For safe excision of malignant skin tumours, complete negative surgical margins are mandatory. The gold standard for analysis is frozen sections or paraffin‐embedded haematoxylin and eosin (H&E)‐stained slides. The production of H&E‐stained slides is time‐consuming (>20 h) while wounds remain unclosed. An upcoming method is confocal laser scanning microscopy (CLSM), a technique that scans unfixed fresh tissue rapidly.

BACKGROUND:To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin.OBJECTIVE:To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy.METHODS:Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions.RESULTS:Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%).CONCLUSION:Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.

Linked Article:Hoorens et al. Br J Dermatol 2016; 174: 847–852.

Background/Aims: Solar ultraviolet (UV) radiation is the most important environmental risk factor for melanoma and non-melanoma skin cancer. It is known that tap water and saltwater baths have a photosensitizing capacity in subsequent UV irradiation of the skin. The aim of the present study was to determine the influence of sweating from heat or from physical activity on the photosensitivity of the skin.Methods: Minimal erythema dose to ultraviolet B (MED/UVB) was determined on the inner forearms of 22 healthy volunteers with a Saalmann Multi-tester(R). Sweating had been provoked by heat (sauna for 10 min) and, on another occasion, physical exercise (logging for 15 min) followed by MED/UVB testing in a similar way.Results: Compared to baseline R MED/UVB there was a highly significant decrease in MED/UVB of up to 31.6% (median 15.8%, mean 15.9%+/-10.0) after 10 min in the sauna and up to 40.9% (median 16.3%, mean 17.2%+/-12.5) after 15 min jogging (P<0.0001).Conclusion: Sweat influences the hydration of the horny layer of the skin, resulting in a decrease in reflection and dispersion of UV light. Moderate physical activities such as jogging and/or heat may facilitate erythema reaction. By sweating, outdoor workers and people practicing outdoor sports who are exposed to considerable amounts of solar UV radiation further increase their risk of sunburn.