Basal cell carcinoma arising from a nonhealing lower extremity ulcer: a case report.

INTRODUCTION: BCC is a malignancy that arises from the basal cells of the epidermis. Despite being the most common cancer worldwide, it rarely occurs in the setting of long-standing ulceration. Malignant transformation of wounds and scars is typically associated with the development of SCC, as with an MU. Reports in the literature of BCC arising within nonhealing, lower extremity wounds are limited. CASE REPORT: The authors report a case of a 65-year-old man with several comorbidities who presented to the clinic with a nonhealing wound on the right lateral ankle. The wound first began as warts during childhood that had necessitated frequent debridement. The lesions persisted and, 7 years ago, developed into an ulcer with a large fungating mass associated with pain, bleeding, and foul-smelling exudate. Biopsy findings were consistent with infiltrative-type BCC. He was not a surgical candidate given his comorbidities and was instead treated with radiation therapy. No evidence of metastasis was seen on follow-up imaging. CONCLUSION: This case highlights the importance of prompt biopsy and cultures in patients with suspicious ulcers and wounds that do not respond to appropriate treatment.

Combination repair of nasal ala and nasolabial fold defects following Mohs micrographic surgery.

BACKGROUND: Repair of excisional defects involving the nose and cheek requires thoughtful planning to maintain the natural contour of the anatomical sites and optimize cosmetic outcomes. We aim to demonstrate that a combination repair of defects involving the ala and nasolabial fold with a full-thickness skin graft and a local flap can be used with good cosmesis and minimal complications. METHODS: This is a case report of a patient with skin cancer on the left ala and left nasolabial fold who underwent Mohs micrographic surgery for tumor extirpation. RESULTS: The patient and the Mohs surgeon reported satisfaction with the cosmetic and functional outcomes at the 6-month postoperative follow-up with no complications. CONCLUSION: The use of a full-thickness skin graft from a standing tissue cone and a cheek crescentic advancement flap is a viable repair option for Mohs micrographic surgery defects involving the ala and nasolabial fold.

From education to action: Development and evaluation of a student-directed service learning program.

PURPOSE: Service learning consists of service activities that respond to community-identified concerns, active learning about the population being served, and self-reflecting on the experience. The Service Learning Program (SLP) is a novel, student-led, longitudinal volunteering experience designed to address social determinants of health (SDOH) education in the undergraduate medical school curriculum. In this program, medical students complete requirements in three domains of service, education, and self-reflection over the span of one academic year. METHODS AND MATERIALS: Participating students are sent surveys prior to and after a year of participation in SLP, which are aimed to measure changes in their perceived knowledge, attitudes, and skills in multiple domains related to service learning and social determinants of health. RESULTS: Over the course of the 2019-2020 year, 110 students who participated in SLP responded to both pre- and post-surveys. These students reported significant improvements in their confidence in various knowledge and skills related to SDOH, such as identifying vulnerable populations and assessing community needs. They also were more likely to report that learning about social determinants of health was 'very important' after participating the program. CONCLUSIONS: Medical students participating in a longitudinal service learning program focused on SDOH can acquire knowledge and skills that will empower them to understand, advocate, and care for underserved populations as future physicians. This program provides a model for integrating service learning into undergraduate medical education.

Ambivalence over emotional expression, intrusive thoughts, and posttraumatic stress symptoms among Chinese American breast cancer survivors.

OBJECTIVE: Posttraumatic stress symptoms (PTSS) are common among breast cancer survivors. However, the association and the underlying mediating mechanism between psychosocial factors and PTSS were rarely investigated among breast cancer survivors. Previous studies have suggested the importance of emotional expression in cancer survivors' PTSS. This study examined the association between ambivalence over emotional expression (AEE; defined as the conflict between the desire to express feelings and the fear of its consequences) and PTSS, and proposed intrusive thoughts as the mediators in such an association. We tested this proposed mediation model among Chinese breast cancer survivors whose culture discourages emotional expression. METHODS: Participants were 118 Chinese-speaking breast cancer survivors in the USA, who were diagnosed with breast cancer of stages 0-III within the past 5 years. They completed questionnaires measuring their levels of AEE, PTSS, and intrusive thoughts. RESULTS: AEE was positively associated with intrusive thoughts (r = 0.43, p < 01), which were positively associated with the arousal and avoidance subscales of PTSS (r = 0.68 and r = 0.62, respectively, p < .01). Path analysis supported a partial mediation model with an indirect effect from AEE to the latent variable of PTSS (with both arousal and avoidance as indicators) via intrusive thoughts (ß = 0.29; 95% CI= 0.18, 0.42) and the direct effect from AEE to the latent variable of PTSS (ß = 0.21, 95% CI = 0.07, 0.35), all p < .001. CONCLUSIONS: Those who are highly ambivalent about emotion expression tend to have higher PTSS, and this may be partially due to the lack of opportunities to discuss emotional events, thereby increasing the repetitive cancer-related negative thoughts. Intervention for PTSS should consider helping cancer patients to develop adaptive emotional regulation strategies to reduce the detrimental effects of cancer-related intrusive thoughts.