Evaluating Predictors of Patient Satisfaction With Facial Appearance After Mohs Micrographic Surgery Using the FACE-Q.

BACKGROUND: Although patient satisfaction with reconstructive outcomes after facial skin cancer resection is an important consideration in Mohs surgery, there is limited information evaluating this concern using validated patient-reported outcome tools. OBJECTIVE: To characterize predictors that may be associated with increased postoperative patient satisfaction with facial appearance after Mohs surgery using the FACE-Q/Skin Cancer survey, a patient-reported outcome tool that has been validated in various studies. METHODS: A total of 202 patients who underwent Mohs surgery for facial skin cancer at the Brigham and Women's Faulkner Hospital between April 2017 and November 2021 were included after completing the postoperative Satisfaction with Facial Appearance scale (FACE-Q scale). RESULTS: Male patients were significantly more likely to have higher satisfaction scores compared with female patients (aOR 2.4, 95% CI 1.1-5.1). Increased preoperative facial satisfaction scores was directly correlated with increased postoperative facial satisfaction scores ( p < .01). Patients with tumors on the lower face/neck (aOR 3.88; 95% CI 1.4-10.7) had significantly greater satisfaction scores compared with those with tumors on their nose/nasolabial folds. CONCLUSION: Potential interventions and counseling methods can be tailored toward specific patient populations with lower satisfaction scores to increase their overall satisfaction with reconstructive outcomes.

Clinicopathologic features of ecthyma gangrenosum: a single integrated health system cohort.

Ecthyma gangrenosum is an uncommon cutaneous eruption that can initially present with painless macules, which rapidly evolve into necrotic ulcers. This study sought to characterize clinicopathologic features of ecthyma gangrenosum from a single integrated health system. Our cohort consisted of 82 individuals diagnosed with ecthyma gangrenosum. Lesions were most commonly found in the lower extremities (55%) and the truncal region (20%). A wide variety of fungal and bacterial etiologies were found among our cohort. The majority of patients with EG were immunocompromised (79%) and 38% of patients also experienced sepsis. The mortality rate seen in our cohort was approximately 34%. No statistical differences in mortality outcome due to EG related complications were seen between pathogen etiology, and distribution or location of lesions. Patients who were septic or immunocompromised died more frequently than non-septic or immunocompetent patients, suggesting poorer prognosis.

Intralesional cidofovir for the management of refractory cutaneous verrucae: a review of applications and opportunities.

Viral warts - manifestations of cutaneous infection by human papilloma virus - can be a significant physical and emotional burden for patients when common treatments fail, particularly for individuals who are immunocompromised or with multiple lesions. Cidofovir, an antiviral agent typically used for the treatment of cytomegalovirus infection, has emerged as an alternative treatment option for viral warts when administered topically or intralesionally. In this review, we highlight the scientific rationale, published evidence, and practical clinical uses of intralesional cidofovir for the management of cutaneous warts as well as ongoing questions requiring further research and exploration of this emerging therapy for refractory verrucae.

Dermatologic toxicities of anti-neoplastic immunotherapy in United States hospitalizations.

A major side effect of anti-neoplastic immunotherapy is the onset of dermatologic toxicities following the administration of several different immunotherapy drugs. We sought to assess the incidence and mortality of anti-neoplastic immunotherapy-associated dermatologic toxicities using a nationally representative sample of United States (US) adults. The National Inpatient Sample database was queried for encounters undergoing anti-neoplastic immunotherapy. Multiple logistic regression models were constructed to analyze incidence of dermatologic toxicity and associated mortality as well as calculate adjusted odds ratios (aOR) after controlling for age, race, sex, household income, and cancer type. Immunotherapy patients demonstrated greater odds of developing pruritus (aOR = 7.59; 95% CI 5.17-11.2; P < 0.001), rash (aOR = 2.81; 95% CI 2.00-3.94, P < 0.001), generalized (aOR = 5.32; 95% CI 3.35-8.43; P < 0.001) and localized (aOR = 2.67; 95% CI 1.01-7.05; P < 0.001) skin eruptions, and vitiligo (aOR = 13.3; 95% CI 5.15-34.4; P < 0.001) compared to patients who did not receive anti-neoplastic immunotherapy. There were no significant differences observed in incidence of non-scarring alopecia (P = 0.7), psoriasis (P = 0.094), and dermatitis (P = 0.9) between the two groups. Patients who underwent immunotherapy were more likely to develop dermatologic toxicity (aOR = 3.93; 95% CI 3.12-4.94; P < 0.001), however, no significant differences in mortality were observed. Patients undergoing anti-neoplastic immunotherapy have an increased risk of developing dermatologic toxicity compared to patients who did not receive anti-neoplastic immunotherapy.

Patient Perspectives on Clinic Note Transparency Within Dermatology.

This survey study assesses dermatology patient experiences with viewing online medical records and seeks to identify areas for improvement.

Adherence of dermatology home page websites to accessibility guidelines for persons with disabilities.

Patients with disabilities utilize accommodations or assistive technologies to access content from healthcare websites, but not all websites are built accessibly. We sought to evaluate the accessibility of dermatology home page websites from the 3 largest hospitals in each state of the United States (n = 150) using evaluation tools SortSite 6.42.924.0 and the Web Accessibility Evaluation Tool (WAVE). Of 150 hospitals evaluated, 128 (85%) were teaching hospitals and 48 (32%) were from the southern United States. The average numbers of contrast errors and all other errors detected by WAVE were 13.6 and 8.9, respectively. The mean number of Level A, AA and AAA issues detected per WCAG 2.1 guidelines were 5.7, 1.5, and 2.5, respectively. There were no significant differences in any accessibility metrics between teaching and non-teaching hospitals. Overall, dermatology home page websites have an average of 6 failures to meet the baseline A criteria of WCAG 2.1 and no websites were completely adherent to standards. The mean elements of contrast errors, other errors, alerts, and structural elements issues were all greater in the dermatology websites than in a federal public health website in a global analysis. Inaccessible dermatology websites present a significant barrier for patients to schedule and receive dermatologic care at hospitals nationally and may result in adverse outcomes for this underserved population. Dermatologic care teams and web developers must prioritize improving the accessibility of their websites to benefit all patients.