Call for Authors
This edition of FP EssentialsTM will cover recent updates in dermatology procedures. The content should include: dermoscopy and other in-office imaging methods; dermabrasion and chemical peels; excision techniques; and laser procedures. The content should emphasize new relevant and evidence-based literature rather than provide a general review of the 4 topics.
The manuscript should be approximately 10,000 words in length, divided into 4 sections of approximately 2,500 words each (corresponding to the topics above). Each section should include an abstract of 150 to 200 words. The manuscript should also include key practice recommendations, a maximum of 15 tables and figures, recommended reading, and a reference list of 100 to 130 citations. High-resolution photographs may be included.
This edition should focus on what is new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to the examples provided, with modifications to emphasize key points; each case should have a conclusion that demonstrates resolution of the clinical situation. The references suggested here include information that should be considered in preparation of this manuscript for FP Essentials. However, these references are only a useful starting point that should be used to identify additional information to review.
Section 1: Dermoscopy
Example case: Victor, a 69-year-old white man, presents with a dark-colored skin lesion. His father had melanoma, so he is concerned about it. On examination, the lesion is 6 mm in diameter with dark coloration and irregular borders. The lesion appears suspicious for melanoma, and you decide to examine it with a dermatoscope.
Key questions to consider:
- What is a dermatoscope?
- In what settings and for what types of lesions is dermoscopy useful?
- How does dermoscopy affect diagnostic accuracy?
- How does dermoscopy affect the percentage of lesions excised?
- What kind of training is needed to become proficient in dermoscopy?
- How do family physicians compare with dermatology subspecialists in diagnostic accuracy with a dermatoscope?
- Is dermoscopy considered the standard of care such that it is inappropriate to evaluate suspicious skin lesions without a dermatoscope?
- What factors should be considered in purchasing a dermatoscope? What determines the quality of a dermatoscope?
- What are the Stolz criteria for follicular invasion, and in what settings are they used?
- What are the Menzies method; the epiluminescence microscopy (ELM) 7-point checklist; and the asymmetry, border irregularity, color variation, and diameter greater than 6 mm (ABCD) method? How do these rating systems compare in terms of sensitivity and specificity for diagnosing melanoma? Does dermoscopy enhance the accuracy of these systems?
- When is digital dermoscopy used? How is it different from standard dermoscopy?
- Is dermoscopy reimbursed? How expensive is it for a family physician to buy and maintain equipment?
Initial references to consider:
- van der Rhee JI, Bergman W, Kukutsch NA. Impact of dermoscopy on the management of high-risk patients from melanoma families: a prospective study. Acta Derm Venereol. 2011;91(4):428-431.
- Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-676.
- Dummer R, Hauschild A, Guggenheim M, Jost L, Pentheroudakis G; ESMO Guidelines Working Group. Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5)(Suppl 5):v194-v197.
- Rosendahl C, Cameron A, Argenziano G, Zalaudek I, Tschandl P, Kittler H. Dermoscopy of squamous cell carcinoma and keratoacanthoma. Arch Dermatol. 2012;148(12):1386-1392.
- Giacomel J, Lallas A, Argenziano G, et al. Dermoscopy of basosquamous carcinoma. [Epub ahead of print]. Br J Dermatol. 2013;169(2):358-364. 10.1111/bjd.12394.
- Karadağ Köse Ö, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012;67(2):206-214.
- Herschorn A. Dermoscopy for melanoma detection in family practice. Can Fam Physician. 2012;58(7):740-745, e372-e378.
- Tromme I, Sacré L, Hammouch F, et al.; DEPIMELA study group. Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study. Br J Dermatol. 2012;167(4):778-786.
- Burroni M, Wollina U, Torricelli R, et al. Impact of digital dermoscopy analysis on the decision to follow up or to excise a pigmented skin lesion: a multicentre study. Skin Res Technol. 2011;17(4):451-460.
- Dolianitis C, Kelly J, Wolfe R, Simpson P. Comparative performance of 4 dermoscopic algorithms by nonexperts for the diagnosis of melanocytic lesions. Arch Dermatol. 2005;141(8):1008-1014.
- Stolz W, Schiffner R, Burgdorf WH. Dermatoscopy for facial pigmented skin lesions. Clin Dermatol. 2002;20(3):276-278.
