Treatment of dermatofibroma sarcoma protuberans using modified Mohs micrographic surgery: no recurrences and smaller defects.

OBJECTIVES: The purpose of this study was to evaluate the use of modified Mohs micrographic surgery (MMS) for dermatofibroma sarcoma protuberans (DFSP) in a single institution by a single surgeon. METHODS: The authors conducted a retrospective analysis of 25 patients with DFSP who were treated with modified MMS over the past 19 years at Scripps Clinic. RESULTS: Of the 25 patients treated with modified MMS for DFSP, there were no identifiable recurrences. The mean follow-up time was 101 months. The defect sizes of DFSP lesions treated by modified MMS are smaller than if the lesions had been treated with the standard wide local excision (WLE) margins of 3 cm. LIMITATIONS: This is a retrospective analysis using the data of one surgeon. Five of the 25 patients were not examined in our office. Not all patients had 5-year follow-up. There were no cases of the fibrosarcomatous variant. CONCLUSION: Our data support the growing literature that modified MMS achieves excellent local control for DFSP with a possible benefit of smaller defects when compared with treatment with WLE. The authors have indicated no significant interest with commercial supporters.

Anterior cervicoplasty: Neck rejuvenation using local anesthesia.

There is a subset of male patients that is troubled by redundant midline skin of the neck. Such patients may not be interested in having a face lift; they simply want elimination of the "turkey neck" appearance. Removal of redundant skin and underlying tissue can produce excellent results. We report our use of anterior cervicoplasty consisting of submental excision, midline platsymal placation and cutaneous Z-plasty using only minimal oral sedation and local anesthesia. This procedure can be a safe alternative to a face-lift for a select group of patients.

What specialties perform the most common outpatient cosmetic procedures in the United States?

BACKGROUND: The number of cosmetic procedures performed annually is on the rise and is being performed by more specialties. PURPOSE: We sought to determine the relative outpatient cosmetic procedure experience of dermatology and other specialties. We also examined demographic data of patients who underwent cosmetic procedures. METHODS: Demographics and data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to estimate the number of visits for office-based cosmetic procedures from 1995 to 2003 by specialty and type of procedure. RESULTS: In order of decreasing frequency, the percentage of all cosmetic procedures performed in the outpatient setting by specialty was as follows: dermatology (48%), plastic surgery (38%), general surgery (>4%), otolaryngology (>3%), ophthalmology (>3%), facial plastic surgery (1%), family practice (<1%), pediatrics (<1%), and internal medicine (<1%). Most cosmetic procedures were performed on white, female patients in the 40- to 59-year-old age group. There was a mean of 55 visits per 1,000 whites and 27 visits per 1,000 nonwhites. Chemical peels and soft tissue fillers were the two most common procedures. CONCLUSIONS: Dermatology as a specialty performs more office-based cosmetic procedures than other specialties. On a per-physician basis, dermatologists and plastic surgeons have far more experience with cosmetic procedures than other physicians.

Treatment of severe cutaneous ulcerative lichen planus with low molecular weight heparin in a patient with hepatitis C.

The ulcerative variant of lichen planus (LP) commonly involves the oral mucosa but is uncommon and difficult to treat when located on other areas. We describe an unusual case of ulcerative LP involving several surfaces, including the palms and scrotum, in a 50-year-old man with hepatitis C. The patient was recalcitrant to treatment with conventional therapy but obtained clearance with a sustained response using low molecular weight heparin (LMWH). This treatment is an option for patients with LP who are not ideal candidates for standard therapy.

Perineal ulcers in an infant: an unusual presentation of postnatal cytomegalovirus infection.

Cytomegalovirus (CMV) disease can cause significant morbidity and mortality in neonates and immunosuppressed patients. Cutaneous disease is rare, even in at-risk patients. We report a case of CMV with perineal papules, erosions, and ulcers in a preterm but presumably immunocompetent patient, whose diagnosis was first suggested by skin biopsy and confirmed with serologic testing. The mode of transmission of CMV was unclear. The lesions resolved without CMV-specific therapy, and the child had no apparent systemic sequelae of infection. CMV disease should be considered in the differential diagnosis of perineal erosions and ulcers in infancy. In addition to the case, we briefly review the literature on cutaneous manifestations of CMV disease.

The extent of dermatopathology education: a comparison of pathology and dermatology.

An indispensable component of all pathology and dermatology residencies is obtaining proficiency in the area of dermatopathology. The purpose of this study is to quantify dermatopathology training in pathology and dermatology residencies and the amount of continuing medical education in dermatopathology in leading journals of both fields. Dermatology residents complete more hours of dermatopathology than pathology residents. There is also more dermatopathology in the dermatology literature than in the pathology literature. Dermatopathology falls into the scope of both pathology and dermatology practice.

Limited availability of psoriasis and phototherapy care: an analysis of advertisements.

Because the number of dermatologists remains stable, patients with medical dermatologic conditions such as psoriasis may find it increasingly difficult to access dermatological treatment. Measuring the competition in the marketing of dermatologic care may provide insight into the availability of dermatology services. The purpose of this study was to determine to what extent dermatologists are using the Yellow Pages to advertise to patients with psoriasis. We performed a quantitative and qualitative assessment of dermatologists' Yellow Pages advertisements in small cities and the ten largest metropolitan regions in the country. Per capita, more advertisements were found in smaller markets than larger markets and a higher percentage was descriptive rather than just a name, address and phone number. Cosmetic and surgical advertisements were more common than psoriasis ads in both markets. Cosmetic ads were more prevalent in larger markets. In all regions, psoriasis and psoriasis treatment ads were least common. These findings raise the concern that incentive structures in the United States healthcare system do not adequately support delivery of dermatologic care for psoriasis. Efforts to promote psoriasis care should be encouraged.

Interpretation of dermatopathology specimens is within the standard of care of dermatology practice.

BACKGROUND: Laws have been passed in New York, California, New Jersey, Nevada, Louisiana, and Rhode Island and were recently tabled in South Carolina to prohibit providers from billing for pathology services provided by other physicians. The Ohio proposal included language stating that only board-certified pathologists be able to directly bill for anatomic pathology services. Dermatologists, however, have extensive training in dermatopathology and frequently bill anatomic pathology codes. OBJECTIVE: To determine if interpretation of cutaneous pathology falls within the standard of care of dermatology practice. DESIGN: We used Medicare part A and B claims data from the Medicare Current Beneficiary Survey, 1992 to 2000. We identified surgical pathology claims by Current Procedural Terminology (CPT) code 88305 and those related to skin disease by the associated International Classification of Disease, 9th Revision (ICD-9), code. Weights were applied to obtain nationally representative estimates. The number of physicians in each specialty was obtained from American Medical Association estimates. RESULTS: Pathologists, independent laboratories and group practices, and dermatologists submitted 59%, 26%, and 13% of total claims, respectively. For skin-related diagnoses, pathologists, dermatologists, and independent laboratories and group practices performed 34.5%, 31.2%, and 32.8% of cases, respectively. Assuming that independent laboratory and group practice claims were performed entirely by pathologists, dermatologists and pathologists submitted 1,047 and 1,154 cases/physician, respectively. CONCLUSION: Dermatologists have extensive training in dermatopathology and interpret a large proportion of cutaneous specimens. Interpretation of anatomic pathology, in particular, skin and subcutaneous pathology specimens, falls within the scope of dermatology practice.