Leslie J. Christenson

Clinical outcome of cutaneous flaps versus full-thickness skin grafts after Mohs surgery on the nose.

BACKGROUND A large proportion of facial skin cancers occur on the nose, and defects after Mohs surgery in this location often present a reconstructive challenge. For intermediate‐sized defects, the choice of reconstruction is usually between skin flap and full‐thickness skin graft. Ongoing debate exists, and limited data are available to determine which of these methods is more satisfactory. OBJECTIVE To evaluate and compare the clinical appearance of wound healing after surgical repair with a skin graft versus a skin flap for Mohs defects on the nose. METHOD In this study, 43 flaps and 24 grafts were evaluated using a modified Hollander Wound Evaluation Scale and a visual analogue scale. RESULTS The mean visual analogue scale score was significantly better for flap repairs than for graft repairs. In addition, 100% of flaps had an acceptable overall cosmetic appearance on the basis of the Hollander Wound Evaluation Scale, compared with only 75% of skin grafts. CONCLUSIONS For defects on the nose where flap and graft repair may both be technically possible, a flap may be more likely to result in superior cosmetic outcome. The authors have indicated no significant interest with commercial supporters.

Effects of Chronic Lymphocytic Leukemia on the Development and Progression of Malignant Melanoma

BACKGROUND An association exists between chronic lymphocytic leukemia and malignant melanoma. OBJECTIVES To study the clinical behavior of malignant melanoma in patients with chronic lymphocytic leukemia. METHODS A retrospective chart review was conducted of patients with chronic lymphocytic leukemia and malignant melanoma. RESULTS Sixty‐nine patients had malignant melanoma and chronic lymphocytic leukemia. The recurrence‐free and metastasis‐free survival rates at 2, 5, and 10 years were 93.4% and 89.1%, 83.8% and 93.4%, and 87.4% and 82.1%, respectively. No significant difference was observed in age‐ and sex‐adjusted mortality rates between patients with chronic lymphocytic leukemia diagnosed before malignant melanoma and those with chronic lymphocytic leukemia diagnosed after malignant melanoma. LIMITATIONS Retrospective study and small patient population. CONCLUSION Patients with malignant melanoma and chronic lymphocytic leukemia were not shown to have worse survival rates than those with stage IA, IB, and IIA disease. Further research and prospective study are needed. The authors have indicated no significant interest with commercial supporters.