- Argenziano G, Soyer HP, Chimenti S, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003;48(5):679-693.
- Menzies SW, Emery J, Staples M, et al. Impact of dermoscopy and short-term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: a sequential intervention trial. Br J Dermatol. 2009;161(6):1270-1277.
Initial website to consider:
- International Dermoscopy Society. Available at http://dermoscopy.telederm.org(dermoscopy.telederm.org).
Section 2: Dermabrasion and Chemical Peels
Example case: Leah, a 23-year-old healthy white woman, presents to discuss options for her skin. She has a history of severe acne and now has multiple facial scars. She wants to know what can be done to improve her skin, and how to choose among procedures.
Key questions to consider:
- What is dermabrasion? How is it performed?
- What are the cosmetic indications for dermabrasion? Are there any medical indications?
- What are the contraindications for dermabrasion?
- How effective is dermabrasion in treating the conditions for which is it used? Do patients with particular skin types benefit from dermabrasion more than others?
- What are the potential side effects and complications of dermabrasion? How are these complications treated? Is it safe to be exposed to the sun after dermabrasion?
- Which adjunctive agents or procedures are used with dermabrasion?
- What is a chemical peel?
- What are the cosmetic indications for chemical peels? Are there any medical indications?
- What are the contraindications for chemical peels?
- Which products commonly are used for chemical peels? Are there new formulations?
- Does the agent used differ by skin type?
- How effective are chemical peels in treating the conditions for which they are used?
- What are the potential side effects and complications of chemical peels? How are these complications treated? Is it safe to be exposed to the sun after a chemical peel?
- Which types of chemical peels can be administered by an aesthetician, and which must be administered by a physician? What is an aesthetician?
- What are the typical charges for dermabrasion and chemical peels? Are they covered by health insurance plans?
- What kind of training is necessary for a physician to become proficient in performing dermabrasion and chemical peels? Where can that training be obtained?
Initial references to consider:
- Picosse FR, Yarak S, Cabral NC, Bagatin E. Early chemabrasion for acne scars after treatment with oral isotretinoin. Dermatol Surg. 2012;38(9):1521-1526.
- Levy LL, Zeichner JA. Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 2012;13(5):331-340.
- Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg. 2010;36(4):483-489.
- Garg T, Chander R, Jain A. Combination of microdermabrasion and 5-fluorouracil to induce repigmentation in vitiligo: an observational study. Dermatol Surg. 2011;37(12):1763-1766.
- Awad SS. Dermabrasion may repigment vitiligo through stimulation of melanocyte precursors and elimination of hyperkeratosis. J Cosmet Dermatol. 2012;11(4):318-322.
- Vázquez-Martínez OT, Martínez-Rodríguez HG, Velásquez-Arenas L, et al. Treatment of vitiligo with a melanocyte-keratinocyte cell suspension versus dermabrasion only: a pilot study with a 12-month follow up. J Drugs Dermatol. 2011;10(9):1032-1036.
- Quezada N, Machado Filho CA, De La Sotta P, Uribe P. Melanocytes and keratinocytes transfer using sandpaper technique combined with dermabrasion for stable vitiligo. Dermatol Surg. 2011;37(2):192-198.
- Samuel M, Brooke RC, Hollis S, Griffiths CE. Interventions for photodamaged skin. Cochrane Database Syst Rev. 2005;(1):CD001782.
- Levesque A, Hamzavi I, Seite S, Rougier A, Bissonnette R. Randomized trial comparing a chemical peel containing a lipophilic hydroxy acid derivative of salicylic acid with a salicylic acid peel in subjects with comedonal acne. J Cosmet Dermatol. 2011;10(3):174-178.
- Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. 2010;12(5):242-245.
- Handog EB, Datuin MS, Singzon IA. Chemical peels for acne and acne scars in Asians: evidence-based review. J Cutan Aesthet Surg. 2012;5(4):239-246.
- Kumari R, Thappa DM. Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma. Indian J Dermatol Venereol Leprol. 2010;76(4):447.
- Kim WS. Efficacy and safety of a new superficial chemical peel using alpha-hydroxy acid, vitamin C and oxygen for melasma. J Cosmet Laser Ther. 2013;15(1):21-24.
- Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol. 2011;10(4):317-323.
