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Background: Imiquimod has been used for basal cell carcinomas (BCCs). This is the first open-label series using imiquimod for nodular BCC with Mohs surgery resection for confirmation of treatment., Objective: To evaluate the efficacy of topical imiquimod in patients with biopsy-proven nodular BCC., Results: After 12 weeks for three times a week application, treatment sites at week 15 were surgically excised using Mohs micrographic surgery. All 15 treatment subjects were clear of BCC. At the 18-month follow-up, no patients had recurrent tumor., Conclusion: Imiquimod 5% cream may be another treatment modality for nodular BCC.

Background: Dementia is an organic mental disorder that is characterized by a general loss of intellectual abilities involving impairment of memory, judgment, and abstract thinking as well as changes in personality. Demented patients are a growing subgroup within the practice of dermatologic surgery and especially in Mohs surgery. These patients often have other medical and social concerns in addition to their dementia., Objective: Demented patients require specific knowledge of their problems to care for them properly, especially in cases in which prolonged procedures are required such as Mohs surgery., Methods: A review the literature is given regarding this subgroup of patients and how to best prepare and care for them before, during, and after dermatologic surgery., Results: Demented patients often have other medical concerns and therefore have associated medications, medical ailments, postsurgical care, and social and mental challenges., Conclusion: The dermatologic surgeon needs to be aware of the special concerns of demented patients, especially in prolonged and potentially complicated surgeries. Not only do they have mental challenges, but they often have other medical and social challenges that need to be specifically accounted for before, during, and after dermatologic surgery.

The multiple enchondromas and hemangiomas of Maffucci syndrome affect the skin and skeletal systems. The disease develops slowly, with enlargement of enchondromas and hemangiomas occurring during the first 2 decades of life. Effects of the disease range from those requiring minor adjustments in activities of daily living to almost total incapacitation.

Background: There are many different topical anesthetics available. Ice is an easy to use and inexpensive topical anesthetic. There are studies comparing different topical anesthetics but none have used ice., Objective: To evaluate the efficacy between EMLA (2.5% lidocaine and 2.5% prilocaine cream) and ice prior to injection with a 30-gauge needle containing a painful stimuli., Method: A fingertip amount of EMLA cream was placed on the upper left arm and occluded with a bandage for an average of 52 minutes. Ice in a rubber glove was placed on the right upper arm for 1-2 minutes. The EMLA site, ice site, and a control site without anesthetic were tested for cutaneous analgesia with an injection of 1% lidocaine with 1:100,000 epinephrine through a 30-gauge needle using a 3 cc syringe. Discomfort was recorded using a visual acuity scale (VAS). Analysis of data was performed using a t test paired sample of two means., Results: Statistically there was a significant difference in pain control between EMLA and ice (P <.05), EMLA and control (P <.01), and ice and control (P <.01). Clinically patients felt that EMLA performed slightly better as an analgesic than ice, and both EMLA and ice were more efficacious than the control., Conclusion: Both EMLA and ice decreased the discomfort associated with needle injection. Although EMLA performed better in pain control, ice has advantages in ease of use, fast action, and is less expensive than EMLA. Both EMLA and ice were good topical anesthetics, each with advantages and disadvantages in clinical use.

Background: Cryosurgery is one of the most common treatment methods in the dermatologists armamentarium. We describe a method combining forceps and a cotton applicator to freeze benign lesions for practitioners who prefer to use cotton-tipped applicators instead of a cryosurgery spray device., Methods: We describe the technique using common in-office instruments., Conclusion: Lesions around delicate areas can be treated with forceps and a cotton-tipped applicator dipped in liquid nitrogen resulting in less pain and decreased collateral damage vs. traditional methods. For the most delicate areas, the forceps dipped directly in liquid nitrogen method is preferred.