Reliability and validity of the Advanced Basal Cell Carcinoma Index (aBCCdex).

BACKGROUND: Patient-reported outcome (PRO) questionnaires were recently developed specifically for use with patients with advanced basal cell carcinoma (aBCC) and basal cell carcinoma naevus syndrome (BCCNS). OBJECTIVES: To evaluate the measurement properties of PRO questionnaires for use in patients with aBCC or BCCNS. METHODS: In total 129 patients from 10 clinical sites in the U.S.A. and the BCCNS Support Network completed the two newly developed questionnaires multiple times over 3 months. Patients also completed the Skindex-16 and the 12-Item Short-Form Health Survey as collateral measures. Psychometric properties of the questionnaires were evaluated, including internal consistency and test-retest reliability, construct and known-groups validity, and responsiveness. RESULTS: Based on the results of exploratory factor analysis and clinical input, the two newly developed questionnaires were combined into a single questionnaire, called the aBCCdex, which is relevant for patients with both aBCC and BCCNS. The internal consistency reliability was acceptable, and all aBCCdex scale scores correlated significantly with conceptually similar scales. When divided into groups that differed based on scores from collateral measures, aBCCdex scale scores differentiated between groups (known-groups validity) and were responsive to change. CONCLUSIONS: The aBCCdex is a brief and comprehensive questionnaire appropriate for use with patients with aBCC and BCCNS. Its reliability and validity have been confirmed. Further research is necessary to estimate the minimally important difference in a larger patient population.

The use of lymphoscintigraphy and PET in the management of head and neck melanoma.

OBJECTIVES: Lymphoscintigraphy with sentinel node dissection and 18 fluoro-2-deoxyglucose positron emission tomography (PET) are being used independently in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 1.0 mm and clinically negative regional nodes that were evaluated prospectively with PET and lymphoscintigraphy. STUDY DESIGN AND SETTING: Between July 1, 1998 and December 30, 2000 PET scans were obtained preoperatively on 18 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy and sentinel node dissection was performed. Resection of the primary lesion was then carried out with adequate margins and the defects were reconstructed. RESULTS: Sentinel node(s) were found in 17/18 patients (94.4%); 5/18 (27.8%) of cases had metastases. PET detected nodal metastasis preoperatively in 3 patients (16.7%), one of which had a positive sentinel node dissection. CONCLUSION: PET and lymphoscintigraphy offer complimentary ways of evaluation for metastatic melanoma.

Unusual cutaneous malignancies.

The most commonly occurring cutaneous malignancies are basal cell and squamous cell carcinoma. There are, however, other rare malignancies that are encountered and should be included in the differential, in which both the clinical and the histological diagnosis may be difficult. Here, the clinical and histological features, management, and prognostic factors of merkel cell carcinoma, microcystic adnexal carcinoma, leiomyosarcoma, dermatofibrosarcoma protuberans, and angiosarcoma are reviewed.

Repetitive pinching of the skin during lidocaine infiltration reduces patient discomfort.

BACKGROUND: The administration of a local anesthetic is often painful. OBJECTIVE: The purpose of this study was to determine whether rapidly shaking and pinching the skin during local anesthetic administration decreases pain perception. METHODS: The skin at the intended site of lidocaine injection was rapidly pinched between the thumb and forefinger just before the injection. Control patients received no intervention. Patients reported their pain perception using a visual analog scale (0 to 10). In the feasibility phase, patients were assigned to receive the pinching technique or no intervention, then randomized in the second phase. RESULTS: In phase 1, 34 patients received 42 excisions. Pain was significantly reduced (p=0.001) in the treatment group. In phase 2, 69 patients had 91 excisions. When adjusted for age and sex (data combined from phases 1 and 2), the treatment significantly reduced pain (p=0.03) when compared with no intervention. CONCLUSION: We describe a simple, noninvasive technique that significantly lowered perceived pain during the administration of unbuffered lidocaine with epinephrine local anesthetic.

Traumatic tattoo from battery-operated earrings.

Traumatic tattoos result from accidental deposition of pigmented particles in the dermis. Battery-operated devices should be added to the list of situations in which traumatic tattoos may arise. In this case, an iron-containing tattoo was removed by Mohs' micrographic surgery with an acceptable cosmetic result.

Electrosurgery and cardiac devices.

The increased number of patients with implantable cardiac devices presents a unique challenge to physicians performing office-based electrosurgical procedures. Electrosurgery can be performed safely if the electrosurgical techniques and potential risks from these devices are understood. We present an overview of the most common types of implantable cardiac devices, potential complications associated with them, and recommendations for preoperative evaluation, intraoperative monitoring, and postoperative follow-up.

Basal cell carcinoma involving the lacrimal canaliculus. A documented mechanism of tumor spread.

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelid and periocular tissues but rarely involves the lacrimal system. In addition, BCC in this location frequently recur due to inadequate margin control. A further understanding of the pathophysiology of periocular BCC was addressed. OBJECTIVE: To report two rare cases of BCC involving the lacrimal system and to account for subtle clinical features yet extensive tissue spread of periocular BCC. METHODS: Using the Mohs micrographic surgical technique, we describe two patients with a BCC involving the lacrimal system that histologically tracked beyond clinically apparent margins. RESULTS: Spread of BCC along mucosal surfaces is documented. CONCLUSION: Rare involvement of the lacrimal system by a BCC is reported in two patients. Superficial histologic involvement can explain the ability of BCC to extend locally and escape adequate treatment.

Nasal reconstruction with the cheek island pedicle flap.

BACKGROUND: Reconstruction of the lower third of the nose can be challenging. Maintaining the nasal subunit symmetry and providing good tissue match with regard to color, sebaceous quality, and thickness is essential. For extensive defects in this area, paramedian forehead flaps are often considered. OBJECTIVE: Our purpose was to develop the technique of preparing and executing the cheek island pedicle flap, as well as to define the limitations and "pitfalls" of the flap. METHODS: The cheek island pedicle flap is described. RESULTS: The cheek island pedicle flap can provide excellent cosmetic results in reconstructing defects of the lower third of the nose. The flap dynamics are predictable, and anticipated complications are described. CONCLUSION: The cheek island pedicle flap provides an excellent alternative to the paramedian forehead flap for reconstruction of extensive defects of the lower third of the nose.

The role of home health nursing: a dermatologic case study.

The role of home health nursing is described in managing a postoperative wound infection. An 87-year-old woman underwent Mohs' cutaneous micrographic excision of an extensive basal cell carcinoma of the nose, with immediate reconstruction using a bilobed transposition flap. Her postoperative course was notable for an extensive wound infection characterized by cellulitis and local abscess formation. Inpatient admission was averted by using extensive home health nursing resources.

Ectodermal dysplasias associated with clefting: significance of scalp dermatitis.

Several clinical syndromes are characterized by ectodermal dysplasia (ED) in association with clefting of the lip and/or palate. The three most commonly recognized entities are (1) the EEC syndrome (ectodermal dysplasia, ectrodactyly, cleft lip/palate); (2) the Rapp-Hodgkin syndrome with ectodermal dysplasia, cleft lip/palate, and mid facial hypoplasia; and (3) the Hay-Wells or AEC syndrome (ankyloblepharon, ectodermal defects, cleft lip/palate). The clinical characteristics of these entities as well as several less common syndromes are reviewed and summarized. The presence of scalp dermatitis in patients with the AEC syndrome and less often the Rapp-Hodgkin syndrome is emphasized.