Impact of the COVID-19 Pandemic on Characteristics of Cutaneous Tumors Treated by Mohs Micrographic Surgery.

The COVID-19 pandemic has impacted the practice of Mohs micrographic surgery (MMS). We sought to determine the characteristics of skin cancers treated by MMS during the pandemic compared with prepandemic controls. A retrospective chart review was conducted. Tumors included were all treated in accordance with best practice guidelines set forth by state- and national-level professional governing bodies. Bivariate and multivariate analyses were performed to compare outcome variables. Changes in tumor characteristics during the pandemic are of clinical significance, potentially affecting extent of reconstructive surgery, cost, operating time, and future tumor characteristics.

Magnification for the dermatologic surgeon.

Ergonomic practice increases the productivity, quality, and longevity of the dermatologic surgeon. When used properly, magnification devices can be ergonomic and beneficial additions to the dermatologic surgeon's practice. Herein, we review the available magnification options for the dermatologic surgeon and evaluate the options based on cost, design, and functional advantages and disadvantages. Magnification for the dermatologic surgeon may be a useful tool for a healthier, more efficient, and higher-quality practice.

Sunscreen use among recreational cyclists: how intentions predict reported behavior.

A nationwide survey measured 927 recreational cyclists' cognitions and perceptions about skin cancer risks, along with sun protection practices and predictors of sunscreen use while cycling. Multiple regressions evaluated associations between perceived costs, rewards, photoaging, self-efficacy and sunscreen use, and potential moderators of the associations between intentions and sunscreen use were examined. Results suggest that when cyclists see the advantages of using sunscreen, are worried about photoaging, and feel efficacious, they have stronger intentions to apply sunscreen before riding. Intentions to use sunscreen while cycling predict reported use of sunscreen, particularly when cyclists perceive sunscreen application as easy and viable.

Sebaceous carcinoma: the great masquerader: emgerging concepts in diagnosis and treatment.

Sebaceous carcinoma (SC) is a rare tumor with a high rate of local recurrence and metastasis to lymph nodes and organs. The majority of SCs occur in the periocular region frequently presenting as painless, round subcutaneous nodules with a high tendency of diffuse and invasive growth in the eyelid and conjunctiva. It frequently masquerades as inflammatory conditions or as other tumors leading to delay in diagnosis, inappropriate treatment and increased morbidity and mortality. Sebaceous carcinoma is associated with Muir-Torre syndrome, a genetic condition presenting with sebaceous skin tumors associated with internal malignancy. Therefore, SC patients must be carefully evaluated and referred to an internist or gastroenterologist when indicated. Surgery is the definitive therapy for SC. In recent years, less radical surgical strategies are being used with improved outcomes. Current studies demonstrate that Mohs micrographic surgery (MMS) provides maximal tissue conservation and lower recurrence rates. Greater awareness and understanding of SC and its behavior has led to earlier diagnosis and appropriate treatment.

Brooke-Spiegler syndrome: report of a case of multiple cylindromas and trichoepitheliomas.

We report a case of Brooke-Spiegler syndrome, a rare autosomal dominant disorder caused by mutations of the cylindromatosis gene (CYLD) tumor suppressor gene resulting in multiple cylindromas and trichoepitheliomas. Treatment of these patients can involve surgical excision, laser therapy, or topical applications of aspirin derivatives.

A pilot feasibility study of a rare skin tumor database.

BACKGROUND: In the United States melanoma is the only individually reported skin cancer. There are no large state or national registries for nonmelanoma skin cancer. Nevertheless, rare, that is, nonmelanoma, nonepithelial, tumors can also be locally aggressive and metastasize. OBJECTIVES: This study's purpose was to demonstrate that Mohs surgeons can share data to create a rare skin tumor database. This database may serve as a model for a nationwide database. MATERIALS AND METHODS: We retrospectively reviewed the surgery logs of five Mohs surgery practices in the Houston, Texas, area for rare-nonmelanoma, nonepithelial-skin cancers. A total of 42,279 biopsy-proven cancers of the skin treated with Mohs micrographic surgery were reviewed. Tumor data including type, prevalence, year of treatment, and the treating Mohs surgeon(s) were compiled and analyzed. RESULTS: Forty-three types of rare tumors were identified. A total of 317 rare tumors were treated. No practice saw more than 28 rare tumor types. Atypical fibroxanthoma was the rare tumor most often treated. CONCLUSIONS: Colleagues can cooperate to create a database of rare tumors removed by Mohs micrographic surgery. A range of tumors greater than that seen in any single practice is now available for study. This should provide the impetus for a nationwide rare skin tumor database.

