Background and Objectives This study was performed to investigate recent trends and factors associated with immediate breast reconstruction (IBR) using a large population-based registry. We hypothesized that rates of IBR have increased since passage of the Women’s Health and Cancer Rights Act of 1998. Methods The SEER (Surveillance, Epidemiology and End Results) database was used to evaluate Stage I–III breast cancer (BC) patients who underwent total mastectomy from 1998–2008. Univariate and multivariate analyses were performed to study predictors of IBR. Results Of 112,348 patients with BC treated by mastectomy, 18,001 (16%) had IBR. Rates of IBR increased significantly from 1998–2008 (p<0.0001). Use of IBR significantly decreased as patient age increased (p<0.0001), as stage increased (p<0.0001), and as the number of positive lymph nodes increased (p<0.0001). Estrogen receptor +/progesterone receptor + (ER+/PR+) patients had significantly higher IBR rates than ER−/PR− patients (p<0.0001). IBR was used in 3615 of 25,823 (14.0%) of patients having post-mastectomy radiation (XRT) and in 14,188 of 86,513 (16.4%) of those not having XRT (p<0.0001). Conclusions The utilization of IBR has increased significantly over the last decade. IBR was found to be significantly associated with age, race, geographical region, stage, ER, grade, LN status, and XRT (p<0.0001).

The incidence of skin cancer is higher than all other cancers and continues to increase, with an average annual cost over $8B in the United States. As a result, identifying molecular pathway alterations that occur with UV exposure to strategize more effective preventive and therapeutic approaches is essential. To that end, we evaluated phosphorylation of proteins within the PI3K/Akt and MAPK pathways by immunohistochemistry in sun-protected skin after acute doses of physiologically relevant solar simulated ultraviolet light (SSL) in 24 volunteers. Biopsies were performed at baseline, 5-minute, 1-, 5-, and 24-hour post SSL. Within the PI3K/Akt pathway, we found activation of Akt (Serine473) to be significantly increased at 5 hrs while mTOR (Serine2448) was strongly activated early and was sustained over 24-hour post SSL. Downstream we observed a marked and sustained increase in phospho-S6 (Serine235/S236) whereas phospho-4E-BP1 (Threonines37/46) was increased only at 24 hours. Within the MAPK pathway, SSL-induced expression of phospho-p38 (Threonine180/Tyrosine182) peaked at 1–5 hrs. ERK 1/2 was observed to be immediate and sustained post-SSL. Phosphorylation of histone H3 (Serine10), a core structural protein of the nucleosome, peaked at 5-hour post SSL. The expression of both p53 and COX-2 was increased at 5-hour and was maximal at 24-hour post SSL. Apoptosis was significantly increased at 24 hrs as expected and indicative of a sunburn-type response to SSL. Understanding the timing of key protein expression changes in response to SSL will aid in development of mechanistic-based approaches for the prevention and control of skin cancers.

The standard of care for wound coverage is to use an autologous skin graft. However, large or chronic wounds become an exceptionally challenging problem especially when donor sites are limited. It is important that the clinician be aware of various treatment modalities for wound care and incorporate those methods appropriately in the proper clinical context. This report reviews an alternative to traditional meshed skin grafting for wound coverage: micrografting. The physiological concept of micrografting, along with historical context, and the evolution of the technique are discussed, as well as studies needed for micrograft characterization and future applications of the technique.

Cutaneous exposure to solar ultraviolet radiation (UVR) is a causative factor in photoaging and photocarcinogenesis. In human skin, oxidative stress is widely considered a key mechanism underlying the detrimental effects of acute and chronic UVR exposure. The lipid peroxidation product malondialdehyde (MDA) accumulates in tissue under conditions of increased oxidative stress, and the occurrence of MDA-derived protein epitopes, including dihydropyridine-lysine (DHP), has recently been substantiated in human skin. Here we demonstrate for the first time that acute exposure to sub-apoptogenic doses of solar simulated UV light (SSL) causes the formation of free MDA and protein-bound MDA-derived epitopes in cultured human HaCaT keratinocytes and healthy human skin. Immunohistochemical staining revealed that acute exposure to SSL is sufficient to cause an almost twenty-fold increase in general MDA- and specific DHP-epitope content in human skin. When compared to dose-matched solar simulated UVA, complete SSL was more efficient generating both free MDA and MDA-derived epitopes. Subsequent tissue microarray (TMA) analysis revealed the prevalence of MDA- and DHP-epitopes in nonmelanoma skin cancer (NMSC). In squamous cell carcinoma tissue, both MDA- and DHP-epitopes were increased more than three-fold as compared to adjacent normal tissue. Taken together, these date demonstrate the occurrence of MDA-derived epitopes in both solar UVR-exposed healthy human skin and NMSC TMA tissue; however, the potential utility of these epitopes as novel biomarkers of cutaneous photodamage and a functional role in the process of skin photocarcinogenesis remain to be explored.

Cephalometric techniques and analyses are versatile tools that can be applied to a wide variety of clinical scenarios involving the craniofacial region. New technologies and expanded applications promise to continue the development and use of this well-established methodology.