1
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Dodson JA, Ibrahim SA, Rogers H, Council ML, Nehal KS, Tung R, Leffell DJ, Zeitouni NC, Totonchy MB, Fosko SW, Lee Soon S, Blalock TW, Brodland DG, Billingsley EM, Scott JF, Leach BC, Ratner D, Washington C, Hanke CW, Otley CC, Golda N, Nijhawan RI, Brewer J, Demer A, Fish F, Harmon CB, Zitelli J, Knackstedt T, Singh G, Mollet T, Carr DR, Albertini JG, Moody BR, McDonald M, Bordeaux JS, Massey PR, MacCormack MA, Vidimos A, Arpey CJ, Arron ST, Ibrahimi OA, Jiang SB, Miller CJ, Maher IA, Wysong A, Leshin B, Goldman GD, Kibbi N, Feng H, Collins L. Identifying critical quality metrics in Mohs Surgery: A national expert consensus process. J Am Acad Dermatol 2024; 90:798-805. [PMID: 38081390 DOI: 10.1016/j.jaad.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. OBJECTIVE The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. METHODS Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. RESULTS Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. LIMITATIONS Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. CONCLUSION With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.
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Affiliation(s)
- Joseph A Dodson
- Rush Medical College of Rush University Medical Center, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Howard Rogers
- President, American College of Mohs Surgery, CMO, Advanced Dermatology, Norwich, Connecticut
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Nathalie C Zeitouni
- Division of Dermatology, Department of Internal Medicine, University of Arizona, Phoenix, Arizona
| | | | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, Florida
| | | | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian C Leach
- The Skin Surgery Center of Charleston, Mount Pleasant, South Carolina
| | - Desiree Ratner
- Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Carl Washington
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Partner; Dermatology Associates of Georgia, Decatur, Georgia
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Indianapolis, Indiana; Program Director, ACGME Micrographic Surgery/Dermatologic Oncology Fellowship Training Program, Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Dermatology, University of Iowa-Carver College of Medicine, Iowa City, Iowa
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Golda
- Dermatology and Skin Cancer Centers, Kansas City, Missouri
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Frederick Fish
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - John Zitelli
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina; Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Todd Mollet
- Department of Dermatology, Skin Surgery Center of Oklahoma, Oklahoma City, Oklahoma
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Michel McDonald
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Warren Alpert Medical School at Brown University, Worcester, Massachusetts
| | | | | | - Allison Vidimos
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Omar A Ibrahimi
- Department of Dermatology, Connecticut Skin Institute, Stamford, Connecticut
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Barry Leshin
- Department of Dermatology, Skin Surgery Center, Winston-Salem, North Carolina
| | | | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Lindsey Collins
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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2
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Tolaymat LM, Reimer DK, Feig J, Gillis MS, Speicher LL, Haga CB, Gabriel EM, Heckman MG, Yin M, Fosko SW, Keaveny AP, Dawson NL. Skin cancer in non-white liver transplant recipients: Mayo Clinic experience. Int J Dermatol 2021; 60:986-990. [PMID: 33742703 DOI: 10.1111/ijd.15519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/21/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data are available on the development of skin cancer and the associated risk factors for non-White liver transplant (LT) recipients. The aim of this study is to determine the incidence of newly diagnosed skin cancer postoperatively and to identify the risk factors for the development of skin cancer in non-White LT recipients. METHODS We conducted an initial retrospective chart review of non-White LT patients who received a transplant at our center between January 1, 2011, and December 31, 2013. RESULTS Of the 96 patients in the study cohort, 32% were Black, 17% were Asian, 15% were White Hispanic, and 10% were Black Hispanic. One patient had a history of nonmelanoma skin cancer before transplant. No skin cancers were diagnosed during follow-up (median, 1.3 years; range, 17 days to 8.6 years). CONCLUSION Our center's experience is consistent with the literature and suggests that the incidence of newly diagnosed skin cancer in non-White liver transplant recipients is low. Longer follow-up may provide additional insights into the specific risk factors for the posttransplant development of skin cancer.
