AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.

Permanent hair reduction with a home-use diode laser: Safety and effectiveness 1 year after eight treatments.

BACKGROUND AND OBJECTIVES: To evaluate the safety and efficacy of a home-use hair removal diode laser (TRIA Beauty, Inc., Dublin, CA) in a multiple treatment regimen. STUDY DESIGN/MATERIALS AND METHODS: Thirteen indicated adults with naturally brown or black hair and Fitzpatrick skin type I-IV received 8 monthly treatments with the diode laser at three fluences, with a fourth area left untreated as a control. Quantitative hair counts were made at each treatment visit and periodically for 12 months after the last treatment. RESULTS: The treated sites exhibited statistically significant hair count reduction that generally increased with each treatment and remained stable during the 1 year follow-up period. The mean percent hair count reduction was 47%, 55%, and 73% at 1 month after the last treatment and 44%, 49%, and 65% at 12 months after the last treatment at fluences of 7, 12, and 20 J/cm(2) , respectively, compared to control. Eighty-six percent (86%) of subjects had greater than 30% hair reduction and 38% had >80% hair reduction at 12 months post-treatment. At the same time point, 31% of subjects reported complete (100%) hair removal and 69% reported that the hair that did regrow was less noticeable due to being finer and/or lighter. The only observed side effects were erythema and edema that were mild, transient, and self-resolving usually within a few hours. CONCLUSIONS: The home-use diode laser was safe and highly effective at permanently reducing unwanted hair.

Safety and Effectiveness of a New Blue Light Device for the Self-treatment of Mild-to-moderate Acne.

OBJECTIVE: To assess the safety and effectiveness of treating acne for eight weeks using a new blue light device at a dose of ˜2J/cm(2)/day (representing typical full-face treatment) or ˜29J/cm(2)/day (representing the typical dose after localized spot treatment of acne). DESIGN: Prospective, single-center, open-label study evaluating two levels of blue light in each subject. SETTING: Subjects were recruited from the local community for self-treatment at home. PARTICIPANTS: Thirty-two subjects with mild or moderate facial acne vulgaris. MEASUREMENTS: Inflammatory lesion count; number, severity, and redness of flares; improvement in skin characteristics (overall appearance, clarity, radiance, tone, texture, and smoothness); tolerability; subject satisfaction. RESULTS: The blue light treatment was associated with significant reductions from baseline in inflammatory lesion count as early as Week 1 with ˜29J/cm(2)/day and Week 3 with ˜2J/cm(2)/day (P≤ 0.01). It was also associated with significant reductions in the number, severity, and redness of flares and with improvements in the skin's appearance, clarity, radiance, tone, texture, and smoothness. Overall, 53 percent of subjects considered the treatment much gentler than traditional acne treatments and 61 percent were satisfied. Three adverse events were probably related to treatment-minimal transient skin dryness (2) and minimal transient hyperpigmentation (1). CONCLUSION: The blue light treatment is effective and well tolerated, offering rapid, gentle, and convenient treatment of inflammatory acne. The blue light device offers a valuable alternative to antibiotics and potentially irritating topical treatments and can also be used adjunctively to complement other therapies.

Evaluation of self-treatment of mild-to-moderate facial acne with a blue light treatment system.

INTRODUCTION: This study evaluated the efficacy and tolerability of treating mild-to-moderate facial acne using a new, hand-held, light-emitting diode blue light device in conjunction with a foam cleanser containing 5% glycolic acid and 2% salicylic acid plus a skin rebuilding serum containing 1.25% salicylic acid, 0.5% niacinamide, 0.08% liposomal-based azelaic acid and superoxide dismutase. METHODS: Volunteers with mild-to-moderate facial inflammatory acne used the blue light device twice daily for eight weeks, plus the cleanser before treatments and the serum after each evening treatment. RESULTS: Among 33 subjects aged 25-45 years old, 28 completed. In a 3 cm x 5 cm target area receiving a daily dose of ~29 J/cm2, treatment was associated with significant reductions from baseline in the inflammatory lesion count from week 1 onward (P≤ .01) and in the non-inflammatory lesion count from week 4 onward (P≤ .05). The number of flares was significantly reduced from baseline from week 2 onward (P≤ .05), and flare severity and flare redness were significantly reduced from baseline from week 4 onward (P≤ .01 and P≤ .05, respectively). At week 8, more than 90 percent of subjects reported improvements in their skin's overall appearance, clarity, radiance, tone, texture and smoothness. In addition, 82 percent were satisfied, very satisfied, or extremely satisfied with the blue light treatment system and 86 percent agreed the treatment system was much gentler than traditional acne treatments. CONCLUSION: The blue light treatment system offers effective, rapid, convenient and well tolerated treatment of inflammatory and non-inflammatory acne lesions. The majority of subjects consider it much gentler than traditional acne treatments and it facilitates effective treatment without the need for antibiotic exposure. The blue light treatment system and blue light therapy alone are attractive treatment options for acne vulgaris, both as alternatives to traditional acne treatments and as adjunctive treatments to complement existing therapies.

