Factors Influencing Squamous Cell Carcinoma In Situ Recurrence and Implications for Treatment Choice.

BACKGROUND: Numerous treatment modalities have been reported for squamous cell carcinoma in situ (SCCIS). Risk factors for recurrence have not been systematically reviewed. OBJECTIVE: To systematically review and summarize the data on risk factors that contribute to recurrence of SCCIS. MATERIALS AND METHODS: A PubMed search was completed using the terms "SCCIS," "Bowen's disease," "Bowen's disease and recurrence," and "Bowen's disease and Mohs." These sources were cross-referenced for the terms "treatment," "management," "therapy," "recurrence," and "margins." Studies were selected on the basis of relevance and applicable treatments. RESULTS: Immunosuppression was the only variable with a statistically signficant association with progression or recurrence of SCCIS. Although there were no data directly correlating subclinical lateral extension or invasive squamous cell carcinoma within SCCIS with recurrence, evidence supports both of these as common features of SCCIS. Other potential recurrence risk factors for which there are limited supporting data included tumor size, depth of follicular extension, and location. CONCLUSION: Immunosuppression was the only risk factor associated with increased risk of tumor recurrence. Subclinical tumor extension and occult invasive squamous cell carcinoma are relatively common features that theoretically could increase recurrence risk. These factors should be considered when deciding upon treatment for SCCIS. Further study is required to quantify variables that influence recurrence and to identify optimal treatment options.

Medical student musculoskeletal education: an institutional survey.

BACKGROUND: Since the 1910 Flexner Report, medical education continues to undergo curriculum and graduation guideline reform to meet the needs of physicians and patients. Our aims were to (1) assess the quality of musculoskeletal education at our institution's School of Medicine by reporting the results of the Freedman and Bernstein examination among our medical students across all four years of training, and (2) stratify results according to medical school year, educational module, and intended career. METHODS: We surveyed the 460 2009-2010 School of Medicine students via e-mail. The survey contained a validated orthopaedic examination of musculoskeletal competency (passing grade, 70%), demographic questions (e.g., year in training, clinical area of interest, and time dedicated to musculoskeletal topics in medical school education), and a 10-point tool for determining confidence in assessing musculoskeletal disorders. There were 354 responses (77.0%); six were excluded for incompleteness, leaving 348 for analysis. Linear regression analysis was used to determine the association between test scores and days spent studying musculoskeletal material. The unpaired Student t test was used to compare performance among areas of interest and training years, with p < 0.05 being considered significant. RESULTS: The mean score was 51.1%; only sixty-seven (19.3%) of the students passed. Fourth-year students scored significantly higher (59.0%) compared with first-year students (37.3%), but >65% of students in both groups failed. Only 34.2% of the graduating students had completed a musculoskeletal elective. Students who participated in elective musculoskeletal education had a higher pass rate (67.5%) than those who did not (43.9%, p < 0.001). A minimum of fifteen days dedicated to elective study of musculoskeletal medicine significantly increased the chance of passing this examination. First-year through fourth-year students ranked their level of confidence in dealing with musculoskeletal issues as 3.18, 3.82, 3.57, and 4.77, respectively. CONCLUSIONS: To our knowledge, this is the first study to test this examination with medical school class years and have quantifiable results that advocate for incorporation of a dedicated musculoskeletal block in medical student education.