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Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether intradiscal Platelet Rich Plasma(PRP) injection has any beneficial role in the management of lumbar disc disease. Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, and Cochrane Library till September 2020 for studies investigating the role of intradiscal PRP in the management of lumbar disc disease. The analysis was performed in the R platform using OpenMeta[Analyst] software. Results: 13 studies including 2 RCTs, 5 prospective, and 6 retrospective studies involving 319 patients were included in the meta-analysis. A single-arm meta-analysis of the included studies showed a beneficial effect of the intervention in terms of pain relief outcomes like VAS score (p < 0.001), pain component of SF-36 (p = 0.003) while such improvement was not seen in functional outcome measures like ODI score (p = 0.071), the physical component of SF-36 (p = 0.130) with significant heterogeneity noted among the included studies. No structural improvement in magnetic resonance imaging was observed (p = 0.106). No additional procedure-related adverse events were noted in the included studies (p = 0.662). Conclusion: There is a paucity of high-quality studies to give conclusive evidence on the benefits of intradiscal PRP for lumbar disc disease. Although intradiscal PRP injection has shown some beneficial effect in controlling pain for lumbar disc disease, we could not find structural or functional improvement from the included studies. Hence, we recommend large double-blind double-arm randomized controlled studies to analyze the benefits of the intervention being analyzed.

The treatment of rheumatoid arthritis (RA) has been closely evolving with an understanding of disease pathogenesis with disease modifying anti-rheumatoid drugs (DMARDS) and Biologic DMARDS being the main stay. platelet rich plasma (PRP) has been the center of research in many specialties in the past decade. Its ability to stop and reverse inflammation have attracted researchers to try PRP in RA. A systematic review of studies on PRP in RA is lacking. The study protocol was prospectively registered in PROSPERO. Detailed search of Cochrane, Scopus, Medline, Embase, and Web of science databases were made to identify the relevant articles till Sep 2020 following Cochrane and PRISMA guidelines. Number of subjects, Animal model used, cell lines used for the study, method of induction of arthritis, PRP dose, concentration used, frequency of administration and clinical, histologic, and molecular changes from baseline following PRP use were extracted and analysed. Eight studies were included for the review. Four of these were in-vitro studies. Two were exclusive animal studies. One study analysed the effects of PRP in RA in both animal models (mice) and Hela cell lines. One study was a report of a series of patients of resistant RA treated with PRP. In the in vitro studies while platelets increase the migration and invasion of RA-FLS, they suppressed the inflammation on the whole. Available animal studies and the Human study have shown encouraging results. There has been no evidence of exacerbation of inflammation in these studies. The quantity and quality of literature on the effects of PRP in treating joint pathologies in RA is limited. Preclinical studies show decrease in disease activity with good safety profile. Invitro studies show suppression of inflammation. Thus, the available literature is encouraging towards the use of PRP in RA. Larger trials and molecular studies to understand the exact role of platelets in disease pathogenesis and treatment mechanisms are needed to decide the future course of PRP in RA.

Osteo Necrosis of the Femoral Head (ONFH) is a form of osteonecrosis that occurs owing to interruption of blood supply to the proximal femur followed by fragmentation, reossification, and remodelling of the femoral head. In United States, the incidence of avascular necrosis of the femoral head is projected to be around 30000, which contributes to 10% of the total hip replacement done every year. It was believed that necrosis of proximal femur occurs due to the inadequate supply of progenitor cells in the femoral head. So, treatment is aimed at introducing stem cells in necrosis area in order to avoid the risk of fracture and collapse to restore the structural design of femoral head. The objective of this review is to highlight the potential of mesenchymal stem cell (MSC) therapy along with core decompression for the management of ONFH with a special reference to umbilical cord-derived stem cells. Keywords: Umbilical cord, Mesenchymal stem cells, Osteonecrosis, Femoral head, Avascular necrosis.