Use of a dental roll coated with flavored viscous lidocaine for nasal mucosal surgery.

BACKGROUND: Nasal mucosal surgery may be unpleasant for patients for a variety of reasons. Injection of local anesthetic into this region may be exquisitely tender, and patients may complain of the taste or passage of anesthetic or other secretions down the nasopharynx. In addition the odor of electrocautery may also be disturbing to some patients. OBJECTIVE: The objective was to decrease patient discomfort during extensive nasal surgery. METHODS: A dental roll coated with flavored viscous lidocaine may be placed in the nasal cavity 5 min before injecting local anesthetic and left in place during extensive nasal surgery. Flavored lidocaine may also be simply applied to the mucosal surface and will help anesthetize the area as well as mask the odor of electocautery. RESULTS: We propose that use of a lidocaine-coated dental roll during extensive nasal surgery will reduce the pain of subsequent local anesthetic injections, disguise the taste of anesthetic and other secretions that may drain down the nasopharynx, and help mask the odor of electrocautery. CONCLUSION: The use of a dental roll coated with flavored viscous lidocaine appears to be a simple way to improve patient comfort during extensive nasal surgery. This form of lidocaine may also be used to improve patient comfort during steel and laser surgery on the oral and nasal mucosas as well as placement of intraoral nerve blocks. Viscous lidocaine can be compounded with flavor at a pharmacy or in the office.

Squamous cell carcinoma of the nail unit with evidence of bony involvement: a multidisciplinary approach to resection and reconstruction.

BACKGROUND: Squamous cell carcinoma (SCC) of the nail bed is a rare disorder that is often misdiagnosed for years before definitive diagnosis with biopsy. Proper evaluation of this carcinoma includes radiographic evaluation for bony involvement of the phalanges of the affected digit. If bony involvement is evident by x-ray, amputation of the distal phalanx or the affected digit is warranted. Mohs micrographic surgery of the affected nail unit is advantageous in preserving vital tissue for reconstruction after phalangeal amputation by a hand surgeon, thus maximizing preservation of the densely innervated tissue from the volar finger pulp. This approach may maximize functional capacity of the reconstructed digit. OBJECTIVE: To describe a multidisciplinary approach to resection, amputation, and reconstruction of digits with SCC of the nail bed. METHODS: This is a description of three cases and a review of the pertinent medical literature. RESULTS: Three SCCs of the nail bed were excised with Mohs micrographic surgery, preserving the volar pulp and skin of the distal finger. The patients were then referred for distal phalanx amputation and reconstruction by a hand surgeon. All patients remained disease free with acceptable function of the reconstructed digits at 15, 17, and 38 months of follow-up. CONCLUSION: Although uncommon, SCC of the nail bed must be considered in all nails with chronic disease. Preoperative evaluation should include hand radiographs in search of bony involvement. Tissue-sparing excision combined with distal amputation of the affected phalanx and reconstruction of the digit using spared tissue may maximize hand and digit function.

Mohs micrographic surgery for the eradication of phaeohyphomycosis of the hand.

BACKGROUND: Phaeohyphomycosis is a rare mycotic infection that is caused by dematiaceous fungi requiring surgical excision or long-term use of oral antifungal agents for treatment. OBJECTIVE: To report a case of phaeohyphomycosis of the dorsal hand successfully cleared with Mohs micrographic surgery. METHODS: We performed Mohs micrographic surgery on phaeohyphomycosis of the dorsal hand. The fungus was cleared in three stages of surgery. Permanent processing and special stains of the final stage confirmed eradication of the infection. RESULTS: The patient remained free of the phaeohyphomycosis, without complications, at the 6-month follow-up. CONCLUSION: Mohs micrographic surgery is an effective, tissue-sparing technique for the eradication of phaeohyphomycosis, potentially eliminating the need for costly long-term antifungal therapy.