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BACKGROUND The presence of scalp nevi in children frequently causes apprehension, leading physicians and parents to consider unnecessary biopsies or excisions of scalp nevi in children. There are limited data on the dermoscopic characteristics of scalp nevi in Chinese children. OBJECTIVE The aim of this study was to comprehensively analyze the clinical and dermoscopic features of scalp nevi in this specific population of Chinese pediatric patients, with a focus on a single pediatric dermatologic surgery practice. METHODS This retrospective cohort study investigated patients who underwent surgical excision of scalp nevi. All patients underwent dermoscopy with photographic documentation. RESULTS Seventy-two scalp nevi in 56 Chinese children were included. Notably, no melanoma cases were detected. The parietal region (35, 48.6%) was the most frequently affected anatomical site. Clinical asymmetry was more prevalent in nevi with a diameter exceeding 6mm(p, .05). The predominant dermoscopic pattern observed was the globular pattern (50, 69.4%) while an intriguing rarity of a reverse-eclipse pattern (1, 1.4%). CONCLUSION This study revealed that scalp nevi in Chinese children usually did not exhibit concerning behavior. Increasing awareness of the clinical characteristics, dermoscopic features, and the natural progression of scalp nevi in children can potentially help reduce unnecessary surgical interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND Reconstructing defects requiring replacement of nasal or auricular cartilage after Mohs micrographic surgery can at times be challenging. While autologous cartilage grafting is considered the mainstay for repair, it may be limited by cartilage quality/quantity, donor site availability/morbidity, and surgical complications. Tissue-engineered cartilage has recently shown promise for repairing properly selected facial defects. OBJECTIVE To (1) provide a comprehensive overview of the literature on the use of tissue-engineered cartilage for nasal alar and auricular defects, and (2) discuss this technology's advantages and future implications for dermatologic surgery. MATERIALS AND METHODS A literature search was performed using PubMed/MEDLINE and Google Scholar databases. Studies discussing nasal alar or auricular cartilage tissue engineering were included. RESULTS Twenty-seven studies were included. Using minimal donor tissue, tissue-engineered cartilage can create patient-specific, three-dimensional constructs that are biomechanically and histologically similar to human cartilage. The constructs maintain their shape and structural integrity after implantation into animal and human models. CONCLUSION Tissue-engineered cartilage may be able to replace native cartilage in reconstructing nasal alar and auricular defects given its ability to overcome several limitations of autologous cartilage grafting. Although further research is necessary, dermatologic surgeons should be aware of this innovative technique and its future implications. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Covid-19 Pandemic prompted the widespread implementation of telemedicine across healthcare. OBJECTIVE: To analyze telemedicine adoption by Mohs Micrographic surgeons (MMS) during the COVID-19 pandemic; to analyze the attitudes and perceived barriers to its long-term continuation by MMS practices. METHODS AND MATERIALS: An online multiple-choice survey was distributed to members of the American College of Mohs Surgeons. RESULTS : 86.1% of surveyed Mohs surgeons initiated telemedicine during the pandemic surge. The most common uses for telemedicine amongst respondents were post-surgery management (77.4%), "spot checks" (60.9%), and surgical consultations (59.1%). 73.1% report patients were receptive to telemedicine. 68.6% believe that telemedicine has a place in dermatologic surgery; 49.5% plan to incorporate telemedicine into their surgical practices long-term. Physical exam limitations, fitting telemedicine into practice workflow, and patient reception/patient training were viewed as the most significant barriers to long-term implementation. CONCLUSIONS: While valuable use cases for telemedicine were identified with most Mohs surgeon respondents feeling that telemedicine has a place in their practices, there is uncertainty in how to implement telemedicine into the dermatologic surgery practice workflow. [ABSTRACT FROM AUTHOR]

