Recommendations for Counseling and Education of Service Members on Endemic African Cutaneous Kaposi Sarcoma: A Case Study.

We report a case of Endemic African Cutaneous Kaposi Sarcoma (EACKS) on the lower extremity of an immunocompetent 31-yr-old male service member from Cameroon. Diagnosis was made using clinical and histologic findings. The service member was treated with local radiation therapy with resolution of his tumor.The goal of this article is to educate practitioners to counsel susceptible service members and leadership on the risk of developing EACKS when traveling to Sub-Saharan Africa, monitor for disease development, and guide in the diagnosis and treatment of patients with this rare disease.

Improving Health-Related Quality of Life in Wounded Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb-Prosthetic Interface.

BACKGROUND: Wounded warriors with lower limb amputations using prosthetics commonly develop dermatologic complaints at the residual limb-prosthetic interface, which impact their health-related quality of life (HRQOL). To optimize this interface, military dermatologists routinely treat the subset of issues related to the pilosebaceous unit with laser hair removal (LHR). OBJECTIVE: To characterize the impact of residual limb skin conditions on HRQOL in wounded warriors using lower limb prosthetics before and after treatment with LHR. METHODS AND MATERIALS: Twenty wounded warriors with lower limb amputations using prosthetics were administered a validated HRQOL survey, the Skindex-16, before and after an average of 3 treatments of LHR to their residual lower limbs. Responses were statistically analyzed within the symptoms, emotions, and functioning subscales of the survey and in aggregate. RESULTS: Statistically significant (p < .05) improvement in HRQOL was observed across the symptoms, emotions, and functioning subscales and in aggregate. CONCLUSION: Dermatologic complaints at the residual limb-prosthetic interface in patients with traumatic lower limb amputation are well-established in the literature. The authors present the first report subjectively quantifying this impact on HRQOL and the marked improvement observed with LHR to the residual limb.

Patient Preferences Comparing Linear Versus Purse String Closures in Dermatologic Surgery Utilizing a Novel Simulator-Based Educational Tool.

BACKGROUND: Patients often query in regard to cosmetic outcomes after cutaneous surgery. This study provides information on this topic by surveying preference on 2 skin closure methods, purse and linear. The authors used a novel method to poll opinions by incorporating simulated skin within the context of the survey. OBJECTIVE: To determine patient's preference for linear or purse string closure. Additional outcomes were to survey patient's opinions regarding which scar characteristics have the highest cosmetic impact, the cosmetic importance of a scar, and the utility of simulators, and patient photographs as methods of understanding closure techniques. MATERIALS AND METHODS: Participants were prospectively recruited to complete a survey. Data outcomes were analyzed using descriptive statistics and the chi-square test of association. RESULTS: About half of the participants (54.7%) preferred linear closure. Preference was independent of gender (p = .90) or having a prior linear or purse string closure (p = .17). Patient photographs were the most influential for determining preference according to 86.2% of participants; however, 88% of the participants found simulator devices useful for educational purposes. CONCLUSION: The methods in this survey may represent a venue for educating patients and incorporating their preferences into the choices they will make regarding dermatologic procedures, which they will undergo.

Secondary Intention Healing and Purse-String Closures.

BACKGROUND: Secondary intention healing and purse-string closures are simple but extremely useful methods for the dermatologic surgeon to master. OBJECTIVE: To review the literature on the use of these two types of closures and offer recommendations based on our collective experiences. METHODS: A literature review was performed using the terms "secondary intention healing" and "purse-string closure." The evidence and recommendations from the resultant references were summarized in our article and synthesized with our own experiences. RESULTS: Twenty-eight sources were cited overall with fifteen related to secondary intention healing, eleven pertaining to purse-string closures, and one randomized, blind clinical trial comparing the two modalities. CONCLUSION: The art of dermatologic surgery often requires a tailored approach to the patient and can involve a spectrum of closures, from the simplest to most complex. This variety not only provides more reconstruction options, but are also necessary to keep dermatologic surgery cost-effective. Certain locations or situations are more amenable for these two types of closures than others. The use of secondary intention healing, either alone or in conjunction with purse-string closures, should be in every dermatologic surgeon's armamentarium.

Microcystic adnexal carcinoma in the axilla of an 18-year-old woman.

