Search

This article discusses the multidisciplinary management of advanced basal cell carcinoma (BCC) in a patient with severe congenital hemophilia A. The patient had been treated with factor VIII (FVIII) replacement for his hemophilia A and had previously been treated with oral vismodegib for the BCC. However, the BCC recurred and surgical evaluation was recommended. The patient underwent Mohs surgery with FVIII pretreatment and coordination with plastic surgery. Despite positive margins, further resection was performed with FVIII pretreatment and the patient had no bleeding issues postoperatively. The article emphasizes the importance of early multidisciplinary care for hemophiliacs with skin cancers and highlights the limitations of vismodegib as a primary treatment for BCC. [Extracted from the article]

Objective: This study aims to investigate the correlation between the quality of cleft lip scar and velopharyngeal insufficiency (VPI)., Methods: Clinical photographs from 56 patients with repaired cleft lip and palate (CLP) were collected and anonymized by cropping the image to the region of interest around the lip and nose. A survey displaying each cleft lip scar image with five associated scar quality features, including scar color, thickness, width, lip shortening, and overall appearance, was distributed. Surveys were distributed using Amazon Mechanical Turk (MTurk), an online crowdsourcing platform, to obtain ratings from 330 laypeople. The same surveys were also distributed to 45 medical students., Main Outcome Measure: Hypernasality was used as the primary speech outcome measure. Ordinal logistic regression was used to compare the ratings for each of the five scar quality categories with the patients' CAPS-A-AM hypernasality rating for both MTurk and medical student raters. Significance was set at α = 0.05., Results: For medical student ratings', ordinal logistic regression showed a statistically significant relationship between lip shortening (P=0.019) and overall appearance (P=0.044) with CAPS-A-AM hypernasality score, whereas the other scar categories showed no significant association. There was no statistically significant relationship between MTurk ratings and hypernasality for any of the scar categories., Conclusions: The association found between lip shortening and overall scar appearance, thought by the authors to indicate scar contracture, and hypernasality, an indicator of VPI severity, provides an interesting insight into how to potentially identify patients who may be at increased risk for developing VPI., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)