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It was perhaps 30 years ago that I attended a lecture by the famous New York (NY) University plastic surgeon, John Marquis Converse. He said he knew there was ''mischief afoot.'' Everytime he called his friendly dermatologist he was told he could not come to the telephone because he was in surgery. That prescient observation relates to this essay. I was asked to give my reflections on the impact of dermatologic surgery on our specialty, including our image and relationship with colleagues in other disciplines. Even a person with command of the obvious would conclude that this emphasis on surgery has had a profound effect. The consequence is both positive and negative.

Patients with chronic snuff-induced keratosis associated with mucosal ulcerations were treated with topically applied vitamin A acid. In each case, after a marked, local inflammatory response initially, topical vitamin A acid showed a definite beneficial effect in promoting healing and involution of the precancerous snuff-induced leukoplakic keratosis. In one patient there was distinct involution of the oral lesions with complete healing and restoration of a normal-appearing mucosa within five weeks after beginning of treatment. In four patients there was healing of superficial ulcerations and regression in the size of the luekoplakic lesions.

Cutaneous changes often indicate the presence of undiagnosed systemic disease. Necrobiosis lipoidica may be the first manifestation of the diabetic state. Lupus erythematosus is characterized by a distinctive distribution of erythema and by scale and atrophic scarring. Hidebound alterations and thick plaques in the skin are distinctive of scleroderma. Heliotrope discoloration of the skin is unique to dermatomyositis.

With the introduction of oral griseofulvin 1 and the demonstration of its effectiveness in onychomycosis, 2,3 a simple oral therapy appeared at hand. Onychomycosis due to the common Trichophyton rubrum organism has long been considered incurable by most dermatologists, there being no reasonable, routinely effective therapy. Early in 1959, when griseofulvin became available to the authors, a study was begun to determine the optimum dosage required to clear nails diseased with Trichophyton rubrum. * It is the purpose of this preliminary report to outline our experiences to date in the treatment of onychomycosis with griseofulvin. Since February of 1959, we have treated 55 patients. No topical remedies were prescribed during the course of this study. Forty-one adult white patients have been observed for three months or more to form the basis of this report. In all cases the involvement of the nails was characterized by elevation and separation of the nail

BASAL cell epithelioma is the most common skin carcinoma in the United States. Because these lesions rarely metastasize, their medical importance has been minimized by some, and others have approached treatment with a cavalier attitude. Fortunately, a majority of basal cell epitheliomas can be cured with a simple treatment approach, especially when the lesions are of the common "rodent ulcer" or solid type (Fig 1), containing only a small amount of fibrous stroma. However, the physician must realize that this carcinoma has an unusual number of clinical traits capable of invading cartilage and bone and extending along blood vessels and nerves, leading toward the recurrent, serious, and complicated cases (Fig'2). These variations include the superficial erythematous type (Fig 3), which may resemble psoriasis or eczema. Treatment may be delayed because of clinical misinterpretation. Another form may be deeply pigmented (Fig 4) and mistaken for a nevus, or malignant melanoma. The