- Cohen JL, Makino E, Sonti S, Mehta R. Synergistic combination of an in-office procedure and home regimen for the treatment of facial hyperpigmentation. J Clin Aesthet Dermatol. 2012;5(4):33-35.
- Sobhi RM, Sobhi AM. A single-blinded comparative study between the use of glycolic acid 70% peel and the use of topical nanosome vitamin C iontophoresis in the treatment of melasma. J Cosmet Dermatol. 2012;11(1):65-71.
- Perić S, Bubanj M, Bubanj S, Jančić S. Side effects assessment in glycolic acid peelings in patients with acne type I. Bosn J Basic Med Sci. 2011;11(1):52-57.
- Nikalji N, Godse K, Sakhiya J, Patil S, Nadkarni N. Complications of medium depth and deep chemical peels. J Cutan Aesthet Surg. 2012;5(4):254-260.
Section 3: Excision Techniques
Example case: Jeff, a 55-year-old white man, presents for a physical. On examination, a dark lesion is found on the dorsum of the left forearm. The lesion is 7 mm in diameter, with an irregular edge and several different colors. To rule out melanoma, you decide to excise the lesion.
Key questions to consider:
- What are the options for excising a skin lesion? When should one option be used versus another?
- For what types of lesions would a shave, punch, or incisional biopsy be appropriate or inappropriate, based on examination?
- Which measures will reduce scarring in full-thickness excisions and other excision techniques?
- When should a patient be referred to a dermatology subspecialist or a plastic surgeon for excision of a skin lesion?
- When is Mohs surgery indicated rather than excision?
- When performing a full-thickness excision, when are deep sutures indicated? What sutures and suture material should be used for this procedure?
- Which closures provide the best outcomes?
- When can skin adhesives be used? When can staples be used?
- How long after an excision should sutures be removed?
- How large should the margin be for a benign lesion? How large should the margin be for a lesion suspicious for melanoma?
- Are postoperative topical antimicrobials effective in preventing infections or reducing scarring?
- How does wound healing differ based on nevus removal technique?
Initial references to consider:
- Fife DJ, Alam M. Alternative techniques for reduction of scar length during staged excision. J Am Acad Dermatol. 2011;65(4):811-818.
- Delaney EK, Duckworth L, Thompson WD, Lee AJ, Murchie P. Excising squamous cell carcinomas: comparing the performance of GPs, hospital skin specialists and other hospital specialists. Fam Pract. 2012;29(5):541-546.
- Kim P, Kim HJ. S-plasty—clinical applications for skin surgery. Aust Fam Physician. 2011;40(4):224-225.
- Lee TS, Murakami CS, Suryadevara AC. Tissue conservation using circular defect with dog-ear deformities excision technique. Laryngoscope. 2011;121(11):2299-2304.
- Zhu JW, Wu XJ, Lu ZF, Cai SQ, Zheng M. Purse-string suture for round and oval defects: a useful technique in dermatologic surgery. J Cutan Med Surg. 2012;16(1):11-17.
- Deerenberg EB, Goyen HJ, Kaufmann R, Jeekel J, Munte K. A novel foil flip-over system as the final layer in wound closure: excellent cosmetic results and patient comfort. Dermatol Surg. 2012;38(11):1829-1834.
- Sladden MJ, Balch C, Barzilai DA, et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev. 2009;(4):CD004835.
- Kunishige JH, Brodland DG, Zitelli JA. Surgical margins for melanoma in situ. J Am Acad Dermatol. 2012;66(3):438-444.
- Eidelman A, Weiss JM, Baldwin CL, Enu IK, McNicol ED, Carr DB. Topical anaesthetics for repair of dermal laceration. Cochrane Database Syst Rev. 2011;(6):CD005364.
- Sheth VM, Weitzul S. Postoperative topical antimicrobial use. Dermatitis. 2008;19(4):181-189.
- Andrew R, Luecke G, Dozier S, Diven DG. A pilot study to investigate the efficacy of tobramycin-dexamethasone ointment in promoting wound healing. Dermatol Ther (Heidelb). 2012;2(1):12.
Section 4: Laser Procedures
Example case: Rebecca, a 36-year-old white woman, presents with dark spots on her face. The coloration started during a pregnancy, 2 years ago, and has persisted unchanged. She has tried multiple creams and ointments, such as tretinoin and onion extract products, with no improvement.
Key questions to consider:
- What is laser surgery?
