Basal Cell Carcinoma Arising in Scars of Subcutaneous Port Sites

xloma.fota13 shared this article with you from Inoreader Basal Cell Carcinoma Arising in Scars of Subcutaneous Port Sites Via Dermatologic Surgery - Current Issue No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Correlation of Suture Diameter With Its Ability to Cut Through an Artificial Skin Model

xloma.fota13 shared this article with you from Inoreader Correlation of Suture Diameter With Its Ability to Cut Through an Artificial Skin Model Via Dermatologic Surgery - Current Issue BACKGROUND Sutures can tear through tissue, but little data exist on the relative ability of different suture gauges and suture types to cut into the skin. OBJECTIVE To quantify the relative ability of various sutures to cut into and tear through the skin. METHODS AND MATERIALS We tested 4 suture types (polypropylene, nylon, polyglactin 910, and poliglecaprone 25) at 2 gauges each (3-0 and 5-0) in their ability to cut into and tear through an artificial skin substitute comprised of a 1-mm thick silicone sheet. The force required to cut into and through the skin substitute was measured using a digital force gauge that generated a force–time curve. The suture diameters were verified using both a precision caliper micrometer and an eyepiece micrometer with the microscope. Statistical analysis was performed using the Student t-test and analysis of variance. RESULTS All 5-0 suture types required less force to cut into and tear through the skin substitute than their 3-0 counterparts. Among each suture gauge, there was no significant difference in tear-through force regardless of the suture type. CONCLUSION Compared with larger gauge sutures, smaller gauge sutures more easily cut into and tear through skin substitute. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of Hypertrophic Scarring Attempted Caustic Tattoo Removal

xloma.fota13 shared this article with you from Inoreader Treatment of Hypertrophic Scarring Attempted Caustic Tattoo Removal Via Dermatologic Surgery - Current Issue No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study

xloma.fota13 shared this article with you from Inoreader Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study Via Dermatologic Surgery - Current Issue BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0–3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of Systemic Mastocytosis With the Pulsed Dye Laser

xloma.fota13 shared this article with you from Inoreader Treatment of Systemic Mastocytosis With the Pulsed Dye Laser Via Dermatologic Surgery - Current Issue No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Foreign Body Reaction to Hydrophilic Polymer Following Mohs Micrographic Surgery

xloma.fota13 shared this article with you from Inoreader Foreign Body Reaction to Hydrophilic Polymer Following Mohs Micrographic Surgery Via Dermatologic Surgery - Current Issue No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities

xloma.fota13 shared this article with you from Inoreader Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities Via Dermatologic Surgery - Current Issue BACKGROUND Preoperative patient screening has been evaluated in many surgical specialties as a way to improve the overall patient experience. Current data are limited regarding patient screening for dermatologic procedures. The goal of preoperative screening is to identify patients at risk for poor outcomes and tailor the treatment plan to ensure a greater overall patient experience. OBJECTIVE To investigate the association between psychological comorbidities and acute postoperative pain in patients treated with Mohs micrographic surgery (MMS). MATERIALS AND METHODS Subjects were recruited from a single center, single provider, uniformed service MMS practice, and asked to complete preoperative and postoperative questionnaires for scheduled MMS. Outcome variables included anticipated pain, actual pain after MMS, duration of pain, and medications used for pain. RESULTS Mohs micrographic surgery was well tolerated. There were no significant differences in anticipated or reported pain, or in medication use between cohorts. Significant differences in pain were noted with closure technique with complex surgical repairs generating the greatest pain across groups. CONCLUSION Mohs micrographic surgery is well tolerated by patients, both with and without psychological comorbidities. Our results show no statistically significant differences, suggesting a limited role for preoperative screening as a tool to guide pain management after MMS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Histopathologic Scoring System for Perineural Invasion Correlates With Adverse Outcomes in Patients With Cutaneous Squamous Cell Carcinoma

xloma.fota13 shared this article with you from Inoreader A Histopathologic Scoring System for Perineural Invasion Correlates With Adverse Outcomes in Patients With Cutaneous Squamous Cell Carcinoma Via Dermatologic Surgery - Current Issue BACKGROUND Perineural invasion (PNI) is a known risk factor for recurrence, metastasis, and death in cutaneous squamous cell carcinoma (cSCC). Current staging systems include PNI, but none define its extent or severity. OBJECTIVE To identify histopathologic features of cSCC with PNI that may be associated with adverse outcomes. MATERIALS AND METHODS This is a retrospective cohort study that included 45 patients with cSCC and PNI treated with surgical excision. Histopathologic slides were analyzed for 5 features of PNI: largest affected nerve diameter, number of nerves affected, depth of nerve involvement, intra- versus extratumoral PNI, and focal versus circumferential PNI. RESULTS The median largest affected nerve diameter was 0.13 mm, and the median number of nerve structures involved was 4. After a median follow-up time of 24 months, 6 patients developed adverse outcomes, including 2 local recurrences, 4 metastases, and 2 tumor-related deaths. Univariate logistic regression analysis revealed that nerve diameter and number of affected nerves were significantly associated with adverse outcome. A composite PNI score, calculated from 5 histopathologic features, was the strongest predictor of adverse outcome (p = .020). CONCLUSION Histopathologic features of PNI can be quantified with a composite PNI score that is significantly associated with adverse outcomes in cSCC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Narcotic Use for Acute Postoperative Pain Management in Mohs Micrographic Surgery Patients With End Stage Renal Disease: A Review of the Literature

