Increased prevalence of left-sided skin cancers.

BACKGROUND: Previous research has shown an increase in photodamage and precancers on the left side of the face. OBJECTIVE: We sought to determine whether there is a higher frequency of skin cancer development on the left side of the body than the right. METHODS: The study was a retrospective review of patients with skin cancer referred to our Mohs micrographic surgery and cutaneous oncology unit in 2004. RESULTS: When including all types of skin cancers and both sexes, more cancers occurred on the left (52.6%) than the right (47.4%) (P = .059), with a stronger trend in men (P = .042). There were significantly more malignant melanoma in situ on the left (31/42, 74%) than the right (11/42, 26%) (P = .002). LIMITATIONS: Population was comprised of patients referred to an academic medical center and often for Mohs micrographic surgery. CONCLUSIONS: There were significantly more skin cancers on the left than the right side in men. This discrepancy was even more profound in malignant melanoma in situ.

The importance of reviewing pathology specimens before Mohs surgery.

BACKGROUND: The review of outside biopsy slides before performing surgery is the standard of care in many surgical specialties. Previous studies have shown high discrepancy rates between the original and second-opinion diagnoses. The frequency with which this practice changes the diagnosis and management of patients undergoing Mohs surgery is undocumented in the literature. It is standard practice at our institution to review all outside biopsy slides before Mohs surgery. OBJECTIVE: To investigate how often review of outside biopsies by an internal dermatopathologist changes patients' initial referral diagnosis and subsequent management. METHODS & MATERIALS: This is a retrospective review of all patients referred to Mohs surgery from January 2003 through March 2007. The number of cases in which the diagnosis changed and how this change affected management were recorded. RESULTS: Seventy-four of 3,345 (2.2%) cases were identified in which the diagnosis changed after review of the biopsy slides. Management was affected in the majority (61%) of cases. Board-certified dermatopathologists originally read nearly half of the biopsies. CONCLUSION: Review of outside biopsy slides before surgery can change the diagnosis in a large proportion of patients, with a resulting change in management. This quality-assurance practice may improve patient care.