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BACKGROUND: As internet access continues to expand, online health care information is increasingly influencing patient decisions. Mohs micrographic surgery (MMS) is commonly used in the field of dermatology but may be unfamiliar to many patients. OBJECTIVE: The purpose of this study was to identify and analyze online educational resources regarding MMS and learn how to optimize the understanding and informational content of MMS for patients and their families. MATERIALSANDMETHODS:Thirty-two websites were evaluated for authorship, quality, and readability using DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid tests. RESULTS: Physician-authored content showed a trend toward higher quality (p 5 .058). Google scored higher in specific DISCERN questions when overlapping websites were excluded. Bing scored higher in JAMA criteria (p 5 .03) in criteria such as authorship and currency. Higher DISCERN scores correlated with lower readability. CONCLUSION: Physician involvement improves content quality, raising questions about physicians' responsibility in online resource creation. Correlations between content quality and readability highlight potential challenges for certain demographics. Balancing medical accuracy with comprehensibility is crucial for equitable patient education. This study underscores the need to refine online resources, ensuring accurate, transparent, and accessible health care information. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exogenous artifacts can interfere with accurate histologic tissue evaluation on frozen sections during Mohs micrographic surgery (MMS). Mohs surgeons should be aware of these anomalies to avoid potential misdiagnoses. OBJECTIVE To review exogenous artifacts encountered in frozen tissue pathology during MMS. OBJECTIVE: To review exogenous artifacts encountered in frozen tissue pathology during MMS. METHODSA: literature search was conducted in PubMed to identify studies reporting on exogenous artifacts encountered during MMS and a list of previously described exogenous artifacts was compiled. A retrospective examination of frozen histology slides from recent Mohs cases at the authors' institution was performed to obtain illustrative examples of these artifacts, supplemented by formalin-fixed paraffin-embedded samples when frozen examples could not be found. RESULTS: Exogenous artifacts represent foreign bodies that have been externally introduced into the skin or artifacts resulting from other external factors. If frozen section evaluation is inaccurate, overdiagnosis can occur during MMS, resulting in unnecessary layers, larger margins, and more complex reconstructions. These exogenous tissue changes can mimic inflammatory processes and melanocytic or keratinocyte malignancies on histology. CONCLUSION: Exogenous artifacts are common findings during margin assessment in Mohs micrographic surgery. The resulting histological findings can be confusing but correlating them with the clinical and surgical history often reassures surgeons. Recognizing these artifacts facilitates accurate diagnosis and promotes optimal patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE Large defects of the nose after Mohs surgery pose a significant reconstructive challenge to both dermatologic and reconstructive surgeons. The authors present their 12-year experience utilizing acellular dermal matrices for nasal reconstruction. METHODS A retrospective review of patients undergoing Mohs surgery and alloplastic nasal reconstruction with acellular dermal matrices between 2010 and 2022 was performed. Patients who underwent single-stage reconstruction and dualstage reconstruction with skin graft with at least 90 days of follow-up were included. RESULTS Fifty-one patients met criteria with a median age of 77 years. Fifty-three lesions were reconstructed with acellular dermal matrices. The most common lesion location was nasal sidewall (50%) with a mean defect size of 10.8 cm2. 30.8% underwent same-day acellular dermal matrix reconstruction, with 69.2% undergoing two-stage reconstruction. Acellular dermal matrices successfully reconstructed acquired defects in 94.2% of lesions. Average time to reepithelialization was 27.6 + 6.2 days. Average time to repigmentation was 145.35 + 86 days. No recurrences were recorded. Total complication rate was 9.62%. Average size for successful healing was 10.8 cm2. Average defect size for complication or failure was 14.7 cm2. Seven sites (13.46%) underwent aesthetic improvement procedures. CONCLUSION Acellular bilayer wound matrix is an adequate reconstructive option for single or dual-stage reconstruction of the nose with low complication and revision rates. [ABSTRACT FROM AUTHOR]

BACKGROUND Immunohistochemical (IHC) staining can be used alongside Mohs micrographic surgery to aid in margin assessment of subtle tumors, yet existing estimates of IHC utilization have primarily relied on survey or older data that lacks stratification. OBJECTIVE To characterize national IHC utilization trends by Mohs surgeons, stratifying by surgeon characteristics and modeling future adoption. METHODS Longitudinal analysis of 2014 to 2021 Medicare Public Use Files. RESULTS In 2021, 158 of 2,058 Mohs surgeons (7.7%) used IHC as compared with 4.0% in 2014 (average annual growth rate [AAGR] +3.6%). Adoption change was highest in the Northeast (AAGR +19.9%), whereas volume growth was greatest in the West (AAGR +25.2%). Multivariable regression revealed significantly greater utilization propensity among Mohs surgeons in academics (adjusted odds ratio [aOR] 3.36), American College of Mohs Surgery (ACMS) members (aOR 2.12), and Micrographic Dermatologic Surgery (MDS)-certified surgeons (aOR 1.66). CONCLUSION Mohs surgeons are steadily incorporating IHC into practice across all regions, with volume growth driven by higher adoption rates. Greater utilization among ACMS members, recipients of MDS certification, and those in academics suggests value of formalized training in enhancing comfort. Additional educational opportunities at conferences may aid in recognition of value and help identify solutions to address integration challenges. [ABSTRACT FROM AUTHOR]