Objective: Evaluation and management of Tuberculous Pyomyositis, a rare manifestation of Mycobacterium tuberculae. Materials and Methods: All the patients who had visited the orthopaedic OPD at Mahamaya Rajkiya Allopathic Medical College Ambedkar Nagar during the period from March 2012 to March 2019 and diagnosis supported by radiological evaluation by MRI/USG and established by acid fast staining/histopathological evaluation of aspirate/biopsy of involved muscle. Results: Depends upon their clinical presentation initially 28 cases were suspected among which 16 cases (57.10%) found positive for tuberculous pyomyositis. Two patients were lost during follow up so finally there were 14 cases (50%) included in this study. Among 14 cases, 7 cases (50%) were female and 7 cases (50%) male. The age of patients varied from 9 year to 68 year and the duration of illness on presentation from 2 months to 12 months. The routes of infection were hematogenous in 11 cases (78.57%) and penetrating injury in 3 cases (21.42%). All cases were managed with anti tubercular drugs as per guideline, and surgery also needed in 8 cases (72.72%). Conclusion: Isolated presentation of tuberculosis as pyomyositis is rare and not widely reported in the literature. Tuberculous pyomyositis should be considered in long standing vague swelling of the upper and lower limb without constitutional symptoms and signs of inflammations. Thus it is our recommendation is to establish the diagnosis of tubercular pyomyositis followed by anti tubercular treatment; and in selected cases surgical drainage and debridement along with ATT. Keywords: Pyomyositis, Tubercular, Muscle, Infection.

The novel Coronavirus Disease (nCOVID-19) is a highly contagious viral infection which emerged as “Pneumonia of Unknown Etiology” at Hubei province of Wuhan city in China. The health authorities provided a considerable empirical evidence after this outbreak and it was notified that the causative virus, named Novel Coronavirus (subsequently SARS-CoV-2) is the culprit for progressively exerting grim effects not only on individual patients but also on the International public health, with high mutational tendencies. WHO declared nCOVID-19 as a Pandemic on 11th March 2020. The spike glycoprotein of SARS-CoV-2 plays a pivotal role in the entry of virus into the cell and it further interacts with ACE-II receptors which are widely distributed on the human cell surface especially on alveolar type II cells (AT-2) and endothelium. The mortality in nCOVID-19 patients is usually preceded by acute respiratory distress syndrome (ARDS) because of the cytokine storm. Advanced molecular biology and regenerative sciences renders a breakthrough in the treatment of severely ill nCOVID-19 patients with Mesenchymal Stem Cells (MSCs). Autologous or allogenic MSCs attenuate cytokine storm, improvise lung compliance, regulate inflammatory response, maintain functional alveoli microenvironment, promote endogenous regeneration and repair with no or minimal side effects. MSCs are naturally resistant to this novel Coronavirus. Even though it is corroborated with evidences from current clinical trials and pilot study, we emphasize the need for conducting more clinical trials with ethical consideration to prove the efficacy and safety of MSCs in combating nCOVID-19 infection and its complications.

Hyperglycemia or diabetes mellitus (DM) is a disorder of the endocrine system. In this condition, the body is insulin-deficient or resistant to insulin. Due to insulin deficiency or resistance, the body is unable to process sugar. The worldwide prevalence of diabetes mellitus is rising substantially. Hyperglycemia makes the immune system weak, which increases the risk of infection in a diabetic patient. Fungal infection is more common in DM. Mucormycosis is a rare fungal infection in a healthy individual, but in DM, it can cause severe complications and even be fatal if not treated adequately and timely. In our literature review, a total of 19 published articles from the PubMed database and Google Scholar were included. We combed the PubMed database and Google Scholar by using various inclusion and exclusion criteria. The result of the review study shows the increased risk of mucormycosis in a diabetic patient.

