A direct comparison of visual inspection, curettage, and epiluminescence microscopy in determining tumor extent before the initial margins are determined for Mohs micrographic surgery.

BACKGROUND: Mohs micrographic surgery (MMS) is a tissue-sparing technique for the removal of cutaneous malignancies. There is no standardized procedure for determining tumor extent before taking the initial margins during the first stage of Mohs. OBJECTIVE: To compare visual inspection, curettage, and dermoscopy in determining tumor extent before initial margins are taken for MMS. METHODS: Fifty-four patients were randomized into three groups (visual inspection, curettage, or dermoscopy) before MMS for basal cell carcinomas on the nose. One of these three methods was used to delineate the biopsy site or residual tumor. The final number of stages and postoperative defect sizes were recorded. RESULTS: There was no statistically significant differences for the final number of stages (p=.20) or the final defect sizes (p=.47) between the three arms. CONCLUSION: There has been controversy as to whether presurgical curettage is appropriate before MMS. Some feel that curettage better delineates the tumor, leading to fewer stages, whereas others feel that curettage may falsely increase the final defect size, negating any tissue-sparing advantages of the procedure. Our study did not demonstrate any differences in the final number of stages or postoperative defect sizes between the three test groups.

Classic and atypical Spitz nevi: review of the literature.

Both classic and atypical Spitz nevi are uncommon melanocytic lesions usually presenting in children and adolescents. The classic Spitz nevus typically is benign and has characteristic clinical and histologic features. In contrast, the atypical Spitz nevus has an unknown clinical prognosis, and its clinical and histologic traits are loosely defined. Melanoma can have similar features to both classic and atypical Spitz nevi and must be ruled out in all cases. We review the literature on classic and atypical Spitz nevi, advances in differentiating both types of nevi from melanoma, and treatment options.

Direct comparison of EMLA versus lidocaine for pain control in Nd:YAG 1,064 nm laser hair removal.

BACKGROUND: Laser hair removal is an effective therapy for the treatment of hirsutism, hypertrichosis, and pseudofolliculitis barbae. Although side effects are uncommon, pain is described by most patients undergoing long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser therapy. OBJECTIVES: To compare the efficacy of topical eutectic mixture of local anesthetics (EMLA) versus topical lidocaine (LMX) in pain control for Nd:YAG 1,064 nm laser hair removal. METHODS: Sixty-four patients were enrolled in a double-blind randomized study over a 6-month period. Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment. Neither was applied under occlusion. Immediately following their treatment session, patients completed a visual analog pain scale. RESULTS: There was no statistically significant difference in pain control between EMLA and LMX. However, female test subjects demonstrated lower pain scores than male test subjects. CONCLUSIONS: Nd:YAG 1,064 nm laser hair removal is a painful procedure. Topical anesthetics have been proven to reduce pain for laser hair removal. There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal. Therefore, cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic.

Generalized granuloma annulare in a patient with adult onset diabetes mellitus.

Granuloma annulare is a benign idiopathic disorder, which affects the dermis. Several reports have demonstrated an association between granuloma annulare and diabetes mellitus. We report the case of a 69-year-old man with an unusual presentation of generalized granuloma annulare following the diagnosis of adult onset diabetes mellitus.