The preoperative patient evaluation: preparing for surgery.

In the preoperative patient evaluation, no strict algorithm can be followed because of the diversity of patients and treatment options available. Cosmetic surgery, skin cancer treatment, and skin resurfacing procedures, for example, all differ in preoperative evaluations, patient expectations, and follow-up. Previously discussed guidelines, however, are basic to the preoperative patient evaluation, and are designed to eliminate risk. Each patient encounter needs to be individualized. Any doubt concerning a positive outcome of a procedure should be cause for postponement or cancellation. The preoperative evaluation should be a forum that: 1. Builds patient-physician rapport and trust. 2. Identifies potential problems so they can be addressed prior to surgery and not at the last minute. 3. Confirms and establishes diagnoses and treatment approaches. 4. Provides an avenue for patient education. 5. Ensures better outcomes for both surgeon and patient.

Scar revision.

Scar improvement is an age old endeavor. Multiple modalities exist for improving a scar's appearance. This article will review scar types and offer a brief overview of nonsurgical and surgical options for scar revision.

Current issues in the performance of Mohs micrographic surgery.

Recently, a survey was sent to all members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology concerning their performance of Mohs micrographic surgery. Responses to numerous questions regarding the daily practice of this technique revealed that many useful modifications have evolved over the years that serve to enhance the efficacy and the efficiency of the original Mohs surgical procedure. The results of this survey are presented and discussed.

Unilateral erythromelanosis follicularis faciei et colli in a young girl.

Erythromelanosis follicularis faciei et colli is uncommon. Fewer than 20 cases have been reported. Except for one case in a woman and one case of unilateral distribution, all other reported cases have been bilateral in young male patients. We report the first case of unilateral distribution in a white girl.

Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency and cutaneous vasculitis. Report of a case with exacerbation of a cutaneous neoplasm during immunosuppressive therapy.

We describe a patient with both Muir-Torre syndrome and alpha 1-antitrypsin deficiency. A keratoacanthoma developed after immunosuppressive therapy for necrotizing vasculitis. To our knowledge, this is the first reported case of Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency.

Cowden's disease--treatment of cutaneous lesions using carbon dioxide laser vaporization: a comparison of conventional and superpulsed techniques.

Cowden's disease is a genodermatosis associated with both cutaneous and visceral manifestations, including cancer. Trichilemmomas represent one of the benign cutaneous lesions associated with this syndrome and may be responsible for significant cosmetic disfigurement. Using the carbon dioxide (CO2) laser in its vaporizational mode of operation, a patient with multiple trichilemmomas of the nose, previously unsuccessfully treated with multiple medical and surgical procedures, obtained excellent cosmetic results.

Assessing dermatitis in epidemiologic studies: occupational skin disease among California grape and tomato harvesters.

We conducted a cross-sectional investigation to determine whether table grape harvesters, who have significant cutaneous contact with crop-associated materials that may cause skin disease, are more likely to develop dermatitis than are a control group of tomato workers performing mechanical harvesting with minimal cutaneous contact with crop-associated substances. A secondary aim was to develop methods for studying skin disease in farm workers, including a standard questionnaire and physical examination. California table grape workers (n = 183) and tomato workers (n = 43) completed an interviewer-administered questionnaire and waist-up physical examination at their work site during harvest operations. On physical examination, pustular eruptions such as acne and folliculitis were present in 30% of subjects, and eczematous rashes were noted in 10% of subjects. Irritant or allergic contact dermatitis was diagnosed in 2% of subjects. No significant differences in prevalence for these skin conditions were observed between the two groups of workers. In contrast to the physical examination results, grape workers were more likely than tomato workers to report a rash occurring in the previous 3 months (52% vs. 19%, p less than 0.001). Explanations for this discrepancy are discussed. The sensitivity of the questionnaire for current skin conditions was 31%, and the specificity was 94%. Improved sensitivity was seen for eczematous skin conditions (55%). We conclude that questionnaires provide an efficient means of assessing subject characteristics, but may have limited sensitivity for some dermatologic outcomes.