Mohs micrographic surgery (MMS) offers the highest cure rates for skin cancers with the greatest degree of tissue sparing. However, data pertaining to the safety of MMS remain limited in scope. In this multicenter prospective cohort study, Alam et al demonstrate an adverse event rate of 0.72%. The most common adverse events following MMS were infections, dehiscence and partial or full necrosis, and bleeding and hematoma. Although this study documents a potential association between sterile (vs clean) gloves during MMS and a reduced infection risk, a randomized clinical trial would be needed to validate any causal association.
Botulinum toxin type A has been extensively used for wrinkle correction with safe and effective results. Commercially available preparations result in similar clinical effects and are used for the same aesthetic indications. The fields of muscle and anhidrotic effect of toxins (diffusion halos) are the best expression of their relevant clinical effects. In this prospective, randomized, double-blind study, Hexsel et al demonstrate that the horizontal and vertical diameters of the fields of effects were significantly larger for onabotulinumtoxinA than for abobotulinumtoxinA when isovolumetric injections were used.
Isotretinoin is the most effective treatment for severe nodulocystic acne vulgaris, and it remains the only treatment option for acne that offers the potential for remission or cure. Current literature fails to clarify the ideal cumulative dosing to optimize treatment response, and traditional recommendations range from 120 to 150 mg/kg. In this prospective, observational, intervention study, Blasiak et al demonstrate that patients receiving a cumulative dose higher than 220 mg/kg had a significantly decreased rate of relapse and no increase in adverse effects.
Continuing Medical Education
Chronic, recalcitrant wounds, commonly caused by venous or arterial insufficiency, repetitive trauma from neuropathy, or prolonged pressure, fail to progress through the normal stages of wound healing. Management of these wounds can be costly and time-consuming. Recent research suggests that catecholamines and β-adrenergic receptors may be new targets to augment the wound-healing response. In this case series, Braun et al demonstrate the efficacy of topical timolol as a potential new adjunct therapy to encourage reepithelialization of these chronic wounds.
There is an increasing interest in BRAF mutations in melanomas and their sensitivity to vemurafenib, a BRAF inhibitor. Approximately 90% of BRAF mutations in melanoma cells occur at exon 15, codon 600. Vemurafenib has a marked antitumor effect against BRAF V600–mutated cells but not wild-type BRAF cells. In this case report, Busser et al describe a patient with metastatic melanoma having a novel complex BRAF mutation, achieving a prolonged response to vemurafenib. Analysis of the location as well as the physical and chemical properties of the amino acids generated by a BRAF mutation might improve the predictability of vemurafenib sensitivity.
Highlights. JAMA Dermatol. 2013;149(12):1365. doi:10.1001/jamadermatol.2013.4098