xloma.fota13 shared this article with you from Inoreader Narcotic Use for Acute Postoperative Pain Management in Mohs Micrographic Surgery Patients With End Stage Renal Disease: A Review of the Literature Via Dermatologic Surgery - Current Issue BACKGROUND Uncontrolled acute postoperative pain presents a significant management challenge when opioids are used in patients with end-stage renal disease (ESRD). Currently, there is a lack of quality pharmacokinetic and pharmacodynamic data regarding opioid medication use in ESRD patients to optimize safe and effective management. OBJECTIVE To review the published literature on pharmacologic evidence for and against the use of opioid medications for acute postoperative pain following Mohs micrographic surgery in ESRD patients. METHODS A search of PubMed was conducted to identify articles on the pharmacokinetic and pharmacodynamic properties of opioid pain medications in ESRD patients through March 1, 2020. RESULTS Seventy-five articles were reviewed. Limited data exist on opioids safe for use in ESRD and are mostly confined to small case series. Studies suggest tramadol and hydromorphone could be considered when indicated. Methadone may be a safe option, but should be reserved for treatment coordinated by a trained pain subspecialist. CONCLUSION Randomized clinical trials are lacking. Studies that are available are not sufficient to perform a quantitative methodologic approach. Evidence supports the judicious use of postoperative opioid medications in ESRD patients at the lowest possible dose to achieve clinically meaningful improvement in pain and function. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nicotinamide for Keratinocyte Carcinoma Chemoprevention: A Nationwide Survey of Mohs Surgeons

xloma.fota13 shared this article with you from Inoreader Nicotinamide for Keratinocyte Carcinoma Chemoprevention: A Nationwide Survey of Mohs Surgeons Via Dermatologic Surgery - Current Issue BACKGROUND Nicotinamide has been shown to reduce keratinocyte carcinoma (KC) in high-risk patients in a randomized controlled trial setting. Data on nicotinamide's use for KC prevention are limited. OBJECTIVE To characterize nicotinamide prescribing patterns among Mohs surgeons. METHODS AND MATERIALS We surveyed 1,500 members of the American College of Mohs Surgeons regarding their demographics, use of nicotinamide, and safety perceptions. We performed multiple logistic regression analysis to evaluate correlations between physician characteristics and nicotinamide prescribing habits. RESULTS 76.9% of survey respondents recommend nicotinamide for KC prevention. Twenty percent of respondents have recommended nicotinamide to more than 100 patients in the past year. Forty-five percent of respondents report a duration of use of 2 years or more in their patients. 63.8% of respondents had no concerns over nicotinamide's safety with long-term use. Individuals who answered "yes," "maybe," or "uncertain" to having safety concerns over long-term nicotinamide use and individuals in practice for more than 10 years were less likely (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.71 and OR 0.20, 95% CI 0.05, 0.82, respectively) to have recommended nicotinamide to patients for KC prevention. CONCLUSION Given the widespread nicotinamide use among Mohs surgeons, additional studies on nicotinamide cost-effectiveness, safety, and use patterns are needed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gadoxetate Disodium-Enhanced Imaging of Gradenigo Syndrome in End-Stage Renal Disease

xloma.fota13 shared this article with you from Inoreader Gadoxetate Disodium-Enhanced Imaging of Gradenigo Syndrome in End-Stage Renal Disease Via North American Neuro-Ophthalmology Society Abstract: A 65-year-old man with end-stage renal disease on peritoneal dialysis was admitted for new onset binocular double vision, failure to thrive, and debilitating right-sided headaches. Medical history was significant for tympanomastoidectomy for polymicrobial mastoiditis and treatment with IV antibiotics. MRI brain without contrast was read by radiology initially as showing expected postsurgical changes; however, given patient's history of mastoiditis infection, there was a high clinical suspicion for Gradenigo syndrome. MRI brain was repeated with gadoxetate contrast to minimize the risk of nephrogenic systemic fibrosis (NSF) in a patient with severe renal disease and this revealed an intracranial empyema involving both the trigeminal and abducens nerves confirming the diagnosis of Gradenigo syndrome. This case presented a diagnostic challenge because of suboptimal visualization on initial nonenhanced MRI. Gadoxetate was chosen because of its unique properties including high hepatobilia ry excretion making it a safer form of gadolinium-based contrast agent that may not have the potential to precipitate NSF. Address Correspondence to Collin M. McClelland, MD, Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Phillips-Wangensteen Building, Floor 9, 516 Delaware Street SE, Minneapolis, MN 55455; E-mail: cmc@umn.edu The authors report no conflicts of interest. © 2021 by North American Neuro-Ophthalmology Society View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Embolic abducens palsy and central retinal artery occlusion in a patient with COVID-19

xloma.fota13 shared this article with you from Inoreader Embolic abducens palsy and central retinal artery occlusion in a patient with COVID-19 Via North American Neuro-Ophthalmology Society No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.