, age, and gender.

Methods: A systematic review of Ovid MEDLINE, Embase, and Web of Science was performed for studies published on or before 2/16/2018. Studies were eligible for inclusion if they contained at least 10 patients 12 years old and younger and reported the number of patients who were sexually abused. The principal summary measures were the odds ratios (OR) of reported CSA with respect to subject age, wart location, and gender.

Results: Three hundred twenty-seven studies were identified through record search. Twenty five were included in a summary synthesis (791 subjects); 10 were included in the final statistical analysis (199 subjects). In our overall review, 102 of 468 (21%) females and 36 of 204 (18%) males with AGW were abused or probably abused. Overlapping HPV types were found in abused and non-abused subjects. Perianal location and gender were not significant predictors of abuse. Both age and genital wart location (penis, vulva) did significantly predict CSA (α = .05). The odds ratio for sexual abuse of children aged 3-4 years was 7.45; 6.52 for ages 5-8 years; and 6.93 for ages 9-12 years compared to those 0-2 years of age. Genital location was associated with an OR of CSA of 5.93.

Conclusions: Our systematic review supports a significant association between AGW in a child greater than 2 years of age and odds of CSA. Genital wart location significantly predicts CSA as well. HPV typing is not a reliable method to ascertain CSA. Male family members and acquaintances were the most likely perpetrators of abuse.
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http://dx.doi.org/10.1111/pde.14650DOI Listing
July 2021

Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Upper Cutaneous Lip: A Systematic Review.

Dermatol Surg 2021 08;47(8):1047-1051

Department of Dermatology, University of California Davis, Sacramento, California.

Background: Despite many options for upper lip reconstruction, each method's advantages and disadvantages are unclear.

Objective: To summarize complications and functional and aesthetic outcomes of localized skin flaps for oncological reconstruction of the upper cutaneous lip (PROSPERO CRD42020157244).

Methods: The search was conducted in Ovid MEDLINE, Ovid EMBASE, and CENTRAL on December 14, 2019. Two reviewers screened 2,958 results for eligibility. Bias assessment was conducted using ROBINS-I criteria.

Results: Our search identified 12 studies reporting outcomes of V-Y advancement, ergotrid, rotation, Karapandzic, alar crescent, and propeller facial artery perforator flaps. Flap complications (infection, hemorrhage/hematoma, wound dehiscence, and flap necrosis) ranged from 0% to 7.69%. Functional outcomes (salivary continence, microstomia, and paresthesia) were poorest for Karapandzic flaps. Aesthetic outcomes, when reported, stated satisfaction rates greater than 90%. V-Y advancement flaps reported the highest rates of poor scarring (0%-20%) and need for revision surgery (0%-46.7%).

Conclusion: Our results provide dermatologic surgeons an overview of upper cutaneous lip flap outcomes reported in the literature. In general, we noted high patient satisfaction rates and low complication rates. Additional research into outcomes of other commonly used flaps is needed. Standardization of reported outcomes could allow further comparison across different flaps or across studies of the same flap.
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http://dx.doi.org/10.1097/DSS.0000000000003063DOI Listing
August 2021

Guidelines of care for the management of actinic keratosis.

J Am Acad Dermatol 2021 10 2;85(4):e209-e233. Epub 2021 Apr 2.

Dermatology & Laser Center of Charleston, Clinical Research Center of the Carolinas, Charleston, South Carolina.

Background: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma.

Objective: This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed.

Methods: A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.

Results: Analysis of the evidence resulted in 18 recommendations.

Limitations: This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data.

Conclusions: Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
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http://dx.doi.org/10.1016/j.jaad.2021.02.082DOI Listing
October 2021

Characteristics of patients with hidradenitis suppurativa seen at a tertiary care facility from 2009-2019: a retrospective chart review study.

Dermatol Online J 2021 Jan 15;27(1). Epub 2021 Jan 15.

Department of Dermatology, University of California Davis, Sacramento, CA.

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January 2021

Reconstruction of a Large Forehead Wound.

Dermatol Surg 2021 09;47(9):1259-1262

Both authors are affiliated with the Department of Dermatology, University of California, Davis, California.