BACKGROUND Over the past decade, several studies have shown that potential of artificial intelligence (AI) in dermatology. However, there has yet to be a systematic review evaluating the usage of AI specifically within the field of Mohs micrographic surgery (MMS). OBJECTIVE In this review, we aimed to comprehensively evaluate the current state, efficacy, and future implications of AI when applied to MMS for the treatment of nonmelanoma skin cancers (NMSC). MATERIALS AND METHODS A systematic review and meta-analysis was conducted following PRISMA guidelines across several databases, including PubMed/MEDLINE, Embase, and Cochrane libraries. A predefined protocol was registered in PROSPERO, with literature search involving specific keywords related to AI and Mohs surgery for NMSC. RESULTS From 23 studies evaluated, our results find that AI shows promise as a prediction tool for precisely identifying NMSC in tissue sections during MMS. Furthermore, high AUC and concordance values were also found across the various usages of AI in MMS, including margin control, surgical recommendations, similarity metrics, and in the prediction of stage and construction complexity. CONCLUSION The findings of this review suggest promising potential for AI to enhance the accuracy and efficiency of Mohs surgery, particularly for NMSC. [ABSTRACT FROM AUTHOR]

This article explores the use of artificial intelligence (AI) in providing accurate and understandable responses to patient inquiries about Mohs micrographic surgery (MMS). The study found that an AI model called ChatGPT 4.0 improved the readability of responses and had mostly medically accurate answers. However, there were some responses that were considered potentially harmful or contrary to national guidelines. The authors recommend using AI to enhance patient education materials, but under the supervision of a board-certified dermatologist. The article also provides detailed information about Mohs surgery, including preoperative marking, intraoperative mapping, and postoperative margin assessment, highlighting the significance of accurate margin assessment for successful outcomes. Published by the American Society for Dermatologic Surgery, this article emphasizes the importance of precise margin assessment in achieving positive results. [Extracted from the article]

BACKGROUND Mohs surgery of eyelid skin cancers requires detailed knowledge of anatomy for precise surgery and accurate evaluation of histology. OBJECTIVE To review the histology of the peritarsal eyelid using frozen sections as encountered intraoperatively by Mohs surgeons. METHODS The authors review the literature describing the anatomy and histology of the peritarsal eyelid from the lens of a Mohs surgeon. Histology from select Mohs cases is used to frame the discussion of the microanatomy of this region. RESULTS The peritarsal eyelids contain a unique mixture of skin, muscle, tarsus, glandular tissue, and conjunctiva. The histologic appearance of many of these structures differs from skin found outside of this anatomic region. Tumors of the eyelid and periocular region may mimic normal histologic structures found within the peritarsal eyelid. CONCLUSION The peritarsal eyelids have unique anatomy and associated histologic structures. Knowledge of the detailed histoanatomy is required for confident execution of Mohs surgery in this anatomic region. [ABSTRACT FROM AUTHOR]

