Combination of 1,064-nm Neodymium-doped Yttrium Aluminum Garnet Laser and Steroid Tape Decreases the Total Treatment Time of Hypertrophic Scars: An Analysis of 40 Cases of Cesarean-Section Scars BACKGROUND The 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Cutera, Inc., Brisbane, CA) and steroid tape (fludroxycortide tape) have been used to treat keloids and hypertrophic scars. OBJECTIVE To evaluate the efficacy of contact-mode 1,064-nm Nd:YAG laser therapy and steroid tape for hypertrophic cesarean-section scars versus conservative therapy (steroid tape only). MATERIALS AND METHODS A medical record review identified 40 consecutive Japanese patients who had hypertrophic scars (total Japan Scar Workshop Scar Scale [JSS] 2015 evaluation scores of 9 to 12) for more than 1 year after a vertical cesarean section and who were treated at our scar-specialist clinic from July 2015 to December 2017. All 40 patients continued treatment until the total JSS score dropped below 3. Recurrence was defined as a ≥1-point increase in the total JSW score 6 months after achieving a total JSS score <3. RESULTS The patients had a mean age of 34.2 years. The test (n = 25) and control (n = 15) groups took on average 16.9 and 24.3 months to achieve a total JSS score <3, respectively (p < .01). In the following 6 months, none of the scars recurred. CONCLUSION Nd:YAG laser treatment effectively decreased the total treatment time of hypertrophic cesarean-section scars. An algorithm for treating mild and severe hypertrophic cesarean-section scars is proposed. Address correspondence and reprint requests to: Rei Ogawa, MD, PhD, FACS, Department of Plastic and Reconstructive Surgery, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan, or e-mail: r.ogawa@nms.ac.jp The authors have indicated no significant interest with commercial supporters. Online date: November 5, 2019 © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Tailored Repair of Extensive Eyebrow Defect No abstract available

Keratinocyte Carcinoma Mortality in the United States as Reported in Death Certificates, 2011–2017 BACKROUND Keratinocyte carcinoma (KC) mortality is relatively modest and its measures are subject to considerable error. Deaths due to KC have been decreasing through 2000 and were relatively stable until 2010. OBJECTIVE To estimate the KC mortality rates (MRs) from 2011 to 2017 in USA based on death certificates. METHODS A population-based analysis of Center of Disease Control and Prevention data. Main outcomes and measures were the age-adjusted (US 2000 standard population) MRs. RESULTS Overall, KC MRs increased significantly (b = 0.04, p < .01). For the period studied, KC MR was 1.24 per 100,000 persons per year (0.62 for sun-exposed sites, 0.38 for genital and 0.23 for perianal sites). At sun-exposed genital and perianal anatomic sites, KC MRs have been increasing in whites, but not in blacks. CONCLUSION There was a 17% decrease in the KC MRs until 2000, followed by an increase of 44% through 2017. The accuracy of KC MRs is uncertain. If indeed the increase in mortality is verified, causes may include an increase in KC incidence, an increase of immunosuppressed populations, and changes in the cause of death documentation. Address correspondence and reprint requests to: Angelica Misitzis, MD, Department of Dermatology, Attiko Hospital, Rimini 1, Chaidari 124 62, Greece, or e-mail: angelicamisitzi@gmail.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Racial and Ethnic Differences in Self-Assessed Facial Aging in Women: Results From a Multinational Study BACKGROUND Racial/ethnic variations in skin structure and function may contribute to differential manifestations of facial aging in various races/ethnicities. OBJECTIVE To examine self-assessed differences in facial aging in women by race/ethnicity and Fitzpatrick skin phototypes. METHODS Women aged 18 to 75 years in the United States, Canada, the United Kingdom, and Australia compared their features against photonumeric rating scales depicting degrees of severity for 10 facial aging characteristics. Impact of race/ethnicity (black, Hispanic, Asian, and Caucasian) and skin phototypes on severity was assessed. RESULTS In total, 3,267 women completed the study. Black women reported the least severe facial aging; Caucasian women reported the most severe facial aging, with Asian and Hispanic women falling between these groups. Similarly, women with a skin phototype V/VI reported lesser aging severity than women with phototypes I through IV. More than 30% of black women did not report the presence of moderate/severe aging of facial areas until 60 to 79 years; most Hispanics and Asians did not report moderate/severe facial aging until 50 to 69 years and Caucasians, 40 to 59 years. CONCLUSION In this diverse sample, black women reported less severe aging of facial features compared with Hispanic, Asian, and Caucasian women. These results were supported by Fitzpatrick skin phototype analyses. Address correspondence and reprint requests to: Julie K. Garcia, PhD, Allergan plc, 2525 Dupont Drive, Irvine, CA 92612, or e-mail: Garcia_Julia@Allergan.com Supported by Allergan plc. Editorial support was provided by Peloton Advantage, Parsippany, New Jersey, and was funded by Allergan plc. A.F. Alexis serves as an investigator and has served on advisory boards for Allergan and Galderma. P. Grimes is an advisory board member for Allergan plc and serves as an investigator for Allergan plc, Galderma, and Valeant. C. Boyd serves on an advisory board and speakers' bureau for Allergan plc. J. Downie serves as a consultant for Pfizer. A. Drinkwater serves as a medical writer for Peloton Advantage, LLC, which receives funding for editorial services from Allergan plc. J.K. Garcia is an employee of Allergan plc and may own stock in that company. C.J. Gallagher was an employee of Allergan plc at the time of this study. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Prognostic Factors, Treatment, and Survival in Primary Cutaneous Mucinous Carcinoma: A SEER Database Analysis BACKGROUND Limited information exists on the demographics, tumor characteristics, and treatment in primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE The authors sought to describe prognostic factors, incidence rates, and the subsequent primary malignancy (SPM) risk in patients with PCMC. METHODS Primary cutaneous mucinous carcinoma cases in the National Cancer Institute's Surveillance, Epidemiology, and End Results data (1972–2013) were analyzed to provide demographic, cancer-related, and treatment information and to calculate incidence and mortality. Patients were stratified by stage (local, regional, distant disease) for comparison. The risk of developing an SPM was calculated. RESULTS Four hundred eleven PCMC cases were identified. The age-adjusted incidence was 0.04 cases per 100,000-person years. Blacks were disproportionately affected by PCMC (0.048; 95% confidence interval, 0.034–0.065; p < .001). Approximately 67.4% of patients had local disease, 10.5% had regional disease, and 5.8% had distant disease. Primary cutaneous mucinous carcinoma–specific mortality was independent of sex, age, race, primary site, histologic tumor grade, tumor size, tumor stage, or treatment. The overall frequency of developing a second primary malignancy was not increased in patients with PCMC. CONCLUSION Although PCMC occurs with equally in both sexes, it may be more common in African Americans than previously recognized. Although eyelid PCMC may have a higher rate of distant metastasis, all patients need close follow-up. Address correspondence and reprint requests to: Thomas J. Knackstedt, MD, Department of Dermatology, MetroHealth Hospital, 2500 Metrohealth Drive, Cleveland, OH 44109, or e-mail: Thomas.j.knackstedt@gmail.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

The Use of Intralesional Sodium Thiosulfate to Dissolve Facial Nodules From Calcium Hydroxylapatite No abstract available

Extramammary Paget's Disease: A Review of the Literature Part II: Treatment and Prognosis BACKGROUND Extramammary Paget's disease (EMPD) is a rare malignancy with unclear pathophysiology that occurs predominantly on apocrine-rich skin. Surgery is the treatment of choice; however, procedures tend to be extensive and associated with a high rate of recurrence. OBJECTIVE To review the current literature on EMPD regarding treatment and prognosis. MATERIALS AND METHODS Literature review using PubMed search for articles related to EMPD. RESULTS Extramammary Paget's disease classically presents as a slowly growing red plaque, which often mimics an inflammatory condition leading to significant delay in diagnosis. Diagnosis requires histopathologic examination and is often supported by immunohistochemical analysis. Once a diagnosis of EMPD is made, the patient must be risk-stratified and evaluated for an underlying malignancy. CONCLUSION Standard of treatment is surgery, with data suggesting that Mohs micrographic surgery may have superior clinical outcomes and lower recurrence rates. Alternatives such as photodynamic therapy and topicals have been explored and may be appropriate in certain situations. Patients with EMPD generally have a good prognosis with a 5-year overall survival rate of 75% to 95%. Address correspondence and reprint requests to: Eva A. Hurst, MD, Dermatologic Surgery, 969 N Mason Road, Suite 200, St. Louis, MO 63141, or e-mail: hurste@wustl.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Anatomy Behind the Facial Overfilled Syndrome: The Transverse Facial Septum BACKGROUND The midface is an area of high demand for minimally invasive cosmetic procedures, that is, soft-tissue filler injections. OBJECTIVE To investigate the functional anatomy behind the facial overfilled syndrome observed after soft-tissue filler injections. MATERIALS AND METHODS The clinical part of the study enrolled 25 volunteers (12 men and 13 women, Caucasians); the anatomical part included 72 fresh frozen cephalic specimens obtained from 32 male and 40 female body donors. 3D surface scanning procedures were applied to calculate the maximal anterior projection of the midface. RESULTS Upon smiling, the point of maximal anterior projection shifted cranially in men by 12.43 ± 8.8 mm (difference between resting and smiling; p < .001) and by 8.75 ± 4.1 mm in women (p < .001). Cadaveric dissections identified a septum originated from the underside of the zygomaticus major muscle forming a transversely running boundary between the buccal space and the deep midfacial fat compartments. CONCLUSION Facial overfilled syndrome can potentially be explained by the presence of the transverse facial septum. Dynamic filling—injecting small amounts of filler and asking the patient to smile repeatedly during the procedure—seems to be a viable way to avoid this adverse event during soft-tissue filler injection. Address correspondence and reprint requests to: Sebastian Cotofana, MD, PhD, Albany Medical College, 47 New Scotland Avenue MC-135, Albany, NY 12208, or e-mail: cotofas@amc.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

A Review of the Use of Telemedicine in Dermatologic Surgery BACKGROUND Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery. OBJECTIVE To provide a review of the applications of telemedicine within dermatologic surgery. MATERIALS AND METHODS A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology. RESULTS The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care. CONCLUSION For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice. Address correspondence and reprint requests to: Grace K. Sohn, MD, Department of Dermatology, Stanford University, 450 Broadway Street, Pavilion C, 2nd Floor, MC5334, Redwood City, CA 94063, or e-mail: gksohn@gmail.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Single-Sling Island Pedicle Flap With Bilevel Undermining for Repair of Superior Helical Rim Defects No abstract available