Squamous Cell Carcinoma In Situ With Occult Invasion: A Tertiary Care Institutional Experience BACKGROUND The rate of occult invasive disease within biopsy-proven squamous cell carcinoma in situ (SCCIS) is not well defined. OBJECTIVE To examine the rate of occult invasion in SCCIS. METHODS An institutional-wide pathology database was retrospectively searched for “squamous cell carcinoma in situ” over a 6-year period, and the treatment modality and final pathology results were analyzed for evidence of invasion. In addition, consecutive tumor blocks from Mohs micrographic surgery (MMS) cases of SCCIS were prospectively analyzed for invasion. RESULTS The rate of occult invasion for biopsy-proven SCCIS treated with excision was 4.0% (N = 49) and for the MMS margins was 3.5% (N = 310). For the prospective MMS tumor block analysis, the rate of occult invasion was 10.1% (N = 69). No clinical factors (age, sex, location, or size) correlated with increased risk of invasion. All invasive SCCs detected were superficial and well differentiated. CONCLUSION The rate of occult invasion for biopsy-proven SCCIS ranged from 3.5% to 10.1%. The detected rate of invasion varies based on the method of excision and pathology processing of specimens. The rate of invasion should be considered when managing SSCIS.

Trends in the Incidence of Bowen Disease Based on a Single-Center Study in the Netherlands BACKGROUND Incidence trends of nonmelanoma skin cancer show an increase. Few data have been published about the incidence of Bowen disease (BD). Three previous studies, conducted more than 15 years ago in North America, found large variation in incidence rates in Caucasians, and trends over longer periods have never been studied. OBJECTIVE To estimate the incidence of BD in a Caucasian population in Northern Europe (Maastricht, the Netherlands) between 2003 and 2013. METHODS Primary and histologically confirmed BD, diagnosed in Maastricht, the Netherlands, in the years 2003, 2008, and 2013, was retrieved from a pathology database. Age-standardized and sex-specific incidence rates per 100,000 inhabitants were calculated by using the age distribution of the European standard population of 2013. RESULTS A statistically significant increase in the annual age-standardized incidence rates per 100,000 people was found from 8.1 (95% confidence interval [CI] 3.7–12.5) in 2003 to 68.9 (95% CI 57.2–80.7) in 2013 (p < .001). For women, there was an increase from 7.7/100,000 (95% CI 2.0–13.4) in 2003 to 76.8/100,000 (95% CI 60.2–93.5) in 2013, respectively (p < .001). An increase from 8.8/100,000 (95% CI 1.8–15.9) in 2003 to 59.2/100,000 men (95% CI 42.8–75.6) in 2013 (p < .001) was found. CONCLUSION These findings suggest an increase in the annual age-standardized incidence rates in BD.

Cellular Dermatofibroma: Clinicopathologic Review of 218 Cases of Cellular Dermatofibroma to Determine the Clinical Recurrence Rate BACKGROUND Cellular dermatofibromas, a variant of dermatofibroma, are reported to recur at rates of 26% to 50%. OBJECTIVE To determine whether there are distinct clinical or histological differences between cellular dermatofibromas that recur versus those that do not. To determine recurrence rates in a real-world clinical setting. MATERIALS AND METHODS A retrospective analysis of the medical records and skin biopsies of cellular dermatofibroma in the University of Utah Health system between December 2011 and 2016. Clinical and dermatopathological features were evaluated to find distinct differences between the cellular dermatofibromas that recurred compared with those that did not. RESULTS There were no significant differences in histology between the primary lesions in recurrent and nonrecurrent cases. One factor that seemed to be associated with a greater likelihood of recurrence was an initial lesion size greater than 1 cm. The authors' data suggest that if the margins are involved on initial biopsy, there is a 10% chance of recurrence. This percentage is far less than the 26% to 50% reported in the past literature. CONCLUSION If a patient presents with a cellular dermatofibroma larger than 1 cm and positive margins at initial biopsy, a careful discussion should be had between the provider and patient about the low risk of local recurrence.

Influence of Age, Sex, and Body Mass Index on the Depth of the Superficial Fascia in the Face and Neck BACKGROUND Nonsurgical skin-tightening procedures are increasing in popularity, as patients seek aesthetic interventions that are safe with minimal downtime. OBJECTIVE This study was designed to provide precise data on the depth of the superficial fascia—the structure of action—of the face and neck. METHODS One hundred fifty Caucasian individuals (75 men and 75 women) were investigated with a balanced distribution of age (n = 30 per decade: 20–29, 30–39, 40–49, 50–59, and 60–69 years) and body mass index (BMI) (n = 50 per group: BMI ≤ 24.9 kg/m2, BMI between 25.0 and 29.9 kg/m2, and BMI ≥ 30 kg/m2). The distance between skin surface and the superficial fascia was measured through ultrasound in the buccal region, premasseteric region, and lateral neck. RESULTS The mean distance between skin surface and superficial fascia was for the buccal region 4.82 ± 0.9 mm, range (2.60–6.90); for the premasseteric region 4.25 ± 0.6 mm, range (2.60–5.80); and for the lateral neck 3.71 ± 0.5 mm, range (2.0–5.0). The depth of the superficial fascia increased with increasing BMI, whereas it decreased with advanced age. CONCLUSION Knowing the precise depth of the superficial fascia for nonsurgical skin-tightening procedures will guide practitioners toward safer and more effective outcomes.

