Damage to the Temporal Branch of the Facial Nerve From Mohs Micrographic Surgery.

BACKGROUND: The temporal branch of the facial nerve is at risk of damage during Mohs micrographic surgery (MMS). This complication leads to motor deficit in the ipsilateral upper face with resultant functional and cosmetic impairment. OBJECTIVE: To identify patient, tumor, and surgical risk factors associated with temporal nerve damage. MATERIALS AND METHODS: A single-institution, retrospective review of MMS cases involving anatomic sites within the temporal nerve danger zone was performed. Risk factors were compared between cases with and without nerve damage. RESULTS: Of 616 cases within the danger zone, 28 (4.5%) had postoperative nerve dysfunction. Variables significantly associated with dysfunction included patient immunosuppression, tumor size, aggressive tumor histology, recurrent tumors, high degree of subclinical spread, and greater average number of Mohs stages. Preoperative tumor size and postoperative defect size of ≥3 cm resulted in a ×37 and ×40 increased odds of nerve damage, respectively. Sex, age, and basal versus squamous cell carcinoma were not significantly associated with temporal nerve damage. No patients with a postoperative defect size measuring <2 cm had nerve damage. CONCLUSION: The overall risk of damage to the temporal nerve during MMS is low, but there are certain risk factors that warrant increased counseling about this potential complication.

Analysis of Speaking Opportunities by Gender at National Dermatologic Surgery Conferences.

BACKGROUND: Although gender disparities for those entering medicine have equalized, the number of women advancing in academia has remained low. Studies have demonstrated that women's representation at academic medical conferences has also remained low across multiple fields. Given that conference presentations and national reputation serve as metrics for academic promotion, women's representation at dermatology conferences may provide insight into women's academic productivity. OBJECTIVE: To examine the gender composition of presenters and speaking time at the 2 main national dermatologic surgery conferences. METHODS: Speaker's gender, presentation time, and topics were collected for 2009 to 2017 for the American College of Mohs Surgery (ACMS) and the American Society for Dermatologic Surgery (ASDS) Annual Meetings. RESULTS: Women had significantly fewer speaking opportunities and speaking minutes at both conferences. This disparity was most pronounced in reconstruction topics and least pronounced in cosmetics topics. The majority of top speakers, repeat speakers, and keynote speakers were men for both conferences. Oral abstracts showed no gender disparity at either conference. CONCLUSION: Women spoke less than men at both the ASDS and ACMS annual meetings over multiple years studied. Recently, this disparity in speaking opportunities has decreased. Further studies are needed to evaluate the speaking opportunities for women at other types of dermatology conferences.

Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines.

Skin cancer is the most common malignancy affecting solid organ transplant recipients (SOTR), and SOTR experience increased skin cancer-associated morbidity and mortality. There are no formal multidisciplinary guidelines for skin cancer screening after transplant, and current practices are widely variable. We conducted three rounds of Delphi method surveys with a panel of 84 U.S. dermatologists and transplant physicians to establish skin cancer screening recommendations for SOTR. The transplant team should risk stratify SOTR for screening, and dermatologists should perform skin cancer screening by full-body skin examination. SOTR with a history of skin cancer should continue regular follow-up with dermatology for skin cancer surveillance. High-risk transplant patients include thoracic organ recipients, SOTR age 50 and above, and male SOTR. High-risk Caucasian patients should be screened within 2 years after transplant, all Caucasian, Asian, Hispanic, and high-risk African American patients should be screened within 5 years after transplant. No consensus was reached regarding screening for low-risk African American SOTR. We propose a standardized approach to skin cancer screening in SOTR based on multidisciplinary expert consensus. These guidelines prioritize and emphasize the need for screening for SOTR at greatest risk for skin cancer.

ASDS Cosmetic Dermatologic Surgery Fellowship Milestones.

BACKGROUND: The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. OBJECTIVE: To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. METHODS: An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. RESULTS: Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. CONCLUSION: Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.

Undermining and Hemostasis.

BACKGROUND: Undermining and hemostasis are basic surgical techniques that can have a significant impact on surgical outcomes. OBJECTIVE: To review the mechanisms and techniques of undermining and hemostasis, with an emphasis on the advantages and limitations of each modality. MATERIALS AND METHODS: The PubMed database was searched for articles with the keywords "undermining," "hemostasis," and "electrosurgery." RESULTS: Whether performing blunt, sharp, or electrosurgical techniques, undermining at the appropriate depth and width is necessary for tissue movement during closures. Both excessive and inadequate undermining can compromise surgical healing. Surgical hemostasis techniques include pressure, suture ligation, topical hemostatic agents, and electrosurgery. Dermatologic surgeons should select the appropriate amount and type of hemostasis for each procedure. Particular care should be taken in performing electrosurgery, given the potential for complications. CONCLUSION: Understanding and optimizing hemostasis and undermining will allow dermatologic surgeons to execute complex closures with minimal complications.