The Two-Stage Folded Paramedian Forehead Flap Without Cartilage Grafts for Full Thickness Distal Nasal Defects: A Review of 35 Patients.

BACKGROUND: Full thickness defects of the ala, soft triangle, and nasal tip involving the nasal lining have traditionally been repaired with the three-stage folded paramedian forehead flap (FPFF), with a cartilage graft for support. For similar defects, the authors utilize the two-stage FPFF without cartilaginous support which provides reproducible functional and aesthetic results.  Objective: To describe the authors’ experience with the two-stage FPFF, including outcomes, complications, and design modifications to enhance functional and aesthetic success.  Methods: An IRB-approved retrospective database review of FPFF was performed at two sites. Using postoperative photographs, outcomes were assessed by blinded non-investigator dermatologist raters using a modified observer scar assessment scale. RESULTS: Thirty-five patients were reconstructed using the two-stage FPFF without cartilage grafts. Subjective assessment of scar vascularity, pigment, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 8.4±1.9 (out of 40). CONCLUSION: The two-stage FPFF without cartilage grafts is a reliable, cosmetically elegant repair that can provide optimal functional and aesthetic results for complex unilateral distal nose defects.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7358.

Factors Influencing General Dermatologists When Referring Patients With Head and Neck Melanoma for Mohs Micrographic Surgery: A Nationwide Cross-Sectional Survey.

BACKGROUND: Mohs micrographic surgery (MMS) for cutaneous melanoma has demonstrated higher cure rates, lower local recurrence rates, and improved survival compared with wide local excision (WLE). However, factors affecting referrals by general dermatologists for MMS of head and neck melanoma (HNM) are unknown. OBJECTIVE: To elucidate referral factors and treatment perspectives of general dermatologists regarding MMS for melanoma in situ (MIS)/lentigo maligna (LM) and early-stage melanoma on the head and neck. MATERIALS AND METHODS: A cross-sectional analysis was performed using survey responses of general dermatologists with membership in the American Academy of Dermatology . RESULTS: A total of 231 and 132 of the 402 responding general dermatologists routinely referred melanoma in situ MIS/LM and early invasive melanoma for MMS, respectively. Lack of local access to a Mohs surgeon was the most common deterring reason for MIS/LM referral to MMS, whereas the preference for WLE was the most common deterring reason for early invasive melanoma. CONCLUSION: Lack of local access to a Mohs surgeon treating HNM with MMS is the primary barrier in referrals to Mohs surgeons for MIS and LM. Among general dermatologists, WLE is preferred for early invasive HNM.

Patients are Willing and Successful With Home Suture Removal After Mohs Surgical Procedures.

BACKGROUND: Suture removal after surgery is low risk; however, it is often performed by a medical provider. The current SARS-CoV-2 pandemic has forced providers to assess means of reducing in-person contact. OBJECTIVE: To determine whether patients undergoing Mohs surgery are willing and successful with home suture removal. MATERIALS AND METHODS: A prospective study was performed with patients undergoing Mohs surgery. Before their surgery, patients were assessed for their willingness to remove sutures before and after viewing educational material. Patients who were willing to attempt removal were contacted after expected suture removal date to verify success and assess their experience. RESULTS: One hundred fifty patients were enrolled in the study. 90.1% were willing to attempt home suture removal. Patients were more willing ( p = .003), more confident ( p = .024), and had lower anxiety ( p = .049) with removal after viewing educational resources. Patients with a history of suture removal were more likely to attempt removal after their procedure ( p = .036). Ninety-seven percent of patients who were willing to attempt suture removal were successful. There were no major complications with removal. CONCLUSION: Patients were overwhelmingly successful with suture removal after an educational intervention. Providers should consider providing this option after surgical procedures when clinically appropriate.

Patients Frequently Overestimate Their Comprehension of Common Mohs Micrographic Surgery Terms: A Cross-Sectional Survey.

BACKGROUND: Patients who understand their diagnosis and treatment are more likely to be satisfied with their care and more compliant with treatment. Dermatologic surgery is a specialized field with associated jargon that many patients may not understand. OBJECTIVE: The aim of the study was to assess patient understanding of dermatology medical terminology. METHODS: This was a single-blinded study conducted with patients 18 years and older from an academic dermatology clinic surveying patients on 12 terms that are frequently used in dermatologic surgery. Participants rated their level of confidence in their understanding of each term using a 5-point Likert scale, followed by explaining the definition of the term. 3 blinded physicians graded each participant’s definition using a 5-point scale of accuracy of understanding, designed to mimic the Likert scale. RESULTS: A total of 200 respondents completed the survey (96% response rate). The average term perceived understanding was 3.90 ±0.66, the average term accuracy was 3.26±0.93. Patients overestimated their understanding 44% of the time, and underestimated their knowledge 17% of the time. The terms with the lowest respondent confidence were the terms secondary intention, Mohs, and flaps. The terms with the lowest respondent accuracy was secondary intention, defect, and Mohs surgery. CONCLUSION: There is a gap in knowledge in commonly used dermatologic surgery terms among patients. Certain demographics appear to be more at risk for not understanding medical jargon or overestimating their understanding of terms. Obtaining these patient demographics may help to identify patients needing additional education regarding dermatologic surgery. J Drugs Dermatol. 2021;20(11):1252-1254. doi:10.36849/JDD.6174.