BACKGROUND Desmoplastic trichoepithelioma (DTE) is an uncommon benign adnexal tumor that histologically may mimic malignant tumors including basal cell carcinoma and microcystic adnexal carcinoma. OBJECTIVE To present a systematic review of the epidemiology, clinical characteristics, treatment, and outcome data on DTEs, with emphasis on comparing Mohs micrographic surgery (MMS) with other treatments. METHODS Using the OVID platform, MEDLINE and Embase were searched from inception for studies providing original data on DTEs. RESULTS A total of 338 cases of DTE from 61 articles were included. No recurrence/persistence (0%) was reported following MMS (n 5 24, mean follow-up of 41.9 months), 13.1% with standard excision (n 5 38, mean follow-up 16.9 months), and 2.1% for electrosurgery/cautery (n 5 49, follow-up 3-72 months). 100% recurrence/persistence for imiquimod (n 5 2) and liquid nitrogen (n 5 4) were identified. In patients who underwent biopsy only, there was a 12.5% recurrence/persistence (n 5 32, mean follow-up 16.5 months). Overall, duration of follow-up varied from 2 months to 6 years for the various management strategies. CONCLUSION Data are limited regarding DTE outcomes. In this review, surgical modalities, specifically MMS, had the lowest rates of recurrence/persistence compared with other options. Given that most lesions are found on cosmetically sensitive locations, MMS seems to be the optimal management strategy for actively managing DTEs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Autofluorescence photography can detect specific light–tissue interactions and record important pathophysiological changes associated with nonmelanoma skin cancer (NMSC), which has been ascribed to the fluorescence of an aromatic amino acid, tryptophan. OBJECTIVE: To assess the impact of a novel, autofluorescence imaging (AFI) device on margin control for NMSCs before Mohs micrographic surgery (MMS) in an effort to decrease overall operating time. METHODS: Before the initial stage of MMS, NMSCs were measured with a 2-mm margin as standard of care (normal margin). The tumor was then imaged with the AFI device. A 2-mm margin was drawn around the fluorescent area captured by the AFI device and was referred to as the camera margin. The tumor was excised based on the normal margin and evaluated on frozen histological section. RESULTS: Imaging based on the AFI device resulted in appropriate recommendations for margin control in 8 of 11 tumors. Four of these tumors did not fluoresce and demonstrated a lack of tumor residuum on stage I specimen, as anticipated. There were no side effects from the AFI device. CONCLUSION: This is an initial pilot study that supports the use of a novel, noninvasive imaging device to help with margin assessment before MMS. On optimization, this device has potential to extend applicability to surgical excisions for tumors that do not fulfill criteria for MMS. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves surgical outcomes. OBJECTIVE: To determine whether intraoperative IHC during MMS and staged excision is associated with a decreased risk of poor surgical outcomes. MATERIALS AND METHODS: Search of 6 databases identified comparative and noncomparative studies that reported local recurrence after MMS or staged excision with or without IHC for melanoma. Random-effects meta-analysis was used to estimate pooled local recurrence rates, nodal recurrence, distant recurrence, and disease-specific mortality. RESULTS: Overall, 57 studies representing 12,043 patients with cutaneous melanoma and 12,590 tumors met inclusion criteria. Combined MMS and staged excision with IHC was associated with decreased local recurrence in patients with invasive melanoma (0.3%, 95% CI: 0–0.6) versus hematoxylin and eosin alone (1.8%, 95% CI: 0.8%–2.8%) [ p <.001]. Secondary outcomes including nodal recurrence, distant recurrence, and disease-specific mortality were not significantly different between these 2 groups. Study heterogeneity was moderately-high. CONCLUSION: Local recurrence of invasive melanoma is significantly lower after MMS and staged excision with IHC as opposed to without IHC. These findings suggest that the use of intraoperative IHC during MMS or staged excision should strongly be considered, particularly for invasive melanoma. Trial Registration PROSPERO Identifier: CRD42023435630. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a study on dermatologists' accuracy in diagnosing melanoma. The study found that dermatologists had a high accuracy rate for clinical melanoma diagnosis, even when observing a lesion for a short amount of time. The study also validated the theory that experienced individuals can make snap decisions based on patterns and cues. However, the study acknowledges the limitations of relying solely on subconscious thinking for clinical diagnosis and emphasizes the importance of a careful clinical examination. The article concludes by suggesting that further studies are needed to explore these findings. [Extracted from the article]

BACKGROUND Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs. OBJECTIVE To evaluate the cost savings associated with a quality improvement. MATERIALS AND METHODS The authors conducted a retrospective cohort study using 100% Medicare fee-for-service claims data to identify the change of mean stages per case for head/neck (HN) and trunk/extremity (TE) lesions before and after the quality improvement intervention from 2016 to 2021. They evaluated surgeon-level change in mean stages per case between the intervention and control groups, as well as the cost savings to Medicare over the same time period. RESULTS A total of 2,014 surgeons performed Mohs procedures on HN lesions. Among outlier surgeons who were notified, 31 surgeons (94%) for HN and 24 surgeons (89%) for TE reduced their mean stages per case with a median reduction of 0.16 and 0.21 stages, respectively. Reductions were also observed among outlier surgeons who were not notified, reducing their mean stages per case by 0.1 and 0.15 stages, respectively. The associated total 5-year savings after the intervention was 92 million USD. CONCLUSION The implementation of this physician-led benchmarking model was associated with broad reductions of physician utilization and significant cost savings. [ABSTRACT FROM AUTHOR]

BACKGROUND Hidradenocarcinoma (HAC) is a rare adnexal carcinoma. To the best of the authors' knowledge, there are no published systematic reviews on HAC. OBJECTIVE To incorporate a case series from the authors' institution and systematically integrate reported information to provide a reference tool for optimization of diagnosis and management. METHODS A comprehensive MEDLINE search was conducted from database inception to 2021 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This yielded 225 studies with 165 cases of HAC. References of included articles were also searched. In addition, 9 patients with HAC were identified from the authors' institution over the past 10 years. RESULTS The mean age of HAC presentation is 60 years with a slight male predilection (60%). The head and neck is the most commonly affected region. Over 36% of cases either presented with metastatic disease or went on to metastasize. The most common treatment type was wide local excision, followed by Mohs micrographic surgery. CONCLUSION Early detection with accurate histologic interpretation is prudent in all cases of HAC. Wide local excision is the current first-line treatment. However, Mohs micrographic surgery offers complete marginal analysis with evidence of reduced risk of metastasis and better outcomes compared with wide local excision. Currently, there are no National Comprehensive Cancer Network guidelines for the treatment of HAC, and consensus guidelines are limited to tumor and nodal metastasis staging provided by the American Joint Committee on Cancer, eighth edition. Thus, this case series and systematic review integrates important aspects of diagnosis, workup, and management of HAC. [ABSTRACT FROM AUTHOR]