BACKGROUND Mohs micrographic surgery is generally safe and well tolerated. Various perioperative practices are employed with the aim of reducing adverse events; however, implementation is variable, and limited efficacy data are available. OBJECTIVE This study sought to assess perioperative practice patterns among dermatologic surgeons with regards to antibiotic prophylaxis (AP), anticoagulation, activity restrictions, and antiseptic choice. METHODS AND MATERIALS Two surveys were distributed by the American College of Mohs Surgery (ACMS) and the American Society for Mohs Surgery (ASMS) to their membership via email. RESULTS One hundres seventy-seven surgeons participated, with membership from ACMS (61%), ASMS (35%), or both organizations (4%) represented. Systemic AP is prescribed preoperatively by 96% (162/168) and postoperatively by 91% (161/177) of surgeons for variable clinical indications. Therapeutic antiplatelet and anticoagulant medications are rarely held (3%-5%, 4-7/149), whereas preventative aspirin (30%, 45/149), NSAIDs (25%, 36/145), and supplements known to have an anticoagulant effect (54%, 80/149) are more commonly held. Antiseptic choice and recommended activity restrictions vary. CONCLUSION Perioperative practices of dermatologic surgeons are variable and, where applicable, may deviate from guidelines. These findings underscore the need for standardization and updated guidelines for perioperative practices in dermatologic surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND There is limited knowledge on the extent physicians delegate cosmetic procedures to midlevel providers. OBJECTIVE To assess dermatology and plastic surgery practice patterns for the injections of neurotoxins and dermal fillers. MATERIALSANDMETHODSFour hundred ninety-two dermatology and plastic surgery practices were identified from 10 major US metropolitan areas. These practices were contacted, and staff were asked a series of questions to best characterize the practice patterns in regard to who performs the injectables in the office. RESULTS Although most dermatology and plastic surgery practices had physicians as the only provider who gives injectables, 18.35% of dermatology and 25.4% of plastic surgery practices had nurse practioners and physician assistants giving injectables both with and without oversight of the supervising physician onsite. CONCLUSION In a large majority of both plastic surgery and dermatology practices, physicians exclusively perform injections of neurotoxins and fillers. For practices that allow midlevel providers to perform injectables, the level of physician supervision is variable. In a small percentage of plastic surgery practices, surveyed midlevel providers exclusively performed injectables. [ABSTRACT FROM AUTHOR]

Background: As the use of injectable skin fillers increase in popularity, an increase in the reported adverse events is expected. Objective: This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers. Methods and materials: Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible. Results: The review included 182 studies. However, IRVC was very rare (1-2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%-80%). Most of the studies were small and noncomparative, making the evidence certainty very low. Conclusion: Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications. [ABSTRACT FROM AUTHOR]

Tumor severity was assessed by approximate final defect area (greatest length by greatest width), final MMS stage number, and MMS Appropriate Use Criteria (AUC) score. The COVID-19 pandemic has disrupted the practice of Mohs micrographic surgery (MMS). One-sided Fisher exact tests were used to compare relative tumor frequency of BCC:SCC (SCCIS and I-SCC) tumors in the prepandemic baseline period (Period 1) to the other periods. [Extracted from the article]

BACKGROUND There is a paucity of data or publications in the literature on best practices for opening a new Mohs surgery unit. OBJECTIVE: The goal of this article is to be a "how to" guide for starting a Mohs and dermatologic surgery practice. MATERIALS AND METHODS: Two academic Mohs surgeons share their personal experiences and data from the literature. RESULTS: Topics discussed include picking a location and identifying space, equipment, staffing, regulatory practices, policies and procedures, marketing and outreach, patient experience, building culture, clinic efficiency, and vision. CONCLUSION: Although opening a new Mohs surgery unit is challenging, it can be rewarding to have the opportunity to develop best practices and systems that create a wonderful working environment and allow for exceptional care of patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The skin hook is a valuable instrument used in the practice of dermatologic surgery. However, because of numerous factors, the degree of its use varies extensively. OBJECTIVE: The purpose of this study was to examine practice trends among dermatologic surgeons regarding the use of skin hooks, as well as analyze factors influencing their use. METHODS : A survey comprising 14 questions was distributed to members of the American College of Mohs Surgery and the American Society for Dermatologic Surgery. Results were recorded, and statistical analysis was conducted using the 2-sample z -test to compare 2 population proportions. RESULTS : Five hundred seventy-one responses were received, with comments. 85.1% of respondents reported using skin hooks. Their use was further characterized as minimal (20.7%), moderate (29.0%), and extensive (35.4%). The utilization of skin hooks was additionally categorized based on age, gender, fellowship training, number of years in practice, practice setting, and history of experience/observance of a sharps exposure. Only the presence or absence of fellowship training demonstrated a statistically significant difference in the use of skin hooks. CONCLUSION: Skin hooks are highly used tools among dermatologic surgeons. Their use requires appropriate training and experience, and care must be taken to minimize risk of exposure. [ABSTRACT FROM AUTHOR]

However, to the best of our knowledge, there have been no formal studies of patient falls in Mohs micrographic surgery (MMS) practices. Overall, 34% of Mohs surgeons screen for patient fall risk through the use of a medical assistant or nurse (69%), medical history form completed by the patient (27%), and/or as part of a consultation visit (12%). [Extracted from the article]

