Rising incidence of mucosal melanoma of the head and neck in the United States.

Background. While it is established that the incidence of cutaneous melanoma has risen over time in the United States, the incidence trend for mucosal melanoma of the head and neck (MMHN) is unknown. Methods. We used the Surveillance, Epidemiology, and End Results (SEER) database to determine incidence trends for MMHN from 1987 to 2009 in the United States. We determined annual percent change (APC) by weighted least squares and joinpoint regression analysis. Results. MMHN incidence increased from 1987 to 2009 (APC 2.4%; P < 0.01). Nasal cavity lesions increased in incidence (APC 2.7%; P < 0.01) over this duration, while the incidence of non-nasal cavity lesions remained stable. The highest rate of increase was in white females ages 55 to 84 (APC 5.1%; P = 0.01). Conclusions. The incidence of MMHN in the United States has been rising since 1987. This trend is driven primarily by increased incidence of nasal cavity melanomas.

Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics.

BACKGROUND: Mohs micrographic surgery (MMS) has a low rate of surgical site infection (SSI) without the use of prophylactic antibiotics. In the studies to date, there has been variation in the steps taken by each surgeon to prevent SSIs but in all cases sterile technique was used during wound reconstruction. OBJECTIVE: We sought to evaluate the rate of SSIs among patients undergoing MMS with the use of clean surgical technique for all steps of MMS including wound reconstruction in the absence of prophylactic antibiotics. METHODS: We prospectively evaluated 1000 patients undergoing MMS using clean surgical technique for SSIs. Clean surgical technique includes the use of clean surgical gloves and towels and a single pack of sterile instruments for all steps including wound reconstruction. RESULTS: There were 11 SSIs among 1000 patients with 1204 tumors, with an overall rate of infection of 0.91% (95% confidence interval 0.38%-1.45%). Three of the 11 infections were complications of hematomas. Four of the 11 infections occurred in flap closures, which had the highest rate of SSIs of 2.67% (4/150). LIMITATIONS: The study was a prospective, single-institution uncontrolled study. CONCLUSION: To our knowledge, this is the first study to examine the rate of SSIs with the use of clean surgical technique, in the absence of antibiotic prophylaxis, for all steps of MMS including wound reconstruction. Our rate of SSIs of 0.91% is exceedingly low, underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique.