KGL Skin Study Center

The use of Mohs micrographic surgery as a treatment for melanoma is rising, but the reliability of Mohs surgeons in assessing MART-1 melanoma en-face margins has not been evaluated. To evaluate interrater and intrarater reliability of Mohs surgeons in interpreting margins of early-stage melanoma. Twenty Mohs surgeons were asked to independently review images of frozen section MART-1 en-face peripheral margins of in situ or early-stage melanoma. Surgeons determined margins as positive or negative at initial evaluation and 6 weeks later. Primary outcomes were interrater and intrarater reliability. Interrater agreement was 84.1% (95% confidence interval [CI]: 75.5%-92.8%) for assessment 1 and 87.5% (95% CI: 78.4%-96.4%) for assessment 2, with kappa values 0.68 (95% CI: 0.50-0.82) and 0.75 (95% CI: 0.57-0.88). Average intrarater percent agreement was 95.0% (95% CI: 70.6%-100.0%) with average kappa 0.90 (95% CI: 0.50-1.00). Substantial interrater and nearly perfect intrarater agreement was identified among surgeons assessing melanoma margins utilizing MART-1 immunostaining, demonstrating consistent and reproducible assessment of melanoma margins during Mohs cases.

Lee, Alice1; Palmbach, Joshua1; Durgin, Sandra2; Lozano, Alicia3; Lowenfeld, Adrian1; Pantle, Nicole1; Ratnasekera, Asanthi4 Author Information

The effects of myristyl nicotinate (MN), a nicotinic acid derivative designed to deliver nicotinic acid to skin without vasodilatation, on subjects with photodamaged skin have been studied. MN increased skin cell nicotinamide adenine dinucleotide (NAD) by 25% (P = 0.001) demonstrating effective delivery of nicotinic acid to skin. Relative to placebo, MN treatment of photodamaged facial skin increased stratum corneum thickness by approximately 70% (P = 0.0001) and increased epidermal thickness by approximately 20% (P = 0.001). In two separate studies, MN treatment increased rates of epidermal renewal by 6% (P = 0.003) to 11% (P = 0.001) and increased the minimal erythemal dose by 8.9 (P = 0.07) and 10% (P = 0.05) relative to placebo. MN treatment resulted in reductions in the rates of transepidermal water loss (TEWL) of approximately 20% relative to placebo on cheeks (P = 0.012) and arms (P = 0.017) of study subjects. Results of a tape stripping challenge before and after MN treatment demonstrated a significant correlation (P = 0.03) between increased skin NAD content and resistance to changes in TEWL for MN treated but not placebo subjects. Rates of TEWL changed more rapidly and to a greater extent in atopic subjects compared with normal subjects. The results indicate that MN enhances epidermal differentiation and barrier function in skin, suggesting that this method of nicotinic acid delivery may prove useful in limiting progression of actinic skin damage and possibly in treating other conditions involving skin barrier impairment.

To evaluate the potential to use subatmospheric intrathoracic pressure to regulate intracranial pressure (ICP) in normovolemic and hypovolemic animals, we tested the hypothesis that mechanical devices designed to reduce intrathoracic pressure will decrease ICP in a dose-related manner. An inspiratory impedance threshold device was used in spontaneously breathing animals and an intrathoracic pressure regulator was attached to a positive pressure ventilator and used in apneic animals: both devices lower intrathoracic pressure. Prospective, randomized animal study. Animal laboratory facilities. A total of 36 female farm pigs in four different protocols (n = 12, 6, 12, and 6, respectively). In all protocols, endotracheal, right atrial, central aortic, and ICP were measured continuously. In protocol 1, spontaneously breathing animals were randomized to breath for 15 mins through an impedance threshold device with a cracking pressure of -10 or -15 mm Hg. In protocol 2, after untreated ventricular fibrillation for 4 mins and successful defibrillation to a normal rhythm, spontaneously breathing pigs were used to evaluate the effect of two different impedance threshold device cracking pressures (-10 and -15 mm Hg) on increased ICP. In protocol 3, the acute effects of an intrathoracic pressure regulator on ICP were evaluated in combination with a positive pressure mechanical ventilator in apneic hypovolemic hypotensive pigs after 35% or 50% blood loss. In protocol 4, after 40% blood loss, an intrathoracic pressure regulator was applied for 120 mins and ICP was recorded to determine whether the intrathoracic pressure regulator effects were sustained over time. Inspiratory impedance successfully decreased ICP in spontaneously breathing pigs in a dose-dependent manner and decreased elevated ICP immediately after cardiac arrest and successful resuscitation. The same effect was seen in apneic animals with the use of the intrathoracic pressure regulator. The effect was more pronounced in hypovolemia, and it was sustained for >/=2 hrs. Reduction of intrathoracic pressure to subatmospheric levels resulted in an instantaneous and sustained reduction in ICP in spontaneously breathing and apneic animals. The effect was most pronounced in the hypovolemic animals.

Glycolic acid (GA), an alpha-hydroxy acid, (AHA) has been widely used in a large number of cosmetics products for daily use over long periods of time (Andersen, 1998). Sustained by the quest for a youthful appearance, the use of AHA's in skin care products has increased dramatically in the last decade. These products claim to reduce wrinkles, spots and other signs of aging (Van Scott, 1989). There is little information available to date about their long-term effects. One of the important question relates to the acute and chronic effects of AHA's on the sensitivity of human skin to sun exposure. This study was conducted to investigate the effects of GA, applied in a cosmetic formulation, in modifying UV-sensitivity, and to determine whether the effect was reversible after discontinuing GA applications.