Skin cancer knowledge, attitudes, and practices among non-medical skin care professionals: A narrative review of cross-sectional and interventional studies.

BACKGROUND: Skin cancers are the most common malignancies in the United States. Total body skin examination by a physician, especially a dermatologist, is the gold standard for detecting suspicious lesions that may require further evaluation. Non-medical professionals (NMPs) including massage therapists, estheticians, hairdressers, and cosmetologists have the unique opportunity to frequently examine their client's skin outside of a clinical setting. By evaluating their knowledge of and comfort with evaluation of suspicious lesions, multiple studies have gauged the utility of patient encounters with NMPs for skin cancer detection. Several studies have also focused on assessment of intervention strategies for assessing and improving NMPs ability to detect suspicious lesions and to refer for physician evaluation when necessary. AIMS: To conduct a narrative review of skin cancer knowledge, attitudes, and practices among NMPs. PATIENTS/METHODS: A systematic search of the databases yielded 16 studies for review. A total of 8 cross-sectional studies examined the knowledge and attitudes of NMPs toward skin evaluation, and 8 studies assessed interventional strategies for improving NMPs' ability to assess skin lesions for consideration of physician referral. RESULTS: This review finds that NMPs are open to the idea of examining the exposed body surfaces relevant to their work with clients and are willing to refer for physician evaluation when needed. Multiple interventional strategies have demonstrated success with educating NMPs on the importance of skin surveillance and the characteristic physical examination findings associated with skin cancers. CONCLUSION: Strengthening the readiness of NMPs to examine their client's skin offers an opportunity to reduce time to skin cancer diagnosis, improve patient outcomes, and lower healthcare-associated costs of skin cancer treatment.

The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture.

The treatment of acetabular fractures in part relies on the selection of a specific surgical approach that allows for accurate reduction of fracture fragments. Moreover, these acetabular approaches were not developed for the insertion of a total hip replacement. Therefore, if a total hip arthroplasty is to be the treatment of an acute acetabular fracture, a single incision that permits reduction of the acetabular fracture fragments and ease of insertion of the arthroplasty components would be desirable. The Levine anterior approach provides both accesses to the anterior wall/column for reduction and fixation and to the femoral shaft for insertion of a total hip replacement. This paper describes that surgical technique and our initial clinical experience with this approach for acute acetabular fractures. A consecutive group of 10 patients with acetabular fractures, all involving the anterior wall/column with articular impaction (>50% of the acetabular roof) including 2 cases with an associated posterior hemitrans-verse component, were reviewed. After fracture reduction and fixation, a hybrid total hip replacement was implanted in all cases with an average acetabular component size of 56 mm (range 52-64). At a mean follow-up of 36 months (range 24-53), all fractures united, and all acetabular components remained fixed with no evidence of migration or loosening. There were 2 complications, a Brooker grade II heterotopic ossification and 1 postoperative anterior dislocation treated successfully with closed reduction and spica cast immobilization. The average Merle d'Aubigné hip score at latest follow-up was 16 (range 13-18). The Levine anterior approach is a reliable, safe, and efficient technique that permits early mobilization of patients with anterior wall/column acetabular fractures requiring a total hip replacement.