Microcystic adnexal carcinoma (MAC) is an uncommon adnexal neoplasm with a predilection for the head and neck. The tumor rarely metastasizes but is locally aggressive and commonly demonstrates perineural invasion. MAC occurs most often in older adults. This report describes a young woman with a MAC in her left axilla who required two stages of Mohs micrographic surgery followed by a wide local excision because of persistent perineural invasion in close proximity to the brachial plexus. Other cases presenting in the pediatric age group are discussed.

Management considerations for giant congenital melanocytic nevi in adults.

Giant congenital melanocytic nevi (GCMN) are a rare type of melanocytic nevus that covers a large body surface, often with satellite nevi scattered on the rest of the skin. There are several complications associated with GCMN, including malignant melanoma and neurocutaneous melanosis. The management of GCMN is very complex because of the cosmetic appearance and the associated psychological distress, the risk of severe complications, and the need for long-term follow-up. We report a case of a 43-year-old active-duty female with a GCMN reporting new and symptomatic satellite lesions with atypical features on dermoscopy.

Survey of medical student preference for simulation models for basic dermatologic surgery skills: simulation platforms in medical education.

BACKGROUND: The authors investigated the use of simulator platforms in fourth-year medical student education. OBJECTIVE: To evaluate which simulation platform students preferred for learning dermatologic procedures and to assess the effectiveness of the exercise in terms of the change in confidence that the students had performing dermatologic procedures. MATERIALS AND METHODS: After medical students were instructed on how to perform a punch biopsy and then assisted in executing the task, they were surveyed to determine their preferred simulation platform and simulator properties. Students were surveyed at the beginning and completion of the teaching block. RESULTS: One hundred fifty-seven students completed the skills laboratory, and 78 completed the preference questionnaire. Of the 11 surveyed categories, students preferred the pig foot in eight categories. Seventy students responded to a surgical skills questionnaire that assessed their overall confidence in planning and executing the procedure before and after the skills laboratory. The students had a statistically significant increase in confidence in dermatologic procedural skills as a result of the activity. CONCLUSION: Preference data show that the pig foot model is preferred for teaching dermatologic surgical skills. These results re-affirm that the pig foot model is an effective, low-cost solution for training.

Simulation in dermatologic surgery: a new paradigm in training.

BACKGROUND: Simulation-based training has become popular in many surgical residencies for acquiring procedural skills, but simulator use is rare in dermatologic training. OBJECTIVE: To evaluate the perceived efficacy of obtaining dermatologic procedural skills using simulators. METHODS AND MATERIALS: Opinions of dermatology residents and staff regarding simulator use were assessed using questionnaires completed after a 2-day surgical symposium in which participants were instructed on and practiced with simulators and cadavers. RESULTS: Overall, 93.9% strongly agreed that simulators are helpful in acquiring procedural skills. More than three-quarters of participants agreed that simulators are useful in acquiring, refining, assessing, and learning these skills. Many participants further thought that simulator use would be beneficial in learning anatomy and trouble-shooting techniques. An overwhelming majority of those surveyed believed that training on simulators would be helpful in learning various dermatologic procedures; 90.9% of participants thought that training using simulators should be, at least in part, a mandatory component of residency. It was felt that this training should be conducted at the beginning of residency, with additional with sessions held throughout training. CONCLUSION: Simulation offers an excellent model for the acquisition and assessment of dermatologic procedural skills. Cost and availability of instructors remain obstacles. Further studies are required to evaluate the implementation and effectiveness of these models.

Collagenase-assisted fat dissociation for autologous fat transfer.

BACKGROUND: The quality of fat for autologous transfer procedures has been a major focus of research in the past few years. The primary goal of these efforts is to improve the viability and longevity of the graft in human subjects. One possible factor in the permanence of theses transplants is the size of the adipose tissue grafts. OBJECTIVE: This study evaluated the effects of collagenase digestion on the viability of human adipose tissue. MATERIALS AND METHODS: Samples of fat were obtained from subjects undergoing tumescent liposuction. The tissue was digested in a variety of concentrations of collagenase using optimized methods of processing. The digested fat was also subjected to mock injections through small bore needles. RESULTS: Eight subjects completed the study. The viability of the fat using the optimized methods of collagenase digestion was consistently higher than 79%. During the mock injection trials, the viability of fat was improved from approximately 17% to 84% by collagenase digestion. CONCLUSIONS: Our results show increased viability of human adipose tissue when digested by collagenase. These techniques can be applied to human autologous lipoaugmentation procedures in an effort to improve longevity of the transplanted tissue.