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http://dx.doi.org/10.1097/DSS.0000000000002913DOI Listing
September 2021

Wound eversion versus planar closure for wounds on the face or neck: A randomized split-wound comparative effectiveness trial.

J Am Acad Dermatol 2020 Nov 9;83(5):1439-1440. Epub 2020 Jun 9.

Department of Dermatology, University of California, Davis, Sacramento, California. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.06.013DOI Listing
November 2020

Sebaceous carcinoma: evidence-based clinical practice guidelines.

Lancet Oncol 2019 12;20(12):e699-e714

Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.

Sebaceous carcinoma usually occurs in adults older than 60 years, on the eyelid, head and neck, and trunk. In this Review, we present clinical care recommendations for sebaceous carcinoma, which were developed as a result of an expert panel evaluation of the findings of a systematic review. Key conclusions were drawn and recommendations made for diagnosis, first-line treatment, radiotherapy, and post-treatment care. For diagnosis, we concluded that deep biopsy is often required; furthermore, differential diagnoses that mimic the condition can be excluded with special histological stains. For treatment, the recommended first-line therapy is surgical removal, followed by margin assessment of the peripheral and deep tissue edges; conjunctival mapping biopsies can facilitate surgical planning. Radiotherapy can be considered for cases with nerve or lymph node involvement, and as the primary treatment in patients who are ineligible for surgery. Post-treatment clinical examination should occur every 6 months for at least 3 years. No specific systemic therapies for advanced disease can be recommended, but targeted therapies and immunotherapies are being developed.
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http://dx.doi.org/10.1016/S1470-2045(19)30673-4DOI Listing
December 2019

Risk of second primary cutaneous and noncutaneous melanoma after cutaneous melanoma diagnosis: A population-based study.

J Am Acad Dermatol 2020 Mar 15;82(3):683-689. Epub 2019 Oct 15.

Department of Dermatology, University of California-Davis, Sacramento, California. Electronic address:

Background: While cutaneous melanomas (CM) account for greater than 90% of all melanomas, noncutaneous melanomas (NCM) are more aggressive and associated with worse outcomes. The shared progenitor cell type among CM and NCM suggests that patients with a history of CM may be at higher risk for subsequent NCM.

Objective: To determine whether patients with a history of CM demonstrate an increased risk of second primary cutaneous, ocular, oral, or vaginal/exocervical melanoma compared with the general population.

Methods: This was a population-based retrospective cohort study using the Surveillance, Epidemiology, and End Results database. We calculated standardized incidence ratios (SIRs) and excess absolute risks of second primary cutaneous, ocular, oral, and vaginal/exocervical melanoma in patients with a history of CM.

Results: Patients with prior CM (n = 169,841) were more likely than the general population to develop a second primary CM (SIR, 8.17; 95% confidence interval [CI], 8.01-8.33), ocular melanoma (SIR, 1.99; 95% CI, 1.54-2.53), oral melanoma (SIR, 6.87; 95% CI, 2.23-16.04), and vaginal/exocervical melanoma (SIR, 10.17; 95% CI, 4.65-19.30).

Limitations: This study is limited by possible under-reporting of CM in cancer registries.

Conclusion: In caring for patients with a history of CM, physicians should be vigilant not only about risk of recurrence but also about second primary CM and NCM.
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http://dx.doi.org/10.1016/j.jaad.2019.10.024DOI Listing
March 2020

Dermal suture only versus layered closure: A randomized, split wound comparative effectiveness trial.

J Am Acad Dermatol 2019 Dec 21;81(6):1346-1352. Epub 2019 Aug 21.

Department of Dermatology, University of California Davis Medical Center, Sacramento, California. Electronic address:

Background: Layered closure of cutaneous wounds is a commonly used surgical practice. However, there are studies that suggest the additional layer of epidermal sutures might not be necessary.

Objective: To compare scar outcomes between the single-layer deep-dermal suture technique and the conventional layered suture technique for primary closure of cutaneous wounds.

Methods: A total of 49 patients were enrolled in a prospective, randomized, evaluator-blinded, split scar study to compare the conventional bilayered closure technique with the single-layer deep-dermal suturing technique for primary closure of wounds. The primary outcome measure was mean sum Patient and Observer Scar Assessment Scale (POSAS) score at 3 and 12 months.

