Heidi B. Donnelly

Retinoids for Chemoprophylaxis of Nonmelanoma Skin Cancer

The authors have indicated no significant interest with commercial supporters.

The Use of Botulinum Toxin in the Treatment of a Parotid Duct Injury During Mohs Surgery and Review of Management Options

BACKGROUND Aggressive skin cancers on the cheeks may involve the parotid duct. For such tumors to be successfully removed, at least part of the parotid duct must be excised as well. Failure to properly address parotid duct injuries that result from Mohs micrographic surgery exposes the patient to a variety of adverse sequelae. OBJECTIVE To discuss the various diagnostic and treatment options that should be considered when managing parotid duct injuries that result from skin cancer extirpation. MATERIALS AND METHODS We describe a patient who sustained a parotid duct injury after Mohs micrographic surgery for treatment of squamous cell carcinoma. The patient was treated with intraparotid injections of botulinum toxin. RESULTS Two weeks after treatment of the injury with botulinum toxin, the patient reported complete resolution of his symptoms. CONCLUSION If a parotid duct injury is diagnosed at the time of tumor extirpation, then surgical repair of the duct should be attempted, but if surgical repair is not possible or if an injury remains unrecognized until well after tumor extirpation, then surgery is not necessary. In such cases, conservative, nonsurgical measures, such as treatment with botulinum toxin, will provide excellent results.

Island Pedicle Flap for Alar Defects

Island pedicle flaps used to repair nasal defects have been well described. In 1983, Rybka described a supratip nasal defect repair for defects up to 1.25 cm using a laterally based myocutaneous island pedicle flap. This flap depended on branches of the angular artery that supply the nasalis muscle. This flap was described as a ‘‘traditional’’ or ‘‘classic’’ island pedicle flap, in which the blood supply is directly below the island of moving skin. Constantine used a similar technique for defects up to 1.5 cm. Wee and colleagues, in 1990, refined the nasal myocutaneous reconstruction using Z-plasty, early dermabrasion, and placement of a bolster. All of these flaps describe repair of defects located superior to the alar groove with a classic island pedicle.

Repair of a glabellar and inferior forehead defect.

This 44-year-old healthy white male was referred to our office for the treatment of a recurrent basal cell carcinoma clinically involving the left inferior forehead extending down to the left glabellar region of the face. The preoperative size of the tumor was 1.5 x 1.5 cm (Figure 1). The lesion had been present since 1998 and had undergone previous liquid nitrogen treatment and, subsequently, excisional surgery. The patient had no significant medical history, and the only medication he had been taking was ibuprofen as needed. The patient did not smoke, nor did he have a history of diabetes. After discussing the various treatment options with the patient, he opted to undergo Mohs micrographic surgery. After two stages, the tumor was fully removed, and the defect measured 2.0 3 2.3 cm (Figure 2). The postoperative defect extended through the frontalis muscle superiorly and the procerus muscle inferomedially, down to the periosteum. The left corrugator supercilli muscle was spared from removal. How would you manage this wound?

Letter: Mohs Micrographic Surgery for Cellular Neurothekeoma with Atypia

A 19-year-old female presented to the office referred by dermatology for a red-brown papule on the left nasal tip that had been slowly growing over many months. Biopsy showed a cellular neurothekeoma with atypia and complete excision was recommended. Owing to the location and the tendency for recurrence, Mohs micrographic surgery was performed. The tumor was cleared in two stages. The resulting defect was repaired with a superiorly based island pedicle flap receiving its blood supply from a lateral nasalis muscle sling.

The Nested M-Plasty for Scar Length Shortening

The extirpation of skin cancer by Mohs micrographic surgery often leaves a roughly circular surgical defect. Many such defects can be closed primarily with the excision of standing cones of redundant tissue from either end of the wound. This results in a linear scar approximately three times the length of the original circular defect. However, at certain anatomical sites, much shorter scars are desirable to avoid vital structures and improve cosmesis. One of the most well-known and commonly used means of achieving this goal is the M-plasty (and its variants). We shall describe a nested M-plasty technique that will allow even more significant scar length shortening than the traditional method.

Novel Camera Mounting Technique for Dermatologic Surgeries

Video recordings of surgical procedures are a useful teaching tool, and techniques to improve video capture have been in development since the 1970s. In recent years, the GoPro camera (San Mateo, CA) has been shown to provide excellent video quality along with ease of use in a number of surgical fields, including ophthalmology, plastic surgery, and orthopedic surgery. In the spine surgery literature, the GoPro HERO4 Silver (GPHS) was shown to have superior video resolution and options for field of view adjustment when compared with Google glass and a Panasonic action camera. In addition, the GPHS camera and its accessories are significantly cheaper compared with traditional specialized surgical camera equipment.

Two Suturing Techniques for the Prevention and Treatment of Nasal Valve Collapse After Mohs Micrographic Surgery

BACKGROUND Tumor extirpation of nonmelanoma skin cancer (NMSC) adjacent to the alar groove, using Mohs micrographic surgery (MMS), may risk causing internal nasal valve (INV) collapse, resulting in reduced airflow during inspiration. There are many surgical options described in the literature to repair INV collapse as a postoperative corrective procedure, but few exist as an intra-operative preventative procedure. OBJECTIVE The authors present 2 distinct methods to prevent and treat INV collapse during the repair of a perialar surgical defect caused by MMS. METHODS A 3-point stitch method or a modified suspension suture technique was used to prevent INV collapse during the repair of MMS defects overlying the alar groove, for nonmelanoma skin cancers. The 3-point stitch was used with a complex repair. The modified suspension suture was used with flap reconstruction. RESULTS The 3-point stitch and the modified suspension suture are simple, single-stage surgical solutions for perialar defects with collapse of the INV caused by loss of subcutaneous tissue during MMS. Once executed, patients experienced immediate subjective airflow improvement which was also supported by clinical examination. Patients were followed at 1 week and at 3 months postoperatively. Thirty-four of 35 patients reported good functional and cosmetic results and were satisfied with the final outcome. CONCLUSION The 3-point stitch and the modified suspension suture techniques are easy and simple methods that can be incorporated into reconstruction after MMS for defects of variable depth covering any multisubunit perialar region to prevent or correct INV collapse.

Obtaining thin and complete Mohs layers using the methylene blue staining technique.

&NA; The authors have indicated no significant interest with commercial supporters.