Effect of a Perioperative Educational Video in Patients Undergoing Mohs Reconstruction: A Randomized Clinical Trial.

BACKGROUND: Skin cancer is the most common type of cancer in the United States, and most are treated with Mohs micrographic surgery (MMS) by fellowship-trained dermatologic surgeons. Complex reconstruction in cosmetically and functionally sensitive areas often requires a plastic surgery consult. The uncertainty regarding reconstructive options and cosmetic appearance is difficult emotionally and cognitively for patients. OBJECTIVES: To improve patient understanding about MMS reconstruction with plastic surgeons, we investigated the utility of a multimedia presentation during perioperative education. METHODS: A randomized clinical trial was conducted at a hospital-affiliated outpatient MMS clinic and surgery center in the United States. Patients in the intervention arm were given a tablet or Web site link to watch a multimedia presentation about reconstruction after MMS. All patients were given a questionnaire about their understanding of MMS reconstruction and satisfaction with the reconstructive care they received. RESULTS: A total of 46 patients were recruited for the study and completed the questionnaire. Of these patients, 22 were randomized to the test intervention arm, and the remaining 24 were in the control group. Among participants in the test intervention arm, feedback regarding the platform was positive with more than 90% of patients reporting that the video was engaging, useful, and easy to understand. Patient understanding and satisfaction scores in the test intervention arm ranked higher across all domains than those of the control group. CONCLUSIONS: This randomized clinical trial showed increases in patient understanding and satisfaction among patients undergoing MMS reconstruction with the implementation of a perioperative educational video.

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures.

BACKGROUND: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. OBJECTIVE: To create opioid-prescribing consensus guidelines for common dermatologic procedures. METHODS: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. RESULTS: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. LIMITATIONS: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. CONCLUSIONS: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Incidence of Epinephrine Reactions With Local Anesthesia in Mohs Micrographic Surgery.

BACKGROUND: The incidence of reactions to epinephrine-containing local anesthetics in Mohs micrographic surgery (MMS) has not been established. OBJECTIVE: To estimate the incidence of epinephrine-induced reactions from local anesthetics in patients who undergo MMS for the removal of cutaneous malignancies. METHODS: From 2016 to 2018, 200 MMS patients were recruited from the authors' surgical center. Assessments were obtained throughout the entirety of the Mohs cases during a single visit. RESULTS: This study estimated the incidence of epinephrine reactions in patients who undergo MMS to be 2.0% (95% confidence interval: 0.1%-3.9%). No relationship between epinephrine dose and incidence of adverse effects was found. Patient age was a significant risk factor for the development of an epinephrine reaction. CONCLUSION: Systemic reactions to epinephrine from local anesthetics are an infrequent adverse event in MMS cases. The data suggest that the absolute dose of local anesthetic with epinephrine does not correlate with the risk of developing an epinephrine reaction. Older age seems to have a protective effect.

Expert Opinion Regarding Appropriately Timing Dermatological Surgeries in Patients With Recent Myocardial Infarctions.

BACKGROUND: There is limited data on the risk of perioperative myocardial infarctions (MIs) in patients with a recent MI who undergo dermatologic surgeries. OBJECTIVE: Present the recommendations of dermatologic surgeons and cardiologists to determine the safety of dermatologic surgeries after a recent MI. METHODS: An electronic survey was distributed to Mohs surgeons and cardiologists to infer the risk of major adverse cardiac events (MACE) inherent to dermatologic surgery and determine timing of dermatologic surgery in patients with a recent MI. RESULTS: One hundred twenty Mohs surgeons and 30 cardiologists were surveyed. Ninety-seven percent of cardiologists and 87% of Mohs surgeons deemed cutaneous excisions and Mohs micrographic surgery as low-risk procedures with less than one-percent chance of MACE. Seventy-seven percent of cardiologists and 46% of Mohs surgeons stated dermatologic surgery should either not be delayed or be delayed up to 1 month after an MI. Responses between cardiologists and Mohs surgeons did not significantly differ. CONCLUSION: A preponderance of surveyed experts believe that most dermatologic surgeries may be safely performed in patients with a history of an MI within 1 month. The decision to implement urgent dermatologic surgery in patients with a recent MI should account for all clinically significant factors.

Pulsed dye laser repurposed: Treatment of refractory molluscum contagiosum in renal transplant patient.

We present a case of a 15-year-old girl with an allogenic renal transplant secondary to chronic glomerulonephritis of unknown etiology who presented with treatment refractory molluscum contagiosum of the lower extremities and perineum. Treatment of mollusca with pulsed dye laser resulted in a clinically significant and sustained response. To our knowledge, this is the first report of a successful treatment of molluscum contagiosum with pulsed dye laser in the setting of a renal transplant.

Communication Strategies in Mohs Micrographic Surgery: A Survey of Methods, Time Savings, and Perceived Patient Satisfaction.

Mohs micrographic surgery (MMS) entails multiple time-consuming surgical and histological examinations for each patient. Efficient communication is key in improving clinic flow, and we surveyed members of the American College of Mohs Surgery to evaluate the efficacy of different techniques utilized by Mohs surgeons across the nation.