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Affiliation(s)
| | | | - Joshua Feig
- University of North Florida, Jacksonville, FL, USA
| | | | - Leigh L Speicher
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Claire B Haga
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mingyuan Yin
- Research Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - Andrew P Keaveny
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy L Dawson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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3
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McLawhorn JM, Stephany MP, Bruhn WE, Crow LD, Coldiron BM, Hruza GJ, Leach BC, Soon SL, Friedmann DP, Stebbins WG, Blalock TW, Graves MS, Billingsley EM, Knackstedt TJ, Miller SJ, Yob EH, Albertini JG, Zeitouni N, Krathen RA, Bichakjian CK, Jellinek NJ, Hanke CW, Samie FH, Mann MW, Carucci JA, Kakar R, Saylor DK, Fosko SW, Ortiz AE, Henghold WB, Jennings TA, Davis DS, Maloney ME, Curcio NM, Behshad R, Tope WD, McCoppin H, Levin JI, Collins L, Stasko T. An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures. J Am Acad Dermatol 2020; 82:700-708. [DOI: 10.1016/j.jaad.2019.09.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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4
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Bray HN, Simpson MC, Zahirsha ZS, Brinkmeier JV, Walen SG, Fosko SW, Osazuwa-Peters N. Head and Neck Melanoma Incidence Trends in the Pediatric, Adolescent, and Young Adult Population of the United States and Canada, 1995-2014. JAMA Otolaryngol Head Neck Surg 2019; 145:1064-1072. [PMID: 31580395 DOI: 10.1001/jamaoto.2019.2769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age ≤40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada). Objective To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. Design, Setting, and Participants A descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries' Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12 462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases-Oncology 3 histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. Main Outcomes and Measures Log-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. Results Of the 12 462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100 000 persons (95% CI, 0.50-0.52 per 100 000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100 000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100 000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100 000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100 000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100 000 persons) were associated with an increased incidence of head and neck melanoma. Conclusions and Relevance The incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase.
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Affiliation(s)
- Haley N Bray
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri
| | - Matthew C Simpson
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri
| | - Zisansha S Zahirsha
- Medical student, Saint Louis University School of Medicine, St Louis, Missouri
| | - Jennifer V Brinkmeier
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri.,Sisters of Saint Mary Cardinal Glennon Children's Medical Center, Department of Pediatric Otolaryngology, St Louis, Missouri
| | - Scott G Walen
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri.,Saint Louis University School of Medicine, Division of Plastic and Reconstructive Surgery, St Louis, Missouri
| | - Scott W Fosko
- Mayo Clinic Jacksonville, Department of Dermatology, Jacksonville, Florida.,Saint Louis University School of Medicine, Department of Dermatology, St Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri
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5
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Crow LD, Jambusaria‐Pahlajani A, Chung CL, Baran DA, Lowenstein SE, Abdelmalek M, Ahmed RL, Anadkat MJ, Arcasoy SM, Berg D, Bibee KP, Billingsley E, Black WH, Blalock TW, Bleicher M, Brennan DC, Brodland DG, Brown MR, Carroll BT, Carucci JA, Chang TW, Chaux G, Cusack CA, Dilling DF, Doyle A, Emtiazjoo AM, Ferguson NH, Fosko SW, Fox MC, Goral S, Gray AL, Griffin JR, Hachem RR, Hall SA, Hanlon AM, Hayes D, Hickey GW, Holtz J, Hopkins RS, Hu J, Huang CC, Brian Jiang SI, Kapnadak SG, Kraus ES, Lease ED, Leca N, Lee JC, Leitenberger JJ, Lim MA, Longo MI, Malik SM, Mallea JM, Menter A, Myers SA, Neuburg M, Nijhawan RI, Norman DJ, Otley CC, Paek SY, Parulekar AD, Patel MJ, Patel VA, Patton TJ, Pugliano‐Mauro M, Ranganna K, Ravichandran AK, Redenius R, Roll GR, Samie FH, Shin T, Singer JP, Singh P, Soon SL, Soriano T, Squires R, Stasko T, Stein JA, Taler SJ, Terrault NA, Thomas CP, Tokman S, Tomic R, Twigg AR, Wigger MA, Zeitouni NC, Arron ST. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 2019; 32:1268-1276. [DOI: 10.1111/tri.13520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/25/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
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6
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Fosko SW, Navarrete-Dechent CP, Nehal KS. Lentigo Maligna—Challenges, Observations, Imiquimod, Confocal Microscopy, and Personalized Treatment. JAMA Dermatol 2018; 154:879-881. [DOI: 10.1001/jamadermatol.2018.0531] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Scott W. Fosko
