Update on Current Treatment Recommendations for Primary Cutaneous Melanoma.

Primary cutaneous melanoma describes any primary melanoma lesion of the skin that does not have evidence of metastatic disease. This article reviews the current workup, treatment, and follow-up recommendations for primary cutaneous melanoma (stages 0, I, and II). Specific attention is focused on recent updates with regard to staging, sentinel lymph node biopsy, and surgical modalities.

Comparing demographic characteristics and adverse event rates at two dermatologic surgery practices.

BACKGROUND: Patient demographics and operative techniques may contribute to adverse events after surgeries. OBJECTIVE: To identify differences in adverse event rates between different dermatologic surgery centers and potential contributing features affecting these rates. METHODS: Data regarding demographics, procedure type, and adverse events were collected at two dermatologic surgery centers. RESULTS: The most common adverse event at both sites was infection: 2.1% at site 1 versus 0.5% at site 2 (p < .001). Using multivariate logistic regression, procedure type (Mohs surgery), geographic location (being at site 1), older age, and anatomic location of surgery were associated with a higher risk of infection. CONCLUSION: Adverse event rate appears to correlate with patient demographics, procedure type, and setting of surgery more than use of prophylactic antibiotics. Identification of differences in adverse event rates and potential contributing variables at different practices may allow for identification of opportunities to prevent adverse events.

Quantifying and characterizing adverse events in dermatologic surgery.

BACKGROUND: Although office-based dermatologic procedures are generally considered safe, there is a lack of prospective data on the rate of adverse events (AEs) associated with these procedures. OBJECTIVE: To determine the frequency of AEs after dermatologic surgery and to characterize the most commonly encountered AEs. METHODS: A web-based interface was designed to track AEs with the input of four dermatologic surgeons. Patient demographic and operative data were collected at the time of the dermatologic surgery procedure. AEs occurring at any time during the data collection period were logged according to an a priori categorization scheme. RESULTS: The AE rate was 2.0% in this series of 2,418 subjects undergoing dermatologic surgery from February 1 through December 14, 2010. The most commonly reported AEs were suspicion of infection (64%), postoperative hemorrhage (20%), and wound dehiscence (8%). Suspicion of infection was slightly less frequent in subjects who received prophylactic preoperative antibiotics (0.4%) than in those who did not (1.5%, p = .07). There were no serious AEs and no deaths. CONCLUSION: AEs are uncommon after office-based dermatologic surgery procedures. Preoperative antibiotics may further decrease the infection rate after dermatologic surgery, but the risks and benefits must be weighed given the already low AE rate.

Increase in procedures performed at dermatology office visits from 1995 to 2001.

BACKGROUND: Over the past few decades, dermatologists have expanded the scope of their practice to include many surgical and cosmetic procedures in response to the development and demand for new procedures. OBJECTIVE: To examine the trend from 1995 in the proportion of dermatology visits associated with procedures to determine if there has been an increase in the number of procedures performed. METHODS: Data from the National Ambulatory Medical Care Survey were used to look at the proportion and types of dermatology visits associated with procedures performed during the years 1995 to 2001. RESULTS: There has been a progressive increase in the number of dermatology visits with procedures, occurring in 29.8% of visits in 1995 and 40.0% of visits in 2001. The top procedures performed are that of excision and destruction, including cryotherapy, electrodesiccation and curettage, and biopsies. CONCLUSION: The number of dermatology visits associated with procedures has increased since 1995. With the numerous new procedures and techniques that have emerged and continue to develop in our field, we expect that dermatologists will continue to be providers of medical, as well as surgical, care for the skin.