Objective and Subjective Evaluation of Lipoinjection for Correction of Temporal Depression BACKGROUND Temporal depression is commonly found among people. OBJECTIVE Objective and subjective evaluation of lipoinjection for correction of temporal depression. METHODS From November 2012 to January 2018, 34 healthy female subjects underwent temporal augmentation by lipoinjection on both sides. Efficacy was assessed by objective and subjective parameters. The quantitative measurement of the temporal defect was obtained using molded plasticine preoperatively and 12 months after treatment. The subjective assessment consisted of excellent, good, fair, and poor results based on the patients' self-evaluations. The adverse events were recorded. RESULTS The follow-up period ranged from 12 to 36 months. It was found that a statistically significant difference existed between the preoperative and postoperative defect on both temples. Regarding the patients' self-evaluations, 17 patients (50.0%) reported feeling excellent, 15 patients (44.1%) as good, and 2 patients (5.9%) as fair, and no patient as poor. After the statistical analysis, it was found that the volumetric restoration rate of the grafted fat decreased as the temporal defect generally increased during the aging process. Injection-site swelling and bruising were commonly found complications; other complications were not found. CONCLUSION Autologous fat is inexpensive and readily available. Fat grafting is an alternative for correction of temporal depression.

Efficacy and Safety of PrabotulinumtoxinA for the Treatment of Glabellar Lines in Adult Subjects: Results From 2 Identical Phase III Studies BACKGROUND PrabotulinumtoxinA is a 900-kDa botulinum toxin Type A produced by Clostridium botulinum. OBJECTIVE To investigate the efficacy and safety of prabotulinumtoxinA for the treatment of glabellar lines. MATERIALS AND METHODS Adult subjects (n = 330 in EV-001; n = 324 in EV-002) with moderate to severe glabellar lines at maximum frown on the 4-point Glabellar Line Scale (GLS; 0 = no lines, 1 = mild, 2 = moderate, and 3 = severe) were enrolled in 1 of 2 identical 150-day, double-blind, placebo-controlled, single-dose, Phase III studies. Subjects were randomized 3:1 to receive 20-U prabotulinumtoxinA or placebo. The primary efficacy end point was the proportion of responders on Day 30 where the investigator and subject independently agreed that a ≥2-point improvement had occurred on the GLS at maximum frown from Day 0. Adverse events (AEs) were evaluated throughout the study. RESULTS Responder rates in the prabotulinumtoxinA and placebo groups were 67.5% and 1.2% in EV-001 and 70.4% and 1.3% in EV-002; absolute differences between groups were 66.3% and 69.1% in EV-001 and EV-002, respectively (both p < .001). No serious AE in either study was assessed as study drug related. CONCLUSION In these studies, a single dose of 20-U prabotulinumtoxinA was safe and effective for the treatment of glabellar lines.

Comparative Efficacy of a 35% Glycolic Acid Peel Alone or in Combination With a 10% and 20% Trichloroacetic Acid Spot Peel for Melasma: A Randomized Control Trial BACKGROUND To study and compare the therapeutic efficacy and side effects of a 35% glycolic acid (GA) full face peel alone or in combination with a 10% or 20% trichloroacetic acid (TCA) spot peel for facial melasma. METHODS Thirty patients with facial melasma were randomly divided into 3 equal Groups A, B, and C. Group A was treated with a 35% GA full-face peel, Group B and C with 35% GA full-face peel followed by a 10% and 20% TCA spot peel respectively once every 15 days. Four peels were performed once every 15 days. The response to the treatment was evaluated by the percentage reduction in melasma area severity index (MASI) scoring. RESULTS All 3 groups had significant reduction of MASI, but there was no significant difference between the groups. Group A had minimum side effects. CONCLUSION Chemical peels with GA alone or in combination with TCA do result in a significant improvement in melasma, but the combination of the peels in the same sitting does not seem to have any additive or synergistic effect while they may increase the side effects.

Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea BACKGROUND Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.

A Retrospective Study of Chinese-Specific Glabellar Contraction Patterns BACKGROUND Botulinum toxin has been widely accepted as safe and effective for the treatment of glabellar lines, and previous studies have classified glabellar contraction patterns into 5 categories. OBJECTIVE To classify the glabellar contraction patterns among a large-scale Chinese population and provide a reference for injections in Chinese patients. METHODS Four hundred eighty-nine Chinese subjects who received botulinum toxin for the treatment of glabellar lines were selected for a retrospective photographic analysis of their glabellar contraction patterns. Using 2 separate previously established classification systems, the patterns were analyzed and classified by a panel of certified Chinese dermatologists. RESULTS Two separate classification systems showed different distributions of glabellar contraction patterns among Chinese compared with Caucasians and Koreans. The classifications allowed for identification of the most frequent patterns in Chinese, which were “converging arrows” and “11” pattern, and provided references for identifying the most important muscles. CONCLUSION Both classification systems are applicable to the Chinese population with varying distributions. Because the classification system of de Almeida and colleagues focuses more on the muscles involved in the formation of glabellar lines, the authors' subjects classified according to this system displayed a more balanced distribution among the 5 patterns. This provides an easier reference for dermatologists in daily clinical practice and guiding treatment strategies.

Reconstruction of a Dorsal Nasal Wound Surrounded by Tight Skin No abstract available