- Department of Dermatology, Mayo Clinic Jacksonville, Jacksonville, Florida
| | - Cristian P. Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Kishwer S. Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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7
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Stuart LN, Tipton RG, DeWall MR, Parker DC, Stelton CD, Morrison AO, Coleman LW, Fosko SW, Vidal CI, Yadira Hurley M, Deeken AH, Gardner JM. Primary cutaneous perivascular epithelioid cell tumor (PEComa): Five new cases and review of the literature. J Cutan Pathol 2017; 44:713-721. [PMID: 28556973 DOI: 10.1111/cup.12972] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/01/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022]
Abstract
PEComas represent a family of uncommon mesenchymal tumors composed of "perivascular epithelioid cells" with a distinct immunophenotype that typically shows both myogenic and melanocytic differentiation. The PEComa family includes angiomyolipoma (AML), clear cell "sugar" tumor of the lung and extra pulmonary sites, lymphangioleiomyomatosis and clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres. Very rarely, PEComas may arise in the skin. Primary cutaneous PEComas typically display a dermal proliferation of epithelioid cells with pale, clear, or granular pink cytoplasm arranged in nests and trabecula with an intervening arborizing network of delicate capillaries. Primary cutaneous PEComas have a lower frequency of myogenic marker expression than their deep soft tissue and visceral counterparts. They also often express strong diffuse CD10, leading to potential confusion with metastatic renal cell carcinoma. Most cases behave indolently. We report 5 additional cases of this rare entity. All showed classic histologic features and expression of either HMB-45 and/or Melan-A/MART-1. Four cases were tested for myogenic markers (2 were positive & 2 were negative). Three cases were tested for CD10 (all 3 were positive). All of our cases with clinical follow-up behaved indolently. Table 1 provides a summary of findings for all 5 cases in our series.
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Affiliation(s)
- Lauren N Stuart
- Finan Templeton Dermatopathology Associates, Atlanta, Georgia
| | - Russell G Tipton
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Michael R DeWall
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Douglas C Parker
- Department of Pathology, Emory University Hospital, Atlanta, Georgia.,Department of Dermatology, Emory University Hospital, Atlanta, Georgia
| | | | | | - Landon W Coleman
- Department of Pathology, Intermountain Medical Center, Murray, Utah
| | - Scott W Fosko
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Claudia I Vidal
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri.,Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Maria Yadira Hurley
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri.,Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Amy H Deeken
- Department of Pathology and Laboratory Medicine, Summa Health System, Akron, Ohio
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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8
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Fosko SW. Counterpoint: Limited life expectancy, basal cell carcinoma, health care today, and unintended consequences. J Am Acad Dermatol 2015; 73:162-4. [PMID: 26089052 DOI: 10.1016/j.jaad.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Scott W Fosko
- Departments of Dermatology, Internal Medicine, Ophthalmology, and Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis University Cancer Center, Saint Louis, Missouri
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9
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Fosko SW. Dermatology at Saint Louis University: Offering the Most Advanced Skin Care in the Area. Mo Med 2015; 112:285-286. [PMID: 26455058 PMCID: PMC6170073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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10
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Fosko SW, Chu MB, Mattox AR, Richart JM, Burkemper NM, Slutsky JB. Lichenoid reaction as a potential immune response marker of intratreatment histological response during successful vismodegib treatment for a giant basal cell carcinoma. Dermatol Ther 2015; 28:359-62. [PMID: 26114264 DOI: 10.1111/dth.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report an 83 year-old patient with a 13 × 7.5 cm(2) basal cell carcinoma (BCC) successfully treated with the combination of vismodegib and minimal surgery. On Day 109, a 0.9 cm papule suspicious for residual BCC was seen centrally within a large pink atrophic plaque. This lesion was excised; pathology confirmed BCC with negative surgical margins. Simultaneously, suspecting noncontiguous histologic response, we performed 21 biopsies at the periphery of the pretreatment tumor location. Seventeen (17/21, 81%) revealed lichenoid dermatitis. No tumor was seen on any. We believe the lichenoid dermatitis observed is a novel finding for two reasons. First, it may be considered a marker of a positive intratreatment response. This may help guide clinicians on the optimal treatment duration of vismodegib to maximize efficacy and mitigate side effects. Second, we think it suggests an additional mechanism of vismodegib action, possibly via local immune effects. Further investigations are warranted.
