Practical Dermatologic Surgery Practical Dermatologic Surgery Edited by Richard G. Bennett, MD Departments of Dermatology University of California, Los Angeles and University of Southern California Los Angeles, CA USA First edition published 2022 by CRC Press 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN and by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 © 2022 Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, LLC This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibil- ity or liability for any errors or omissions that may be made. 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For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact [email protected] Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identi- fication and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Bennett, Richard G., editor. Title: Practical dermatologic surgery / edited by Richard G. Bennett. Description: First edition. | Boca Raton : CRC Press, 2021. | Includes bibliographical references and index. | Summary: “Covering the full range of dermatologic surgery, this text will be essential reading for residents in dermatology, family practice, and surgical specialties needing to review a topic in detail. Each chapter is in brief, with tables, line drawings, and the essential references, offering an authoritative and up-to-date guide”-- Provided by publisher. Identifiers: LCCN 2021011682 (print) | LCCN 2021011683 (ebook) | ISBN 9780367511050 (paperback) | ISBN 9780367511098 (hardback) | ISBN 9781003052432 (ebook) Subjects: MESH: Dermatologic Surgical Procedures Classification: LCC RD520 (print) | LCC RD520 (ebook) | NLM WR 670 | DDC 617.4/77059--dc23 LC record available at https://lccn.loc.gov/2021011682 LC ebook record available at https://lccn.loc.gov/2021011683 ISBN: 978-0-367-51109-8 (hbk) ISBN: 978-0-367-51105-0 (pbk) ISBN: 978-1-003-05243-2 (ebk) Typeset in Times LT Std by KnowledgeWorks Global Ltd. For beautiful Lisa & our wonderful daughters Didi & Amelie Contents Preface ......................................................................................................................................................ix Acknowledgments .....................................................................................................................................xi List of Contributors .................................................................................................................................xiii Section I Dermatologic Surgery Background 1. History of Dermatologic Surgery ...................................................................................................3 Richard G. Bennett and Danielle Urman 2. Preoperative Evaluation and Avoiding Surgical Problems .........................................................11 Elisabeth K. Shim 3. Benign Skin Lesions ......................................................................................................................21 Hina Ahmad 4. Pre-malignant and Malignant Skin Lesions ...............................................................................29 Steven Chow 5. Skin Biopsy Techniques ..................................................................................................................41 Silvina Pugliese, Tanya Nino, and Abel Torres Section II Dermatologic Surgery Basics 6. Wound Healing ...............................................................................................................................49 Teresa Soriano 7. Anatomy ..........................................................................................................................................57 Allison Hanlon 8. Electrosurgery ................................................................................................................................71 Austin Liu and Naomi Lawrence 9. Dressings and Their Effects on Wound Healing .........................................................................79 Ronald G. Wheeland 10. Basic Suturing and Excision Techniques .....................................................................................89 Kapila V. Paghdal and Murad Alam 11. Nail Unit Surgery .........................................................................................................................107 Michael Xiong and Richard G. Bennett vii viii Contents Section III Reconstructive Dermatologic Surgery 12. Skin Grafts ....................................................................................................................................127 Ken K. Lee 13. Cutaneous Flaps ............................................................................................................................135 Jonathan L. Cook 14. Mohs Micrographic Surgery ........................................................................................................143 Manish Gharia and Brittany Ahuja Section IV Cosmetic Dermatologic Surgery 15. Neurotoxins ....................................................................................................................................153 Alastair Carruthers and Jean Carruthers 16. Soft Tissue Fillers .........................................................................................................................159 Jeanette M. Black and Derek H. Jones 17. Chemical Peeling ...........................................................................................................................169 Gary D. Monheit 18. Lasers..............................................................................................................................................175 Lisa Y. Xu and Mathew M. Avram 19. Sclerotherapy and Endovenous Ablation ....................................................................................187 Mitchel P. Goldman 20. Tumescent Liposuction ................................................................................................................193 William P. Coleman III and Kyle Coleman 21. Hair Transplantation ...................................................................................................................199 Paul McAndrews 22. Miscellaneous Procedures: Intense Pulsed Light, Photodynamic Therapy, Cryotherapy, Cryolipolysis, Microdermabrasion, Salabrasion, Dermabrasion, Microneedling, Radiofrequency, and Ultrasound.....................................................................207 Jennifer A. Ledon and Richard G. Bennett Index .......................................................................................................................................................215 Preface During the latter 20th century, a renaissance of dermatologic surgery occurred. Although dermatolo- gists were initially at the forefront of skin surgical techniques in the early days of their specialty around 1900, a lag (1920–1975) ensued during which surgery became dormant in dermatology; at that time dermatology evolved into a medical rather than a surgical specialty. Fortunately in 1975, the first surgical journal in dermatology, the Journal of Dermatologic Surgery, appeared and has been published continu- ously ever since. There are now over 80 fellowships in Mohs Micrographic Surgery and Dermatologic Oncology overseen by the Accreditation Council for Graduate Medical Education (ACGME) and over 20 cosmetic dermatology fellowships overseen by the American Society for Dermatologic Surgery. Thus, almost one-quarter of dermatology residents take a 1-year surgical specialty fellowship after residency. Many of the innovations in skin surgery that are now widely accepted were pioneered by dermatolo- gists. For instance, hair transplantation, dermabrasion, and laser surgery were all first used by derma- tologists. Perhaps the greatest contribution to skin surgery has been the development and expansion of Mohs micrographic surgery, which is a surgical/pathological technique for removing skin cancer. Many unique reconstructive techniques have been developed by dermatologic surgeons to close wounds after skin cancer removal. In addition, because dermatologists are required to have extensive pathology train- ing during residency, they have been in a unique position to develop and advance this technique. In the realm of cosmetic and aesthetic dermatology, dermatologists also have been at the forefront researching skin rejuvenation and expanding use of skin fillers, botox, and laser surgery. Because of extensive training in skin biology, dermatologists have a unique and expansive background to research cutaneous surgery. The purpose of this book is to provide medical students and residents a practical summary of core knowledge in dermatologic surgery. The chapters are written by experts in each topic and presented in outline form that focuses on important facts and “pearls”. Heavy emphasis is placed on historic develop- ment of dermatologic surgery as we feel it is important to understand where dermatologic surgery came from and where it is headed in the future. Richard G. Bennett, MD Los Angeles, CA ix