- What types of skin conditions can be treated with laser procedures? Are they all cosmetic conditions, or are there medical indications?
- What are the indications and contraindications for use of dermatological laser therapy?
- How do these vary based on skin type?
- What are the advantages of laser therapy compared with other skin procedures? What are the disadvantages?
- What are the different types of lasers used for office-based skin treatment? How do the various types of lasers differ, and how does this affect the indications for use?
- What is fractional laser resurfacing?
- What side effects or complications occur due to laser therapy?
- What are the effects of laser treatment on facial scars?
- What adjunctive treatments are used with laser therapy?
- Which indications for laser surgery of the skin are covered by health insurance plans?
- How much does a laser unit cost? Does it make sense financially or medically for a family physician to perform laser skin procedures?
Initial references to consider:
- Ibrahimi OA, Bangash H, Green L, Alam M, Armstrong AW, Eisen DB. Perceptions of expertise in cutaneous surgery and cosmetic procedures: what primary care physicians think. Dermatol Surg. 2012;38(10):1645-1651.
- Tierney EP, Hanke CW. Fractionated carbon dioxide laser treatment of photoaging: prospective study in 45 patients and review of the literature. Dermatol Surg. 2011;37(9):1279-1290.
- Kauvar AN. Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers. Lasers Surg Med. 2012;44(2):117-124.
- Whitton ME, Pinart M, Batchelor J, Lushey C, Leonardi-Bee J, González U. Interventions for vitiligo. Cochrane Database Syst Rev. 2010;(1):CD003263.
- Yang C, Liu S, Yang S. Treatment of facial recalcitrant verruca vulgaris with holmium: YAG laser: an update. J Cosmet Laser Ther. 2013;15(1):39-41.
- Naein FF, Soghrati M. Fractional CO2 laser as an effective modality in treatment of striae alba in skin types III and IV. J Res Med Sci. 2012;17(10):928-933.
- Verhaeghe E, Ongenae K, Bostoen J, Lambert J. Nonablative fractional laser resurfacing for the treatment of hypertrophic scars: a randomized controlled trial. Dermatol Surg. 2013;39(3 Pt 1):426-434.
- Kessels JP, Hamers ET, Ostertag JU. Superficial hemangioma: pulsed dye laser versus wait-and-see. Dermatol Surg. 2013;39(3 Pt 1):414-421.
- Luo YJ, Xu XG, Wu Y, et al. Split-face comparison of ultrapulse-mode and superpulse-mode fractionated carbon dioxide lasers on photoaged skin. J Drugs Dermatol. 2012;11(11):1310-1314.
- Trelles MA, Mordon S, Velez M, Urdiales F, Levy JL. Results of fractional ablative facial skin resurfacing with the erbium:yttrium-aluminium-garnet laser 1 week and 2 months after one single treatment in 30 patients. Lasers Med Sci. 2009;24(2):186-194.
- Spandau DF, Lewis DA, Somani AK, Travers JB. Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin. J Invest Dermatol. 2012;132(6):1591-1596.
- Zhang RN, Wang DK, Zhuo FL, Duan XH, Zhang XY, Zhao JY. Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J (Engl). 2012;125(18):3288-3291.
- Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed. 2012;28(3):133-136.
- Hedelund L, Haak CS, Togsverd-Bo K, Bogh MK, Bjerring P, Haedersdal M. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation. Lasers Surg Med. 2012;44(6):447-452.
- Faurschou A, Olesen AB, Leonardi-Bee J, Haedersdal M. Lasers or light sources for treating port-wine stains. Cochrane Database Syst Rev. 2011;(11):CD007152.
- Funayama E, Sasaki S, Furukawa H, et al. Effectiveness of combined pulsed dye and Q-switched ruby laser treatment for large to giant congenital melanocytic naevi. Br J Dermatol. 2012;167(5):1085-1091.
- AlNomair N, Nazarian R, Marmur E. Complications in lasers, lights, and radiofrequency devices. Facial Plast Surg. 2012;28(3):340-346.
- Jalian HR, Jalian CA, Avram MM. Common causes of injury and legal action in laser surgery. JAMA Dermatol. 2013;149(2):188-193.
- Shin JU, Park J, Oh SH, Lee JH. Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial. Dermatol Surg. 2013;39(3 Pt 1):435-442.