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Affiliation(s)
- Scott W Fosko
- Saint Louis University Departments of Dermatology, Internal Medicine, Ophthalmology and Otolaryngology-Head and Neck Surgery, Saint Louis University Cancer Center, St. Louis, Missouri
| | - Melinda B Chu
- Saint Louis University Department of Dermatology, St. Louis, Missouri
| | - Adam R Mattox
- Saint Louis University Department of Dermatology, St. Louis, Missouri
| | - John M Richart
- Saint Louis University, Department of Internal Medicine, Division of Hematology and Medical Oncology, St. Louis, Missouri
| | | | - Jordan B Slutsky
- Stony Brook Medicine, Department of Dermatology, Stony Brook, New York
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11
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Mathias SD, Chren MM, Crosby RD, Colwell HH, Yim YM, Reyes C, Chen DM, Fosko SW. Reliability and validity of the Advanced Basal Cell Carcinoma Index (aBCCdex). Br J Dermatol 2015; 173:713-9. [PMID: 25939524 DOI: 10.1111/bjd.13877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) questionnaires were recently developed specifically for use with patients with advanced basal cell carcinoma (aBCC) and basal cell carcinoma naevus syndrome (BCCNS). OBJECTIVES To evaluate the measurement properties of PRO questionnaires for use in patients with aBCC or BCCNS. METHODS In total 129 patients from 10 clinical sites in the U.S.A. and the BCCNS Support Network completed the two newly developed questionnaires multiple times over 3 months. Patients also completed the Skindex-16 and the 12-Item Short-Form Health Survey as collateral measures. Psychometric properties of the questionnaires were evaluated, including internal consistency and test-retest reliability, construct and known-groups validity, and responsiveness. RESULTS Based on the results of exploratory factor analysis and clinical input, the two newly developed questionnaires were combined into a single questionnaire, called the aBCCdex, which is relevant for patients with both aBCC and BCCNS. The internal consistency reliability was acceptable, and all aBCCdex scale scores correlated significantly with conceptually similar scales. When divided into groups that differed based on scores from collateral measures, aBCCdex scale scores differentiated between groups (known-groups validity) and were responsive to change. CONCLUSIONS The aBCCdex is a brief and comprehensive questionnaire appropriate for use with patients with aBCC and BCCNS. Its reliability and validity have been confirmed. Further research is necessary to estimate the minimally important difference in a larger patient population.
