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Sapijaszko M, Samadi S, Chow EY. Optimizing Surgical Site Infection Prevention in Dermatologic Surgery. J Cutan Med Surg 2025; 29:167-178. [PMID: 39628048 PMCID: PMC11979309 DOI: 10.1177/12034754241303086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
We aim to review modifiable risk factors and practices for surgical site infections (SSIs) reduction in cutaneous surgeries. The existing norms are assessed with the latest evidence, with the aim of enhancing and optimizing intra and postoperative strategies. This review seeks to offer an updated summary of the results of evidence for SSI reduction strategies tailored for practicing general dermatologists. Searches were conducted for "cutaneous surgery surgical site infection complications" using PubMed Central® and DynaMed®. Articles with pragmatic guideline recommendations were selected. We found evidence for intraoperative factors such as non-sterile gloves, brushless hand scrubbing/simple hand washing, sterile materials, and chlorhexidine gluconate as a skin antiseptic. For postoperative factors, there is a lack of evidence to support the use of topical antibiotic ointments, dressings, or waiting 48 hours before wetting to prevent SSI. Several intra/postoperative factors not specific to dermatologic procedures are briefly discussed for additional context. Several SSI risk factors are inherent to patients or necessary procedures; however, dermatologists have identified modifiable risk factors and developed protocols to mitigate SSI risks intraoperatively and postoperatively. By questioning established practices in cutaneous surgery aimed at preventing SSIs, we can work towards the optimal utilization of resources. This dual-focused approach not only enhances the efficiency of the healthcare system but also diminishes the risks associated with SSIs. It is important to acknowledge that this review does not encompass all factors essential for consideration in these recommendations. Nonetheless, it will approach these factors with an evidence-based lens, placing SSI prevention at the forefront.
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Affiliation(s)
- Mariusz Sapijaszko
- Division of Dermatology, Department of Medicine, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Sana Samadi
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Eunice Y. Chow
- Division of Dermatology, Department of Medicine, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
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Oh CS, Sher EF, Bieber AK. Melanoma in pregnancy. Semin Perinatol 2025; 49:152040. [PMID: 40089319 DOI: 10.1016/j.semperi.2025.152040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2025]
Abstract
Cutaneous melanoma is a malignant neoplasm of melanocytes that most frequently affects the skin. It is the most common malignancy in women of childbearing age, and accounts for almost one-third of all malignancies diagnosed during gestation. The pathophysiology of melanoma, particularly during pregnancy, is not well understood, but there are several ways in which the physiologic state pregnancy may impact melanoma. Based on the available literature, pregnancy does not seem to worsen maternal outcomes with melanoma, and outside of placental and fetal metastases, melanoma does not seem to cause serious obstetric or fetal complications. Treatment of localized melanoma during pregnancy follows guidelines for the general population, but advanced melanoma in pregnancy poses unique challenges given the lack of unifying research and management recommendations. Herein, we review the current literature, highlighting diagnostic clinical pearls and key multidisciplinary management considerations with regard to melanoma in the child-bearing population.
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Affiliation(s)
- Christina S Oh
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Elizabeth F Sher
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Amy K Bieber
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA.
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George-Washburn EA, Himeles JR, Marton A, Lewin JM. Superficial Thrombophlebitis After Mohs Micrographic Surgery in a Breast Cancer Survivor With Lymphedema. Dermatol Surg 2025; 51:641-643. [PMID: 39936660 DOI: 10.1097/dss.0000000000004580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Affiliation(s)
- Elisabeth A George-Washburn
- All authors are affiliated with the Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Gronbeck C, Beltrami EJ, Jain N, Hargis G, Sloan B, Cook BL, Grant-Kels JM, Feng H. Surface anatomy in dermatology: Part II-Impact on perioperative management, procedural technique, and cosmesis. J Am Acad Dermatol 2024; 91:223-240. [PMID: 37429437 DOI: 10.1016/j.jaad.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
This CME series reviews updated Delphi consensus surface anatomy terminology through the lens of common medical and procedural dermatology scenarios, helping to underscore high-yield points that can be readily integrated into clinical practice to support patient care. Part I of the series reviewed the current state of standardized surface anatomy, provided an illustrative review of consensus terminology, highlighted prominent landmarks that can aid in critical diagnoses, and related the importance of precise terminology to principles of medical management. Part II will utilize consensus terminology to heighten recognition of key landmarks in procedural dermatology to support optimal functional and aesthetic outcomes.
