Complications After Mohs Micrographic Surgery in Patients Aged 85 and Older.

BACKGROUND: As the US population ages, safe surgical procedures are necessary for treatment of cutaneous neoplasms in very elderly patients. OBJECTIVE: To determine the incidence of complications associated with Mohs micrographic surgery (MMS) in patients aged 85 and older, and the risk factors that predispose to complications. METHODS: A 9-year retrospective chart review of patients aged 85 and older who underwent MMS at our institution between 07/2007 and 11/2016 was performed. Six types of complications associated with scalpel-based cutaneous surgery were recorded, as well as patient, tumor, and repair characteristics. RESULTS: This study included 949 patients totaling in 1683 MMS cases. There were 30 complications: infection (N = 11), wound dehiscence (N = 6), hematoma (N = 6), hemorrhage (N = 5), flap necrosis (N = 1), and graft necrosis (N = 1), resulting in an overall complication rate of 1.78%. Independent risk factors associated with a statistically higher incidence of complications were anticoagulant use (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.26-6.13; p = .012), extremity location (OR, 2.80; 95% CI, 1.19-6.54; p = .018), greater than 2 MMS stages (OR, 2.43; 95% CI, 1.08-5.46; p = .032), and flap repair (OR, 2.27; 95% CI, 1.05-4.90; p = .036). CONCLUSION: Mohs micrographic surgery is a safe procedure for treatment of cutaneous neoplasms in the very elderly.

Surveyed dermatologists are less likely to curette invasive squamous cell carcinoma in solid organ transplant recipients.

BACKGROUND: The risk of squamous cell carcinoma (SCC) is increased in solid organ transplant recipients (OTRs), and preferential treatment modalities vary among clinicians. OBJECTIVES: The purpose of this study was to survey dermatologists regarding practice patterns for electrodesiccation and curettage (EDC) of SCC in OTRs and nontransplant patients. METHODS: An 18-question survey was sent to dermatologist members of the International Transplant Skin Cancer Collaborative, Association of Professors of Dermatology, and American College of Mohs Surgery. Differences in EDC practice patterns for treatment of SCC in OTRs and nontransplant patients were evaluated. RESULTS: Dermatologists in this study (N = 227) were more likely to treat SCC with EDC in nontransplant patients (67.4%) than in OTRs (48.0%; P = .0003).Dermatologists who perform EDC in both groups (n = 108) were unlikely to use EDC on the H-zone of the face; they were more likely to EDC tumors on non-H-zone areas of the face and neck in nontransplant patients compared to OTRs (P = .0007). Dermatologists were more likely to use EDC over surgery in nontransplant patients compared to OTRs with the following demographics: dementia or psychiatric disease (P = .04), multiple medical comorbidities (P = .03), or anticoagulation medications (P = .02). CONCLUSIONS: In OTRs with SCC, 48% of clinicians would consider EDC. The main factors that affect the decision to perform EDC include tumor location and patient comorbidities.

Topical and Systemic Modalities for Chemoprevention of Nonmelanoma Skin Cancer.

Chemoprevention of nonmelanoma skin cancer should be considered in patients likely to develop numerous, invasive, or metastatic nonmelanoma skin cancers. This article reviews the various topical and systemic substances studied as chemopreventive agents.

Risk Factors for Basal Cell Carcinoma in Men Younger Than 40 Years: A Case-Control Study.

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignancy in the United States and is more prevalent in older populations. OBJECTIVE: The aim of this study was to investigate BCC risk factors in male patients younger than 40 years. MATERIALS AND METHODS: A consecutive series of male patients with pathology-proven BCC and younger than 40 years at time of diagnosis were retrospectively identified along with matched controls. Phone interviews were conducted using a structured questionnaire, and differences between patients with and without BCC were investigated. RESULTS: A total of 50 patients with BCC and 27 controls were included in this study. Compared with controls, patients with BCC worked outdoor jobs for longer lengths of time (43.2 vs 15.6 months; p = .04), were more likely to have a family history of skin cancer (66% vs 44%; p = .02), and were more likely to use sunscreen heavily after biopsy (p = .02). Patients with multiple BCCs (n = 20) were more likely to have a history of substantial recreational sun exposure (p = .01) than patients with solitary lesions (n = 30). CONCLUSION: The authors conclude that outdoor sun exposure in patients with underlying genetic susceptibility is the most likely mechanism of BCC formation in young male patients.

Healing Skills from the Underserved Patient Perspective.

The purpose of this study was to identify physician actions that facilitate meaningful doctor-patient relationships, from the perspective of the medically underserved patient. Twenty-five patients were interviewed at the United Neighborhood Health Services Northeast Clinic in Nashville, Tennessee, which serves an underinsured patient population. Patients were asked to identify the qualities of engagement with their doctor that move beyond simple diagnosis and treatment. Interviews were audio-recorded, professionally transcribed, made anonymous, and analyzed by the grounded theory method of qualitative research. Six physician actions emerged as vital to the doctor-patient relationship. As presented in the words of the patient, they are: Sits down with me; Treats me like family; Cares about me as a person; Takes the time; Gets to the root of it; Will not push me away. How the doctor made the patient feel was vitally important to the clinical encounter.

Hoarseness as a presentation of mycosis fungoides infiltrating the larynx.

Laryngeal involvement is a rare manifestation of mycosis fungoides (MF), with only nine reported cases of cutaneous T cell lymphoma with laryngeal or vocal cord involvement. Herein, we report the case of a patient with a 7-year history of MF who presented to the emergency department with hoarseness, throat tightness and cough, as well as erythroderma and skin tumours. Laryngoscopy and CT imaging were concerning for lymphomatous involvement of the left false vocal cord. A biopsy was taken of the false vocal cord lesion, which revealed an aberrant immunophenotype consistent with MF. The patient was started on doxorubicin with initial rapid improvement in symptoms. Within 2 months, her respiratory status and skin involvement worsened. Subsequent studies showed bone marrow involvement. The patient expired 4 months after original presentation. This report describes the patient's presentation and clinical course, and reviews the literature on vocal cord and laryngeal involvement of MF.