Carl V. Washington

Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

OBJECTIVE To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes. DESIGN We developed a computer‐simulation, probabilistic, decision model to perform a cost‐effectiveness analysis, with each patient serving as his or her own control. SETTING University of Connecticut dermatology clinic, a tertiary care referral center. PARTICIPANTS Input data were derived from results of a consecutive sample of 98 patients with nonmelanoma skin cancer on the face and ears, estimates in the literature on 5‐year recurrence rates, and a query of healthy focus‐group participants. INTERVENTION We considered Mohs and traditional excision strategies. MAIN OUTCOME MEASURES Outcomes were measured in quality‐adjusted life years, cost, and cost‐effectiveness. RESULTS The Mohs strategy was

Non-surgical treatments of primary, non-melanoma eyelid malignancies: a review

292 less expensive than the traditional surgical strategy and was more effective by an incremental quality‐adjusted life year of 0.056 (translating to approximately 3 weeks of optimal quality of life). Results were robust to subgroup and sensitivity analyses. CONCLUSIONS Mohs may be more cost‐effective than traditional excision in eradicating nonmelanoma skin cancer. Further investigation of costs from various geographic payment localities and assessment of quality‐of‐life outcomes from a population‐based sample are needed. The authors have indicated no significant interest with commercial supporters.

Clinical Spectrum of Atypical Fibroxanthoma and Undifferentiated Pleomorphic Sarcoma in Solid Organ Transplant Recipients: A Collective Experience

The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologists practice. Skin cancers comprise nearly one‐third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non‐surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non‐surgical treatment options, indications and efficacies for non‐melanoma primary eyelid malignancies.

The public's perception of dermatologists as surgeons.

BACKGROUND Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are uncommon, spindle cell cutaneous malignancies. Solid organ transplant recipients (SOTRs) are immunosuppressed and therefore have a higher incidence of cutaneous malignancies. OBJECTIVE We describe the clinical spectrum of AFX and a more‐aggressive, deeper variant, UPS, in SOTRs. MATERIALS AND METHODS A retrospective chart review of AFX and UPS in SOTRs was implemented. Cases from Vanderbilt University, Emory University, Mayo Clinic—Jacksonville, and University of Rochester were included. A literature search included previously published cases. RESULTS The average age of SOTRs at time of tumor presentation was younger than typically seen in immunocompetent patients for AFX. Rates of local recurrences and metastases were higher in the SOTRs than is noted in the immunocompetent literature. Rates of recurrence were higher in those treated with excision than in those treated with Mohs micrographic surgery (MMS). CONCLUSION AFX and UPS may have a greater risk for recurrence, metastases, and mortality in SOTRs, in whom early treatment with MMS may demonstrate certain advantages in terms of minimizing risk of recurrence and metastasis. UPS and recurrent tumors should be staged appropriately and may respond to adjuvant radiation therapy and reduction of immunosuppression. Immunohistochemical evaluation is recommended to exclude other spindle cell tumors. The authors have indicated no significant interest with commercial supporters.

Hydrocolloid dressings promote granulation tissue on exposed bone.

BACKGROUND Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons. OBJECTIVE Our study was designed to assess the publics perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physicians specialty biases people when they assess the cosmetic appearance of a surgical scar. MATERIALS AND METHODS We administered an institutional review board–approved survey to individuals at the Emory Student Center and the Emory Dermatology Clinic. Participants rated the perceived skills and training of the different medical specialties and scored the cosmetic appearance of 16 surgical scars created by a fellowship‐trained Mohs surgeon labeled as the work of different specialists. RESULTS Results from 467 participants were overwhelmingly in favor of plastic surgeons (p<.001). The physicians specialty did not bias participants in assessing the cosmetic appearance of surgical scars. CONCLUSION The study population had greater confidence in the surgical skills of plastic surgeons than in those of dermatologists, although participants were objective in rating the cosmesis of surgical scars, regardless of the purported surgeons specialty. Although dermatologic surgeons must continually refine our surgical expertise, we must also educate the public about the breadth and depth of our work. The authors have indicated no significant interest with commercial supporters.

Acral lentiginous melanoma mimicking benign disease: The Emory experience

We describe a simple technique of using hydrocolloid dressings on exposed bone devoid of periosteum to induce a robust bed of granulation tissue amenable to successful skin grafting. Healing of surgical defects overlying bone devoid of periosteum is an important reconstructive challenge for dermatol