This article, titled "Recovery of Facial Nerve Function After Vismodegib Treatment of Advanced Basal Cell Carcinoma," discusses the case of a patient with undiagnosed familial Mediterranean fever (FMF) who was initially misdiagnosed with squamous cell carcinoma (SCC). The article emphasizes the importance of recognizing histologic mimickers and closely correlating clinical findings to avoid misdiagnosis. It also highlights the potential for secondary epithelial alterations in the setting of MF, which can lead to a misdiagnosis of carcinoma. The article concludes by suggesting that awareness of this phenomenon can help clinicians and dermatopathologists avoid diagnostic pitfalls. [Extracted from the article]

The article discusses two separate cases in the field of dermatology. The first case involves a diagnostic pitfall in which folliculotropic mycosis fungoides with syringoid squamous metaplasia and pseudoepitheliomatous hyperplasia mimicked carcinoma. The authors highlight the need for alternative bandaging options and raise awareness of potential complications. The second case focuses on the recovery of facial nerve function in a 63-year-old man with advanced basal cell carcinoma who regained motor function during vismodegib therapy. The article emphasizes the potential of targeted therapy for the treatment of locally advanced and metastatic basal cell carcinoma. [Extracted from the article]

This article discusses the reconstruction of a multisubunit defect of the lateral upper lip caused by a basal cell carcinoma. The authors explore various techniques for reconstructing the defect, including primary closure, wedge excision with linear closure, second intention healing, skin grafting, and local skin flaps. They ultimately choose a superiorly based full upper cutaneous lip (UCL) subunit rotation flap with an apical triangle full-thickness Burow graft and a partial mucosal advancement. The authors provide key considerations and techniques for realigning the vermilion border and achieving optimal cosmesis. [Extracted from the article]

This article discusses the repair of a complex defect spanning the nasal sill, vestibule, and columellar septum in an 81-year-old woman who underwent Mohs micrographic surgery for a basal cell carcinoma. The primary reconstructive option considered was a full-thickness skin graft, but it was not favored due to aesthetic concerns. Instead, an advancement flap of the lateral upper cutaneous lip and nasolabial cheek was performed, along with a small full-thickness skin graft for the remaining columellar septum defect. The patient had a satisfactory outcome with minimal asymmetry and a patent airway. The article highlights the importance of patient selection and describes a unique technique using lateral alotomy to accommodate the advancement flap. [Extracted from the article]

This article discusses the repair of a large multi-subunit nasal defect in a 68-year-old man who had a basal cell carcinoma on his right nasal tip. The tumor was removed through Mohs micrographic surgery, resulting in a complex composite defect involving the tip, supratip subunit, right nasal sidewall, and ala. The authors describe the use of various techniques, including perialar crescentic advancement flap, Burrow's graft, and interpolated paramedian forehead flap, to reconstruct the defect. The surgical method involved marking the anatomical nasal subunits, elevating and advancing flaps, and meticulous suturing. The outcome was a restoration of normal symmetry and contour with minimal color mismatch. [Extracted from the article]

This article discusses the repair of a large defect on the earlobe, conchal bowl, inferior helix, and antihelix caused by the removal of a malignant melanoma. The authors describe the challenges of reconstructing such a complex and multi-subunit defect and outline the surgical techniques used. They ultimately used a combination of a full-thickness skin graft and a superiorly based banner transposition flap to restore the natural contour and bulk of the earlobe, helical rim, and antihelix. The patient achieved a functionally and cosmetically acceptable result with no complications or recurrence of the disease. [Extracted from the article]

This article discusses the reconstruction of a wide preauricular defect involving the tragus in a 72-year-old male patient who underwent Mohs micrographic surgery for basal cell carcinoma. The defect involved multiple cosmetic subunits, including the preauricular cheek and auricle. The authors considered various reconstruction options, ultimately deciding to use two separate flaps: an inferiorly based crescentic rotation-advancement flap and a superiorly based O-to-L advancement flap. The procedure was successful, resulting in an excellent cosmetic outcome. The article provides insights into the considerations and techniques involved in reconstructing such defects. [Extracted from the article]

Supplemental Digital Content is Available in the Text. BACKGROUND: Tissue preservation and tumor clearance are hallmarks of Mohs micrographic surgery, but no standardized method currently exists to guide trainees on how to balance the two. OBJECTIVE: The authors provided residents and fellows with additional histologic information to enhance their surgical decision-making without changing the standard methodology of Mohs surgery. METHODS AND MATERIALS: Trainees were provided initial biopsy slides (IS) and frozen vertical sections (VS) of the first Mohs layer. All Mohs layers were excised in standard fashion, and vertically oriented sections were taken from the layer without disturbing the surgical margins to obtain VS. Surveys were used to assess trainees' confidence in performing Mohs surgery with and without these tools. RESULTS: Trainees reported increased confidence in performing Mohs surgery when they reviewed IS before surgery and viewed VS of the first layer. CONCLUSION: Reviewing IS and VS improved trainees' confidence in performing Mohs surgery. This additional histological information was obtained while maintaining the usual steps of Mohs surgery. Objective information obtained from IS and VS may explain why trainees' confidence increased using this technique. Both IS and VS can be valuable teaching tools that may enhance trainees' ability to perform Mohs surgery. [ABSTRACT FROM AUTHOR]