WHO declared SARS-CoV-2 as a pandemic disease on 11th March 2020. Due to global lockdown and restricted social movements, there is a rising curve in the morbidity of health of non- SARS-CoV-2 orthopaedic rheumatology patients and an impairment in the functional quality of life necessitating a pandemic response protocol into action in all fields of patient care. The development of ideal strategies and recommendations for the management of orthopaedic rheumatologically predisposed population and principles to be followed in their practice is the need of the hour. We hereby give a comprehensive list of strategies that can be followed in orthopaedic rheumatology practice by encompassing the recommendations given by the European League Against Rheumatism (EULAR), The American College of Rheumatologists (ACR), and Indian Association of Orthopaedic Rheumatology - Indian Orthopaedic Association (IORA-IOA). SARS-CoV-2 pandemic has put enormous pressure on patients with Rheumatic Diseases (RD) due to their innate weakness and shared treatment protocols in management. Though RD needs a multidisciplinary approach, which remains a challenge in this pandemic scenario, these strategic recommendations would aid in their optimal care amidst the adversity of SARS-CoV-2. Keywords: Orthopaedic Rheumatology, SARSCoV2, COVID19, Rheumatic Diseases.

Background Head and neck cutaneous squamous cell carcinoma (HNCSCC) is a non-melanoma skin cancer that is mostly caused by solar ultraviolet radiation exposure. While it usually has an excellent prognosis, a subset of patients (5%) develops nodal metastasis and has poor outcomes. The aim of this study was to systematically review the literature and evaluate the prognostic factors of HNCSCC in order to better understand which patients are the most likely to develop metastatic disease. Methods A comprehensive literature search was performed on PubMed and EMBASE to identify the studies that evaluated the prognostic factors of HNCSCC. Prognostic factors were deemed significant if they had a reported p-value of Results The search yielded a total of 958 citations. Forty studies, involving a total of 8535 patients, were included in the final analysis. The pre-operative/clinical prognostic factors with the highest proportion of significance were state of immunosuppression (73.3%) and age (53.3%); while post-operative/pathological prognostic factors of importance were number of lymph nodes involved with carcinoma (70.0%), margins involved with carcinoma (66.7%), and tumor depth (50.0%). Conclusion This systematic review is aimed to aid physicians in assessing the prognosis of HNCSCC and identifying the subsets of patients that are most susceptible to metastasis. It also suggests that immunosuppressed patients with a high-risk feature on biopsy, such as invasion beyond subcutaneous fat, could possibly benefit from a sentinel lymph node biopsy. Graphical abstract

Tuberculous tenosynovitis is a chronic and rare infection of flexor tendon sheath of forearm, mainly around the wrist. Patients presents with swelling and pain, and sometime also with neurological symptoms when median nerve get involved. Patient evaluated clinically for the diagnosis, but the MRI is the gold standard tool for the diagnosis. Histopathological evaluation is also needed to confirm the diagnosis. Management is mainly surgical followed by full course of anti tubercular therapy. A delay in the management may leads to complications due to asymptomatic swelling. Keywords: Wrist swelling, Compound palmar ganglion, Tubercular tenosynovitis, Melon seeds, Median nerve.

The linchpin for COVID-19 pathogenesis is the severe inflammatory process in the respiratory tract wherein the accumulation of excessive cytokines paves the way for a series of systemic hemodynamic alterations and mortality. The mortality rate is higher in individuals with co-morbidities and advancing age. The absence of a specific therapy is responsible for this uncontrolled spread and the significant mortality. This renders potential insight for considering biologics as a plausible option to repair and regenerate the affected lung tissue and pulverize the causative organism. The plausible role of megakaryocytes against invading microbes was not clearly understood. Platelet lysate is an acellular product consisting of regenerative molecules released from a cluster of platelets. It attenuates the changes caused by immune reactions in allogenic utility with the introduction of growth factors, cytokines, and proteins at supraphysiologic levels and thereby serves as a regenerative immunomodulatory agent to combat COVID-19. This platelet lysate can be used in nebulized form for such acute respiratory distress conditions in COVID-19 elderly patients. Platelet lysate may emerge as a pivotal player provided investigations pace up in this context. Here, we discuss how the platelet lysate can plausibly perquisite to relegate COVID-19. Undertaking prospective randomized controlled trials to prove its efficacy is the need of the hour in this pandemic scenario.