Laser treatment of superficial leg veins: a review.

BACKGROUND: Superficial leg veins affect millions of people worldwide, and treatment of these vessels is a common dermatologic request. The advance of lasers in recent years has led to numerous laser and light devices intended to treat these superficial vessels. OBJECTIVE AND METHOD: A review of the literature on the laser and light devices available for the treatment of superficial leg vessels with historical and recent trends is presented. RESULTS AND CONCLUSIONS: The appropriate choice of light system to treat telangiectases, venulectases, and reticular veins varies depending on anatomical, physiological, and biological differences in the vessels. Safe and efficacious treatment of superficial leg vessels can be achieved with multiple lasers by taking advantage of the oxyhemoglobin absorption peaks. The authors have indicated no significant interest with commercial supporters.

Simulated consumer use of a battery-powered, hand-held, portable diode laser (810 nm) for hair removal: A safety, efficacy and ease-of-use study.

BACKGROUND AND OBJECTIVES: Safety, efficacy and ease-of-use of a hair removal diode laser for consumer use were evaluated. STUDY DESIGN/MATERIALS AND METHODS: The treatment group consisting of 77 appropriate users measured safety and efficacy from three self-administered treatments. The non-treatment group consisting of 44 inappropriate users measured safety from delivery of a single laser pulse. RESULTS: The mean hair reduction was 61% 3 weeks after the first treatment, 70% 3 weeks after the second treatment, 60% 1 month after the third treatment, 24% 2 months after the third treatment, 6% 3 months after the third treatment, 41% 6 months after the third treatment, 31% 9 months after the third treatment, and 33% 12 months after the third treatment. The only observed side effect for appropriate users was transient erythema. CONCLUSIONS: In simulated consumer use, the laser was highly effective at removing hair with minimal side effects for appropriate users.

The pitfalls of regulating office-based surgery by state legislatures and boards of medical examiners.

Many surgical specialties currently provide their patients with cost-effective surgical procedures that are performed safely in an office-based setting. However, the growing number of procedures performed in this setting has lead many state legislatures and boards of medical examiners to the belief that these procedures must somehow be regulated to ensure patient safety. The first pitfall is demonstrating that a problem with safety exists, in spite of the fact that numerous published, peer-reviewed articles have proven that there is no problem. While it is relatively easy to develop a set of criteria to meet in order to certify a facility in which office surgery is to be performed, it is exceedingly difficult to determine similar criteria or scope of practice definitions that can be used fairly and accurately to determine which physicians are qualified to use those facilities. The use of hospital privileges, board certification, transfer agreements or extramural certification of facilities all have been recommended at one time or another as methods to determine physician qualifications, but no single standard has been developed that accurately reflects a fair and impartial method of determine physician qualifications.

The pitfalls of treating all actinic keratoses as squamous cell carcinomas.

The greatest difficulties in managing a patient with numerous actinic keratoses is deciding the order in which to treat the specific lesions and what modality to use. The patient with a small number of lesions is probably most conveniently and cost effectively treated using destructive techniques like cryosurgery, electrodesiccation or photodynamic therapy with lasers. However, patients with large numbers of lesions are probably best managed using a topical chemotherapy agent, like 5-florouracil or imiquimod. If the patient's health insurance company limits coverage for the treatment of a specific number AK's per visit, it may be most prudent and logical to begin treatment of the largest or most rapidly growing AK's first and continue treatment of remaining lesions at subsequent visits until all lesions have been eradicated.