This article discusses the reconstruction of a full-thickness defect involving the nasal tip, bilateral nasal ala, and alar rim with complete loss of cartilage. The author presents a case of a 100-year-old female patient with a basal cell carcinoma that required surgical intervention. The most reliable repair option for this type of defect is a foldover or prelaminated paramedian forehead flap with cartilage struts. However, due to the patient's specific circumstances, bilateral foldover nasolabial transposition flaps with cartilage struts were chosen as a single-stage repair. The article provides a detailed description of the surgical technique and discusses the functional and cosmetic outcomes of the procedure. [Extracted from the article]

BACKGROUND Preoperative education has uncertain benefits on the preparedness and satisfaction of patients undergoing Mohs micrographic surgery (MMS). OBJECTIVE We sought to determine the effect of a preoperative telephone call on preparedness and satisfaction in patients undergoing same-day office consultation and MMS. MATERIALS AND METHODS All new patients (N = 208) scheduled for same-day office consultation and MMS were mailed a standardized preoperative packet. Approximately half of those patients were randomly selected to also receive a preoperative phone call. On the day of the surgery, patients completed an anonymous preoperative and postoperative survey assessing their preparedness and satisfaction with the preoperative education received. RESULTS There was no significant difference in patient preparedness between the letter only (LO) and phone call and letter study groups. There was a significant difference in preoperative satisfaction--a higher percentage of LO patients were "somewhat satisfied" or "not satisfied" with the preoperative education received (p = .013). CONCLUSION Preoperative phone consultation, in addition to mailed educational materials, did not have a statistically significant effect on patient preparedness in patients undergoing MMS; however, there was a trend toward increased satisfaction with the preoperative education provided in patients who received a preoperative phone call. [ABSTRACT FROM AUTHOR]

BACKGROUND Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest. OBJECTIVE Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery. METHODS A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed. RESULTS Of 13,464 Mohs surgery cases, 4.53% (n=610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% (n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% (n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications. CONCLUSION Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness. [ABSTRACT FROM AUTHOR]

BACKGROUND There is a paucity of literature describing family planning challenges faced by Mohs fellows. OBJECTIVE To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows. MATERIALS AND METHODS A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship. RESULTS In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female (n = 81, 69.8%) than male (n = 35, 30.2%). Most had children before completion of their Mohs training (n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% (n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents (n = 10) who breastfed or pumped did not have a convenient place to do so. CONCLUSION This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND Based on recent research, second intention wounds may be at greater risk for postoperative infection compared with sutured wounds. Accurate diagnosis of postoperative wound infections on the lower leg can be challenging and result in unnecessary antibiotic administration. OBJECTIVE The objective of this study was to identify bacterial organisms that commonly colonize second intention surgical wounds after Mohs micrographic surgery (MMS) and isolate pathogenic organisms. METHODS Patients with second intention surgical wounds on the lower leg were evaluated 2 weeks after MMS. Wounds were swabbed for bacteria and categorized as infected or not infected based on clinical appearance. Any colonizing bacteria were recorded once the culture results were reported. RESULTS Twenty-five clinically infected wounds and 26 control wounds were cultured. Staphylococcus aureus was the most common bacteria, colonizing 8 infected wounds (15.7%) and 5 control wounds (9.8%). Eight cultures (32%) from clinically infected wounds grew normal skin flora alone. CONCLUSION Staphylococcus aureus is the most common bacteria colonizing wounds healing by second intention on the lower extremity. Thirty-two percent of clinically infected wounds grew normal skin flora, demonstrating the challenge of accurately diagnosing infection in lower extremity second intention wounds. [ABSTRACT FROM AUTHOR]

BACKGROUND Although advances have been made in the understanding of recurrence patterns in dermatofibrosarcoma protuberans, the current understanding of disease-specific mortality after surgical management is limited. OBJECTIVE To understand disease-specific mortality rates associated with dermatofibrosarcoma protuberans treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). MATERIALS AND METHODS A systematic literature search was conducted on March 6, 2023, to identify patients treated with MMS or WLE for dermatofibrosarcoma protuberans. RESULTS A total of 136 studies met inclusion criteria. Overall, the disease-specific mortality rate was not significantly different after treatment with MMS (0.7%, confidence interval [CI] 0.1-1.2, p: 0.016) versus WLE (0.9%, CI 0.6-1.2, p, .001). For recurrent tumors, the MMS treatment group had a statistically significantly lower disease-specific mortality rate (1.0%, CI 0.0-2.0, p 0.046) compared with the WLE treatment group (3.5%, CI 2.0-5.1, p, .001). The mean follow-up for all studies was 57.6 months. CONCLUSION AND RELEVANCE The authors' meta-analysis suggests there is no substantial difference in diseasespecific mortality between MMS and WLE in patients with dermatofibrosarcoma protuberans, except in the case of recurrent tumors, where MMS seems to confer a survival advantage. [ABSTRACT FROM AUTHOR]

