Lisa Scholl

Clinical Characteristics and Survival Data of Melanoma Patients With Nevus Cell Aggregates Within Sentinel Lymph Nodes

Histopathologic differentiation of nevus cell aggregates and metastatic melanoma in lymph nodes is challenging. Patients with melanoma who had undergone sentinel lymph node (SLN) biopsy were evaluated using univariate and multivariate analyses as well as Kaplan-Meier statistics. Of the 651 patients, 50 (7.7%) had a nodal nevus in the SLN. In the logistic regression model, primary melanoma on the lower extremities proved to be the strongest independent negative predictor of nodal nevi with an odds ratio of 0.11 (95% confidence interval, 0.034-0.36; P = .0002). Overall 5-year survival (P = .17) and 5-year disease-free survival (P = .45) of patients with nodal nevi did not significantly differ from that of patients with negative SLNs. The frequency and anatomic localization of nodal nevi observed in the present study are in line with previous studies. Our 5-year survival data clearly demonstrate that nevus cell aggregates in lymph nodes have to be considered a benign condition even though it occurs in patients with melanoma. This study provides an indirect proof of validity and accuracy of current histopathologic methods for differentiation between nodal nevi and melanoma metastasis.

Surgical treatment of chondrodermatitis nodularis helicis via a retroauricular incision

First described by Winkler in 1915, chondrodermatitis nodularis helicis (CNH) is defined as a small and highly painful nodule predominantly located on the helix of the ear [1]. More than 50 % of cases occur in middle-aged to elderly men [2]. Usually a solitary unilateral lesion, CNH is most frequently located on the outer edge of the helix over Darwin’s tubercle [1, 2]. The precise pathogenesis is unclear. Suggested causes include the hardening of cartilage with increasing age, fixed sleep habits as well as trauma that can lead to pressure necrosis [1]. Clinically, CNH presents as an often markedly painful skin-colored, whitish or reddish firm nodule that arises spontaneously and gradually increases in size. There may be central ulceration. Both conservative and surgical methods have been described as therapeutic options. The former include intralesional or topical corticosteroids, collagen injections, or pressure relief using a special protective ear bandage [3–5]. Surgical procedures described include laser ablation, cryosurgery, cauterization, and curettage [6, 7]. Another commonly used technique is full-thickness removal of the lesion by wedge-shaped excision followed by immediate wound closure [8]. In the “punch and graft technique”, the skin – including the affected cartilage underneath – is punched out, and the defect is covered by a full-thickness skin graft [9]. As an alternative, Long et al. described a technique without skin resection, in which an incision is made over the lesion, with subsequent mobilization and undermining of the wound edges followed by tangential excision of the affected cartilage [10]. In this article, we present a modification of the method reported by Long et al., which allows a good cosmetic result using a retroauricular incision.

The comet flap: an alternative technique for the reconstruction of facial defects

There are several techniques for the reconstruction of surgical defects of the face, with primary side-to-side closure being the simplest and most effective method [1]. However, depending on defect size, location, and adjacent free margins, primary wound closure is not always feasible. In such cases, and when there is excessive tension, skin grafts and local flaps are used [1, 2]. In the following paragraphs, we describe the comet flap (synonym: dog-ear rotation flap) as a simple solution enabling the closure of medium-sized as well as large defects. First described by Mellette in 1986, the term comet flap derives from its shape after the sutures are completed [3]. On one end, the defect is closed in a primary side-to-side fashion. On the other end, where primary closure is not possible because of high tension, a rotation flap is performed using the extra skin arising from the dog ear. Eventually, one part is closed by a single-line suture, the other by two suture lines that both merge into the single-line suture, thus resembling a shooting star or comet ś tail.

