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Background Reconstructing defects on the nose can be challenging. The bilobed transposition flap and the nasalis-based V to Y (NBVY) flaps can be excellent repair options, each with their own advantages and disadvantages. Objective To compare bilobed and NBVY flap scar appearances, postoperative complications, scar revision rates, flap sizes, and relative costs. Materials and methods We reviewed 95 cases of Mohs surgery defects on the nose repaired with either a bilobed or a NBVY flap from 2010 to 2018 at our institution. Eleven reviewers judged postoperative scar images using a modified visual analog scale. Results There were no significant differences in reviewer-rated scar appearances, complication rates, or revision rates between bilobed and NBVY flaps. The NBVY flaps were 50% smaller than bilobed flaps, with significantly lower CPT billing codes. The NBVY flaps yielded better scar appearance scores compared with bilobed flaps on highly sebaceous noses. Conclusion The NBVY and bilobed flaps demonstrated similar scar appearance outcomes, but the NBVY flap has several advantages. Compared with the bilobed flap, the NBVY flap is smaller, less expensive, and may yield better cosmetic outcomes in patients with highly sebaceous noses.

There is a lack of data characterizing tumors located within male facial hair subunits and determining if terminal hair growth obscures tumor detection, thus leading to a delay in diagnosis. Our objective was to evaluate the difference in cutaneous tumor size in men who had facial hair compared to men without facial hair. This retrospective chart review analyzed Mohs micrographic surgery cases of tumors located within facial hair subunits from January 2015 to December 2018 at The University of North Carolina at Chapel Hill. Patients and dermatologists should maintain a high index of suspicion for any concerning lesion contained within skin underlying facial hair to ensure prompt diagnosis and treatment of cutaneous tumors.

EMPD is an intraepidermal adenocarcinoma most often limited to the epidermis, with typical cases affecting genital skin in women and men. In patients with invasive disease, prognosis is based on the degree of invasion, with tumors less than 1 mm deep having very low mortality. Careful evaluation for an underlying malignancy should be carried out to exclude life-threatening disease, but the association of many coexistent malignancies is controversial. Reported underlying adnexal adenocarcinoma may, at least in some patients, represent invasive spread of primary epidermal disease. Mohs surgery has proven effective in the treatment of EMPD, and the implementation of CK7 immunostaining shows promise in further reducing the recurrence rate. Alternative treatments, including topical treatment with imiquimod and 5-fluorouracil as well as photodynamic therapy, may be effective in select cases of EMPD.

Background Mohs micrographic surgery (MMS) has been used effectively to treat invasive melanoma. Objective To further study the safety and efficacy of MMS in the treatment of invasive melanoma. Methods and materials A retrospective cohort study evaluated 123 melanomas excised using MMS with MART-1 immunostain. Local recurrence, metastasis, overall survival, and disease-free survival rates were calculated. These were compared with historical controls. Results Among included patients, 78 were men (63%) and 45 were women (37%), with a mean age of 66.48 years. Mean follow-up time was 1,273 days (3.49 years). Local recurrence was identified in 2/123 (1.63%; 95% confidence interval, 0.20%-5.75%) lesions. Local recurrence was identified in 1/70 (1.43%; 95% confidence interval, 0.04%-7.70%) of head and neck cases. Tumor location was head and neck in 70 lesions (56.9%). Overall survival was 95.12% and disease-specific survival was 100%. Conclusion Mohs micrographic surgery is an effective treatment method for invasive melanoma, as evidenced by low recurrence rates and high rates of disease-free survival.

Petrified ear is the transformation of normal, flexibleauricular cartilage into rigid, immobile auricularcartilage due to abnormal calcification or ossification.Etiologies of petrified ear include tissue injury,systemic endocrine diseases, congenital disorders,or petrified ear of unknown origin. We present a caseof a 69-year-old male with a one-month history ofnon-painful rigidity of the right ear that was found tohave petrified ear of unknown etiology confirmed byradiography.

Petrified ear is the transformation of normal, flexibleauricular cartilage into rigid, immobile auricularcartilage due to abnormal calcification or ossification.Etiologies of petrified ear include tissue injury,systemic endocrine diseases, congenital disorders,or petrified ear of unknown origin. We present a caseof a 69-year-old male with a one-month history ofnon-painful rigidity of the right ear that was found tohave petrified ear of unknown etiology confirmed byradiography.

We describe deep granuloma annulare (DGA) of the forehead mimicking inflamed cysts. Reactive inflammation and sterile purulent drainage may be an underrecognized feature of DGA.

BackgroundExisting predictive models for lung cancer focus on improving screening or referral for biopsy in general medical populations. A predictive model calibrated for use during preoperative evaluation of suspicious lung lesions is needed to reduce unnecessary operations for a benign disease. A clinical prediction model (Thoracic Research Evaluation And Treatment [TREAT]) is proposed for this purpose.MethodsWe developed and internally validated a clinical prediction model for lung cancer in a prospective cohort evaluated at our institution. Best statistical practices were used to construct, evaluate, and validate the logistic regression model in the presence of missing covariate data using bootstrap and optimism corrected techniques. The TREAT model was externally validated in a retrospectively collected Veteran Affairs population. The discrimination and calibration of the model was estimated and compared with the Mayo Clinic model in both the populations.ResultsThe TREAT model was developed in 492 patients from Vanderbilt whose lung cancer prevalence was 72% and validated among 226 Veteran Affairs patients with a lung cancer prevalence of 93%. In the development cohort, the area under the receiver operating curve (AUC) and Brier score were 0.87 (95% confidence interval [CI], 0.83–0.92) and 0.12, respectively compared with the AUC 0.89 (95% CI, 0.79–0.98) and Brier score 0.13 in the validation dataset. The TREAT model had significantly higher accuracy (p < 0.001) and better calibration than the Mayo Clinic model (AUC = 0.80; 95% CI, 75–85; Brier score = 0.17).ConclusionThe validated TREAT model had better diagnostic accuracy than the Mayo Clinic model in preoperative assessment of suspicious lung lesions in a population being evaluated for lung resection.