A Surgical Conundrum: Addressing a Large Nasal Defect Following Mohs Micrographic Surgery.

Managing large nasal defects following Mohs surgery presents complex reconstructive challenges due to the nose's prominent and visible nature. These cases require a careful balance of preserving structural integrity, optimizing cosmetic outcomes, and maintaining vascular health. In situations where primary closure is impractical due to defect size and location, innovative techniques like the double rhomboid transposition flap offer versatile solutions, addressing both aesthetic concerns and functional requirements. The double rhomboid flap allows surgeons to achieve continuity of surrounding tissue, ensuring aesthetically pleasing texture, color, and thickness while minimizing complications like skin tension and potential airway issues. This case highlights the reconstructive challenges faced in managing large nasal defects following Mohs micrographic surgery for basal cell carcinoma. An 84-year-old male presented with a significant nasal defect following Mohs surgery that involved the dorsum, sidewall, tip, and ala, complicating primary closure due to skin tension and cosmetic concerns. Utilizing a double rhomboid transposition flap technique allowed for effective aesthetic and structural reconstruction, addressing skin tension and preserving nasal symmetry. This case emphasizes the importance of tailored reconstructive strategies to achieve optimal cosmetic and functional outcomes in complex nasal Mohs defects.

Beyond the surface: unveiling gaps in medical education through eyes of diverse learners.

Inadequate education regarding disease manifestations in diverse skin colors hinders diagnosis and exacerbates health disparities. All levels of medical trainees report low confidence in accurately identifying disease in skin of color (SOC). To help further elucidate these concerns, our research aims to assess medical student confidence in recognizing cutaneous diseases in SOC and their viewpoints regarding SOC education within their institution. An eight-question, open-ended survey was provided to medical students before and after a SOC presentation. The survey assessed participants' confidence in their diagnostic ability and perspectives on educational material. Among the 70 attendees, 58 (82.8%) and 64 (91.4%) completed the pre- and post-seminar surveys, respectively. There was a significant discrepancy in confidence levels when assessing cutaneous manifestations of internal pathology in light (Monk Skin Colors 1-5) versus dark (Monk Skin Colors 6-10) skin (p < 0.009). Notably, 78.7% (37/47) perceived the institutional learning materials as insufficient for SOC. Post-seminar reflections indicated that 87.2% (40/46) of students lacked confidence in diagnosing SOC, with 78.7% (32/46) citing inadequate curriculum coverage as the cause. An additional 8.5% (6/46) identified the predominance of white-centric medical descriptions as a hindrance. Students collectively called for improved educational approaches, including better visual representation of diseases in darker skin. Medical education must continue to strive for increased SOC representation to train competent physicians in treating a diverse patient population and reduce disparities in SOC patients.