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Affiliation(s)
- S D Mathias
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - M M Chren
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - R D Crosby
- Health Outcomes Solutions, Neuropsychiatric Research Institute, and University of North Dakota School of Medicine and Health Sciences, Fargo, ND, U.S.A
| | - H H Colwell
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - Y M Yim
- Genentech, San Francisco, CA, U.S.A
| | - C Reyes
- Genentech, San Francisco, CA, U.S.A
| | - D M Chen
- Genentech, San Francisco, CA, U.S.A
| | - S W Fosko
- Departments of Dermatology, Internal Medicine, Head and Neck Surgery-Otolaryngology and Ophthalmology, Saint Louis University Cancer Center, Saint Louis University School of Medicine, St Louis, MO, U.S.A
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12
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Rogers HW, Armbrecht E, Coldiron BM, Albertini J, McDonald M, Dinehart SM, Hendi A, Hruza G, Fosko SW, Moody BR. Properly Selected Skin Cancer Treatments Are Very Effective. J Invest Dermatol 2014; 134:1133-1135. [DOI: 10.1038/jid.2013.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Mathias SD, Chren MM, Colwell HH, Yim YM, Reyes C, Chen DM, Fosko SW. Assessing Health-Related Quality of Life for Advanced Basal Cell Carcinoma and Basal Cell Carcinoma Nevus Syndrome. JAMA Dermatol 2014; 150:169-76. [DOI: 10.1001/jamadermatol.2013.5870] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - Yeun Mi Yim
- Genentech Inc, South San Francisco, California
| | | | | | - Scott W. Fosko
- Departments of Dermatology, Internal Medicine, Otolaryngology–Head and Neck Surgery, and Ophthalmology, Saint Louis University School of Medicine, Saint Louis University Cancer Center, St Louis, Missouri
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14
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15
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Erickson QL, Fosko SW. Complications and Emergencies in Dermatologic Surgery. Dermatol Surg 2012. [DOI: 10.1002/9781118412633.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Green JS, Tournas JA, Allen EJ, Youker SR, Fosko SW. Mohs frozen tissue sections in comparison to similar paraffin-embedded tissue sections in identifying perineural tumor invasion in cutaneous squamous cell carcinoma. J Am Acad Dermatol 2012; 67:113-21. [PMID: 22533992 DOI: 10.1016/j.jaad.2011.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 02/04/2011] [Accepted: 03/01/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Perineural invasion (PNInv) in cutaneous squamous cell carcinoma (cSCC) increases the risk of recurrence, possibly because of suboptimal identification on frozen or paraffin-embedded tissue sections. Perineural inflammation (PNInf) may portend PNInv. OBJECTIVE We sought to correlate identification of PNInv and PNInf in hematoxylin-eosin-stained Mohs frozen sections with PNInv and PNInf identified in similarly oriented paraffin-embedded sections obtained in cases of cSCC. METHODS We reviewed same patient Mohs frozen and paraffin-embedded tissue sections for all patients presenting within a 2-year period to our Mohs micrographic surgical unit for removal of cSCC with PNInv or PNInf identified on either type of tissue section. RESULTS Of 537 patients undergoing surgical resection of cSCC, 21 (3.9%) had either PNInv (n = 11) or PNInf (n = 10) on frozen sections. PNInv on Mohs frozen sections was identified in 11 cases and confirmed on paraffin-embedded sections in 9 cases (82%). Paraffin-embedded sections failed to identify PNInv present in Mohs frozen sections in two (2/11), or 18% of cases. PNInf on Mohs frozen sections was confirmed on paraffin-embedded sections in 3 cases (30%), but PNInv was identified in 5 cases (50%). LIMITATIONS Our results are a retrospective case review from a specific time period by one institution. Furthermore, it is impossible to compare identical tissue specimens using two sequential tissue processing techniques. CONCLUSION PNInv can be accurately identified with Mohs frozen sections. PNInf on Mohs frozen sections suggests the presence of PNInv and requires further histologic investigation.
