Matthew R. Donaldson

Scars after second intention healing.

Second intention healing (SIH) is useful for many defects after skin cancer removal. SIH decreases intraoperative morbidity and reduces procedure costs. Granulating wounds are rarely infected, have minimal pain or bleeding, and care is simple. Location is the key determinant in cosmetic outcomes of SIH. Concavities of the face including the medial canthus and conchal bowl often heal imperceptibly. Defects on convex surfaces such as the nasal tip and malar cheek can heal poorly with depressed scars. Flat areas of the cheeks, forehead, and chin heal favorably but cosmesis can be unpredictable. These regions are often described by NEET (concavities of the nose, eyes, ears, and temple), NOCH (convexities of nose, oral lips, cheek, chin, and helix), and FAIR (flat areas of the forehead, antihelix of the ear, eyelids, and rest of the nose, lips, and cheeks). We review the limited literature describing SIH based on regional anatomy of the face. Complications of SIH include exuberant granulation tissue, hypopigmented or telangiectatic scars, and distortion of free lid margins. SIH should be an integral part of the surgeons reconstructive algorithm after skin cancer removal.

Mohs micrographic surgery utilization in the Medicare population, 2009.

BACKGROUND Mohs micrographic surgery (MMS) is the criterion standard treatment for high‐risk skin cancers. Few data on current MMS Utilization are available. OBJECTIVE To better understand current trends in MMS use in the Medicare population. METHODS AND MATERIALS The 2009 Medicare Limited Data Set Standard Analytic File (LDSSAF), carrier claims, 5% sample and the Physician Supplier Procedure Master File (PSPMF) 100% summary were analyzed. RESULTS In 2009, 558,447 Medicare MMS cases were performed, with an average of 1.75 stages per case. In the 5% claims sample, 0.3% and 1.3% of MMS cases were performed for melanoma and carcinoma in situ, respectively. Total annual volume predictions for 1,777 providers showed a left‐shifted curve. 65.8% of LDSSAF cases had same‐day MMS repairs: 48.7% of repairs were complex, 9.8% intermediate, 32.4% flaps, and 7.4% full‐thickness skin grafts. CONCLUSIONS The 5% LDSSAF is highly predictive of total claim volumes and is useful for modeling practice trends. There is wide variation in MMS provider annual case volume. These data reflect only Medicare Part B enrollees in 2009; 5% LDDSAF extrapolations are predictions based on sampling.

Superficial CD34-Positive Fibroblastic Tumor Treated With Mohs Micrographic Surgery

Superficial CD34-positive fibroblastic tumor (SCPFT) is a recently characterized mesenchymal neoplasm of the suprafascial tissues. Limited data (21 reported cases) suggest that SCPFT is a contiguous-growth tumor that is infiltrative but circumscribed with a low risk of metastasis. This tumor is characterized histologically by cellular fascicles and sheets of spindled to epithelioid cells. Nuclear pleomorphism is prominent, but mitotic activity is minimal. CD34 is diffusely and strongly positive. All previously reported cases of SCPFT were treated with excision. In this report, the authors describe a new case of SCPFTwith margin control achieved using Mohs micrographic surgery (MMS).

Toluidine Blue Supports Differentiation of Folliculocentric Basaloid Proliferation From Basal Cell Carcinoma on Frozen Sections in a Small Single-Practice Cohort

Eduardo Weiss, MD, FAAD Cosmetic Fellowship at Hollywood Dermatology and Cosmetic Surgery Specialists Hollywood, Florida Mohs and Procedural Dermatology Fellowship Skin Institute of South Florida Coral Springs, Florida Department of Dermatology and Cutaneous Surgery Florida International University Miami, Florida Department of Dermatology and Dermatological Surgery Miller School of Medicine University of Miami Miami, Florida

Scalpel reduction of giant nasal folliculosebaceous hamartoma and reconstruction using porcine xenograft.

Superficial decortication of proliferative tissue in rhinophyma allows for reepithelialization from deep and adjacent tissue to occur with satisfactory cosmetic outcomes. We report a case of giant nasal folliculosebaceous cystic hamartoma (FSCH) presenting similarly to rhinophyma. After surgical reduction, a porcine xenograft was placed to serve as a protective dressing to facilitate healing, demonstrating that a surgical approach traditionally used for rhinophyma may be implemented for FSCH, as well as the value of porcine xenografts in these repairs.

JAAD Grand Rounds quiz∗: Dusky intertriginous plaques and acral erythema after bone marrow transplant

LEARNING OBJECTIVES At the conclusion of this learning activity, physician participants should be able to assess their own diagnostic and patient management skills and use the results of this exercise to help determine personal learning needs that can be addressed through subsequent CME involvement. Instructions for claiming CME credit appear in the front advertising section. See last page of Contents for page number. INSTRUCTIONS In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier questions, please answer the questions in each series in sequence.