Epidermal Carcinoma of the Conchal Bowl: Creation of a Multidisciplinary Pathway Approach.

BACKGROUND: Malignant neoplasms of the auricle make up 6% of all skin cancers. Management of cutaneous neoplasms of the conchal bowl presents a unique challenge in visualizing and defining margins that may extend into the external auditory canal (EAC). OBJECTIVES: The objective of this study was to create a multidisciplinary pathway for cutaneous carcinoma of the conchal bowl extending into the EAC. METHODS: We present a series of patients that were referred to dermatology or otolaryngology, with cutaneous neoplasms arising in the conchal bowl. A consensus approach from otolaryngology and dermatology, for evaluation and treatment, was created based on evaluation of these cases, and review of the otolaryngology and dermatology literature, in collaboration between the two specialties. RESULTS: Initial evaluation should be done by both dermatology and otolaryngology, with otomicroscopic evaluation of the canal. Imaging is recommended for lesions that approach the EAC, for bony and soft tissue spread. Excision of the tumor with Mohs micrographic surgery to achieve clearance in the conchal bowl should be performed initially. If extension into the external auditory meatus is present, otolaryngology would proceed with en bloc resection. Repair is dictated by the defect, with both specialties involved in follow-up. CONCLUSIONS: In collaboration between dermatology and otolaryngology, and following review of the literature, a pathway was created to manage skin cancer of the conchal bowl. This resulted in a stepwise approach for evaluation and management, ensuring that patients have a streamlined pathway for the treatment of these lesions.

Too young for attention deficit disorder? Views from preschool.

A review of public-school administrative records and interviews with early-childhood directors from special and regular programs were used to collect information about factors associated with outcomes for young children with attention-deficit disorder with or without hyperactivity (AD/HD) in preschool. Special-education preschool administrators and community-based child care and preschool directors differed in their fundamental view of "what works" with preschool AD/HD children, but they agreed in principle on other issues (e.g., public-school providers attested to faith in adult-directed programming; community providers cited child-centered approaches as effective with AD/HD). The records review and interviews indicate that intrinsic program structure, gentle and constant adult help, acceptance of the child, family integrity, gross motor facilities, and attention to comorbidities were seen as positively related to child success. Multiple caregivers, poor understanding of development, failure to foster self-soothing and other personal mastery skills, expectations of perfection, and delegated parenting were identified as negatively related to good outcomes over time for children with AD/HD or similar profiles.