This month's news from across the specialty
What's hot
May 1, 2021
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
As published in a recent Dermatologic Surgery paper, Surget Cox et al performed a systematic review on the potential for dissemination of human papillomavirus (HPV) through inhaled aerosols during ablative laser procedures (doi: 10.1097/DSS.0000000000002757). They reviewed several case reports and studies that raise concern for the development of laryngeal papillomatosis or HPV-related squamous cell carcinomas of the head and neck in laser operators. Similar risks may exist when using electrodesiccation with curettage or any surgery where electrocoagulation is used. Although data is inconclusive, dermatologists would be wise to protect themselves when treating HPV lesions through (1) the routine use of N95 or N100 surgical masks when treating HPV lesions with ablative modalities; (2) holding smoke evacuator tips within 1 centimeter of surgical sites; and (3) consideration for HPV vaccination in all health care providers who participate in laser treatment of HPV lesions.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup at staging.aad.org/dw.
Does Mohs micrographic surgery have a significantly higher complication rate in patients over the age of 85? The answer is no — according to a recent nine-year retrospective study of 1,683 Mohs cases in patients 85 years of age or older (Derm Surg. 2021. 47(2): 189-93). The mean age was 88 years (range: 85-101), and the distribution of male to female was almost equal. 49% were repaired with a complex linear layered closure, 16% left to heal by second intent, 21% with a flap, and 6% with a graft. The remaining 8% were repaired with a variety of methods. There were 30 complications with an overall complication rate of 1.78%. The most common complication was infection followed by wound dehiscence, hematoma, hemorrhage, and flap or graft necrosis. The authors identified four independent risk factors associated with a higher incidence of complications. These included anticoagulant use, extremity location, greater than two Mohs micrographic surgery stages and flap repair. Of the 11 patients with infection, 10 resolved with oral antibiotics while one patient with cellulitis required intravenous antibiotics. Of the six patients with wound dehiscence, only one required resuturing. The patients with flap and graft necrosis healed well by secondary intention postoperatively and did not require repeat procedures. As Mohs micrographic surgery in the general population has reported complication rates from 0.72% to 2.6%, a 1.78% complication rate in a population aged 85 and older is not significantly different. Mohs micrographic surgery and subsequent reconstruction is a safe means of treating skin cancer in the elderly.
