Proliferating Pilar Tumor: Two Cases and a Review of the Literature.

Trichilemmal cysts (TCs) are the most common cystic lesions arising on the scalp and up to 2% give rise to a proliferating trichilemmal tumor (PTT). A rare subset of PTTs are termed malignant due to their histologic characteristics, aggressive behavior and potential for metastasis. The histological hallmark of TCs and PTTs is the absence of a granular layer resulting in abrupt trichilemmal keritanization.

Mohs Micrographic Surgery for Genital Skin Cancer: A Review of Cases and Reconstructive Techniques.

As the incidence of non-melanoma skin cancer (NMSC) increases in the United States, one area of particular concern is NMSC arising on the genitalia. In the past, most genital skin tumors have been treated by conventional radical surgical approaches such as penectomy, vulvectomy, or wide local excision. In recent years, tissue sparing Mohs micrographic surgery (MMS) has been established as a safe and effective method of achieving cutaneous genital tumor clearance. The aim of this article is to provide an overview of NMSCs arising on genital skin treated with MMS, and describe some of their indications, results, and associated complications. A summary of case reports, case series, and retrospective reviews is made available to guide decision making and surgical planning for tumors of this nature. Pertinent anatomy, site-specific surgical techniques, and reconstruction options of genital skin will be discussed. J Drugs Dermatol. 2021;20(3):311-319. doi:10.36849/JDD.5656.

Intraoperative Electrosurgical Depilation of a Skin Graft.

Full-thickness skin grafts harvested from hair-bearing areas may negatively impact cosmetic outcomes if the recipient site is hairless. Intraoperative depilation of unwanted hair follicles using an electrosurgical device can permanently remove hair with a single treatment and improve overall cosmesis.

A Systematic Review of the Treatment of Superficial Leiomyosarcoma With Mohs Micrographic Surgery.

BACKGROUND: Wide local excision (WLE) with 2 to 5 cm margins has been conventionally used for the treatment of superficial leiomyosarcoma (LMS). Because margin control is the strongest predictor of clinical recurrence, many dermatologic surgeons have recently recommended Mohs micrographic surgery (MMS) over wide local excision (WLE) as the primary treatment modality. OBJECTIVE: To determine the aggregate rate of local recurrence after treatment of superficial LMS with MMS among the few reports in the literature. METHODS: A systematic literature search using the PubMed/MEDLINE database and the Cochrane Library was performed from inception to June 2017. One case report from our institution was included. RESULTS: A meta-analysis of 14 reports of 48 cases of superficial LMS treated with MMS showed a mean recurrence rate of 2.08% to 6.25% with a mean follow-up period of 1570.9 days, compared to reported recurrence rates of 30% to 50% for WLE. Among these cases there were no reports of distant metastases. CONCLUSION: Treatment of superficial leiomyosarcoma with MMS shows markedly lower rates of recurrence compared to reported rates of recurrence after WLE. Further prospective trials with larger sample sizes are needed to compare both modalities.

Disseminated superficial actinic porokeratosis treated with ingenol mebutate gel 0.05.

Disseminated superficial actinic porokeratosis (DSAP) is a chronic condition characterized by numerous atrophic papules and patches with a distinctive peripheral keratotic ridge, typically found on sun-exposed areas. Treatment of DSAP is warranted not only for cosmetic and symptomatic benefits but also to prevent malignant transformation. Successful treatment of DSAP often is difficult and frequently requires the use of multiple modalities. Ingenol mebutate gel 0.05% is a topical medication primarily used for the treatment of actinic keratosis (AK) by inducing cell death. We report a case of DSAP treated effectively with ingenol mebutate gel 0.05%.

The use of an imagery mnemonic to teach the porphyrin biochemical pathway.

We designed an imagery mnemonic to help medical students and residents learn the porphyrin pathway and associated diseases. Fourth year medical students at the Icahn School of Medicine at Mount Sinai in the spring of 2014 participated. One group (n=11) received the porphyrin pathway in a lecture explaining a mnemonic, whereas a second group (n=11) was simply taught the steps of the pathway. A pre-intervention assessment before the lectures was given to assess baseline differences in knowledge of the porphyrin pathway between the groups. Immediately following the lecture, 1 week after the lecture, and 3 weeks after the lecture, the students were given quizzes to assess their knowledge. Students were aware of the week 1 quiz and were asked not to study for it. The week 3 quiz was a surprise. There were no statistically significant differences in knowledge of the pathway at baseline (p=.45), at the immediate post-intervention (p=.22), or one week post-intervention (p=.40). Three weeks after the lecture, students in the mnemonic group scored 20% higher than controls (p=.02). Students who had learned the mnemonic demonstrated better long-term retention of information than students learning by the control method. This mnemonic minimizes study time while improving long-term retention.

Teaching the Simple Suture to Medical Students for Long-term Retention of Skill.

IMPORTANCE: Instructional methods for the simple suture technique vary widely and are seldom based on educational research. Published data indicate that video primers and structured instruction and evaluation decrease learning time and improve skill acquisition. OBJECTIVES: To determine the amount of practice needed to attain simple suture proficiency and to identify the optimal teaching schedule for retention of skill. DESIGN, SETTING, AND PARTICIPANTS: First-year and second-year medical students at the Icahn School of Medicine at Mount Sinai with little to no suturing experience were randomly divided into 2 equal groups, with one being taught on day 1 and tested for proficiency on day 30 (control group) and the other being taught on day 1 and tested for proficiency on days 10, 20, and 30 (experimental group). Students were evaluated using the objective structured assessment of technical skills method and a checklist. Those initially not proficient on a given day were immediately prompted to practice and retest. This cycle continued until proficiency was achieved for that day. The study was conducted from April 7, 2014, to June 30, 2014. MAIN OUTCOMES AND MEASURES: Simple suture proficiency at 30 days and the mean number of practice sutures needed for proficiency on day 1. RESULTS: All students ultimately achieved proficiency. The mean (SD) number of practice sutures required to achieve proficiency at the initial training was 41 (15). Students in the control group had a 0% pass rate at the 30-day initial proficiency test, while students in the experimental group had a 91.7% pass rate at day 30 (P < .001). There were no differences in instructional time, cumulative number of sutures, or objective structured assessment of technical skills scores at proficiency between groups across the study. CONCLUSIONS AND RELEVANCE: Single instructional sessions may not be sufficient to maintain simple suture proficiency over the course of a 30-day elective. We propose the use of preparatory instructional videos, followed by instructor demonstration to introduce the technique. Independent practice with intermittent evaluation and critique allows for skill acquisition and time efficiency at the initial training. Students should view instructional videos and practice at least 10 repetitions every 10 days to maintain their skill.

What is new in fungal pharmacotherapeutics?

Approximately 20-25% of the population worldwide is affected by superficial cutaneous mycoses (SCM). SCM are cutaneous fungal infections with a wide array of systemic and topical treatment options. However, successful therapeutic outcomes are limited by patient non-adherence, medication side effects, potential drug interactions, antifungal resistance and disease recurrence. Advances in formulation technology have allowed for the development of more effective and safer therapies. In this article we will review several new and emerging pharmacotherapeutics for onychomycosis and tinea pedis.