A Novel Severity Assessment Scoring System for Hidradenitis Suppurativa

Importance The variation in both clinical appearance and responses to diverse treatment options emphasize the importance of an accurate, clinically relevant, yet easy-to-use scoring system in hidradenitis suppurativa. Objective To propose and provide validation data for the newly designed Severity Assessment of Hidradenitis Suppurativa score. Design, Setting, and Participants We prospectively assessed disease severity using Hurley staging and the modified Hidradenitis Suppurativa Score in 355 patients referred to Ruhr-University Bochum Department of Dermatology between March 2016 and June 2017. We also assessed disease severity via the Severity Assessment of Hidradenitis Suppurativa score. Main Outcomes and Measures Evaluation and assessment of convergent validity and responsiveness to treatment of the Severity Assessment of Hidradenitis Suppurativa score. Results Eighty-eight of the 355 patients (134 [37.7%] men and 221 [62.3%] women with a median [IQR] age of 40 [30-49] years) were classified as Hurley stage I, 221 were Hurley stage II, and 46 were Hurley stage III, with an overall median modified Hidradenitis Suppurativa Score of 31 (interquartile range [IQR], 19.3-53). The median total Severity Assessment of Hidradenitis Suppurativa score was 6 (IQR, 4-9), significantly different among the 3 Hurley groups. The median SAHS score for patients in Hurley stage I was 5 (IQR, 3-6), 6 (IQR, 5-9) for patients in Hurley stage II, and 9 (IQR, 7-12) for patients in Hurley stage III (P < .001, Kruskal-Wallis test). Correlation analysis showed a significant correlation between the modified Hidradenitis Suppurativa Score and the Severity Assessment of Hidradenitis Suppurativa score (r = 0.79, P < .001). Disease severity assessment before and after 3 months of conservative systemic treatment showed a significant correlation between the Severity Assessment of Hidradenitis Suppurativa score and modified Hidradenitis Suppurativa Score. Both the mHSS (P = .001) and the SAHS score (P < .001) significantly differed between the baseline visit (median mHSS, 33 [IQR, 24-52]; median SAHS score, 6 [IQR, 5-9]) and the 3-month visit (median mHSS, 28 [IQR, 15-43.5]; median SAHS score, 5 [IQR, 4-6.3]). The 2 patient-reported items demonstrated excellent test-retest reliability with intraclass correlation coefficient values greater than 0.8. Conclusions and Relevance Our validation data demonstrated that the Severity Assessment of Hidradenitis Suppurativa score is a disease severity instrument that significantly correlates with Hurley staging and the modified Hidradenitis Suppurativa Score, and is responsive enough to measure treatment outcome.

Surgical Treatment of Sinus Tracts and Fistulas in Perianal Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) in the perianal region may present with deep invading sinus tracts and fistulas, especially in patients with longstanding disease and with previous perianal surgery. 1 The appropriate clinical and surgical management of these cases is challenging due to the complexity of perianal sinus tracts and fistulas. Furthermore, a clear differentiation and definition are missing. We herein present a definition and clinical algorithm for the surgical treatment of sinus tracts and fistulas in perianal HS ( Figure 1 ). An abscess is defined as an acute, fluctuant inflammatory process that can rupture. Because of scarring due to recurrent lesions and/or previous surgery, an abscess might not be able to discharge towards the skin surface but longitudinally into the intradermal plane, forming a sinus tract. The latter can be defined as a cavity or an abnormal subcutaneous canal leading from a focus of suppuration. Typically, it is lined by granulation tissue with a missing internal opening. In the course of the disease, sinus tracts can be covered with squamous epithelium surrounded by dense inflammatory infiltrates and fibrosis. 2 In contrast, a fistula is characterized as an abnormal communication between 2 epithelial-lined surfaces, has 2 openings, and is lined by a mature epithelium. 3 5 It might also develop once 2 epithelial-lined sinus tracts communicate. In HS, fistulas can arise from the skin of the anal canal distal to the dentate line, which contains large apocrine and sebaceous glands. 5 Therefore, in HS, the fistulas usually lie superficially to the sphincter muscles, whereas cryptoglandular infections or Crohn’s disease frequently lead to interand transsphincteric fistulas. 5

