The public's perception of dermatologists as surgeons.

BACKGROUND: Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons. OBJECTIVE: Our study was designed to assess the public's perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physician's specialty biases people when they assess the cosmetic appearance of a surgical scar. MATERIALS AND METHODS: We administered an institutional review board-approved survey to individuals at the Emory Student Center and the Emory Dermatology Clinic. Participants rated the perceived skills and training of the different medical specialties and scored the cosmetic appearance of 16 surgical scars created by a fellowship-trained Mohs surgeon labeled as the work of different specialists. RESULTS: Results from 467 participants were overwhelmingly in favor of plastic surgeons (p<.001). The physician's specialty did not bias participants in assessing the cosmetic appearance of surgical scars. CONCLUSION: The study population had greater confidence in the surgical skills of plastic surgeons than in those of dermatologists, although participants were objective in rating the cosmesis of surgical scars, regardless of the purported surgeon's specialty. Although dermatologic surgeons must continually refine our surgical expertise, we must also educate the public about the breadth and depth of our work. The authors have indicated no significant interest with commercial supporters.

Hot or not--evaluating the effect of artificial tanning on the public's perception of attractiveness.

BACKGROUND: Despite strong evidence that sun exposure causes skin cancer, a significant proportion of the population continues to purposefully tan. Many individuals deliberately tan because they believe a tanned complexion makes them appear more attractive. OBJECTIVE: To measure the effect that a tanned complexion has on the public's perception of attractiveness. MATERIALS AND METHODS: Forty-five women aged 21 to 35 were recruited. A digital photograph was taken of each subject. Each image was uploaded onto a public website until it had been rated at least 100 times on a scale from 1 to 10. An average baseline, or untanned, rating of the image was calculated. The image was then given an artificial tan using a skin tanning protocol available for Adobe Photoshop. The tanned image was then re-uploaded onto the website and another average rating was calculated using the same criteria. RESULTS: The mean score±standard deviation was 6.3±2.3 for the untanned images and 6.5±2.3 for the tanned images (p<.001). CONCLUSIONS: The population who logged onto the website considers tanned people to be more attractive.

Clinical and pathologic findings of paraneoplastic dermatoses.

UNLABELLED: Paraneoplastic dermatoses comprise a heterogeneous group of noninherited skin conditions that manifest internal malignancy. Familiarity with paraneoplastic dermatoses is important to both clinician and pathologist alike, as recognition of such a condition offers opportunity for early diagnosis and treatment of internal malignancy; monitoring for tumor recurrence; and insight into pathophysiology which may yield possible clues to treatment. Herein are reviewed 16 of the best established paraneoplastic dermatoses that display distinctive clinical and pathologic findings. LEARNING OBJECTIVE: At the conclusion of this leaning activity, participants should be able to recognize, diagnose, and describe the clinical and pathologic findings of paraneoplastic dermatoses.

Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study.

BACKGROUND: Cutaneous scars resulting from surgical procedures can be erythematous, hypertrophic, pruritic, painful, or cosmetically unacceptable. An onion extract-based topical gel (Mederma, Merz Pharmaceuticals, Greensboro, NC, USA) has been marketed as a product to improve scar appearance and texture. However, few data are available to substantiate these claims. OBJECTIVE: To compare the efficacy between the onion extract gel and a petrolatum-based emollient (Aquaphor, Beiersdorf, Inc., Wilton, CT, USA) in improving the appearance and symptoms of new surgical scars. METHODS: Twenty-four patients with new surgical wounds of at least 4 cm in length were enrolled in the study. Using a randomized, double-blinded, split-scar study design, each scar was divided into two equal portions, and each half was assigned treatment with either onion extract gel or petrolatum ointment at the time of suture removal. Each product was applied three times daily for 8 weeks, and patients were evaluated at 2, 8, and 12 weeks following initiation of treatment. A follow-up telephone interview was conducted at least 11 months postoperatively. RESULTS: Scar halves were evaluated by blinded investigators for overall cosmetic appearance, erythema, and hypertrophy. Patients also independently rated side-specific erythema, pruritus, burning, and pain. Using the paired t-test and the Wilcoxon signed rank test, we found no statistically significant difference (p < .1) between the two treatment groups in any of the outcome variables studied. CONCLUSION: Petrolatum-based topical agents constitute standard therapy in the management of postoperative wounds. In this side-by-side, randomized, double-blinded, split-scar study, the onion extract gel did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment.

Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins.

BACKGROUND: Whether presurgical curettage (PC), light curettage performed before Mohs surgery to delineate tumor margin, is appropriate or causes unnecessary removal of normal tissue has not been well established. OBJECTIVE: We aim to determine histologically whether PC appropriately increases the size of the stage I specimen or causes unnecessary removal of healthy tissue. METHODS: Before a surgical margin guided by PC was taken, a hypothetical margin determined by visual and tactile assessment alone (no curettage [NC]) was marked outside the clinically defined tumor. Histologic analysis at the NC and the PC margins revealed whether the increase in the stage I specimen as a result of PC was appropriate. RESULTS: PC appropriately increased the stage I specimen in 21 cases and unnecessarily removed normal tissue in only 1 case. The estimation of tumor margins with PC was 15 times more accurate than with NC (p value = .0012). CONCLUSION: For basal cell and squamous cell carcinomas at least 4 mm in diameter, light curettage performed prior to Mohs surgery could better delineate subclinical extensions of the tumor margin and appropriately increase the size of the stage I specimen.

Use of ex vivo confocal scanning laser microscopy during Mohs surgery for nonmelanoma skin cancers.

BACKGROUND: Ex vivo confocal scanning laser microscopy offers rapid optical reflectance imaging of excised tissue without conventional frozen histopathology that can potentially expedite Mohs surgery. OBJECTIVE: The objective was to determine the feasibility of using ex vivo confocal scanning laser microscopy during Mohs surgery for detecting residual basal cell carcinoma and squamous cell carcinoma. METHODS: One-hundred fifteen Stage I Mohs surgery excisions (92 basal cell carcinoma, 23 squamous cell carcinoma) were imaged with acetowhitening and confocal scanning laser microscopy and compared to conventional Mohs frozen histologic sections for normal and tumor features. RESULTS: Large aggregates of residual tumor such as nodular basal cell carcinoma were easily detected by ex vivo confocal scanning laser microscopy, whereas smaller tumor foci were not consistently identified. Confocal morphology of tumor subtypes is described. CONCLUSION: Ex vivo confocal scanning laser microscopy can potentially expedite Mohs surgery in rapidly detecting large nodular basal cell carcinomas without conventional frozen histopathology. Further improvements in instrumentation and image quality are necessary to allow broader application and acceptance of this novel technology in Mohs surgery.

Interactions of a herbal combination that inhibits growth of prostate cancer cells.

PURPOSE: PC SPES is an eight-component herbal product marketed for the treatment of prostate cancer. The manufacturer of PC SPES claims that the herbal combination is a synergistic blend, but the purported synergy has never been tested. We examined the interaction in cell culture of these eight individual herbal components by the use of an isobologram. METHODS: US patent no. 5,665,393 (1997) for PC SPES was acquired, and each of the eight herbal components described was acquired, properly identified, and extracted by 95% ethanol. The extracts were tested for cytotoxicity to PC 3 human prostate cancer cells in culture by the MTT (3-[4,5-dimethythiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. Seven combinations of herbal extracts were made, varying in the proportion of the most cytotoxic herbal extract, that of Panax notoginseng. The interactions of P. notoginseng with the other seven herbs were evaluated through the use of an isobologram. RESULTS: In all seven herbal combinations, P. notoginseng was found to be antagonistic with the other seven herbal components in the cytotoxicity assay ( P values: 0.09, 0.12, 0.12, 0.33, 0.45, 0.56, and 0.76). CONCLUSIONS: The interaction between the most cytotoxic herbal component of a widely used herbal product and the other seven components was antagonistic. Herbal combinations are no different from traditional combination pharmacotherapy. If herbal combinations are able to achieve antagonism, then theoretically they can achieve synergism if combined properly.