BACKGROUND Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs micrographic surgery. Given variable training and experience, dermatologic surgeons may seek additional references to help reconstruct certain advanced defects. We sought to synthesize literature from dermatologic surgery, plastic surgery, and otolaryngology to review repair options and considerations for repair of nasal lining defects. OBJECTIVE To present a comprehensive literature review of repair options for nasal lining reconstruction and discuss advantages, disadvantages, specific anatomic considerations, and techniques to execute such options. MATERIALS AND METHODS Articles from several different reconstructive specialties including dermatologic/Mohs surgery, otolaryngology, and plastic and reconstructive surgery were reviewed. Instructive images were compiled to illustrate several techniques, with additional medical illustration recreations included to help showcase important reconstructive approaches. RESULTS A comprehensive descriptive review of nasal lining repair options for the reconstructive surgeon. CONCLUSION Advanced tumors can result in full-thickness nasal defects, and this review describes various reconstructive options for reconstruction based on the extent of the defect. [ABSTRACT FROM AUTHOR]

BACKGROUND Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. OBJECTIVE Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. METHODS All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. RESULTS Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% (n5 27) after second intention healing (p = .004). Both groups experienced high facial and scar satisfaction, low appearancerelated distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score (p = .02). CONCLUSION This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC. [ABSTRACT FROM AUTHOR]

BACKGROUND As the use of melanoma antigen recognized by T cells (MART-1) immunohistochemistry (IHC) with Mohs surgery increases for the treatment of melanoma in situ and invasive melanoma, surgeons should be aware of MART-1 staining patterns of incidental lesions often encountered on frozen sections. Lack of this knowledge can lead to unnecessary additional surgery, increased health care costs, and loss of valuable laboratory staff time and resources. OBJECTIVE To characterize the histopathologic features of incidental lesions encountered during Mohs surgery for melanoma. To review key diagnostic and differentiating features on hematoxylin and eosin staining (H&E) and MART-1 IHC of these lesions. METHODS A comprehensive review of frozen-section histopathology slides from Mohs cases with MART-1 IHC at our institution was conducted from 2021 to 2023. RESULTS Incidental benign and malignant lesions were identified and characterized on H&E frozen sections and MART-1 IHC. Although such entities can share MART-1 staining characteristics with melanoma in situ or melanoma, distinguishing characteristics on H&E and lack of histopathologic criteria for melanoma on MART-1 IHC can be used to distinguish these incidental lesions from melanoma. CONCLUSION Staining of frozen sections for Mohs micrographic surgery with H&E and MART-1 IHC together can differentiate common incidental benign and malignant cutaneous lesions from melanoma. [ABSTRACT FROM AUTHOR]

BACKGROUND Mohs micrographic surgery (MMS) is used for melanoma in situ (MIS) and thin invasive melanomas, particularly on the head and neck, during which a debulk section is typically prepared. Tumor upstaging occurs if the debulking specimen meets criteria for an increased tumor (T) stage per the American Joint Committee on Cancer 8th edition compared with the initial biopsy. Upstaging can alter survival and recurrence outcomes, resulting in increased patient morbidity and mortality. OBJECTIVE To determine the rate of cutaneous melanoma upstaging during MMS. MATERIALS AND METHODS A multicenter study was performed. Information from electronic medical records from 3 dermatologic surgeons performing MMS for cutaneous melanoma were logged from January 1, 2017 to December 31, 2021. Deidentified information regarding patient demographics and tumor characteristics was recorded. RESULTS Three-hundred and ten cases of cutaneous melanoma treated with MMS were identified. 2.3% of cases were upstaged, ranging from T1a to T3a. No significant risk factors for upstaging were identified. CONCLUSION Our data demonstrate a lower rate of cutaneous melanoma upstaging during MMS than the current literature. Differences may be accounted for because of differing patient populations, cutaneous melanoma detection at an earlier clinical stage, and evolving melanoma histologic criteria. [ABSTRACT FROM AUTHOR]

This document discusses a modified technique called "Carbolic Acid (Liquid Phenol) 89% Ring Paint" for treating boxcar and polymorphic acne scars. The authors explain the technique and its advantages over other methods, such as trichloroacetic acid (TCA) CROSS. They also provide a protocol for performing the treatment. The authors argue that the current training in cosmetic dermatology for residents is insufficient and call for more emphasis on cosmetic procedures in residency programs. [Extracted from the article]

The article discusses a case study of a 72-year-old man with an atypical fibroxanthoma on his ear. The authors describe a technique called wedge-shaped single-stage Mohs surgery with a bisected specimen, followed by closure with a primary ear wedge repair. This method allows for expedited excision of tissue at high risk for cartilage invasion and provides 100% margin control. The authors find this technique useful for certain types of skin cancer but not when cartilage preservation is expected. The article also briefly mentions other treatment options for metastatic melanoma. Another section of the article discusses a method of using horizontal mattress pulley sutures to improve reconstruction after staged excision on the scalp. [Extracted from the article]

