Rate of Growth in Melanomas: Characteristics and Associations of Rapidly Growing Melanomas
Objectives: To investigate the spectrum of growth rates in melanomas and to identify clinical associations of rapidly growing melanomas.
Design: Clinical interview, skin examination, and pathology review.
Setting: Three tertiary melanoma referral centers and 2 private dermatology practices.
Patients: A total of 404 consecutive patients with invasive primary cutaneous melanomas.
Main Outcome Measure: A surrogate for rate of growth in primary invasive melanoma was calculated as the ratio of Breslow thickness to time to melanoma development based on a previously reported assessment tool.
Results: One third of the melanomas grew 0.5 mm per month or more. The median monthly growth rate was 0.12 mm for superficial spreading melanomas, 0.13 mm for lentigo maligna melanomas, and 0.49 mm for nodular melanomas. Rapid tumor growth was associated with tumor thickness (≤1 mm, geometric mean ratio [GMR] = 1.0; 1.01-4 mm, GMR = 3.9; and >4 mm, GMR = 12.1) and mitotic rate (<1/mm2, GMR = 1.0; 1-4/mm2, GMR = 2.9; 5-10/mm2, GMR = 6.1; and >10/mm2 GMR = 9.7). Rapid tumor growth occurred more often in males (GMR = 1.7), elderly individuals (≥70 years old, GMR = 2.8), and patients with fewer melanocytic nevi (n<50, GMR = 2.0) and fewer freckles (GMR = 2.5). Rapidly growing melanomas were more often symmetrical (GMR = 2.5), elevated (GMR = 1.4), amelanotic (GMR = 1.7), regular in border (GMR = 2.5), and symptomatic (GMR = 1.7).
Conclusions: Rapid growth of primary cutaneous melanomas is associated with aggressive histologic features and atypical clinical features. It occurs more frequently in elderly men and individuals with fewer nevi and fewer freckles.
Liu W, Dowling JP, Murray WK, McArthur GA, Thompson JF, Wolfe R, Kelly JW
In Vivo Stimulation of De Novo Collagen Production Caused by Cross-linked Hyaluronic Acid Dermal Filler Injections in Photodamaged Human Skin
Objective: To determine whether endogenous synthesis of new extracellular matrix may contribute to the degree and duration of clinical benefits derived from cross-linked hyaluronic acid dermal filler injections.
Design: In vivo biochemical analyses after filler injections.
Setting: Academic referral center.
Participants: Eleven healthy volunteers (mean age, 74 years) with photodamaged forearm skin.
Interventions: Filler and vehicle (isotonic sodium chloride) injected into forearm skin and skin biopsy specimens taken 4 and 13 weeks later.
Main Outcome Measures: De novo synthesis of collagen, the major structural protein of dermal extracellular matrix, was assessed using immunohistochemical analysis, quantitative polymerase chain reaction, and electron microscopy.
Results: Compared with controls, immunostaining in skin receiving cross-linked hyaluronic acid injections revealed increased collagen deposition around the filler. Staining for prolyl-4-hydroxylase and the C-terminal and N-terminal epitopes of type I procollagen was enhanced at 4 and 13 weeks after treatment (P<.05). Gene expression for types I and III procollagen as well as several profibrotic growth factors was also up-regulated at 4 and 13 weeks compared with controls (P<.05). Fibroblasts in filler-injected skin demonstrated a mechanically stretched appearance and a biosynthetic phenotype. In vitro, fibroblasts did not bind the filler, suggesting that cross-linked hyaluronic acid is not directly stimulatory.
Conclusions: Injection of cross-linked hyaluronic acid stimulates collagen synthesis, partially restoring dermal matrix components that are lost in photodamaged skin. We hypothesize that this stimulatory effect may be induced by mechanical stretching of the dermis, which in turn leads to stretching and activation of dermal fibroblasts. These findings imply that cross-linked hyaluronic acid may be useful for stimulating collagen production therapeutically, particularly in the setting of atrophic skin conditions.
Wang F, Garza LA, Kang S, Varani J, Orringer JS, Fisher GJ, Voorhees JJ
Evaluation of Plasma Skin Regeneration Technology in Low-Energy Full-Facial Rejuvenation
Objective: To evaluate the use of multiple, low-energy, full-face plasma skin regeneration treatments.
Design: Plasma skin regeneration delivers energy to the skin through plasma pulses induced by passing radiofrequency into nitrogen gas. Single-treatment, high-energy, 1-pass treatments have been demonstrated to achieve good results with an excellent safety profile. Eight volunteers underwent full-face treatments every 3 weeks, for a total of 3 treatments, using energy settings of 1.2 to 1.8 J. Before each subsequent treatment, the quality of regenerated epidermis, the degree of downtime, and erythema were recorded. Full-thickness skin biopsy specimens were obtained from 6 patients before treatment and 90 days following the last treatment. Patients were seen for follow-up 4 days after each treatment and 30 and 90 days after the third treatment.
Results: Three months after treatment, investigators found a 37% reduction in facial rhytids and study participants noted a 68% improvement in overall facial appearance. Reepithelialization was complete in 4 days. Patients assessed erythema to persist an average of 6 days after treatment. Epidermal regeneration from the first treatment was longer than from the following treatments (9 vs 4 and 5 days, respectively). One patient developed localized hyperpigmentation after the first treatment, which resolved by follow-up at day 30. No scarring or hypopigmentation occurred. A histologic evaluation 3 months after treatment revealed a band of new collagen at the dermoepidermal junction with less dense elastin in the upper dermis. The mean depth of new collagen was 72.3 μm.
Conclusions: Plasma skin regeneration using the multiple low-energy treatment technique allows significant successful treatment of photodamaged facial skin with minimal downtime. Results are comparable to a single high-energy treatment, but with less healing time.
Bogle MA, Arndt KA, Dover JS
The Impact of Video Games on Training Surgeons in the 21st Century
Background: Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable.
Hypothesis: There is a potential link between video game play and laparoscopic surgical skill and suturing.
Design: Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun). Three different video game exercises were performed, and surveys were completed to assess past experience with video games and current level of play, and each subject's level of surgical training, number of laparoscopic cases performed, and number of years in medical practice.
Setting: Academic medical center and surgical training program.
Participants: Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002.
Main Outcome Measures: The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience.
Results: Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P = .04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P<.001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.
Conclusions: Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.
Rosser JC Jr, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2007;9(3):219. doi: