Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center.

BACKGROUND: High perioperative patient anxiety is predictive of worse postoperative pain and quality of life. Several Mohs micrographic surgery (MMS) patient characteristics influence anxiety; however, the contributions of certain factors remain uncertain. OBJECTIVE: Investigate factors influencing perioperative MMS patient anxiety, especially those with debated impact or unclear data. METHODS: The authors surveyed 145 adult patients receiving MMS performed by a single MMS surgeon from 2018 to 2020. Patients self-reported demographics, history, and 10-point visual analog scale anxiety assessments at multiple stages. Health care provider (HCP)-perceived anxiety assessments were queried. A stepwise multiple regression modeling approach was used to explore potential factors. RESULTS: Younger age, female sex, and a self-reported history of anxiety confirmed by prior HCP diagnosis were significant predictors of pre-MMS anxiety. Postoperative anxiety increased with more layers removed and higher pre-MMS anxiety. HCP-perceived patient anxiety increased with younger patient age, more layers removed, prior skin cancer removal, and HCP-perceived pre-MMS patient anxiety. CONCLUSION: Anxiety-reducing interventions should target young female patients with a history of HCP-diagnosed anxiety, and patients with more layers removed. Prior skin cancer removal is associated with increased HCP-perceived intraoperative patient anxiety; however, it is not significant for patient-reported anxiety. Pre-MMS consultation may not be effective for anxiety reduction.

Seborrhea herpeticum: cutaneous herpes simplex virus infection within infantile seborrheic dermatitis.

Eczema herpeticum has been well described in the setting of atopic dermatitis (AD) and other dermatoses. We present the case of a 2-month-old infant boy with cutaneous herpes simplex virus (HSV) infection within existing diffuse infantile seborrheic dermatitis. Providers should be aware that cutaneous HSV can be confined to a seborrheic distribution and may represent underlying epidermal dysfunction secondary to seborrheic dermatitis.

Coprescription of Isotretinoin and Systemic Corticosteroids for Acne: An Analysis of the National Ambulatory Medical Care Survey.

Introduction: Isotretinoin treatment has been linked to flares of severe acne, which can be managed by the coadministration of systemic corticosteroids or prevented by beginning with a low dose of isotretinoin. To our knowledge, there are no estimates in the literature on the frequency of coprescription of isotretinoin and systemic corticosteroids. Objectives: We sought to quantify the estimated frequency of coprescription of isotretinoin and systemic corticosteroids and assess trends of the use of isotretinoin with systemic corticosteroids for acne as they relate to age, sex, race, insurance, and provider specialty. Methods: Data from the National Ambulatory Medical Care Survey (NAMCS) from 2003 to 2015, National Hospital Ambulatory Medical Care Survey Hospital Outpatient Departments (NHAMCS-OPD) from 2003 to 2011, and National Hospital Ambulatory Medical Care Survey Hospital Emergency Departments (NHAMCS-ED) from 2003 to 2014 were aggregated for this analysis. The number of prescriptions for isotretinoin and/or systemic corticosteroids was estimated by specialty (for NAMCS) and by survey type (for NHAMCS-OPD and NHAMCS-ED). Results: Among all first visits to a physician for acne (n=18,914,096), approximately 3.9 percent prescribed isotretinoin, 0.24 percent prescribed corticosteroids, and the remaining 96 percent prescribed neither drug. This was comparable to estimates for first visits to a dermatologist for acne (n=13,920,913), where approximately 4.2 percent prescribed isotretinoin, 0.32 percent prescribed corticosteroids, and the remaining 95 percent prescribed neither medication. Conclusion: Currently, isotretinoin and systemic corticosteroids are rarely prescribed together.

Fibromatosis arising from the pectoralis major muscle mimicking breast cancer.

Fibromatoses are soft tissue tumors composed of fibroblasts which commonly appear in the muscular aponeurosis of the abdomen. Mammary fibromatoses occur in only 0.2% of breast neoplasms and have been reported in association with prior breast augmentation and Gardner's syndrome. Multiple imaging modalities have been used to characterize the appearance of breast fibromatosis; however, it remains a tissue diagnosis given the variability both within and across modalities. We present the case of a 25-year-old female with a history of palpable breast mass who was evaluated with ultrasound, diagnostic mammography, MRI, and CT. Ultrasound-guided biopsy revealed fibromatosis, and MRI ultimately revealed that the mass was arising from the pectoralis major muscle and extensively involved the chest wall.