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Background: According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown., Objective: To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus., Methods: An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery., Results: Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training., Conclusion: Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations., (Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

The rising incidence of cutaneous squamous cell carcinoma (cSCC) represents a public health crisis. Although most cases of cSCC are cured with surgical excision alone, high-risk disease requires a coordinated strategy involving accurate staging, possible multimodal therapy, and clinical and radiologic surveillance. In the following review, we present an evidence-based update on the current paradigm of diagnosis and management of cSCC and discuss the most relevant areas of active research related to prognostic staging as well as the appropriate use of radiologic imaging and adjuvant therapy., Competing Interests: Disclosure None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma with a high rate of local recurrence. Recent studies have indicated a potential benefit in local control with the addition of adjuvant radiotherapy (RT)., Objective: This study sought to evaluate the outcomes of adjuvant RT for patients with DM., Materials and Methods: The National Cancer Database was queried (2004-2015) for patients with newly diagnosed, nonmetastatic DM. Patients were divided into 2 groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS., Results: There was no difference in median OS between patients treated with RT when compared with patients observed (111.4 months vs 133.9 months, p = .1312). On multivariable analysis, older age, T stage ≥2, N stage ≥1, and no receipt of immunotherapy were associated with worse OS., Conclusion: In this large study evaluating efficacy of adjuvant RT in DM, no overall survival benefit was observed among patients receiving adjuvant RT., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae., Objective: To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects., Materials and Methods: A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS)., Results: A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes., Conclusion: The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.