Purpose There is a paucity of psychosocial research on non-melanoma skin cancer (NMSC) despite the fact that these malignancies mainly develop on the head and neck, frequently recur, and are associated with an increased risk for other cancers. The current study aims to respond to this gap in the scholarship by determining the prevalence of supportive care needs and examining the relationship between patients’ needs and distress. Method A cross-sectional research protocol included a consecutive sample of 60 patients with squamous and/or basal cell carcinomas who completed a survey comprised of the Skin Cancer Index (SCI), the Hospital Anxiety and Depression Scale (HADS), the Supportive Care Needs (SCNS) Survey, an inquiry about informational needs regarding skin cancer prevention, and a socio-demographic questionnaire. Results More than half of the patients indicated unmet needs, most frequently endorsing moderate and high needs for help with: the prevention of future skin cancers, the health system and informational matters. Psychological needs were strongly associated with skin cancer-specific and general distress. Higher levels of anxious and depressive symptoms were related to greater patient needs across all domains. Conclusions Despite NMSC not being life threatening in most cases, there is a significant proportion of patients, who have unmet supportive care needs and experience heightened distress levels. This study raises awareness for health care professionals to be vigilant about the supportive care needs and the psychological health of patients with non-melanoma skin cancer.

Sixteen resistant and neglected clubfoot deformities in patients of age group from 8 months to 11 years were treated with external fixator during December 2012 to November 2013. The radiological evaluation of feet was done to know the alignment of bones to decide the extent of correction required. Results were graded as good. How to cite this article Khanna M, Kumar M. Radiographic Analysis of Resistant and Neglected Clubfoot treated by Fixator. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):71-73.

N onmelanoma skin cancer (NMSC) is the most prevalent form of cancer among Caucasian populations worldwide (Kim & Armstrong, 2012; Madan, Lear, & Szeimies, 2010). The exact number of NMSC diagnoses worldwide is likely to be underesti-mated because few national and federal cancer registries record NMSCs (Lucas, McMichael, Smith, & Armstrong, 2006). As such, incidence estimates are based on regional registration practices and epidemiologic research (Cza-jkowska, Radiotis, Roberts, & Korner, 2013). Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) account for 95% of all NMSC cases (Jung, Metelitsa, Dover, & Salopek, 2010; Trakatelli et al., 2007). NMSC often appears in highly visible areas of the body, with 60%–70% of cases occurring in the head and neck region (Jung et al., 2010; Ragi, Patel, Masud, & Rao, 2010). No-tably, 80% of the NMSC cases that occur in this region are located on the face (Caddick, Green, Stephenson, & Spyrou, 2012).Studies have shown that the diagnosis and treatment of many cancer types have a variety of negative psy-chological effects (Bultz & Berman, 2010; Ernst, Gotze, Brahler, Korner, & Hinz, 2012; Katz, Irish, Devins, Rodin, & Gullane, 2003; Meyer et al., 2012; Singer, Das-Munshi, & Brahler, 2010), which can impact overall patient health (Dausch et al., 2004). An estimated 16%–25% of newly diagnosed patients with cancer experience symptoms of depression (Sellick & Crooks, 1999). Depression has been linked to functional limitations such as loss of independence in instrumental tasks of daily living in cancer survivors, as well as increased costs and use of resources, reduced quality of life (QOL), and decline in patient adherence to medical advice (Adler & Page, 2007; DiMatteo, Lepper, & Croghan, 2000; Korner et al., 2013).Despite the high incidence rates of NMSC and the negative psychological effects of being diagnosed with cancer, few studies have directly investigated the psy-chosocial effects of NMSC and its treatment (Chren, Sa -hay, Bertenthal, Sen, & Landefeld, 2007; Czajkowska, Ra -diotis, Roberts, & Korner, 2013; Essers et al., 2006; Rhee et al., 2004; Roberts, Czajkowska, Radiotis, & Korner, 2013). Such research is important because treatment of NMSC often results in scars or physical disfigurement, which are experienced as particularly disturbing when occurring in the head and neck region. Patients with tumors on conspicuous areas of the body have reported higher levels of distress (Sollner, Zingg-Schir, Rumpold