BACKGROUND Retention of academic Mohs surgeons is important for the growth of this specialty and teaching of residents and students. OBJECTIVE To examine factors that influence retention of Mohs surgeons in academics and to better understand reasons for their departure. MATERIALS AND METHODS A survey was electronically distributed to academic Mohs surgeons in the American College of Mohs Surgery, asking them to rate the importance of several variables on their decision to remain in academia. Private practice Mohs surgeons who had left academics were also surveyed. RESULTS Two hundred thirty-six dermatologic surgeons completed the survey. Twenty-nine percent work full time in academics, and approximately 7% work part time. The top reasons for practicing in the academic setting are intellectual stimulation, teaching opportunities, and collaboration with other university physicians and researchers. Seventy-one percent of respondents reported they would stay in academics, 7% indicated they would not, and 22% were unsure. Unfair compensation, inadequate support staff, poor leadership, increased bureaucracy, and decreased autonomy were top reasons that may compel a Mohs surgeon to leave. CONCLUSION Opportunities for intellectual stimulation, collaboration, and teaching remain the main draw for academic Mohs surgeons. A supportive environment, strong leadership, and establishing fair compensation are imperative in ensuring their stay. [ABSTRACT FROM AUTHOR]

The article focuses on temporal rejuvenation with fillers which is considered a global faceculpture approach. It attributes the evolution of facial rejuvenation and aesthetics to changes in procedures, products, demands from patients. This surgical procedure is beneficial for individuals who are at mid-30s or early 40s. The recommendations for its nonsurgical techniques and the consideration of effective products are also discussed.

BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29–39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29–39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [ABSTRACT FROM AUTHOR]

Background. Recently Mohs micrographic surgery, which is widely used for the removal of nonmelanoma skin cancers, has been used to remove lentigo maligna with both rush permanent sections and frozen sections. Several investigators have incorporated the use of immunohistochemical techniques to aid in the interpretation of the specimens. Objective. To determine the current practices of Mohs surgery laboratories, including the use of immunostains and automation of laboratory processes. Methods. A total of 108 laboratories responded to a written questionnaire with 13 items about the types of tumors resected, routine stains performed, average number of slides processed per day, and use of automation and immunostains. Results. Forty-nine percent of the laboratories are completely manual and 51% are automated. The Linistainer automated system, which is the predominant one used, decreased processing time by about 30% and provided an estimated 21–30% improved quality. Automation was associated with the number of slides processed. Immunostaining is performed by a limited number of laboratories which use the technique for basal and squamous cell carcinoma, lentigo maligna, and dermatofibrosarcoma protuberans. Conclusion. Automation of routine slide preparation with a Linistainer decreased staining variability by providing a consistent environment, and decreased processing time. Most laboratories do not perform immunostaining. The relatively high cost of reagents, lack of a reliable automated process, the additional time to process specimens, and the additional technician and physician time makes the procedure impractical for many laboratories. [ABSTRACT FROM AUTHOR]

The article discusses a subcutaneous corset plication technique used in sutures. It states that the technique is said to be fast, simple, and may relieve wound edge tension before applying other sutures. Moreover, it has the advantage of distributing wound tension over a broader area, while disadvantages includes the suture being difficult to perform and that it has tendency to break.

The article focuses on the use of specific color dyed embedding medium and slide labels to lessen the errors in Mohs micrographic surgery. It says that every patient must have a designated color embedding medium to reduce tissue processing errors. It also mentions that colored medium will not influence the quality of slide interpretation or preparation.

The article provides information on hand signals that can be used during surgery. Hand signals minimize the technical-based verbal communication and enable the surgical team to converse with the patient and relieve his or her anxiety. It discusses how using technical and descriptive language during dermatologic surgery such as cut, scalpel, and skin hook causes patients' discomfort and anxiety. Hand signals also intend to increase patient satisfaction with the surgical procedure.

A letter to the editor is presented on the erasure of skin marks made during dermatologic operations.

The article throws light on results and complications of sclerotherapy. Patients are not randomized and only the results and complications of polidocanol are fully reported in the study. The empty vein technique, in combination with low mass of reflux, will give the best results for sclerotherapy. In daily practice this means that all major points of reflux have to be eliminated by highly selective surgery. The final treatment decision will be made by type of varicosis, reflux prognosis, and experience.

The author discusses a study which describes the expertise of Mohs surgeons in assessing cancer slides and understanding results. He relates that slides from the Mohs surgery practice are sent for review to the referral pathologist, who examines the sample as an unknown entity for histologic diagnosis. He adds that such examinations have resulted in a 99.1% concordance between Mohs surgeons and dermatopathologists.

The article focuses on a couple of issues. First is that of involving the appropriate consultants to manage problems uncovered in the preoperative workup. For a patient with an implanted cardioverter/defibrillator to be managed properly, a whole team needs to be assembled, a complicated logistical plan has to be devised, and everything needs to be centrally coordinated and monitored by one person. Secondly, a real mine field can occur in a busy, regional referral surgery practice where patients may be required to come a long way to receive specialized care.