RESUMEN
BACKGROUND: Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence. OBJECTIVE: To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction. METHODS: This was a multi-institutional Delphi consensus study consisting of a panel of members of the American College of Mohs Surgery from various practice settings. Participants were first asked to describe scenarios in which they prescribe opioids at various frequencies. These scenarios then underwent 2 Delphi ratings rounds that aimed to identify situations in which opioid prescriptions should, or should not, be routinely prescribed. Consensus was set at ≥80% agreement. Prescription recommendations were then distributed to the panelists for feedback and approval. RESULTS: Twenty-three Mohs surgeons participated in the study. There was no scenario in which consensus was met to routinely provide an opioid prescription. However, there were several scenarios in which consensus were met to not routinely prescribe an opioid. CONCLUSION: Opioids should not be routinely prescribed to every patient undergoing MMS. Prescription recommendations for opioids after MMS and reconstruction may decrease the exposure to these drugs and help combat the opioid epidemic.
Asunto(s)
Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos/normas , Cirugía de Mohs/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Adulto , Consenso , Técnica Delphi , Femenino , Humanos , Masculino , Persona de Mediana Edad , Epidemia de Opioides/prevención & control , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/prevención & control , Dolor Postoperatorio/etiología , Pautas de la Práctica en Medicina/normas , Neoplasias Cutáneas/cirugía , Sociedades Médicas/normas , Cirujanos/normas , Estados UnidosRESUMEN
OBJECTIVES: To present a case series of 4 patients who underwent postoperative hair removal using the long-pulsed Alexandrite or Nd:YAG laser following intraoral cutaneous flap reconstruction. METHODS: Patients underwent epilation in dermatology clinic with long-pulsed Alexandrite or Nd:YAG lasers, spaced 8 weeks apart, until hair removal was achieved. RESULTS: All patients achieved improvement in hair removal regardless of initial flap donor site with significant improvement in quality of life and minimal side effects. CONCLUSIONS: The long-pulsed Alexandrite and Nd:YAG represent safe and effective treatment options to improve patient quality of life following intraoral flap repair following excision of malignancy.
Asunto(s)
Remoción del Cabello/métodos , Terapia por Láser , Complicaciones Posoperatorias , Calidad de Vida , Trasplante de Piel/efectos adversos , Colgajos Quirúrgicos/efectos adversos , Adulto , Anciano , Berilio/uso terapéutico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Rayos Láser , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Orales/métodos , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/terapia , Trasplante de Piel/métodos , Resultado del TratamientoAsunto(s)
Hipotricosis/diagnóstico , Alopecia , Niño , Diagnóstico Diferencial , Femenino , Humanos , Hipotricosis/genética , Hipotricosis/patología , Linaje , Cuero CabelludoAsunto(s)
Anilidas/uso terapéutico , Antineoplásicos/uso terapéutico , Carcinoma Basocelular/tratamiento farmacológico , Carcinoma Basocelular/patología , Neoplasias Faciales/tratamiento farmacológico , Neoplasias Faciales/patología , Neoplasias Nasales/patología , Piridinas/uso terapéutico , Administración Oral , Anciano de 80 o más Años , Anilidas/administración & dosificación , Antineoplásicos/administración & dosificación , Diferenciación Celular , Resistencia a Antineoplásicos , Femenino , Humanos , Cirugía de Mohs , Neoplasias Nasales/cirugía , Piridinas/administración & dosificación , Colgajos QuirúrgicosAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Melanoma/tratamiento farmacológico , Carcinoma de Células Escamosas/secundario , Femenino , Humanos , Indoles/administración & dosificación , Melanoma/patología , Metotrexato/administración & dosificación , Persona de Mediana Edad , Sulfonamidas/administración & dosificación , Resultado del Tratamiento , VemurafenibRESUMEN
IMPORTANCE: Cancer worry about developing melanoma in at-risk patients may affect one's quality of life and adherence to screening. Little is known about melanoma-related worry in patients with atypical mole syndrome (AMS). OBJECTIVES: To quantify levels and elucidate predictors of worry related to developing melanoma in patients with AMS and to determine whether total-body digital photography (TBDP) in pigmented lesion clinics (PLCs) reduces worry. DESIGN, SETTING, AND PARTICIPANTS: In this pretest-posttest study, patients with AMS from PLCs at 2 academic medical centers were recruited from June 1, 2005, through October 31, 2008, to answer questions about cancer worry before and after undergoing TBDP. Questionnaires used included the new melanoma and recurrent melanoma Revised Impact of Event Scale (RIES), the Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale, and the Life Orientation Test. INTERVENTIONS: All patients underwent TBDP. MAIN OUTCOMES AND MEASURES: Changes in the MWS and new melanoma RIES scores. RESULTS: A total of 138 patients completed baseline questionnaires; 108 patients (78.3%) completed questionnaires after TBDP. Baseline levels of worry were low and reduced further after TBDP. In patients with a personal history of melanoma, worry was reduced on all scales. In patients without a personal history of melanoma, only the new melanoma RIES score was significantly decreased. Predictors of baseline MWS scores include female sex, personal history of melanoma, and higher Hospital Anxiety and Depression Scale scores, adjusted for demographics, family history of melanoma, and Life Orientation Test scores. Adjusted predictors of the baseline new melanoma RIES score were similar but also included lower educational level and did not include sex. CONCLUSIONS AND RELEVANCE: Patients with AMS have low levels of melanoma-related worry, which is similar to data from other populations at high risk of cancers. We found that TBDP is a clinically useful tool that can be used in PLCs to help decrease worry about developing melanoma in at-risk patients.