Ergonomics in office-based surgery: a survey-guided observational study.

BACKGROUND: The practice of office-based surgery is increasing in many specialties. OBJECTIVE: Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders. METHODS: All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders. RESULTS: All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures. CONCLUSION: Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery.

Eruptive epidermoid cysts resulting from treatment with imiquimod.

BACKGROUND: Because of its unique mechanism of action and safety profile, imiquimod, a topical immune response modifier, is used for many benign and malignant dermatologic conditions. Adverse effects are typically limited to treatment site erythema and erosion. OBJECTIVE: To describe a newly recognized adverse effect of imiquimod. METHODS: A 79-year-old woman being treated with imiquimod 5 days per week for a nodular basal cell developed a verrucous plaque over the treatment area after 7 weeks of therapy. RESULTS: Scouting biopsies demonstrated multiple comedones and ruptured epidermoid cysts. There was no evidence of residual basal cell carcinoma. CONCLUSIONS: Imiquimod is a new and novel treatment option for cutaneous malignancies. We report its successful use in the treatment of a nodular basal cell carcinoma. The multiple comedones and ruptured epidermoid cysts are newly reported adverse effects of imiquimod therapy.

The historical link between solid-organ transplantation, immunosuppression, and skin cancer.

BACKGROUND: Skin cancers are more common in organ transplant recipients than in the general population. OBJECTIVE: The objective of this study was establish the historical link between organ transplantation, immunosuppression, and the development of skin cancer. METHODS: The pertinent literature in cutaneous oncology and transplantation is reviewed. RESULTS: There is a historical link between organ transplants, immunosuppression, and the subsequent development of skin cancers. CONCLUSIONS: Organ transplant recipients have more skin cancer than those in the general population and this is temporally related to their degree of immunosuppression.

Skin cancer in an atomic veteran: cause or coincidence?

BACKGROUND: Some military personnel who were exposed to ionizing radiation during atomic weapons tests subsequently developed skin cancer, but the cause-effect relationship is unclear. OBJECTIVE: To explore the possible relationship between exposure to atomic tests and the development of skin cancer. METHODS: We reviewed available literature regarding the effects of radiation on the skin and the case history of a patient in whom more than 300 basal cell carcinomas developed over a 30-year period after exposure to radiation during atomic testing. RESULTS AND CONCLUSIONS: Ionizing radiation can cause skin cancer, usually basal cell carcinoma. In some veterans of atomic testing, skin cancer may have been initiated by ionizing radiation and promoted by ultraviolet radiation. We conclude that exposure to ionizing radiation during atomic weapons testing contributed to the excessive number and location of basal cell carcinomas in our patient.

Complete closure by purse-string suture after Mohs micrographic surgery on thin, sun-damaged skin.

BACKGROUND: The purse-string suture technique is useful for partial closure of surgical defects. OBJECTIVE: We demonstrated that 100% closure can often be obtained on surgical defects of the thin skin on the upper extremities. METHODS: Standard purse-string suture techniques were used to close surgical defects on the upper extremities. RESULTS: 100% closure of surgical defects on upper extremities was demonstrated. CONCLUSIONS: Purse-string suture technique is useful for repairs of surgical defects on the upper extremities when the skin is very thin but not recommended when the skin is thick.