Vidal, Nahid Y.

BACKGROUND: Prior literature notes increased rates of delayed diagnosis and increased morbidity and mortality for patients with Fitzpatrick skin types IV to VI with melanoma and nonmelanoma skin cancers, noting surgical delays and larger postoperative defects. Dyschromia is among the most common concerns in Fitzpatrick skin types IV to VI. OBJECTIVE: To consolidate the latest information on patient counseling, suture selection, and interventions related to postoperative pigmentary complications for Fitzpatrick skin types IV to VI. MATERIALS AND METHODS: A literature review was conducted using the Embase, Scopus, Google Scholar, PubMed from 2014 to 2025 focused on surgical considerations, pathophysiology of surgical considerations, hypopigmented scars, suture selection, postinflammatory hyperpigmentation, and treatment and counseling of postsurgical complications or outcomes in Fitzpatrick skin types IV to VI. RESULTS: Preoperative factors that may worsen wound healing include the use of skin lightning agents. Intraoperative factors include secondary intention healing and full-thickness grafts., Opting for direct or flap closure and noninflammatory suture selection minimizes postoperative dyschromia. Postoperative considerations include Ultraviolet A/B and visible light photoprotection counseling and suture removal timing. Promising treatments need further research including microdermal grafting for hypopigmented scars. CONCLUSION: Special considerations in preoperative history taking, intraoperative repair and suture selection, and postoperative counseling minimize the risk of postoperative dyschromia.

BACKGROUND Health care resource use, pollution, and greenhouse gas emissions are increasingly studied to balance quality patient care with environmental, social, and financial impacts. However, consolidated sustainability recommendations for Mohs micrographic surgery (MMS) remain unexplored. OBJECTIVE To assess current recommendations and studies on environmental sustainability in MMS. MATERIALS AND METHODS Following PRISMA-ScR guidelines, a literature review was conducted across PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane databases from 2014 to 2024. English peer-reviewed studies using keywords “climate change,” “margin control,” “environment,” “sustainability,” “waste,” “resource,” “Mohs micrographic,” “Mohs,” and “micrographic” were included. Duplicates and conference abstracts were excluded. RESULTS Of 5,526 articles, nine met inclusion criteria after independent review. Recommendations included standardized surgical sets, limiting instruments to essentials, and redesigning procedure rooms to improve recycling access. Three articles found no significant difference in infection rates between sterile and nonsterile glove use. Other suggestions involved recycling plastics, using microtubules to reduce chromacoding dye waste by minimizing spillage and drying, and scheduling virtual preoperative visits to reduce travel emissions. Insurance reimbursement for virtual visits remains a limitation. CONCLUSION Restructuring surgical protocols and procedure room design encourages innovation and addresses workflow inefficiencies rooted in tradition rather than evidence, promoting sustainability in MMS.

BACKGROUND There is a paucity of literature investigating the use of liposomal bupivacaine (LB) in a dermatologic surgery setting. OBJECTIVE To identify the treatment characteristics and adverse events, including Local Anesthetic System Toxicity (LAST), in patients receiving perioperative LB. MATERIALS AND METHODS A retrospective chart review was performed at a single institution using an institutional database and key words “Exparel” or “liposomal bupivacaine.” Patients ≥18 years old who received perioperative LB to the surgical site and surrounding skin were included. RESULTS A total of 140 LB administrations and 129 patients were included. Liposomal bupivacaine was used most often in the setting of excisions ( n = 88, 62.9%) and Mohs micrographic surgery ( n = 49, 35%), with hidradenitis suppurativa ( n = 77, 55%) and cutaneous neoplasms ( n = 56, 40%) the most frequent diagnoses. The median postoperative area and length were 23.6 cm 2 and 15.4 cm, respectively. The median LB dosage was 20 mL (range 1.5–20). There were no adverse events in 134 out of 136 patients of LB administration (98.5%). There were 2 reports (1.5%) of nausea on POD1 while these patients were taking opioids. CONCLUSION Liposomal bupivacaine should be considered for postoperative analgesia in patients undergoing dermatologic surgery because it is well tolerated and efficacious. The authors observed no cases of LAST.