This document, titled "Sustained Shift Toward Intermediate Repairs by Mohs Surgeons Following Updated 2020 Coding Guidelines: A National Medicare Analysis," discusses the use of staged excisions and subsequent reconstruction in dermatologic surgery. The authors highlight the benefits of this method for patients with lentigo maligna melanoma in the head and neck region, as it has shown high local control rates while preserving tissue. The study analyzes Medicare trends from 2013 to 2019 and reveals that Mohs surgeons dominate cutaneous reconstructions in cosmetically and functionally sensitive sites. The document also provides data on the frequency of complex repairs in different medical specialties. [Extracted from the article]

The article discusses the use of cryotherapy in the treatment of various benign and malignant diseases. The authors applied cryotherapy to three patients with three cycles of 30 seconds each, resulting in blisters and ulceration. Cryotherapy is believed to stimulate the body's immune response against malignant cells, and combining it with other treatments may have additional benefits. The article also mentions the impact of revised repair guidelines on the proportion of complex repairs performed by Mohs micrographic surgeons, showing a reduction in complex repairs billed by these surgeons. [Extracted from the article]

This article discusses the repair of a large full-thickness ear defect resulting from surgery to remove a basal cell carcinoma. The authors explore various reconstructive options and ultimately decide to use a multistaged temporoparietal fascia interpolation flap (TPFF) with full-thickness skin grafting. The TPFF provides a robust vascular base for the skin grafts and serves as an effective reconstructive option for complex defects of the ear. The article highlights the versatility and benefits of the TPFF in head and neck reconstruction. [Extracted from the article]

This article discusses a case study of a 67-year-old man with a complex nasal alar defect resulting from the removal of a basal cell carcinoma. The defect extended into multiple cosmetic subunits, including the nasal ala, upper cutaneous lip, and medial cheek. The authors explore various reconstructive approaches to address this challenging defect, considering the unique contours and convexity of the area. They ultimately used a combination of repair techniques, including a "flipped island pedicle" flap, to reconstruct the nasal ala and repair defects in adjacent cosmetic subunits. The patient had a successful outcome with no complications. [Extracted from the article]

This article discusses the reconstruction of a full-thickness lower lip defect after Mohs micrographic surgery. The case involves a 54-year-old man with squamous cell carcinoma on his lower lip. The authors explore different options for repairing the defect, ultimately deciding on a buccal myomucosal flap combined with skin advancement. The technique provides vermillion coverage and muscular bulk without the need for large incisions, resulting in optimal aesthetic and functional outcomes. [Extracted from the article]

A study published in the journal Dermatologic Surgery investigated the risk of surgical site infection (SSI) after dermatologic surgery in solid organ transplant recipients (SOTRs). The study found conflicting evidence regarding the association between immunosuppression and SSI rates. However, SOTRs who were prescribed post-transplant antibiotic prophylaxis were less likely to carry Staphylococcus aureus (S. aureus) in their nasal passages, which is a common cause of SSI. The study suggests that regular post-transplant antibiotic prophylaxis may be sufficient to prevent SSI in SOTRs, but further research is needed to determine if additional antibiotic prophylaxis is necessary for those not prescribed post-transplant antibiotic prophylaxis. [Extracted from the article]

This article discusses the multidisciplinary management of advanced basal cell carcinoma (BCC) in a patient with severe congenital hemophilia A. The patient had been treated with factor VIII (FVIII) replacement for his hemophilia A and had previously been treated with oral vismodegib for the BCC. However, the BCC recurred and surgical evaluation was recommended. The patient underwent Mohs surgery with FVIII pretreatment and coordination with plastic surgery. Despite positive margins, further resection was performed with FVIII pretreatment and the patient had no bleeding issues postoperatively. The article emphasizes the importance of early multidisciplinary care for hemophiliacs with skin cancers and highlights the limitations of vismodegib as a primary treatment for BCC. [Extracted from the article]

Supplemental Digital Content is Available in the Text. [ABSTRACT FROM AUTHOR]

This article discusses the reconstruction of a nasal sill and upper cutaneous lip defect in a 69-year-old woman who had a squamous cell carcinoma (SCC). The defect was caused by the removal of the tumor through Mohs micrographic surgery. The article explores different repair options and ultimately describes a creative facial defect repair using a combination of a double z-plasty within a V to Y advancement flap. The patient had a successful outcome with no complications and satisfactory cosmetic and functional results. The article emphasizes the importance of considering symmetry and functional outcomes when reconstructing facial defects in the area surrounding the nose. [Extracted from the article]

This article discusses the reconstruction of a large scalp defect in a 73-year-old male patient with acantholytic squamous cell carcinoma. The article explores the challenges of reconstructing large scalp defects and the various techniques that can be used, such as skin grafts, flaps, and tissue expansion. The authors describe their chosen technique, the temporoparietal fascial sling island pedicle flap, which allows for full defect coverage, preservation of tissue, and minimal tension. The article provides a detailed surgical technique for this method and highlights its advantages over other techniques. [Extracted from the article]

