Daily Cosmetic Research Analysis

BACKGROUND: Basal cell carcinoma (BCC) is frequent in older adults, many of whom are poor surgical candidates, especially for curved, cosmetically sensitive facial sites. High-dose-rate (HDR) surface brachytherapy is effective, but standard flat applicators may fit poorly and increase dose heterogeneity. Patient-specific 3D-printed applicators could improve conformity, yet geriatric BCC data are limited. OBJECTIVE: To assess feasibility and 12-month outcomes of personalized 3D-printed HDR surface brachytherapy in geriatric patients with BCC. METHODS: In this prospective single-arm study, 15 patients aged ≥65 years with histologically confirmed BCC (predominantly facial) unsuitable for surgery received HDR surface brachytherapy using custom 3D-printed applicators. Treatment delivered 51 Gy in 17 fractions with CT-based planning. Repeat CT evaluated applicator fit/reproducibility and target coverage. Acute skin toxicity was graded by RTOG. At 12 months, response was assessed clinically and dermoscopically; cosmesis and quality of life (DLQI) were recorded. RESULTS: All patients completed treatment. Positioning was highly reproducible (mean setup error <1 mm) with >90% target dose coverage. At 12 months, all lesions achieved complete remission with no local recurrence on dermoscopy. Acute reactions were mostly mild (73% grade 1), with 13% grade 2 and 13% grade 3; no grade 4 toxicity or serious adverse events occurred. Cosmesis was favorable, and DLQI improved (mean 10.5 pre-treatment vs 2.9 at 1 year; p < 0.01). CONCLUSIONS: Personalized 3D-printed HDR surface brachytherapy appears feasible and well tolerated in this small, monocentric cohort of older patients with BCC, with favorable 1-year local control and quality-of-life improvement when surgery is contraindicated. However, the limited sample size and single-center design represent limitation, and the observed benefit should be regarded as suggestive rather than definitive.

BACKGROUND: Breast reconstruction is an important aspect of the process of recovery for patients recovering from mastectomy. However, postmastectomy radiation therapy (PMRT) disrupts flap perfusion and cosmetic results. These complications have prompted comparisons of irradiated and nonirradiated flaps, especially in immediate and delayed reconstruction. METHODS: Using preferred reporting items for systematic reviews and meta-analyses guidelines, a PubMed and Cochrane Library search from the year 2000 to 2024 was performed to compare the irradiated and nonirradiated flaps. The inclusion criteria restricted the analysis to comparing flap viability, flap complications, aesthetic outcome, or satisfaction level of patients. The meta-analysis was used, and variance was reduced by using fixed- and random-effects models. RESULTS: The analysis involved 12 studies showing that flaps receiving irradiation, particularly in immediate reconstructions, had higher complication rates, including fat necrosis and flap contracture. Nevertheless, delayed reconstruction following PMRT was linked to reduced postoperative complication rates and favorable reconstructive results, whereas flap survival did not differ between immediate and delayed reconstruction. Subgroup analysis demonstrated lower fat necrosis in deep inferior epigastric perforator flaps (≈12%) compared with transverse rectus abdominis muscle (≈25%) and latissimus dorsi flaps (≈40%), suggesting that flap-specific planning is necessary for irradiated patients. These pooled percentages reflect averaged values across included studies. CONCLUSIONS: Patients undergoing immediate reconstruction in the PMRT setting have increased rates of postoperative complications, especially fat necrosis, fibrosis, and flap contracture, and worse aesthetic outcomes. On the contrary, delayed reconstruction is associated with lower complications and better cosmetic results, whereas no significant difference is noted in flap survival between immediate and delayed reconstruction.

Merkel cell carcinoma (MCC) is a rare, aggressive neurocutaneous malignancy associated with ultraviolet damage, immunosuppression, and Merkel cell polyoma virus infection. Periocular MCC is uncommon but has high rates of local recurrence and metastasis and presents unique therapeutic challenges due to functional and cosmetic considerations. Immune checkpoint inhibitor (ICI) therapy has shown efficacy in systemic MCC; however, evidence for periocular use is limited to small case series and reports without consolidated evidence or consensus. Thus, this study summarizes and evaluates the effectiveness and safety of ICIs for periocular MCC. A systematic literature search across PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Randomized and nonrandomized studies, case series, and case reports in English describing ICI use for periocular MCC were included. Non-human studies, non-periocular MCC, and reports without ICI treatment were excluded. Extracted data included patient demographics, tumor characteristics, treatment regimen, and patient outcomes. Seven studies reporting ten patients were included. Treatment regimens consisted of pembrolizumab (n = 6) and avelumab (n = 3), or both medications (n = 1). At a mean follow-up of 11.4 ± 9.0 months, nine patients had complete response (90%); only one patient developed subsequent distant progression despite local response. Patients with both localized periocular disease and metastatic involvement demonstrated favorable responses to ICI. Adverse effects were infrequent and typically mild; only one patient discontinued therapy due to adverse effects. ICIs may be an effective and well-tolerated treatment for local and advanced periocular MCC; however, larger, prospective studies are needed.