Recurrence Rates of Mohs Micrographic Surgery vs Radiation Therapy for Basal Cell Carcinoma of the Ear.

Basal cell carcinoma (BCC) of the ear may have aggressive histologic subtypes and a greater propensity for subclinical spread than BCC in other anatomic locations. In this retrospective analysis, we evaluated recurrence rates of BCC of the ear in 102 patients who underwent treatment with Mohs micrographic surgery (MMS) or radiation therapy (RT) at a single institution between January 2017 and December 2019. Data on patient demographics, tumor characteristics, treatment modality, and recurrence rates were collected from medical records. Recurrence rates were assessed over a mean follow-up time of 2.8 years. Although MMS is the gold standard for treatment of BCC of the ear, RT may be a suitable alternative for nonsurgical candidates.

Neurotropic melanoma arising from a neurocristic hamartoma.

Neurotropic melanoma is a rare type of malignant melanoma with nerve invasion or neural differentiation. Neurocristic cutaneous hamartoma is a rare, benign tumor of the skin and superficial soft tissue that arises from aberrant migration of neural crest cells. We report a rare case of a 74-year-old man with a clinically diagnosed giant congenital nevus of the right mid-back, histopathologically confirmed to be a neurocristic cutaneous hamartoma, who developed neurotropic spindle cell melanoma within the lesion. The patient was treated with serial re-excisions until clear margins were achieved.

Mohs Micrographic Surgery for Melanoma: A Convincing Treatment Modality.

Mohs micrographic surgery (MMS) is the gold standard for treating keratinocyte carcinomas in specific locations or due to other tumor-specific factors, given its comprehensive margin assessment, tissue sparing, and high cure rate. The use of MMS for treating invasive melanoma with intraoperative immunostains is still a subject of debate. Herein, a literature review supports the following recommendations. In cosmetically or functionally demanding sites such as head, neck, hands, feet, and pretibial leg, we recommend MMS for MMIS and all thin melanomas measuring <0.8 mm Breslow depth. Additionally, on the head and neck, all superficial spreading and lentigo maligna melanoma (LMM) histologic subtypes <0.8 mm Breslow depth should be treated with MMS. We recommend using melanoma antigen recognized by T cells 1 (MART-1) immunostain intraoperatively given its high sensitivity. However, microphthalmia transcription factor (MITF) and Sry-related HMG-Box gene 10 (SOX10) are useful adjuncts for difficult cases.

Upstaging of basal cell and squamous cell carcinomas during definitive surgery: a review of predictive preoperative clinical and histologic features.

The incidence of nonmelanoma skin cancer (NMSC) in the United States is increasing with approximately 3.6 million cases diagnosed per year. The staging and treatment of NMSC is guided by histologic subtype based on skin biopsy, along with other tumor-specific factors. However, a biopsy only represents a portion of the tumor, so there is a risk of upstaging at the time of definitive surgery. We conducted a review of the literature and found that a significant proportion of NMSC were upstaged during surgery. The rate of upstaging of basal cell carcinoma (BCC) was 7-31% and that of squamous cell carcinoma in situ (SCCIS) to squamous cell carcinoma (SCC) was 3-39%. Biopsy sampling error and variability in interpreting and reporting by dermatopathologists contribute to these discrepancies. It is pertinent to consider more comprehensive treatment modalities for tumors at high risk for upstaging. Diligence to identify tumors at higher risk for upstaging will allow clinicians to optimize management.

A concise clinician's guide to therapy for hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, often debilitating, skin condition that historically does not respond well to treatment. Although there is no cure for HS, symptoms can be managed if the appropriate diagnosis is made. HS most commonly develops in postpubertal women and manifests as painful, deep-seated, inflamed lesions, including nodules, sinus tracts, and abscesses. HS flares are marked by increased pain and suppuration at varying intervals and can occur in women before menstruation. HS is commonly misdiagnosed; physicians might mistake a lesion for an infection, abscess, or sexually transmitted infection. Incision and drainage of these lesions often leads to recurrence. Given that management of this chronic disease is often difficult, we sought to outline current diagnosis and management strategies for HS.

"I'm Not Telling an Illness Story. I'm Telling a Story of Opportunity": Making Sense of Voice Hearing Experiences.

This study aimed to explore how adults with lived experiences of voice hearing, who have participated in hearing voices groups based on approaches of the Hearing Voices Movement, understand their voice hearing experiences (VHE). A phenomenological approach guided the study design. In-depth semi-structured interviews were conducted with five participants who attended a hearing voices group. Participants experienced a journey of understanding VHE. The overarching theme 'tension and recalibration' permeated five themes: beliefs about voices; navigating the relationship with my voices; learning to live with my voices; rediscovering myself with my voices; and, influences to understanding my voices. This study highlights how voice hearers' understanding can evolve over time and throughout phases of recovery. Implications regarding intervention to support individuals to explore VHE are discussed.

Use of standardized methods to improve extinction-risk classification.

