Justin J. Vujevich

Pilot study of the safety and efficacy of myobloc (botulinum toxin type B) for treatment of axillary hyperhidrosis

Background  Botulinum toxin type B (BTX‐B, Myobloc™, San Francisco, CA, USA) was FDA‐approved for the treatment of cervical dystonia in December 2000. It has since been used off‐label for the treatment of axillary hyperhidrosis. However, there are sparse data in the medical literature evaluating the safety and efficacy of Myobloc™ (botulinum toxin type B) for this indication.

The 20-Minute Rapid MART-1 Immunostain for Malignant Melanoma Frozen Sections

BACKGROUND Immunohistochemical staining has been used to help detect malignant melanoma on Mohs surgery frozen sections. Previous investigators have developed protocols for reliable MART-1 immunostaining of frozen sections, but these protocols are time-consuming. OBJECTIVE The objective was to report a rapid 20-minute MART-1 immunostaining protocol for frozen sections. METHODS The protocol was utilized on 30 melanomas treated with Mohs micrographic surgery. RESULTS The stain clearly highlighted normal background melanocytes, as well as melanocytic hyperplasia and malignant melanoma. CONCLUSIONS The 20-minute protocol provides a rapid and reliable method for immunostaining of malignant melanoma. The availability of more rapid immunostaining methods improves efficiency of the Mohs laboratory and significantly reduces patient and physician waiting time.

Mohs Micrographic Surgery Using a Flexible Blade for Tumors of the Scalp

Surgery of the scalp poses a challenge to the dermatologic surgeon. First, the scalp has an abundant vascular supply, often requiring significant electrocautery for hemostasis. Second, adjacent skin for reconstructing surgical defects is in limited supply. Third, although hair-bearing skin is closed together during reconstruction, scarring and alopecia frequently form at the surgical site. Finally, wound dehiscence and scar depression are commonly seen on the scalp when closures are performed under tension.

Nonverbal Hand Signals: A Tool for Increasing Patient Comfort During Dermatologic Surgery

The use of technical and descriptive language during dermatologic surgery can be a source of discomfort and anxiety for patients. Several investigators have identified poor communication and technical language as consistent elements involved in filing malpractice claims. During dermatologic surgery procedures, patients are universally awake, alert, and aware of the surgeon’s descriptive and technical language when communicating with surgical assistants, particularly dermatologic surgery residents or fellows in training.

Recurrent nodule on the nasal columella: a good reason to re-biopsy

Background  A 15‐year‐old Caucasian male presented with 9‐month history of a recurrent nodule on the nasal columella. The previous biopsy was reported as a neurofibroma.

The Four Angles of Cutting

The first angle of cutting refers to the advancing angle of the scalpel handle relative to the surface of the skin. As noted in Figure 1, this angle determines how easily the blade cuts into the skin. When the angle of the handle is 901 to the skin, the tip of the blade cuts at 901 perpendicular to the dermis (Figure 1A). This part of the blade is useful for the tips of elliptical excisions but cuts poorly through straightline incisions. On the other hand, when the handle is held between 301 and 601 to the skin, the sharpest part of the blade, the belly, cuts into the skin (Figure 1B). This angle ensures a precise, sharp cut through the skin.

Superior Helical Rim Advancement Flap for the Repair of Ear Defects

Surgical defects of the auricular helix generally require reconstruction to maintain the contiguous border of the helical rim. Whereas the traditional helical advancement flap (Figure 1A) provides an excellent repair for defects along the lateral helix, this flap is not ideally suited for repair of defects of the superior helix. We report a superior helical advancement flap that utilizes donor skin from the laxity of the superior preauricular area to repair defects of the superior helical rim (Figure 1B).