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Background: Squamous cell carcinomas (SCCs) generally have been reported to be more prevalent on the lips than basal cell carcinomas (BCCs), but in our experience, BCCs of the lips are common, particularly in women., Objectives: To determine the tumor characteristics of lip SCCs and BCCs, including tumor type, anatomic location, and size; and to identify the relationship between patient characteristics, including age and sex, and lip tumor characteristics., Methods and Materials: Retrospective review of all BCCs and SCCs located on the lip treated between January 1995 and October 2010., Results: Of 470 lip nonmelanoma skin cancers (NMSCs) identified, 71.4% were BCCs, and 28.6% were SCCs. Lower lip tumors were predominantly SCCs (79.8%, p < .01), whereas upper lip tumors were predominantly BCCs (85.7%, p < .01). Patients with lower lip tumors were significantly older (68.8 vs. 64.7, p = .02) and were largely male (70.8%, p < .01). Patients with SCCs were mostly male (62.2%, p = .02), whereas those with BCCs were predominantly female (68.8%, p < .01). Subgroup analysis showed that upper lip tumors were 98.1% cutaneous or more than 50% cutaneous, whereas 56.3% of lower lip tumors were mucosal or more than 50% mucosal; 87.1% of mucosal tumors were SCCs, whereas 83.6% of cutaneous tumors were BCCs (p < .01). Seventy-one percent of patients with mucosal tumors were men, whereas 67% of patients with cutaneous only tumors were women (p < .01)., Conclusion: These data provide evidence of significant differences in patient and tumor characteristics between NMSCs of the upper and lower lips., (© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background: Controversy exists in the literature regarding the use of Mohs surgery for the treatment of melanoma in situ (MIS). Mohs surgery provides the advantage of complete margin assessment; however, variations in surgical and laboratory techniques employed, make comparison of outcomes difficult., Objective: To review the current literature regarding Mohs surgery for treatment of MIS and to evaluate treatment options., Methods: We review the literature regarding traditional excision margins for MIS, the proportion of biopsy-proven MIS lesions that prove to have an invasive component, and the efficacy of Mohs surgery for MIS., Results: Many authors report a need for surgical margins larger than the recommended 5 mm, particularly with MIS arising in sun-exposed areas. Further, a review of the literature reveals that nearly one-quarter of biopsy-proven MIS lesions are found to contain invasive melanoma after complete surgical removal and pathologic examination. Substantial evidence supports the value of complete margin assessment in the treatment of MIS, particularly in the head and neck region., Conclusion: Complete surgical excision with careful margin assessment is required to adequately treat MIS lesions, particularly given the high rate of invasive melanoma in lesions initially thought to be MIS. Mohs surgery remains the treatment of choice for all clinically ill-defined MIS.

As physicians and health administrators increasingly incorporate patients' perspectives into health care, patient satisfaction has become a significant health care outcome. However, there is limited knowledge regarding the patient satisfaction instruments being used by leading academic medical centers. The objective of this study was to determine the types of patient satisfaction instruments used by leading academic medical centers. We conducted a telephone survey of 16 leading academic medical centers across the United States to determine the types of patient satisfaction instruments used at each institution for outpatient and inpatient care. Among the institutions surveyed, a significantly higher proportion used internally developed surveys for satisfaction measurement among outpatients than for satisfaction measurement among inpatients. Although much attention has been focused on patient satisfaction in recent years, there is little standardization of the patient satisfaction instruments currently being used at the academic medical centers surveyed, particularly for outpatient care. This lack of standardization limits opportunities for benchmarking of patient satisfaction data among peer institutions and may limit efforts to improve care.