Reduced pain with use of proprietary hyaluronic acid with lidocaine for correction of nasolabial folds: a patient-blinded, prospective, randomized controlled trial.

BACKGROUND: Pain during and after implantation of dermal gel fillers is a consistent complaint of patients undergoing soft tissue augmentation. Reduction of pain during injection would increase patient comfort and improve the overall patient experience. OBJECTIVE: To evaluate pain at the injection site during and after the injection of Prevelle SILK or Captique and to evaluate outcomes after 2 weeks. METHODS & MATERIALS: In a patient-blinded, prospective, randomized, split-face design trial, a non-animal-derived hyaluronic acid based filler formulated with lidocaine (Prevelle SILK) was injected in one nasolabial fold (NLF), and the same filler without lidocaine (Captique) was injected in the contralateral NLF of 45 enrolled patients. Injection site pain was measured using a visual analogue scale at injection (time 0) and 15, 30, 45, and 60 minutes after injection. Patients were asked to return for an evaluation after 2 weeks and to complete a self-assessment questionnaire during the follow-up visit. RESULTS: There was more than 50% less pain associated with the dermal gel with lidocaine than with the same filler without lidocaine at all time points (p<.05). The greatest difference in pain was recorded at the time of injection, and then the effect gradually declined over the 60-minute period. Both fillers were well tolerated, and there was no difference in outcome after 2 weeks. CONCLUSION: Addition of lidocaine to a filler resulted in significantly less pain associated with the procedure without compromising outcomes.

Dermabrasion in our practice.

Dermabrasion is a technique of facial resurfacing that allows the physician to sculpt the skin surface by surgically abrading, or planing the contours of the skin. User technique, device settings, and the combination of dermabrasion with other skin resurfacing treatments enable the physician to treat a wide variety of skin defects.

Characteristics of Mohs practices in the United States: a recall survey of ACMS surgeons.

OBJECTIVE: The purpose of this study is to better characterize the typical Mohs practice in the United States and to generate data that may be useful in future practice models. METHODS: A survey was mailed in 2004 to all 599 members of the American College of Mohs Surgery with United States addresses listed in the 2003 directory. RESULTS: Most respondents were part of a single speciality group, in a suburban or urban setting, performed between 501-1,000 cases per year, and had been in practice from 0-5 years. The vast majority of Mohs excisions are for basal cell cancers and squamous cell cancers, followed by melanoma. Primary closure is the most common method of repair, followed by the use of flaps. Only 6% of cases were referred to other specialties for closure. Many surgeons augment their practice with non-Mohs cosmetic procedures. CONCLUSION: The characteristics of current Mohs surgery practices in the United States provides useful data for training programs, potential trainees, workforce issues, statistical modeling systems, and Mohs surgeons in the evaluation of their own practices.

Adenoma of anogenital mammary-like glands.

Adenomas in the anogenital region are uncommon. There has been debate about the origin, including ectopic breast tissue, cutaneous apocrine gland, and most recently anogenital mammary-like gland. An anogenital mass in a 36-year-old woman was excised, and histopathologic examination and immunostaining were performed. Microscopic tissue sections showed a morphologic pattern similar to that of a mammary fibroadenoma, and immunostaining demonstrated the presence of estrogen receptors and progesterone receptors. The possibility of adenomas of anogenital mammary-like glands should be considered when evaluating patients with a mass in this area with confirmation by tissue biopsy or aspiration cytology.

Localized argyria after exposure to aerosolized solder.

GOAL: To understand localized argyria to better manage patients with the condition OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss how localized and generalized argyria differ. 2. Describe how to diagnose argyria. 3. Identify treatment options for argyria.

Skin cancer chemoprevention with systemic retinoids: an adjunct in the management of selected high-risk patients.

Systemic retinoids (isotretinoin, etretinate, and acitretin) have been shown to be effective chemotherapeutic agents in studies of patients with xeroderma pigmentosum, the nevoid basal cell carcinoma syndrome, and recipients of organ or bone marrow transplantation. In addition, patients who do not have these disorders but who are actively developing large numbers of new skin cancers may also benefit from this approach. All patients developing large numbers of skin cancers need rigorous UV protection and frequent dermatologic examinations. Although isotretinoin and acitretin share overlapping toxicities, there are differences that may affect drug choice. Because low doses may be effective, there are advantages to beginning treatment at a low dose, and subsequently, increasing dose if necessary, based on patient response. Laboratory monitoring including pregnancy testing should be performed before and during treatment. Long-term toxicity, primarily involving the skeletal system, can be monitored with imaging studies.

Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons.

BACKGROUND: Despite rising medical malpractice costs, little is known about the factors associated with claims filed against Mohs surgeons. OBJECTIVE: We sought to define the scope of medical malpractice claims filed against Mohs surgeons and to identify salient factors associated with the filing and disposition of those claims. METHODS: A comprehensive survey was mailed to 599 physicians with US addresses listed in the 2003 directory of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. RESULTS: Of the 300 completed surveys returned, 33 (11%) reported ever having been sued. Physicians who practiced Mohs surgery for a longer period of time were more likely to have been sued for malpractice. Physicians reported the wrong site and functional outcome as the most frequent causes of malpractice lawsuits.

Meningiomas after medulloblastoma irradiation treatment in a patient with basal cell nevus syndrome.

A 23-year-old woman with basal cell nevus syndrome (BCNS), or Gorlin's syndrome, was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiation. Multiple basal cell carcinomas developed at the craniospinal irradiation port site 8 years later. She subsequently developed multiple meningiomas within the area of irradiation at age 20 years. This case reviews early presentation of BCNS, newly described differences between medulloblastomas in patients with BCNS and nonsyndromic medulloblastomas, and global assessment of patients by the treating dermatologist of this patient population. This is the first report in the dermatologic literature, to our knowledge, of radiation-induced meningiomas in a patient with BCNS.

Post-Mohs micrographic surgical margin tissue evaluation with permanent histopathologic sections.

BACKGROUND: Incomplete resection of nonmelanoma skin cancer is associated with a relatively high rate of recurrent tumors. Mohs micrographic surgery provides microscopic evaluation of tumor margins to ensure complete excision of nonmelanoma skin cancers at high risk of recurrence. OBJECTIVE: This purpose of this study is to confirm the histologic accuracy of Mohs excision of facial skin cancers by evaluating an additional layer of tissue with permanent histopathologic sections after Mohs excision. METHODS: Two hundred ninety-six Mohs cases were identified, which, after excision, were sent to a single plastic surgeon for reconstruction. This plastic surgeon routinely takes an additional layer and sends for permanent histopathologic evaluation at the time of reconstruction. A review of the pathology reports and tissue specimens on these patients provides valuable data on tumor margins and the effectiveness of the Mohs technique for tumor excision. RESULTS: Two excisions of nodular basal cell cancer were determined by the pathologist to have positive tumor involvement on post-Mohs permanent tissue. On additional review, one specimen was interpreted to be more consistent with follicular epithelium, and the second was verified as a focus of nodular basal cell cancer. CONCLUSION: These data support the high reliability of Mohs surgery for margin control.

Gentamicin ointment versus petrolatum for management of auricular wounds.

BACKGROUND: Surgeons frequently create defects on the ear in the treatment of cutaneous malignancies. Potentially significant complications of second-intention healing on the ear are suppurative and inflammatory chondritis. Consequently, many physicians advocate the use of oral or topical prophylactic antibiotics after auricular surgery. OBJECTIVE: The purpose of this study is to compare the efficacy of gentamicin ointment with that of petrolatum for the prevention of suppurative chondritis during second-intention healing of auricular wounds after Mohs surgery. METHODS: One hundred forty-two patients with a total of 147 second-intention wounds were prospectively selected to receive either gentamicin ointment or petrolatum postoperatively. RESULTS: One hundred forty-four wounds were evaluated in a follow-up examination or by telephone interview. Eight (5.56%) wounds developed suppurative chondritis. Four wounds received gentamicin and four received petrolatum, for incidences of 4.76% and 6.67%, respectively. Twelve (8.33%) other wounds developed inflammatory chondritis. Ten (11.90%) received gentamicin and two (3.33%) received petrolatum. CONCLUSIONS: There is no statistically significant difference between the use of gentamicin ointment and petrolatum in the prevention of postoperative auricular suppurative chondritis. The data also demonstrate a disproportionate number of cases of inflammatory chondritis in the gentamicin-treated group. This study supports the cost-effective and potentially less irritating use of petrolatum for wound care in this difficult to manage area.