Paradoxical effect of epinephrine on lesion redness and vascularity

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dc.contributor.authorNazir, Zaeem H.
dc.contributor.authorRishpon, Ayelet
dc.contributor.authorKose, Kivanc
dc.contributor.authorMarghoob, Nadeem G.
dc.contributor.authorLiopyris, Konstantinos
dc.contributor.authorNavarrete-Dechent, Cristian
dc.contributor.authorDusza, Stephen W.
dc.contributor.authorDaoud, Alexander
dc.contributor.authorMarghoob, Ashfaq A.
dc.date.accessioned2025-01-20T20:17:23Z
dc.date.available2025-01-20T20:17:23Z
dc.date.issued2023
dc.description.abstractIntroductionEpinephrine is commonly used in combination with local anesthetic (lidocaine/epinephrine) due to its beneficial vasoconstrictive properties. Typically, pallor is appreciated after injection as a sign of effect; however, we observed that some cutaneous malignancies paradoxically revealed increased redness and vascularity after injection of lidocaine/epinephrine. In this study, we investigate this phenomenon among a series of biopsied lesions to identify characteristics of lesions associated with increased redness and/or vascularity.ObjectivesTo determine characteristics of lesions which become redder or more vascular after injection with lidocaine/epinephrine prior to biopsy.MethodsThis cross-sectional study consisted of a convenience sample of lesions scheduled for biopsy. Lesions were photographed prior to and 7 min after injection of lidocaine/epinephrine as a part of standard care. Two readers blinded to study objectives and histopathological diagnosis assessed lesions for changes in redness and vascular features.ResultsFifty-four lesions from 47 patients-61.7% male, mean age 64.8 years, age-range 24-91 were included. Thirty-six lesions were biopsy confirmed malignant, with 5 in situ and 31 invasive malignancies; the remaining 18 lesions were benign. In comparison with non-malignant lesions, malignant lesions were associated with an increase in clinically appreciable vascular features after injection of lidocaine/epinephrine, X-2 (1) = 21.600, p < 0.001. Further stratification into benign, in situ, and invasive lesions strengthened the association, X-2 (1) = 23.272, p < 0.001.ConclusionsCombination lidocaine/epinephrine has been shown to paradoxically increase the visibility of vessels seen in cutaneous malignancies. This is consistent with prior literature suggesting aberrant adrenergic signaling in neoangiogenic vessels.
dc.description.funderMemorial Sloan Kettering Cancer Center's NIH/National Cancer Institute Cancer Center
dc.fuente.origenWOS
dc.identifier.doi10.1007/s00403-023-02524-6
dc.identifier.eissn1432-069X
dc.identifier.issn0340-3696
dc.identifier.urihttps://doi.org/10.1007/s00403-023-02524-6
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/92394
dc.identifier.wosidWOS:000938833900001
dc.issue.numero7
dc.language.isoen
dc.pagina.final2147
dc.pagina.inicio2145
dc.revistaArchives of dermatological research
dc.rightsacceso restringido
dc.subjectDermoscopy
dc.subjectSkin cancer
dc.subjectBasal cell carcinoma
dc.subjectSquamous cell carcinoma
dc.subjectMelanoma
dc.subjectAnesthetic
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleParadoxical effect of epinephrine on lesion redness and vascularity
dc.typeartículo
dc.volumen315
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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