James D. Whalen

Nutrition and nonmelanoma skin cancers

The incidence of nonmelanoma skin cancer is increasing every year. Basal cell carcinoma and squamous cell carcinoma are the two major types of nonmelanoma skin cancer. Among other factors, understanding the potential role of nutrients in the development, progression, and treatment of nonmelanoma skin cancer is critical. This contribution provides a review of the nutrients that have been more extensively investigated in the literature with regard to nonmelanoma skin cancer, including dietary fats, retinol, carotenoids, vitamin C, vitamin D, vitamin E, selenium, copper, iron, zinc, green tea, and black tea.

Unusual presentation of a Merkel cell carcinoma

Merkel cell carcinoma (MCC) is an uncommon, potentially lethal, cutaneous tumor that mainly occurs in sun-exposed skin of the head and neck area of the elderly. We report a case of MCC presenting as a 2-mm crusted erosion on the nose of an elderly patient, the smallest MCC reported thus far in the literature. The optimal management of MCC has not been clearly established. In view of its high local recurrence rate, predilection to metastasis, and significant mortality, aggressive treatment has been advocated. Identification of this tumor at such a small size posed a management dilemma because of lack of prospective treatment data involving biologic markers of prognostic significance for MCC.

Xylene substitutes in frozen sections.

BACKGROUND Toxic exposure to xylene may occur during routine histopathologic staining procedures. Safer xylene substitutes have been available for over a decade, however, a 1991 survey of 25 Mohs training programs revealed that only 56% were using xylene substitutes. OBJECTIVE The purpose of this study was to compare xylene to xylene substitutes in the histologic preparation of frozen sections with respect to staining quality, clarity, cellular detail, and tissue distortion. METHODS Xylene and xylene substitutes were used as the final clearing agent in the routine histologic preparation of fresh frozen horizontal sections. The slides were evaluated by a dermatopathologist and a Mohs surgeon in a blinded manner. RESULTS No difference between xylene and the xylene substitutes were noted. CONCLUSION In light of the improved safety profile and efficacy of the xylene substitutes, they should replace xylene in the Molis laboratory.

An age-based approach to dermatologic surgery: Kids are not just little people

Surgical dermatologic procedures in children pose unique challenges that differ from those in adults. Child and parental anxiety, along with procedural anxiety in adults, necessitate different approaches. Special considerations are reviewed in the application of topical anesthesia and administration of local anesthesia in children as opposed to adults, and the use and safety of general anesthesia in children is highlighted. In addition, management of postprocedural analgesia differs in children, largely due to concern for safety of opioids in children.

Ethical dilemmas in dermatologic surgery

Dermatologic surgery presents a unique set of ethical dilemmas not frequently discussed within the medical literature. This contribution presents a few cases commonly encountered by dermatologic surgeons. The case-based discussion follows a principles-based framework for analysis and seeks to identify the central moral conflict and exemplify the development of sound reasoning for subsequent decision making through the consideration of multiple viewpoints and the weighing of potential consequences. Additional cases are provided in concise format to encourage further analysis and discourse on the distinct ethical dilemmas encountered within dermatologic surgery.