Argon plasma coagulation of actinic keratoses imaged by optical coherence tomography: An in vivo study indicating a possible lesion-directed treatment

Actinic keratoses (AKs) can progress into invasive squamous cell carcinoma and thus may become a life threatening disease. Argon plasma coagulation (APC) might complement the therapeutic armamentarium in particular for AK lesions. However, there is no data on APC-induced micromorphological changes following the treatment of AKs. We aimed to determine in vivo APC-induced effects on the epidermis and dermoepidermal junction (DEJ) zone in AK lesions. We performed APC in 108 AKs using the spray mode with a power setting of 15 W and a flow rate of 2.0 L/min. Before and after the intervention, optical coherence tomography (OCT) was performed. After APC, 74.2% (46/62) lesions presented with clearly demarcated DEJ and without any epidermal tissue left, 25.8% (16/62) of treated lesions showed residual epidermal tissue left. In 19.4% (12/62), parts of the DEJ and in 6.5% (4/62), the entire DEJ could not be discriminated. The χ2 test showed a significant (P = 0.0025) association between the presence of hyperkeratosis prior to APC and intact DEJ after APC. In conclusion, APC as shown by OCT is a well controllable treatment modality for AKs causing only limited damage to dermal tissue. Further studies are needed to evaluate clinical outcome as well as recurrence rates.

Photoprotection by Clothing and Fabric

The main aspects that play a role in the prevention of ultraviolet (UV)-induced skin cancer and photodermatoses by means of clothing are discussed. In vitro and in vivo test methods are reviewed. Furthermore, we describe various fabric parameters (e.g., composition, construction, dye) and other factors that have an influence on the UV-blocking properties of clothing. Standards on sun protective clothing are briefly introduced as well.

BH3-only protein Bim predicts advanced stage of cutaneous melanoma.

Bim having strong pro‐apoptotic effects belongs to the BH3‐only proteins of the Bcl‐2 protein family and contributes to survival pathways in cancer cells.

Presuturing: A simple technique for excision of large skin lesions

SOLUTION A simple and reliable way to reduce the number of staged excisions and risk of wound dehiscence is the so-called presuturing technique (Figs 1, A and 2, A). Under local anesthesia, multiple nonresorbable sutures (eg, with Ethilon) are placed across the lesion, pulling the edges and folding the adjacent skin over the area that is to be excised (Figs 1, B and 2, B). The sutures should be placed at least 24 hours up to 5 days before excision. The principle behind this technique is the stretching of adjacent skin beyond its inherent extensibility to reach sufficient skin laxity. Thus, reduction of the number of staged excisions or a complete 1-stage excision of the lesion with a standard primary closure technique can be achieved.

Interne und externe Tabaksbeutelnähte in der Dermatochirurgie: Dermatochirurgie - Tricks of the Trade / Dermatosurgery - Tricks of the Trade

Tabaksbeutelnähte kommen in der Dermatochirurgie als einfache und schnell durchzuführende Technik zur Anwendung und werden in eine interne und externe Variante unterteilt. Die interne Tabaksbeutelnaht (ITN) dient dem partiellen oder vollständigen Verschluss ovaler oder rundlicher Defekte vor allem im Gesichtsbereich (Stirn und Schläfe), am Hals und an den Extremitäten. An konvexen Lokalisationen ist sie analog zur sekundären Wundheilung weniger geeignet. Die sekundäre Wundheilung wird durch die ITN beschleunigt und es resultiert eine kleinere Narbe [1]. Im Gegensatz zur Lappenplastik oder Hauttransplantation entfällt jedwede Narbe im Bereich der Donorstelle mit einhergehender Gewebetraumatisierung. Die ITN kann auch als Interimsverschluss, beispielsweise im Rahmen der mikrographisch kontrollierten Chirurgie, eingesetzt werden [2]. Die externe Tabaksbeutelnaht (ETN) dient der Blutstillung und reduziert das Risiko von intraund postoperativen Blutungen [2].