Mohs micrographic surgery and surgical excision for nonmelanoma skin cancer treatment in the Medicare population.

OBJECTIVES: To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. DESIGN: A retrospective analysis of Medicare beneficiaries. SETTING: Surveillance, Epidemiology, and End Results database. PATIENTS: Patients undergoing MMS or other surgical intervention for the treatment of NMSC from January 1, 2001, through December 31, 2006. MAIN OUTCOME MEASURES: Surgical treatment, patient, and lesion characteristics. RESULTS: A total of 26,931 operations were performed for the treatment of NMSC from 2001 through 2006, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period (1.8 vs 2.1 per 100 Medicare beneficiaries), the rate of MMS doubled (0.75 vs 1.5 per 100 Medicare beneficiaries). In 46.9% of facial lesions, MMS was performed, whereas MMS was used to treat 14.7% of total body lesions. Atlanta, Georgia, had the highest proportion of patients treated with MMS (45.1%); Louisiana had the lowest (11.0%). Age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use (all P < .001). CONCLUSIONS: Surgical treatment of NMSC increased substantially from 2001 through 2006, primarily because of a doubling in the rate of MMS procedures. Significant differences in surgical rates, depending on patient age, race, lesion location, and geographic region, of treatment were found.

Non-ablative lasers.

Non-ablative laser devices exert their effects by inducing dermal collagen remodeling while sparing the epidermis. The remodeling process is achieved by producing thermal energy in a controlled and precise fashion, which recruits fibroblasts and stimulates collagen production. Although these devices do not produce the same degree of improvement as traditional CO(2) or er:YAG resurfacing techniques, they are an excellent alternative for people seeking gradual aesthetic improvement with minimal downtime. They are also extremely well suited to patients with darker skin types. In this chapter, we review the various non-ablative devices currently available on the market, with an emphasis on safety profiles and efficacy.

Cutaneous manifestations of thyroid disease.

The diagnosis of thyroid disease can often first be identified by recognizing various cutaneous manifestations associated with an imbalance of circulating thyroid hormone. This article reviews the pathophysiology of thyroid disease, characteristic cutaneous findings of the hypothyroid and hyperthyroid states, and cutaneous conditions associated with thyroid disease.

Smoking and skin aging in identical twins.

BACKGROUND: A twin pair can provide a rare opportunity to control for genetic susceptibility and exposure variables, which often serve as major confounders in population-based studies on the relationship between smoking and skin aging. OBSERVATIONS: We describe a unique twin pair who spent not only their first 2 decades of life together but also in their later decades had the same type of job at the same latitude, resulting in well-matched levels of significant sun exposure. However, the twins differed markedly in regard to smoking history; the twin with an approximately 52.5-pack-year smoking history showed more severe skin aging than did the nonsmoking twin. CONCLUSION: The difference in skin aging illustrated by this twin pair may serve as a motivator for smoking cessation.