ABSTRACT
In-transit metastatic melanoma is classified as a regional intralymphatic metastasis of melanoma. Currently, there is no standardized regimen used to treat in-transit metastatic melanoma, and therapy is individualized based on the patient. While many patients undergo surgical procedures, those with surgical contraindications or declination face challenges when attempting to find adequate treatment options. This case report demonstrates the successful treatment of multiple in-transit metastatic melanoma lesions using the combination of shave excision, electrodesiccation and curettage, and topical imiquimod cream. Several months later, examination showed clinical resolution of the original metastatic lesions. This treatment regimen may provide an alternative option for a select group of patients with certain comorbidities and therapeutic contraindications. J Drugs Dermatol. 20(5):555-557. doi:10.36849/JDD.5675.
Subject(s)
Imiquimod/administration & dosage , Melanoma/therapy , Skin Cream/administration & dosage , Skin Neoplasms/therapy , Aged, 80 and over , Chemotherapy, Adjuvant/methods , Combined Modality Therapy/methods , Curettage/methods , Electrocoagulation/methods , Humans , Male , Melanoma/diagnosis , Melanoma/secondary , Skin Neoplasms/diagnosis , Skin Neoplasms/pathologySubject(s)
Carcinoma, Squamous Cell/surgery , Mohs Surgery , Skin Neoplasms/surgery , Tattooing/adverse effects , Aged , Female , HumansABSTRACT
BACKGROUND: Anxiety toward pain has been shown in several studies to increase postoperative pain after surgical procedures. This anxiety can be measured by several validated questionnaires, the Pain Catastrophizing Scale (PCS) and the Pain Anxiety Symptoms Scale (PASS). Higher scores on these scales correlate with increased pain after surgery, but this has not yet been demonstrated in dermatologic surgery. OBJECTIVE: To assess whether pain anxiety will predict postoperative pain after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients at 2 private Mohs practices were recruited to fill out 2 pain questionnaires, the PCS and the PASS. Their postoperative pain was assessed after MMS. RESULTS: Three hundred fifty-six patients completed the study. Overall, most patients experienced little postoperative pain after Mohs surgery. However, for people with high anxiety toward pain, they also experienced statistically significant greater postoperative pain. Other factors that contributed to greater postoperative pain included female gender and lower extremity location. Second intention healing had lower pain than other repair types. CONCLUSION: This study shows that postoperative pain is affected by pain anxiety, even in dermatologic surgery. However, most patients still had very little discomfort after surgery, further supporting MMS as an effective and safe procedure with relatively few postoperative problems.
Subject(s)
Anxiety/psychology , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Mohs Surgery/adverse effects , Pain, Postoperative/etiology , Psychiatric Status Rating Scales , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Female , Humans , Lower Extremity , Male , Middle Aged , Pain Measurement , Predictive Value of Tests , Sex FactorsABSTRACT
Years of violence have resulted in a lack of trained health care providers in Iraq. To address this need, International Medical Corps has implemented a national emergency care program for the country. As part of this program, we implemented via tele-education the country's first civilian course in Pediatric Advanced Life Support.