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.

Z-plasty for correction of standing cutaneous deformity.

Cutaneous head and neck reconstruction following Mohs micrographic surgery frequently presents the surgical dilemma of dog-ear formation during wound closure. Z-plasty corrects a dog-ear deformity without skin excision by recruiting tissue from the axis of the standing cone and redistributing it along another. We describe dog-ear correction using the Z-plasty technique.

Deepithelialized flaps and grafts: applications in dermatologic surgery.

Deepithelialized flaps and grafts have been widely used by reconstructive surgeons in a diverse array of surgical specialties and have more recently made an appearance in dermatologic surgery. These techniques may be advantageous in their enabling of contour preservation of deep defects, reconstructions in areas of high mechanical tension, single-stage repairs, auricle reconstruction requiring tissue transfer, and reconstruction requiring free margins in areas with a paucity of local soft tissue. This article provides a review of the literature on deepithelialized flaps and grafts. We also highlight the use of these techniques in the field of dermatology and encourage appropriate application of deepithelialized flaps and grafts in dermatologic surgery.

Trypophobia, skin, and media.

Trypophobia is the fear of patterns of clustered holes, bumps, or nodules. Trypophobia has a special relationship with dermatology because of its effects on individuals with skin disease, its relationship with disease avoiding behavior, and its utilization in many online skin disease hoaxes. Trypophobic patterns on skin and characters can be found in movies, TV shows, and videogames. Several popular horror villains take advantage of trypophobic patterns like Freddy Kreuger, Jason Vorhees, and Pinhead. Most recently, another blockbuster villain has joined their ranks - Killmonger. Public health messaging about these biases and the often noncontagious nature of skin disease is warranted to attenuate public stigma of skin disease perpetuated by media.

Mohs Surgical Reconstruction Educational Activity: a resident education tool.

BACKGROUND: Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents' ability to plan surgical reconstructions. MATERIALS AND METHODS: The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale. RESULTS: Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50-2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00-3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25-0.50 Likert scale points among all residents participating in the educational activity and 0.50-1.00 Likert scale points in the dermatology resident subset. All residents participating in the educational activity somewhat or completely agreed with the statement, "I am faster at planning reconstructions after my Mohs rotation." In addition, 88% of participants "somewhat or completely agreed" that the exercise was a good educational experience. CONCLUSION: The Mohs Surgical Reconstruction Educational Activity is a valuable novel tool for learning reconstructive planning that is easy to incorporate into existing dermatology residency curricula, inexpensive, and utilizes active learning.