Subject(s)
Autoimmune Diseases , Blister , Humans , Blister/diagnosis , Autoimmune Diseases/pathology , Biopsy/methodsABSTRACT
BACKGROUND: The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines. OBJECTIVE: The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma. MATERIALS AND METHODS: A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery. RESULTS: A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS. CONCLUSION: Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.
Subject(s)
Cytoreduction Surgical Procedures/statistics & numerical data , Melanoma/surgery , Mohs Surgery/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Skin Neoplasms/surgery , Adult , Cross-Sectional Studies , Cytoreduction Surgical Procedures/methods , Cytoreduction Surgical Procedures/standards , Female , Humans , Immunohistochemistry , MART-1 Antigen/analysis , Male , Margins of Excision , Melanoma/diagnosis , Melanoma/pathology , Middle Aged , Mohs Surgery/methods , Mohs Surgery/standards , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Neoplasm Staging , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Skin/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Surgeons/standards , Surgeons/statistics & numerical data , Treatment OutcomeABSTRACT
Primary closure of suborbital skin defects can cause tension along the closure resulting in ectropion. The bicycle wheel analogy is a simple yet effective guide to aid in reducing tension vectors resulting in ectropion.
Subject(s)
Cheek/surgery , Ectropion/etiology , Plastic Surgery Procedures/methods , Cheek/anatomy & histology , Humans , Plastic Surgery Procedures/adverse effectsABSTRACT
Vertical surgical sites or those on reclining patients often present a challenge when establishing and securing a sterile field. The drape or towel most proximal to the physician is often vertically oriented. The forces of gravity and movements of surgery can shift or detach this vertical drape. Sterile clamps are not always available or are needed for securing other instruments. We present a method to secure this vulnerable drape using a central fenestrated adherent drape.
Subject(s)
Dermatologic Surgical Procedures/instrumentation , Surgical Equipment , Humans , SterilizationABSTRACT
The diagnosis of pyoderma gangrenosum (PG) is often difficult to establish based on a clinical presentation, which can mimic other dermatologic conditions. The formation of a mnemonic that incorporates the most prevalent clinical features of PG could aid in accuracy and speed of diagnosis. The 5 P's of PG: Painful, Progressive, Purple, Pretibial, Pathergy, and systemic associations, incorporate parameters recognizable on the first encounter with a patient with PG without reliance on histopathology and laboratory findings or treatment response. We postulate that this simple mnemonic will have the most utility with non-dermatology clinicians encountering a lesion suspicious for PG. By assisting in differential diagnosis formation, this mnemonic may lead to timelier biopsies and treatment initiation. The limitations of this approach mirror those of other studies and include lower sensitivities in patients with an atypical PG presentation. In conclusion, the 5 P's of PG offer a useful mnemonic for the diagnosis of PG, particularly in the initial clinical diagnosis prior to skin biopsy and treatment. J Drugs Dermatol. 2019;18(12):1282-1283.