Standardized classification methods based on quantifiable risk metrics are critical for evaluating extinction threats because they increase objectivity, consistency, and transparency of listing decisions. Yet, in the United States, neither federal nor state agencies use standardized methods for listing species for legal protection, which could put listing decisions at odds with the magnitude of the risk. We used a recently developed set of quantitative risk metrics for California herpetofauna as a case study to highlight discrepancies in listing decisions made without standardized methods. We also combined such quantitative metrics with classification tree analysis to attempt to increase the transparency of previous listing decisions by identifying the criteria that had inherently been given the most weight. Federally listed herpetofauna in California scored significantly higher on the risk-metric spectrum than those not federally listed, whereas state-listed species did not score any higher than species that were not state listed. Based on classification trees, state endemism was the most important predictor of listing status at the state level and distribution trend (decline in a species' range size) and population trend (decline in a species' abundance at localized sites) were the most important predictors at the federal level. Our results emphasize the need for governing bodies to adopt standardized methods for assessing conservation risk that are based on quantitative criteria. Such methods allow decision makers to identify criteria inherently given the most weight in determining listing status, thus increasing the transparency of previous listing decisions, and produce an unbiased comparison of conservation threat across all species to promote consistency, efficiency, and effectiveness of the listing process.

Uso de Métodos Estandarizados para Mejorar la Clasificación del Riesgo de Extinción Resumen Los métodos estandarizados de clasificación basados en medidas cuantificables del riesgo de extinción son sumamente importantes para evaluar las amenazas de extinción ya que incrementan la objetividad, consistencia y transparencia de las decisiones de listado. Aún así, en los Estados Unidos, ni las agencias federales ni las estatales usan métodos estandarizados para enlistar a las especies para su protección legal, lo que podría poner en discrepancia a las decisiones de listado con la magnitud del riesgo. Usamos un conjunto de medidas cuantitativas del riesgo, desarrollado recientemente para la herpetofauna de California, como un estudio de caso que nos permitiera resaltar las discrepancias en las decisiones de listado hechas sin métodos estandarizados. También combinamos dichas medidas cuantitativas con un análisis de árbol de clasificación para intentar incrementar la transparencia de las decisiones de listado previas al identificar los criterios a los cuales se les había otorgado mayor peso inherentemente. La herpetofauna de California que se encontraba enlistada a nivel federal tuvo un puntaje significativamente más alto en el espectro de la medida del riesgo que aquellas especies que no estaban enlistadas, mientras que las especies enlistadas a nivel estatal no tuvieron un puntaje más alto que aquellas especies que no estaban enlistadas a nivel estatal. Con base en los árboles de clasificación, el endemismo estatal fue el indicador más importante del estado de listado a nivel estatal y tanto la tendencia de distribución (declinación del tamaño de la extensión de una especie) y como la tendencia poblacional (declinación de la abundancia de una especie en sitios localizados) fueron los indicadores más importantes a nivel federal. Nuestros resultados enfatizan la necesidad que tienen los cuerpos de gobierno de adoptar los métodos estandarizados que están basados en criterios cuantitativos para la evaluación del riesgo de conservación. Dichos métodos permiten que quienes toman las decisiones identifiquen los criterios a los cuales se les otorga inherentemente el mayor peso al determinar el estado de listado, lo que incrementa la transparencia de las decisiones previas de listado, y produce una comparación sin sesgos de la amenaza de conservación en todas las especies para promover la regularidad, eficiencia y efectividad de los procesos de listado.

Amphibian responses to livestock use of wetlands: new empirical data and a global review.

Pastureland currently occupies 26% of Earth's ice-free land surface. As the global human population continues to increase and developing countries consume more protein-rich diets, the amount of land devoted to livestock grazing will only continue to rise. To mitigate the loss of global biodiversity as a consequence of the ever-expanding amount of land converted from native habitat into pastureland for livestock grazing, an understanding of how livestock impact wildlife is critical. While previous reviews have examined the impact of livestock on a wide variety of taxa, there have been no reviews examining how global livestock grazing affects amphibians. We conducted both an empirical study in south-central Florida examining the impact of cattle on amphibian communities and a quantitative literature review of similar studies on five continents. Our empirical study analyzed amphibian community responses to cattle as both a binary (presence/absence) variable, and as a continuous variable based on cow pie density. Across all analyses, we were unable to find any evidence that cattle affected the amphibian community at our study site. The literature review returned 46 papers that met our criteria for inclusion. Of these studies, 15 found positive effects of livestock on amphibians, 21 found neutral/mixed effects, and 10 found negative effects. Our quantitative analysis of these data indicates that amphibian species that historically occurred in closed-canopy habitats are generally negatively affected by livestock presence. In contrast, open-canopy amphibians are likely to experience positive effects from the presence of livestock, and these positive effects are most likely to occur in locations with cooler climates and/or greater precipitation seasonality. Collectively, our empirical work and literature review demonstrate that under the correct conditions well-managed rangelands are able to support diverse assemblages of amphibians. These rangeland ecosystems may play a critical role in protecting future amphibian biodiversity by serving as an "off-reserve" system to supplement the biodiversity conserved within traditional protected areas.