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Abstract Background Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. Objective To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. Methods A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. Results One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. Study limitations Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. Conclusion The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.

Introduction: Mohs micrographic surgery is a complex but essential aspect of functional and cosmetic skin cancer removal. It allows for skin cancers to be removed from cosmetically challenging areas in the most efficient and effective possible method; however, closure of these lesions can be difficult. Case: An 80-year-old male presented for Mohs surgery of a basal cell carcinoma on the right nasal sidewall that measured 3.4 cm. The patient underwent seven stages of Mohs surgery, and the final defect measured 6.5 cm × 5.5 cm, resulting in a large area for closure with multiple cosmetic and functional units affected. Discussion: This case discusses options for complex closure of large defects on the nose and the reasoning behind the final choice in closure.

Objective: The optimal timing for surgery following neoadjuvant immunochemotherapy for lung squamous cell carcinoma appears to be a topic of limited data. Many clinical studies lack stringent guidelines regarding this timing. The objective of this study is to explore the effect of the interval between neoadjuvant immunochemotherapy and surgery on survival outcomes in patients with lung squamous cell carcinoma. Methods: This study conducted a retrospective analysis of patients with lung squamous cell carcinoma who underwent neoadjuvant immunochemotherapy between January 2019 and October 2022 at The First Affiliated Hospital, Zhejiang University School of Medicine. Patients were divided into two groups based on the treatment interval: ≤33 days and > 33 days. The primary observational endpoints of the study were Disease-Free Survival (DFS) and Overall Survival (OS). Secondary observational endpoints included Objective response rate (ORR), Major Pathological Response (MPR), and Pathological Complete Remission (pCR). Results: Using the Kaplan-Meier methods, the ≤ 33d group demonstrated a superior DFS curve compared to the > 33d group (p = 0.0015). The median DFS for the two groups was 952 days and 590 days, respectively. There was no statistical difference in the OS curves between the groups (p = 0.66), and the median OS was not reached for either group. The treatment interval did not influence the pathologic response of the tumor or lymph nodes. Conclusions: The study observed that shorter treatment intervals were associated with improved DFS, without influencing OS, pathologic response, or surgical safety. Patients should avoid having a prolonged treatment interval between neoadjuvant immunochemotherapy and surgery. [ABSTRACT FROM AUTHOR]

This document is a collection of articles from the Australasian Journal of Dermatology. The articles cover various topics related to dermatology and skin cancer treatment. One article discusses a technique for reconstructing the nasal ala using adjacent tissue, while another explores the use of oral benzodiazepines to reduce anxiety in patients undergoing Mohs micrographic surgery. Another article examines risk factors for deeper tumor invasion in nasal tumors, and a pilot study investigates the use of in vivo reflectance confocal microscopy for basal cell carcinoma. Additionally, there is an update on the use of Mohs micrographic surgery for keratinocyte cancers with perineural invasion, and a retrospective analysis of Mohs surgery in the Australian public health system. Finally, there is a review of full thickness and split thickness skin grafts for the repair of skin cancer defects. These articles provide valuable insights into various aspects of dermatology and skin cancer treatment. [Extracted from the article]

Lentigo maligna (LM) is a melanoma in situ that is prevalent in chronically sun-damaged skin. Characterized by a slow growth pattern and high mutation rates due to chronic UV exposure, LM poses diagnostic and therapeutic challenges, particularly given its tendency to mimic other skin lesions and its occurrence in cosmetically sensitive areas. Its diagnosis is based on an integrated approach using dermoscopy and reflectance confocal microscopy (RCM). Despite its slow progression, LM can evolve into lentigo maligna melanoma (LMM), making its treatment necessary. Treatment modalities encompass both surgical and non-surgical methods. Surgical treatments like Wide Local Excision (WLE) and Mohs Micrographic Surgery (MMS) aim for clear histological margins. WLE, a standard melanoma surgery, faces challenges from LM's subclinical extensions, which increase the recurrence risk. MMS, effective for large or poorly defined lesions, is defined by precise margin control while considering cosmetic outcomes. Non-surgical options, including radiotherapy and imiquimod, are alternatives for non-surgical candidates. Radiotherapy has been effective since the 1950s, offering good control and cosmetic results, especially for older patients. Imiquimod, an immunomodulator, shows promise in treating LM, though its application remains off-label. The increasing incidence of LM/LMM necessitates a balance in treatment choices to minimize recurrence and maintain cosmetic integrity. A multidisciplinary approach, integrating clinical examination with dermoscopy and RCM and histological assessment, is essential for accurate diagnosis and effective LM management. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and potential benefits of Mohs micrographic surgery (MMS) in India for the treatment of certain types of skin cancer. While MMS is gaining popularity as an effective treatment option, there are obstacles to its widespread adoption, including limited access to specialized centers, cost considerations for patients, and the need for continued training and education among healthcare professionals. The article suggests that as awareness increases and infrastructure improves, MMS is likely to become more widely available and accepted as a standard of care for appropriate cases of skin cancer in India. [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]