BACKGROUND: Lower extremity surgical sites are at an increased risk of wound infection following Mohs micrographic surgery. OBJECTIVE: To evaluate the rate of lower extremity surgical site infections following a 14-day regimen of preoperative 4% chlorhexidine gluconate (CHG) rinses and postoperative wound occlusion for 14 days. MATERIALS AND METHODS: Retrospective data were collected from procedures performed by the senior author from January 2022 through June 2023. To meet inclusion, patients must have completed waist-down CHG soak and rinse for 14 days before surgery, including the day before surgery. In addition, the patient must have kept the dressing clean, dry, and intact until the postoperative appointment at 14 days. RESULTS: A total of 100 Mohs cases met inclusion criteria. Zero patients developed a surgical site infection. CONCLUSION: Chlorhexidine gluconate preoperative rinsing and postoperative occlusion for 14 days may minimize the risk of wound infection. Although further research is indicated, an opportunity exists for the adoption of CHG into routine clinical practice in the outpatient dermatology setting. [ABSTRACT FROM AUTHOR]

This document discusses a pilot study on the use of teledermatology for follow-up appointments after dermatologic surgery. The study found that a majority of patients preferred electronic follow-up over in-person appointments, citing convenience and flexibility as the main reasons. However, there were some limitations to the study, such as selection bias and the lack of patient characteristics data. The document also briefly mentions the adverse events associated with microneedling procedures and emphasizes the importance of using approved topical medications. [Extracted from the article]

This article discusses the challenges and techniques involved in reconstructing a large nasal defect that includes the nasal tip, soft triangle, and ala. The authors emphasize the importance of careful planning and design to achieve optimal cosmetic and functional outcomes. The surgical approach involves a stepwise process, starting with the repair of the internal nasal lining, followed by the use of cartilage grafts and a paramedian forehead flap to reconstruct the external nasal structures. The article provides detailed descriptions of the surgical technique and highlights the successful outcome of the procedure. [Extracted from the article]

This document discusses two separate cases related to dermatologic surgery. The first case involves the use of an anterior alarotomy technique to access and visualize a basal cell carcinoma of the nasal vestibule during Mohs micrographic surgery. The second case describes the use of Mohs micrographic surgery for the treatment of a newly described nail unit malignant neoplasm called malignant onychopapilloma. Both cases highlight innovative surgical approaches and demonstrate the potential effectiveness of Mohs micrographic surgery in treating these specific conditions. [Extracted from the article]

The article discusses the knowledge and training gap in Micrographic Surgery and Dermatologic Oncology (MSDO) fellowships regarding the interpretation and troubleshooting of Mohs frozen section tissue processing. The authors conducted a survey among MSDO fellows-in-training to assess their training and comfort level in this area. They then developed an interactive lecture series to address the gaps identified. The post-intervention survey showed improvement in fellows' knowledge and confidence, indicating the effectiveness of the lecture series. The study highlights the need to strengthen fellowship education in the interpretation and troubleshooting of Mohs frozen sections. [Extracted from the article]

BACKGROUND Reconstruction of auricular defects after Mohs surgery is challenging given the prominence of the ear and its complex 3-dimensional architecture. OBJECTIVE Evaluation of postoperative pain, healing time, and postoperative complications of auricular defects after split-thickness skin graft (STSG) placement versus secondary intent healing (SIH). MATERIALS AND METHODS During this prospective, observational study, 30 patients recorded their daily maximum postoperative pain using the numeric pain rating scale from postoperative days 0 to 8. Surgical site healing was assessed at postoperative day 8 and 30. All postoperative complications were collected during the 30-day follow-up window. RESULTS Patients undergoing STSG experienced significantly more pain during the first 3 postoperative days than patients in the SIH group. Maximum pain was experienced on the night of surgery, with a mean pain score of 3.6 in the STSG groups versus 0.8 in the SIH group. Healing was significantly faster in the STSG group, with 87% of patients fully healed at 1 week versus 21% in the SIH group. No major complications were experienced in either group. CONCLUSION Split-thickness skin graft and SIH healing are well tolerated and provide excellent repair choices for auricular defects. [ABSTRACT FROM AUTHOR]

BACKGROUND Patient experience metrics are gaining prominence in health care. We introduce the CAPABLE survey to assess postoperative experiences of Mohs surgery patients. OBJECTIVE We sought to determine whether CAPABLE scores aligned with overall patient satisfaction in Mohs surgery. METHODS This was a cross-sectional, survey-based study of patients presenting for their first postoperative visit after Mohs surgery. The CAPABLE survey included questions on postoperative instructions, activity limitations, pain control, provider accessibility, and bleeding, followed by 2 overall satisfaction questions taken from the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems survey. The pilot study took place at the University of Texas Dell Medical School (DMS), followed by a validation study (n = 206) at DMS and Oregon Health and Science University (OHSU). We assessed for correlations between CAPABLE scores and overall satisfaction. RESULTS In the pilot study (n = 137), overall CAPABLE scores and scores of individual CAPABLE components correlated positively with overall satisfaction. In the multisite validation study (n = 206) spanning DMS and OHSU, CAPABLE scores correlated positively with overall satisfaction. CONCLUSION The CAPABLE survey is a concise tool for assessing specific, actionable components of the postoperative patient experience in Mohs surgery, while correlating with overall patient satisfaction. [ABSTRACT FROM AUTHOR]