Reconstruction of perioral defects post-Mohs micrographic surgery: a dermatological surgeon's approach.

BACKGROUND: The perioral location has great functional, aesthetic and social importance. Over 100 procedures have been described for lip reconstruction, emphasizing the challenges that reconstructive surgeons face when dealing with such defects. OBJECTIVES: To outline the surgical reconstruction techniques of perioral defects post-Mohs micrographic surgery (MMS). METHODS: The design and surgical techniques of reconstruction of perioral defects post-MMS are described. RESULTS: The results of the surgical techniques described are illustrated. CONCLUSIONS: Herein, we describe the nuances of reconstructive techniques that we have found useful for repairing perioral defects post-MMS.

Patient satisfaction with post-operative telephone calls after Mohs micrographic surgery: a New Zealand and U.K. experience.

BACKGROUND: Mohs micrographic surgery (MMS) is regarded as the gold standard for treating nonmelanoma skin cancers of the head and neck. Surgical interventions can generate anxiety for patients and efforts to minimize this may enhance their experience. OBJECTIVES: To assess the perceived patient benefits of post-operative telephone follow-up (TFU) calls after MMS. METHODS: A prospective, controlled, questionnaire-based assessment of patient satisfaction with TFU calls in patients undergoing MMS was conducted in two centres (New Zealand and U.K.) over a 4-month period from June to September 2011. All individuals in the study group were telephoned on the evening of their surgery by the operating surgeon. Questionnaires were completed by all patients at the time of suture removal. RESULTS: The median Likert score on a 10-point scale relating to patients' perception of the TFU service was higher in the study group compared with the control group (10 vs. 9), with no correlation to closure type of the surgical defect. Overall patient satisfaction with the TFU service was high (94% New Zealand; 96% U.K.), and this was independent of the patient's place of residence. There was no age or sex difference in the minority who did not find the TFU call helpful. The majority of patients felt the best time to call was the night of the surgery (89% New Zealand; 94% U.K.). All patients who had undergone MMS previously found the TFU call just as useful as the first time. The majority of patients (94% New Zealand; 96% U.K.) did not need to call the doctor post-surgery, although 7% of patients in the control group rang the surgeon with issues that could have been readily dealt with by the TFU service. Comparatively, more patients from the U.K. felt their satisfaction would have been the same with a nurse-led TFU call service compared with New Zealand (94% vs. 66%). A significant proportion of those who preferred to be called by the doctor underwent cutaneous flap closures. Patients felt that other specialities that perform surgical procedures under local anaesthetic should adopt a TFU service post-surgery. CONCLUSIONS: TFU calls post-MMS are a cost-effective, time-efficient way of achieving high levels of patient satisfaction.

Frontalis-based island pedicle flaps for the single-stage repair of large defects of the forehead and frontal scalp.

BACKGROUND: Medium- to large-sized surgical defects of the forehead and frontal scalp provide a challenge for the reconstructive surgeon. OBJECTIVES: To highlight the utility of a frontalis-based island pedicle flap (FIPF) for the single-stage, aesthetic reconstruction of such defects. METHODS: The design and detailed surgical technique required for a FIPF are described. RESULTS: The long-term results are illustrated. CONCLUSIONS: FIPFs, despite significant tissue dissection, are readily performed under local anaesthesia and are well tolerated by patients. The FIPF adds to the dermatological surgeon's armamentarium in the reconstruction of large defects of the central forehead and frontal scalp.

The incidence of basal cell carcinoma in the under-30s in the UK.

BACKGROUND: Basal cell carcinoma (BCC) is the commonest cancer in many countries, but the current incidence in young people from the UK is unknown. AIM: To ascertain a recent incidence of BCC in the under-30 population in the UK. Methods. Cancer registry data from part of the Eastern Region of the UK was analysed for two periods: 1981-1989 and 1998-2006. Case notes were examined for a cohort of the patients from 1998 to 2006. RESULTS: The incidence of BCC increased from 0.73 to 1.79 per 100 000 in those aged < 30 years over the study period. More than half (55%) of BCCs were on the head and neck, and the most common histological subtype was superficial BCC (38%). CONCLUSIONS: The reported incidence of BCC in those aged < 30 years has increased by 145% during this period, corresponding to an average annual increase of 8.53%. This may be partially due to earlier presentation and to increased use of surgical treatments.

Two cases of pustular toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.