Background hydrochlorothiazide (HCTZ) diuretics were correlated with an increased risk of non-melanoma skin cancer (NMSC) and melanoma in the general population. Information is a scarce regarding this effect in kidney transplant recipients who are at increased risk of skin malignancies under immunosuppression. Methods Single-center retrospective analysis of adult kidney transplant recipients between 1 January 2010 and 31 December 2015. The primary outcome of the study was the first diagnosis of skin cancer that was removed and pathologically analyzed. Exposure to thiazides was defined as HCTZ use daily for at least one year at a dose of 12.5 mg. Results Among 520 kidney transplant recipients, 50 (9.4%) were treated with HCTZ. During a median follow-up of 9.8 years, 67 patients underwent surgical removal and pathological analysis of at least one skin cancer. Exposure to HCTZ during the 3 years following transplantation was associated with an increased risk of skin cancer (P  = 0.004). In a multivariate model, there was a significant association between HCTZ exposure and NMSC (HR 2.54, 95%CI 1.26–5.15, P  = 0.007). There was a higher rate of basal cell carcinoma with HCTZ exposure, according to both univariate and multivariate analyses (HR 2.61, 95%CI 1.06–6.43, P  = 0.037) and (HR 3.03, 95%CI 1.22–7.55, P  = 0.017, respectively). However, no significant association was observed between HCTZ exposure and squamous cell carcinoma. Conclusions These findings suggest a benefit of increased frequency of dermatologist inspection in kidney transplant recipients receiving HCTZ especially in increased ultraviolet exposure area. [ABSTRACT FROM AUTHOR]

Summary of review paper: Introduction and purpose: Condyloma acuminata, a benign manifestation of HPV infection, is a common sexually transmitted disease. Condyloma acuminata most commonly affects the anogenital area, but can also occur in the oral cavity. Macroscopically the lesions present as raised, fleshy papules, sometimes flat and broad, pedicled or cauliflower-like. Generally, the lesions are multiple, and as they grow, tend to coalesce into larger ones. Due to the lack of symptoms, condyloma acuminata are often found incidentally during routine medical appointments, e.g. in gynecologist's offices. Additional symptoms and signs are pain, minor bleeding and pruritus. Patients suffering from condyloma acuminata are often in psychological and psychosexual distress. This work aims to provide a summary of the currently available treatment options based on scientific reports to date. A brief description of the state of knowledge: Among the factors that increase the risk of the HPV infection are age, lifestyle, promiscuity, smoking, HIV infection, a history of chlamydia or gonorrhea infections. To date, no treatment algorithm has been developed for condyloma acuminata. Two vaccines are on offer as primary prevention, Gardasil and Cervarix. The available treatment options are divided into two main groups: patient-administered and physician administered. Surgical methods have the highest therapeutic efficacy. Condyloma acuminata has a high recurrence rate. Usually, a multi-session combination treatment is needed to reach total remission. Summary (conclusions): The treatment of condyloma acuminata includes personalized targets due to their diverse clinical picture and the limitations of certain patient groups. The available treatment options do not exhaust the needs of patients suffering from condyloma acuminata. Further research into the effectiveness of specific treatments is advisable. [ABSTRACT FROM AUTHOR]

Objective: The aim of this case series is to present an alternative approach to managing post-Mohs Micrographic Surgery (Mohs) wounds with hypothermically stored amniotic membrane (HSAM). Method: A case series of patients with post-Mohs wounds is presented, with four patients referred for hard-to-heal wounds following a Mohs procedure that was performed 1–3 months previously. All wounds underwent weekly assessment, debridement, and application of HSAM and secondary dressings. Treatment also included management of bioburden, proper skin care and compression therapy for lower extremity wounds. Results: This case series of seven wounds consisted of four females and three males with a mean age of 87.6 years. Mean wound size at first application of HSAM was 1.34±1.20cm2. All wounds closed, with an average time to wound closure of 43.7±27.1 days. Patients received an average of 4.6±2.5 HSAM applications. The four post-Mohs wounds with a history of being hard-to-heal had an average time to wound closure of 35.5±16.3 days, with an average duration of 86.5±32.4 days prior to the first HSAM application. Conclusion: The results of this case series suggest that use of HSAM may provide an alternative approach to managing post-Mohs wounds. In addition, these findings suggest that HSAM may be of greatest benefit when applied early after Mohs surgery. [ABSTRACT FROM AUTHOR]