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Affiliation(s)
- Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Eric J Beltrami
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Geneva Hargis
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Brett Sloan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Bernard L Cook
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, the University of Florida College of Medicine, Gainesville, Florida
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Lakdawala N, Gronbeck C, Feng H. Comparison of prescribing patterns of non-physician clinicians and dermatologists in the Medicare population. Arch Dermatol Res 2023; 315:2679-2681. [PMID: 37195299 DOI: 10.1007/s00403-023-02638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
Non-physician clinicians (NPCs) are playing an increasing role in dermatologic patient care. This study expands upon existing workforce assessments of dermatology NPCs through the use of publicly-available Medicare datasets to better clarify prescribing patterns among independently-billing dermatology NPCs. The findings demonstrate prescribing similarities between NPCs and dermatologists for most medications, including biologic and immunosuppressive medications, although with higher use of oral prednisone, gabapentin, and hydroxyzine among NPCs. Dermatologists more frequently utilized high-potency topical steroids. These data provide initial insights into NPC prescribing patterns and should motivate further study of the identified differences and potential implications for patient care.
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Affiliation(s)
- Nehal Lakdawala
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT, 06032, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT, 06032, USA.
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Gallagher N, Berger J, Jones HB, Lloyd CJ. Frailty as an indicator of postoperative complications following surgical excision of non-melanoma skin cancer on the head and neck. Ann R Coll Surg Engl 2023; 105:342-347. [PMID: 35950511 PMCID: PMC10066642 DOI: 10.1308/rcsann.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) predominantly affects those aged over 90 years, with 85% of lesions arising on the head and neck, where surgical excision remains the treatment of choice. Frailty is a measure of physiologic age and can be used as a predictor of adverse treatment outcomes. The aim of this study was to determine if the Rockwood Frailty Index is predictive of complications following excision of NMSC. METHODS Data were collected prospectively for patients who underwent an excision of a suspected NMSC from the head or neck across a two-month period. Details of the patient, lesion and procedure were recorded alongside ASA grade and Rockwood's Frailty score. Postoperative complications were recorded four weeks later. RESULTS There was a total of 125 patients: 74 (60%) male, 51 (40%) female; mean age was 78 (±9.8) years. Of the excised sites, 61% were closed primarily, 26% with a full thickness skin graft (FTSG), 13% with a local flap. Frailty ranged from 1 to 7 (median = 4). ASA ranged from 1 to 4 (median = 3). A total of 21 (17%) patients reported postoperative complications. Within this group, the median frailty and ASA grades were 5 and 3. Both frailty and ASA were positively significantly associated with age (p ≤ 0.001). There was no significant difference between the frailty or ASA grades of patients that experienced complications and those who did not. Patients who had a FTSG were significantly more likely to experience complications (p ≤ 0.05). CONCLUSIONS Frailty is not predictive of postoperative complications following excision of NMSC on the head and neck. Postoperative complications are significantly more associated with FTSG.
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Affiliation(s)
| | - J Berger
- Betsi Cadwaladr University Health Board, UK
| | - HB Jones
- Betsi Cadwaladr University Health Board, UK
| | - CJ Lloyd
- Betsi Cadwaladr University Health Board, UK
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Shah H, Frech FS, Dreyfuss I, Hernandez L, Nouri K. Perioperative anticoagulation recommendations for cutaneous oncologic surgery: a review of the literature. J DERMATOL TREAT 2022; 33:2940-2945. [PMID: 35775785 DOI: 10.1080/09546634.2022.2097161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Consistent perioperative management is important to the practice of dermatologic surgery. With the widespread use of anticoagulant medications such as aspirin, warfarin, clopidogrel, factor Xa inhibitors, and thrombin inhibitors for a number of cardiovascular indications, it is important to standardize the use of these drugs in the setting of skin cancer surgery. Limited literature is available, however, regarding recommendations for dermatological perioperative anticoagulation management. Most published manuscripts involving anticoagulation and skin cancer surgery focus on complications and outcomes rather than providing guidelines for decision-making. In addition, survey studies have largely shown that even with existing recommendations in the literature, many dermatologists continue to have varying management of these medications. Overall, this review finds compelling evidence to support the safety of continuing anticoagulation therapy such as warfarin, aspirin, and clopidogrel throughout treatment for cutaneous malignancies. It is important that dermatologists, while having primary care and cardiology available for consultation, are aware of the safety data and feel comfortable managing their patients perioperatively.
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Affiliation(s)
| | - Fabio Stefano Frech
- Dr. Phillip Frost Department of Dermatology, University of Miami School of Medicine, Miami, FL, USA
| | - Isabella Dreyfuss
- Nova Southeastern Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology, University of Miami School of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology, University of Miami School of Medicine, Miami, FL, USA
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