Matrix metalloproteinases compose a family of enzymes involved in degradation of the extracellular matrix. Tumor cells must penetrate the basement membrane and traverse the extracellular matrix in order to invade surrounding structures and metastasize to distant sites. Gelatinases, particularly gelatinase A (matrix metalloproteinase-2), demonstrate degradative activity against components of the basement membrane and may be involved in the progression of in situ squamous cell carcinoma lesions. Matrix metalloproteinase-2 overexpression has been correlated with tumor invasiveness and metastasis in a wide variety of cancer types, including squamous cell carcinoma arising on mucous membranes. However, correlation between matrix metalloproteinase-2 overexpression and the spread and prognosis of cutaneous squamous cell carcinoma has not been characterized in the literature at present. In this study, we used immunohistochemical techniques to examine the expression of matrix metalloproteinase-2 in 10 actinic keratosis, 15 in situ, 13 invasive, 13 primary (with documented metastatic disease), 11 metastatic, and 8 recurrent squamous cell carcinoma cases. We found that while the average staining intensity (scale 0-3+, 3+ being strongest) of actinic keratosis and in situ lesions was not statistically significant (0.87-1.3 and 0.75-1.4, respectively), the average staining intensity of invasive squamous cell carcinomas (1.6-2.5) was significantly greater than that of actinic keratosis and in situ lesions. Likewise, while the average staining intensity of primary squamous cell carcinomas and metastatic squamous cell carcinomas was not found to be statistically significant (3.1-3.5 and 3.1-3.8, respectively), the average staining intensity of these lesions was significantly higher than that of invasive lesions. We also found that the intensity of matrix metalloproteinase-2 staining correlates with cellular atypia, inflammation, neovascularization, and the invasive tumor front, as well as tumor aggressiveness, and may play a role in the pathogenesis, invasion, and metastasis of cutaneous squamous cell carcinoma.

Early detection of vascular lesions such as exudates, hemorrhages, and tumors in the retina is important in early detection of diabetes, hypertension, and cancer. For example, diabetic retinopathy is the leading cause of blindness in adults in the United States and the presence of exudates in fundus imagery is an early sign of diabetic retinopathy. In this paper we present a novel technique to automatically detect exudates, hemorrhages, and tumors in fundus imagery that is robust against spatial and temporal variations of background noise. The detection threshold is adjusted dynamically, based on the local noise statics around the pixel under test in order to maintain a pre-determined, constant false alarm rate (CFAR). A pre-processing step is introduced to accommodate the detection of bright lesions (exudates) as well as dark lesions (hemorrhages and tumors). The CFAR detector addresses the challenge of detecting bright lesions in RGB and multispectral fundus imagery where the background clutter often exhibits variations in brightness and texture. These variations present a challenge to common, global thresholding detection algorithms and other methods. Performance of the adaptive threshold CFAR algorithm is assessed using a publicly available, annotated, diabetic retinopathy database including the Retina Image Bank. Performance of the CFAR detector proves to be superior to techniques such as Otsu thresholding.

Diabetic retinopathy is the leadi ng cause of blindness in adults in the United States. The presence of exudates in fundus imagery is the early sign of diabetic retinopathy so detection of these lesions is essential in preventing further ocular damage. In this paper we present a novel tech nique to automatically detect exudates in fundus imagery that is robust against spatial and temporal variations of background noise. The detection threshold is adjusted dynamically, based on the local noise statics around the pixel under test in order to m aintain a pre -determined, constant false alarm rate (CFAR). The CFAR detector is often used to detect bright targets in radar imagery where the background clutter can vary considerably from scene to scene and with angle to the scene. Similarly, the CFAR de tector addresses the challenge of detecting exudate lesions in RGB and multispectral fundus imagery where the background clutter often exhibits variations in brightness and texture. These variations present a challenge to common, global thresholding detect ion algorithms and other methods. Performance of the CFAR algorithm is tested against a publicly available, annotated, diabetic retinopathy database and preliminary testing suggests that performance of the CFAR detector proves to be superior to techniques such as Otsu thresholding. Keywords: CFAR detector, radar, exudates, diabetic retinopathy.