Cutaneous angiosarcoma (CAS) is a rare aggressive malignancy that most commonly manifests in White men older than 60 years and often appears as an enlarging ecchymosis on the head, neck, or scalp. Surgery with negative margins is the first-line treatment. The role of Mohs micrographic surgery (MMS) is uncertain but can be used in smaller, well-circumscribed lesions on the head and neck. The greatest impact that dermatologists can have in the management of CAS is through a thorough total-body skin examination and heightened awareness resulting in a shortened time to diagnosis. Until quality evidence allows for the creation of consensus guidelines, multidisciplinary care at a cancer center that specializes in rare difficult-to-treat tumors is essential in optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

Nasal mucosa tumors are an uncommon process and very dificult to work on with surgery. Radiotherapy associated or not with chemotherapy is the standard method to treat the disease. However, its access it is in the majority of the case not possible, making the surgery the best choice to try to achieve the patient's control. The anatomy of the region makes the complete surgical resection very difficult to achieve using the common and conventional blade scalpel surgery. The study features the advantages of using a CO2 laser to perform nasal mucosa carcinoma surgery in 6 dogs (N = 6). For the work we used an Aesculigth CO2 surgical laser model -Vetscalpel®, with the settings of 12Watts in a Superpulse mode, and a 0.25–0.4 mm focus to dissect the nasal mucosa, and a 1.5 mm focus for vaporization of the area. All the masses were histopathologically characterized as squamous cells carcinoma. The CO2 surgical laser allow us to work in a bloodless region promoting a more accurate dissection of the nasal mucosa sparing therefore the underlying and adjacent tissues and being less invasive. Also, it was possible to do the vaporization of the entire surgical area interviened. None of the patients presented relapse of clinical signs. Only 2 individuals were alive at the end of the study, presenting a survival rate of 420 and 514 days, which is in the same line of literature results of the treatment with radiotherapy combined with chemotherapy wich shows a median of 474–580 days. The study demonstrates successful outcomes with CO2 laser surgery in treating nasal mucosa SCC in dogs, with patients experiencing improved survival rates compared to traditional treatment methods. This highlights the efficacy and potential of CO2 laser surgery as a valuable tool in managing aggressive nasal tumors in veterinary oncology. [ABSTRACT FROM AUTHOR]

Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages. [ABSTRACT FROM AUTHOR]

Introduction: Surface mold brachytherapy(SMBT) is an established treatment modality in skin cancer, especially in accessible areas, and has shown comparable outcomes to surgery. We have presented our results for the skin tumor treatment with SMBT treated with high-dose-rate (HDR) brachytherapy in terms of clinical outcomes and toxicity at our institute. Materials and Methods: In this retrospective analysis, 15 patients with skin cancer were treated with customized tube-based SMBT at our institute between January 2019 and July 2021. The patients were treated using HDR-brachytherapy using Iridium-192. The median dose was 40 Gy in 10 fractions. The dosimetric parameters were assessed, and patients were followed up as per the institutional protocol. All patients underwent individualized CT-based planning. Skin toxicity was assessed using the Dermatology Life Quality Index (DLQI). Results: With the majority of the patients being male, the median age was 59 years and the most common site affected was the face (8/15; 53.3%). Among the 15 cases, five were squamous cell carcinoma, nine were basal cell carcinoma, and a single case of sebaceous cell carcinoma. The median depth of invasion was 4 mm, and the median catheter-to-surface distance was 1 mm. The complete response rate among the 10 definitive cases was 90% and partial response in one case. The treatment was well-tolerated with no grade 3-5 toxicities. The median V95% and V90% were 94.8% and 97.1%, respectively. The mean coverage index (C.I.), dose non-uniformity ratio (DNR), and overdose volume index(ODI) were 0.97, 0.13, and 0.05, respectively. After a median follow-up of 12 months, none of the patients had recurrence. On assessment of DLQI, the scores were found to be significant in association with the tumor size and tumor site with scores favoring <2 cm and non-exposed area lesions. Conclusion: SMBT is a safe and effective treatment modality for skin tumors providing excellent response and cosmetic outcomes. It is well-tolerated and a non-invasive option for elderly patients with comorbidities and lesions in inoperable areas. [ABSTRACT FROM AUTHOR]

