NRAS Q61R and BRAF G466A Mutations in Atypical Melanocytic Lesions Newly Arising in Advanced Melanoma Patients Treated with Vemurafenib

Background

BRAF inhibition has improved overall survival in patients with BRAF mutant melanoma but this is associated with a range of known and predictable cutaneous side effects, including squamous cell carcinomas associated with RAS mutations.

Methods

We identified three severely dysplastic nevi, one atypical intraepidermal melanocytic proliferation, and four melanoma in situ lesions, newly arising in four patients undergoing treatment with vemurafenib. To characterize mutations in these atypical melanocytic lesions, we used a custom iPlex panel detecting 74 mutations in 13 genes known to play a role in melanoma pathogenesis.

Results

We identified an NRAS mutation at codon 61 (Q61R) and a rare BRAF exon 11 mutation (G466A) in atypical melanocytic lesions that arose in patients treated with vemurafenib.

Conclusions

There appears to be development or accelerated growth of atypical melanocytic lesions in the setting of BRAF inhibition. Our results underscore the need for careful surveillance for melanocytic lesions in patients on BRAF inhibitor therapy and shed light on potential mechanisms for melanoma pathogenesis in the context of BRAF pathway blockade. Further studies are warranted to demonstrate a causal relationship.

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Experiences of Dermatologic Surgeons With the Sunshine Act: A National Survey

No abstract available

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Incidence, Risk Factors, Progression, and Treatment of Endovenous Heat-Induced Thrombosis Class 2 or Greater After Endovenous Radiofrequency Ablation

BACKGROUND Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA). OBJECTIVE To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA. MATERIALS AND METHODS This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT. RESULTS A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037). CONCLUSION The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism. Address correspondence and reprint requests to: Nuttawut Sermsathanasawadi, MD, PhD, Division of Vascular Surgery, Department of Surgery Faculty of Medicine Siriraj Hospital, Mahidol University 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand, or e-mail: nuttawut@gmail.com Supported by a grant from the Siriraj Research Development Fund (managed by Routine to Research: R2R), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Discrepancy Between Online Images of Mohs Surgery and Reality: An Opportunity for Improvement

No abstract available

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The “Sketch, Etch, and Sketch” Approach to Improve Accuracy and Durability of Surgical Skin Markings: Surgical Pearl

No abstract available

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A Survey of Mohs Tissue Tracking Practices

BACKGROUND There are little data regarding error within the multistep process of Mohs micrographic surgery (MMS). OBJECTIVE A survey of Mohs surgeons was performed to evaluate variation in tissue handling and processing within the MMS process. METHODS AND MATERIALS A 9-question electronic survey was distributed to members of the American College of Mohs Micrographic Surgery. A total of 97 responses were analyzed. RESULTS Most surgeons personally transport the tissue (71.1%), most frequently in a specimen container (54.6%). Method of tissue identification during transportation varied significantly. Most surgeons personally hand-draw the map (77.1%). A diagram was most commonly used to convey tissue orientation to the histotechnician (65.4%). Only 31.3% of histotechnicians used labeling of blocks to identify tissue within the cryostat. Most respondents (72.2%) are the only surgeon processing tissue in the laboratory at one time; however, 28.9% reported performing 10 or more cases per day. CONCLUSION Most respondents are responsible for tissue transport and mapping, which likely reduces potential error. However, the method of transport and labeling, as well as identification by the histotechnician, was more variable. Ultimately, having a consistent process and clear communication with personnel will help reduce potential error during Mohs surgery. Address correspondence and reprint requests to: Jessica B. Dietert, MD, 505 W Louis Henna Blvd, Suite 200, Austin, TX 78728, or e-mail: nikkidietert@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Clinical Evaluations of a Novel Thread Lifting Regimen Using Barbed Polyglyconate Suture for Facial Rejuvenation: Analysis Using a 3-Dimensional Imaging System

BACKGROUND Thread lifting with absorbable sutures has recently gained prominence for rejuvenating ptotic and sagging soft tissues in aging face. A barbed, delayed absorbable polyglyconate monofilament shows significantly high tensile loads with superior flexibility and elasticity. OBJECTIVE To evaluate the safety and efficacy of novel thread lifting regimen with barbed polyglyconate suture for counteracting the descent and laxity of the aging face. METHODS A retrospective chart review was conducted for 25 Korean patients with mild to moderate facial skin laxity receiving thread lifting procedures using barbed polyglyconate suture. Dermatologists' objective assessments using a 5-point Global Aesthetic Improvement Scale (GAIS), 3D imaging system, and subjective satisfaction were recorded at baseline and 4 months after treatments. RESULTS In most patients (84%), GAIS scores were more than score 3 ("improved"), with 40% of score 4 ("much improved") and 24% of score 5 ("excellent") at the follow-up point. Subjective assessments paralleled these patterns. Three-dimensional analysis quantitatively showed volume migration of low face upward, clinically interpreted as facial lifting. No serious adverse effect was observed. CONCLUSION This novel thread lifting procedure using barbed polyglyconate suture is a safe and effective method for tightening and lifting for aging face with mild to moderate face sagging. Address correspondence and reprint requests to: Jae Yoon Jung, MD, Oaro Dermatology Clinic, 507, Nohaero, Nowongu, Seoul 01695, Republic of Korea, or e-mail: jaeyoon007@hanmail.net The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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