The commercial production of tea tree oil, extracted from Melaleuca alternifolia Cheel, has considerably increased over the past 15 years in response to a strong demand for natural remedies and aromatic substances. The number of case reports that describe allergic contact dermatitis (ACD) to this essential oil is also on the rise. We report an additional case of ACD to tea tree oil that presented with an extensive erythema multiforme-like reaction. A skin biopsy was performed from a targetlike lesion distant from the site of the initial dermatitis. The patient was treated with systemic and topical corticosteroids. Five months later, he was patch tested to the North American standard series, to his own tea tree oil, to a fresh batch of tea tree oil, and to some related allergens. The skin biopsy showed a spongiotic dermatitis without histological features of erythema multiforme. Patch testing elicited a 3+ reaction to old, oxidized tea tree oil, a 2+ reaction to fresh tea tree oil, a 2+ reaction to colophony, a 1+ reaction to abitol, and a 1+ reaction to balsam of Peru. We believe this is the first report of erythema multiforme-like reaction secondary to ACD from tea tree oil. Other interesting features are the stronger reaction to oxidized than to fresh tea tree oil, and concomitant reactivity to colophony, abitol, and balsam of Peru.

We report a rare case of polymelia in a 6-month-old female child who presented with developed lower limbs and an additional underdeveloped left lower limb.

Background Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology. Methods/Design The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings. Discussion The identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.

Background: Reports of textile dye allergic contact dermatitis are becoming frequent in the literature. Occupational exposure to textile dyes has been reported, but less frequently. Objective: To report 2 cases of allergic contact dermatitis to Disperse Blue dyes 106 and 124 occurring in airline personnel. Methods: The patients were patch tested to the European or North American standard series, a textile dye series, and 1 patient was tested with pieces of textile from an airplane seat. Results: Patch testing elicited in both patients a 2+ reaction to Disperse Blue dyes 106 and 124, and a 1+ reaction to paraphenylenediamine in one patient. Conclusion: We describe 2 cases of occupational textile dye allergy occurring in airline personnel. Both cases showed the utility of Disperse Blue dyes 106 and 124 to serve as the screening allergens for textile dermatitis. Mandatory uniforms might be an occupational hazard in certain professions.

Medical records of patients treated with surgical repair of mandible fractures by the otolaryngology and plastic surgery departments at a level 1 trauma centre were obtained and reviewed. Two study groups were compared: patients treated within 72 h of the injury and those treated after this time period. Patient demographics, time to repair, fracture types, substance abuse history, etiology, surgical management, complications and length of hospital stay were assessed. The complication rate was 41% (n=7) within the immediate group and 38% (n=6) within the delayed group (P=0.56). Complications were prevalent in patients with history of substance abuse in both groups. Complication rates did not increase when repair of mandible fractures was delayed beyond 72 h, while substance abuse was a factor in increasing complications rates. Outpatient triage with elective repair of isolated mandibular fractures appears to be more cost-effective than admission with inpatient management.

Background: There are numerous histopathologic features related to prognosis in cutaneous squamous cell carcinoma (CSCC). We hypothesize that there is no uniform approach toward the reporting of these features. This may be related to differing opinions on their prognostic use. Methods: A written survey concerning the microscopic evaluation of CSCC was sent to 120 dermatopathologists in the United States and Canada. Respondents were asked whether they comment on specific microscopic features of CSCC, and whether they believe that each specific feature can predict prognosis. Results: The response rate was 78%. Histologic type, and the presence of perineural or vascular/lymphatic invasion, is reported by most dermatopathologists (90%, 96%, and 95%, respectively). These features are also thought to predict prognosis by the majority of respondents. Only 54% report histologic grade, and 49% think grade predicts prognosis. Depth is reported anatomically by 63%, but by only 8% in actual millimeters of invasion. However, 55% think tumor depth predicts prognosis. A total of 43% report the presence of an associated actinic keratosis, although very few (16%) think it predicts prognosis. Very few comment on the presence of inflammation. Conclusions: Histopathologic reporting of CSCC is not uniform among dermatopathologists. Also, there appears to be differing opinions on the use of certain histopathologic features for predicting prognosis. (J Am Acad Dermatol 2003;48:721-6.)