Introduction: Basal cell carcinoma is the most common form of skin cancer. The lifetime risk is estimated as 33% to 39% in white men and 23% to 28% in white women. Because of that it is a very crucial disease for public health. In this article will be described main pathways of treatment which are especially recommended and are the most wide used for different types of basal cell carcinoma. Main division of interventions type used in treatment of basal cell carcinoma are surgical (physical) and non-surgical (medical). Surgical (physical) includes surgical standard excision, Mohs micrographic surgery, curettage and cautery, cryosurgery and laser therapy (ablative lasers, pulsed dye lasers). Non-surgical (medical) includes radiotherapy, topical imiquimod, topical 5-fluorouracil, photodynamic therapy, intralesional interferon. Aim of study: Literature review of the most recommended treatment of basal cell carcinoma. State of knowledge: In this publication will be desribed a current state of knowledge about basic and the most crucial basal cell carcinoma treatment. Conclusion: Because of incidence rate of basal cell carcinoma which is very high-there are many reports about treatment of this disease. Treatment of this disease, especially among low risk patients, is very effective. [ABSTRACT FROM AUTHOR]

Ultrasound and high-frequency ultrasound assessment of melanoma and non-melanoma skin cancer in the pre-therapeutical setting is becoming increasingly popular in the field of dermatosurgery and dermatooncology, as it can provide clinicians with relevant, "in vivo" parameters regarding tumor lateral and depth extension as well as potential locoregional spread, cancelling the need of more extensive imaging methods and avoiding a delay in diagnosis. Furthermore, preoperative sonography and color Doppler can aid in orienting the clinical diagnosis, being able in numerous situations to differentiate between benign and malignant lesions, which require a different therapeutic approach. This preoperative knowledge is of paramount importance for planning an individualized treatment regimen. Using sonography at the time of diagnosis, important surgical complications, such as neurovascular damage, can be avoided by performing a preoperative neurovascular mapping. Furthermore, sonography can help reduce the number of surgical steps by identifying the lesions' extent prior to surgery, but it can also spare unnecessary surgical interventions in cases of locally advanced lesions, which infiltrate the bone or already present with locoregional metastases, which usually require modern radiooncological therapies in accordance to European guidelines. With this review, we intend to summarize the current indications of sonography in the field of skin cancer surgery, which can help us improve the therapeutic attitude toward our patients and enhance patient counseling. In the era of modern systemic radiooncological therapies, sonography can help better select patients who qualify for surgical procedures or require systemic treatments due to tumoral extension. [ABSTRACT FROM AUTHOR]

Background: Melanoma causes most skin cancer–related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. Methods: Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. Results: 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% (n = 96620) were in urban areas and 6.7% (n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR.52, 95% CI:.29-.90, P =.02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P =.03) even after additionally controlling for surgery receipt. Conclusion: Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients. [ABSTRACT FROM AUTHOR]

This case report describes an 80-year-old man who presented with a growing erythematous nodule with erosion, measuring 0.6 cm × 0.6 cm, on his right temple. This lesion was later diagnosed as atypical fibroxanthoma (AFX). Instead of undergoing Mohs surgery, the gold standard treatment, the patient opted to pursue a topical treatment regimen because of financial costs associated with surgical removal and repair. This topical regimen consisted of tazarotene cream, imiquimod cream, and 5-fluorouracil solution, applied for 30 days. The patient was directed to use this combination 5 days per week for 6 weeks. The specified dosage for each medication was a fifth of a packet of imiquimod 5% cream, an equivalent amount of tazarotene 0.1% cream, and a single drop of 5-fluorouracil 2% solution. These were combined on a bandage and placed on the lesion overnight. Following the treatment, a 3-week post-application examination revealed an erosion, 1.0 cm × 0.9 cm, amidst erythema. A subsequent incisional biopsy with histopathology and stains for CD10 and CD99, 3 weeks after treatment, and three punch biopsies with histopathology and stains for CD10 and CD99, 1-year post-treatment, confirmed the absence of AFX. AFX is a superficial variant of pleomorphic dermal sarcoma (PDS), which shares histologic similarities, yet the exact relationship between AFX/PDS and undifferentiated pleomorphic sarcoma is still not well understood. Previous studies have indicated a genomic similarity between AFX/PDS and cutaneous squamous cell carcinoma (cSCC), which suggests the potential efficacy of cSCC-targeted treatments for AFX/PDS. This case marks the first recorded instance of successful topical medical treatment of AFX, offering an alternative for patients who may opt out of surgical intervention. Continued research to assess the broader efficacy of this approach is encouraged. [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]

Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS. [ABSTRACT FROM AUTHOR]

Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers. [ABSTRACT FROM AUTHOR]

Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM. [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 article provides information on the common symptoms and early diagnosis of basal cell carcinoma (BCC), the most common type of skin cancer. The study analyzed 69 respondents with BCC and found that different symptoms were more common in different types of BCC. The study also emphasized the importance of dermoscopy as a reliable diagnostic method for early detection of BCC. Additionally, the article discusses the distribution and clinical characteristics of BCC, noting that it is more commonly diagnosed in females and younger individuals. The document also includes information on superficial spreading BCC and references to other relevant studies on BCC. [Extracted from the article]

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The article discusses the implementation of digital dermatopathology at a multisite academic institution and its impact on trainees' perceptions. Through surveys and focus groups, trainees expressed favorable views on digital dermatopathology, citing benefits such as improved workflow efficiency and educational opportunities. While concerns about retaining conventional microscopy skills were raised, overall satisfaction with digital pathology platforms was high among trainees, indicating a positive reception to technological advancements in the field. [Extracted from the article]

This document is a letter published in the Archives of Dermatological Research. The authors evaluated the accuracy, completeness, and readability of responses generated by large language models (LLMs) to preoperative questions about Mohs micrographic surgery (MMS). They queried ten common MMS preoperative questions to three LLMs and assessed the responses for accuracy, completeness, and readability. The initial survey found an overall accuracy and completeness of 59% across LLMs, with ChatGPT having the highest accuracy. However, many responses contained minor errors, and the average reading level of the responses was higher than recommended for medical educational materials. The authors suggest that while LLMs may provide some helpful information, there are also extraneous details and inaccuracies present. They recommend increasing the reliability and readability of LLM-generated responses to improve their clinical utility, and caution Mohs surgeons and patients to be aware of potentially inaccurate or confusing information from LLMs. [Extracted from the article]

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]

This article discusses a study conducted at the Manhattan Veterans Affairs Medical Center aimed at improving adherence to total body skin examination (TBSE) among veterans treated for skin cancer. The study implemented a targeted reminder phone call intervention to remind patients of their scheduled TBSE and the importance of follow-up. The results showed that the intervention group had significantly higher adherence to TBSE compared to the control group, particularly among patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The study suggests that reminder phone calls can effectively improve follow-up rates for TBSE in this population. [Extracted from the article]

This article discusses the diagnosis and treatment of non-pigmented basal cell carcinoma (BCC), the most common type of skin malignancy. Non-pigmented BCC can be challenging to diagnose due to its lack of pigment. The article describes a case study of a 59-year-old female with non-pigmented BCC on her nose. The diagnosis was made using dermoscopy, reflectance confocal microscopy (RCM), and high-frequency ultrasound (HFUS). Mohs micrographic surgery was performed to remove the tumor, guided by HFUS to accurately delineate the surgical boundary. The article concludes that noninvasive imaging techniques, such as dermoscopy, RCM, and HFUS, can aid in the diagnosis and treatment of non-pigmented BCC. [Extracted from the article]

This article discusses the use of a 4-mm-wide double scalpel in dermatologic surgery. The double scalpel with a 4-mm separation between the blades allows for the retrieval of 90° homogeneous surgical pieces, which are ideal for processing and collection in pathology cassettes. This scalpel is particularly useful for the excision of lesions with margins greater than 2 mm, such as large or high-risk basal cell carcinomas, squamous cell carcinomas, Merkel cell carcinomas, and dermatofibrosarcoma protuberans. The main limitation of this scalpel is the lack of experience and limited marketing, but it offers potential benefits in margin-controlled micrographic surgery. [Extracted from the article]

A 68-year-old man presented with skin lesions on his right thigh that had been present for 6 years. The lesions had grown over time and were surgically removed multiple times. After ineffective treatment, the patient was diagnosed with superficial cutaneous leiomyosarcoma (SCLM), a rare malignant tumor that can be easily misdiagnosed. SCLM typically displays larger size, cellular atypia, and infiltrative growth compared to skin leiomyoma. Surgical removal is the most effective treatment, but there is a risk of recurrence. Mohs micrographic surgery is recommended to minimize the risk of recurrence. [Extracted from the article]

The article titled "Squamoid eccrine ductal carcinoma: A frequently misdiagnosed entity" discusses a type of skin cancer that is often misdiagnosed. The authors reference several studies that have examined this condition, providing anatomoclinical information and clinicopathologic studies. The article also mentions a case report and a review of the literature on this topic. Overall, the article aims to provide valuable information about squamoid eccrine ductal carcinoma to aid in accurate diagnosis and treatment. [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]