Benefit of Mohs Micrographic Surgery Over Wide Local Excision for Melanoma of the Head and Neck: A Rational Approach to Treatment.

BACKGROUND: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma. OBJECTIVE: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE. MATERIALS AND METHODS: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013. RESULTS: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148). CONCLUSION: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.

Radiation Therapy in Dermatology: Non-Melanoma Skin Cancer.

Background: Dermatologists were historically well versed in the use of radiation therapy for the management of non-melanoma skin cancers and various inflammatory dermatologic conditions. With the advent of Mohs micrographic surgery and therapeutic discoveries for treating inflammatory dermatoses, radiotherapy assumed loss of a role in the clinical repertoire of the dermatologist. In recent years, its importance has again been realized for the management of non-melanoma skin cancers not amenable to surgical treatment or as adjuvant or palliative therapy.

Objective: To review the evolving use of radiation therapy in the treatment of non-melanoma skin cancer.

Methods and Materials: All published literature regarding the applications of radiotherapy for the treatment of non-melanoma skin cancer were analyzed and collated.

Results: A comprehensive review of radiotherapy for the treatment of non-melanoma skin cancer was outlined.

Conclusion: Dermatologists should be well versed in radiation therapy in order to deliver the best possible care for patients, as radiotherapy is an important adjuvant tool for the treatment of non-melanoma skin cancer.

J Drugs Dermatol. 2017;16(5):464-469.

Resident Rounds: Part III - Case Report: Betel Quid Induced Irritant Contact Dermatitis of the Hand.

Betel quid is a drug used in Far East Asia, India, and the South Pacific. The habit of betel quid chewing is widely reported to cause oral cancer and tooth and gum disease. However, skin disease due to betel quid use is underreported. We report a case of irritant contact dermatitis to betel quid components in a 35-year-old male betel quid user who presented for evaluation of a persistent rash on his fingertips.

Sinus pericranii with a hair collar sign.

Sinus pericranii is a rare vascular malformation in which the extracranial veins are connected to the intracranial venous circulation. It typically appears as a soft mass with a blue hue on the scalp. We describe a patient with sinus pericranii and associated hair collar sign.

Scalp sarcoidosis: a sign of systemic sarcoidosis.

Sarcoidosis is a systemic disease often with cutaneous manifestations. Scarring alopecia of the scalp is a rare form of cutaneous sarcoidosis. Herein, we describe a case of sarcoidosis of the scalp mimicking discoid lupus.

Vitamin D deficiency is associated with atherosclerosis-promoting risk factor clustering but not vascular damage in children.

BACKGROUND: Vitamin D has been associated with multiple cardiometabolic risk factors in children but there is a paucity of studies examining its correlation to vascular function and structure. Our objective was to determine whether there is a correlation between vitamin D, cardiometabolic risk, vascular distensibility and carotid artery intima-media thickness (CIMT) in high-risk children. MATERIAL/METHODS: This was a cross-sectional, cohort study that compared vitamin D to cardiometabolic risk factors, carotid artery distensibility, and CIMT in 74 children with multiple, modifiable atherosclerosis-promoting risk factors. Vitamin D was used as a continuous variable and also categorized as deficient (<20 ng/mL) or sufficient (≥20 ng/mL). Seven modifiable atherosclerosis-promoting risk factors were analyzed - body mass index, systolic blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting insulin, & tobacco smoke exposure history. RESULTS: For the entire cohort, vitamin D was 26.1 ± 9.4 ng/mL (6-63 ng/mL); and the levels were deficient in 20%. The number of modifiable atherosclerosis promoting risk factors per child was 3.3 ± 1.6. Distensibility index was 2.62 ± 0.87% per 10 mmHg, CIMT 0.54 ± 0.06 mm. There was an inverse correlation between vitamin D and risk factor score (r=-0.27, p=0.02); this remained significant after adjusting for age, sex, and race. There was no association between vitamin D levels and distensibility index or CIMT. CONCLUSIONS: Even though vitamin D levels were inversely correlated with cardiometabolic risk factor score in high-risk children, there are no demonstrable vascular functional or structural effects.

RADIATION THERAPY for the Adjunctive Treatment of Surgically Excised Keloids: A Review.

BACKGROUND: Radiotherapy has been used historically to treat a wide variety of dermatologie conditions, including nonmelanoma skin cancers, lymphomas, and inflammatory skin conditions. Recently, radiotherapy has been used increasingly as a valuable tool in the postsurgical treatment of large or recalcitrant keloids. OBJECTIVE: The objective of this review was to explore the use of radiation therapy as an adjuvant to surgically excised keloids. DESIGN: A PubMed search of all published English literature regarding the applications of radiotherapy for the treatment of keloids was performed using a combination of keywords including radiation, radiotherapy, brachytherapy, electron beam, superficial radiation, orthovoltage radiation, and keloid. The results were analyzed and collated. RESULTS: A comprehensive review of radiotherapy for the adjuvant treatment of keloids was outlined. CONCLUSION: Radiotherapy appears useful as an adjuvant therapy to surgically excised keloids. Dermatologists should be well versed in radiotherapy to provide optimal care for patients with recalcitrant keloids.

Retrospective Study of Punch Scoring Versus Freehand Approach for First Stage Mohs Micrographic Surgery.

Objective: The objective was to observe whether there is a difference in the number of subjects requiring more than one stage of Mohs micrographic surgery for small lesion nonmelanoma skin cancers using the punch scoring method versus freehand approach. Design: Retrospective review. Setting: Outpatient Mohs Clinic. Participants: Thirty patients with small lesion (<5mm) basal cell and squamous cell carcinoma who had Mohs micrographic surgery using either the punch scoring method (15) for scoring the first layer or the freehand method (15). Measurements: Differences between the two groups were evaluated by the number of subjects requiring more than one stage and the reason for any additional stages. Results: There was no observed difference in the number of subjects requiring more than one Mohs stage between the punch scoring group and the freehand group. Conclusion: Dermatologic surgeons can use the punch scoring method or the freehand approach for scoring small lesion Mohs based on provider preference.