Nasal Reconstruction of Post-Mohs Defects >1.5 cm in a Single Cosmetic Subunit Under Local Anesthesia by a Combination of Plastic Surgeon and Mohs Surgeon Team: A Cross-sectional Study and Review of Algorithmic Nasal Defect Closures.

INTRODUCTION: We present an algorithmic approach to the reconstruction of larger post-Mohs defects treated in a practice with both a plastic surgeon and Mohs surgeon. The aim of the study is to present post-Mohs reconstructive choices made by our team compared with closures done by solo dermatologists. METHODS: A cross-sectional study was designed. Participants were 66 consecutive cases of nasal Mohs repairs performed under local anesthesia. For each Mohs case, data were collected on the age of the patient, smoking status, tumor type, tumor location, tumor diameter, the number of Mohs stages needed to clear the surgical margins of any remaining cancer, final defect diameter, reconstructive methods used, and postoperative complications. RESULTS: Basal cell carcinoma was the most common tumor treated on the nose, and post-Mohs basal cell carcinoma defects were closed predominantly with full-thickness skin grafts (FTSGs), rotation flap (RF), or a combination of both. The sidewall was the cosmetic unit most affected by skin cancer, and defects were commonly closed by FTSG and RF. Fifty percent of the sidewall defects required more than 1 closure method, compared with 24% of the nasal tip defects. FTSG combination closure was performed on 20 cases, usually with an advancement flap. CONCLUSIONS: The addition of a plastic surgeon shifted the nasal reconstructive techniques when compared with dermatologists alone. Post-Mohs defect >1.5 cm in a single cosmetic subunit was reconstructed under local anesthesia with either RF or a combination of FTSG and an advancement flap, whereas dermatologists most commonly chose a primary closure.

Pemphigus foliaceus presenting as eruptive seborrheic keratosis and responding to oral gold treatment.

Pemphigus Foliaceus (PF) is an antibody-mediated autoimmune disease. IgG directed against desmoglein-1 induces acantholysis in the superficial epidermis, leading to the classic presentation of crusted erosions in a seborrheic distribution. We report a case of a 51-year-old African-American man with an 8-year history of PF, who developed multiple hyperpigmented, 'stuck-on' appearing verrucous papules and plaques on the back, chest, and neck. Skin biopsy and direct immunofluorescence from the seborrheic keratosis-like lesions was consistent with pemphigus foliaceus. The patient was treated by adding oral gold (auranofin) to his regimen of prednisone and discontinuing hydroxychloroquine. After six months of follow-up his erosions healed. This is the first report of treating pemphigus foliaceus with oral gold.