Results: At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the standard layered closure. However, at the 12-month follow-up, this difference was lost, with the exception of scar color, which was significantly more noticeable on the wound side closed with only dermal sutures.

Limitation: Single-center study.

Conclusion: Three months after surgery, the layered closure technique resulted in a slightly better scar outcome than the single-layered closure containing only dermal sutures. At 12-months' follow-up, this difference diminished, with scars for both sides appearing similar.
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http://dx.doi.org/10.1016/j.jaad.2019.08.040DOI Listing
December 2019

Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis.

Dermatol Surg 2020 05;46(5):628-634

Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California.

Background: Although the use of 2-octylcyanoacrylate (OCA) in cutaneous surgery offers increased efficiency, there is scant data comparing scar outcomes achieved with OCA versus 5-0 fast-absorbing gut suture (FG).

Objective: To compare scar cosmesis achieved with OCA versus FG for surgical wound closure.

Materials And Methods: A total of 44 patients with postoperative defects of at least 3 cm were included. Half of each wound was randomized to receive closure with either OCA or FG. At 3 months, patients and 2 blinded observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS).

Results: The total observer POSAS score (mean [SD]) for the side repaired with OCA (12.3 [4.72]) and the side that received FG (11.6 [4.36]) did not differ significantly (p = .40). There was no significant difference in the total patient POSAS scores between closure with OCA (14.9 [8.67]) and FG (14.6 [8.90]) (p = .70). Based on observer POSAS scores, scar pigmentation was significantly worse on the scar half repaired with OCA (1.98 [0.91]) compared with FG (1.79 [0.80]) (p = .05).

Conclusion: With the exception of inferior scar pigmentation with OCA, there was no statistically significant difference in wound cosmesis after linear wound closure with OCA versus FG.
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http://dx.doi.org/10.1097/DSS.0000000000002076DOI Listing
May 2020

Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review.

JAMA Dermatol 2019 Sep;155(9):1059-1068

Division of Mohs and Dermatological Surgery, Department of Dermatology and Cosmetic Dermatology, Henry Ford Hospital, Detroit, Michigan.

Importance: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients.

Objective: To develop recommendations for the care of adults with MAC.

Evidence Review: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins.

Findings: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management.

Conclusions And Relevance: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.
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http://dx.doi.org/10.1001/jamadermatol.2019.1251DOI Listing
September 2019

Surgical and Noninvasive Modalities for Scar Revision.

Dermatol Clin 2019 Jul;37(3):375-386

Department of Dermatology, University of California Davis Medical System, 3301 C Street, #1400, Sacramento, CA 95816, USA. Electronic address:

Scar revision is of premier importance to the dermatologic surgeon. Some of the least invasive modalities include use of silicone gel sheets, resurfacing with electrosurgical instruments, dermabrasion, chemical peels, and subcision. Laser technology also has been implemented to selectively target and ablate fibrous scar tissue via selective thermolysis. Other lasers have been used to target dyschromia associated with scar formation. Lastly, invasive modalities of scar revision include excisional modalities and/or rearrangement of skin to enhance cosmesis of unsightly or morbid scars. Herein is a discussion of the multiple modalities of scar revision as well as advantages and disadvantages of each.
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http://dx.doi.org/10.1016/j.det.2019.03.007DOI Listing
July 2019

Blunt curettage for postoperative hematomas.

J Am Acad Dermatol 2020 Aug 19;83(2):e117-e118. Epub 2019 Apr 19.

Department of Dermatology, University of California, Davis, Sacramento, California.

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http://dx.doi.org/10.1016/j.jaad.2019.04.031DOI Listing
August 2020

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.

J Am Acad Dermatol 2019 Jul 11;81(1):76-90. Epub 2019 Mar 11.

Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada.

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.
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http://dx.doi.org/10.1016/j.jaad.2019.02.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131894PMC
July 2019

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management.

J Am Acad Dermatol 2019 Jul 11;81(1):91-101. Epub 2019 Mar 11.

Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada.

Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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http://dx.doi.org/10.1016/j.jaad.2019.02.068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131892PMC
July 2019
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