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Green JS, Burkemper NM, Fosko SW. Failure of Extensive Extramammary Paget Disease of the Inguinal Area to Clear With Imiquimod Cream, 5%. ACTA ACUST UNITED AC 2011; 147:704-8. [DOI: 10.1001/archdermatol.2011.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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18
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Fosko SW. Melanoma of the skin and laterality. J Am Acad Dermatol 2011. [DOI: 10.1016/j.jaad.2010.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Missall TA, Hurley MY, Fosko SW. Lentiginous melanoma in situ treatment with topical imiquimod: need for individualized regimens. ACTA ACUST UNITED AC 2010; 146:1309-10. [PMID: 21079078 DOI: 10.1001/archdermatol.2010.338] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Brant J, Arthur C, Chaudhry S, Jagwani S, Ravanfar P, Youker S, Fosko SW, Cornelius L, Johnson FE, Lickerman S. A collaborative skin cancer educational program for adolescents. Mo Med 2009; 106:226-228. [PMID: 22641918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Jason Brant
- Department of Surgery, Saint Louis University Hospital, St. Louis, USA
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Missall TA, Fosko SW. The Use of Imiquimod to Minimize the Surgical Defect When Excising Invasive Malignant Melanoma Surrounded by Extensive Melanoma In Situ, Lentiginous Type. Dermatol Surg 2009; 35:868-74. [DOI: 10.1111/j.1524-4725.2009.01146.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rouse CR, Youker SR, Hurley MY, Cortese CM, Fosko SW, Hsueh EC, Johnson FE. QS450. Improved Assessment of Melanoma Margin Using Ultraviolet Light. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Kling CW, Jones EC, Fosko SW. Surgical Pearl: The cotton-tipped applicator as a suture scissors stabilizer in cutting suture. J Am Acad Dermatol 2005; 53:330-1. [PMID: 16021131 DOI: 10.1016/j.jaad.2005.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Christopher W Kling
- Department of Dermatology, Mohs Surgery and Cutaneous Oncology, St Louis University School of Medicine, St Louis, Missouri 63104, USA
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25
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Abstract
Basal cell carcinoma (BCC) is the most common cutaneous skin malignancy. BCC generally has a clinical course characterized by slow growth, minimal soft tissue invasiveness, and a high cure rate. Occasionally, however, BCC behaves aggressively with deep invasion, recurrence, and potential regional and distant metastasis. Several factors, including tumor size, duration, histology, and perineural spread, have been postulated as markers of the aggressive BCC phenotype. It is undetermined whether intrinsic biological factors within certain subsets of BCC predispose these tumors toward an inherently aggressive behavior, or whether any BCC with inadequate early management may assume this phenotype. Review of the pertinent literature on this topic suggests that both intrinsic biological factors and extrinsic management factors play a role in the development and progression of aggressive BCC.
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Affiliation(s)
- Hobart W Walling
- Department of Dermatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Affiliation(s)
- Ashley A Smith
- St. Louis University, 4961 Laclede Avenue, Suite 601, St. Louis, MO 63108, USA
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Abstract
The periocular area is a complex region with free margins and cosmetic landmarks that are easily distorted during surgical reconstruction. Repair of surgical defects should maintain both periorbital function and aesthetics. In this article we discuss the basic methods of closure (side-to-side closure, flaps, grafts and second intent healing) as they apply to the periocular area and suggest an algorhythmic approach to reconstruction by aesthetic subunit. Pertinent regional anatomy and perioperative management are also reviewed.
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Affiliation(s)
- Paul H Bowman
- Department of Dermatology, Mohs Micrographic Surgery Unit, St Louis, MO 63104, USA.
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Abstract
OBJECTIVE To determine the ability of fluorodeoxyglucose F 18 positron emission tomography (FDG-PET) to image basal cell carcinoma (BCC). DESIGN Case series study. SETTING Mohs surgery practice in a tertiary university hospital. PATIENTS Six patients with BCC larger than 1.0 cm of the head and neck region were identified. RESULTS Patients were imaged using FDG-PET before surgery. In 3 patients, PET imaging correlated well with the size and extent of the soft tissue invasion. Histologically, all 3 tumors were of the nodular subtype. The remaining 3 patients failed to demonstrate identifiable tumor activity on PET. Two of these 3 tumors were of the infiltrative histologic subtype, and 1 was of the nodular subtype. Perineural spread was detected by tissue biopsy in 1 infiltrative tumor, but not by FDG-PET imaging. CONCLUSIONS In our study, FDG-PET imaging was able to image and identify BCC in the head and neck region in 3 of 6 patients. In some cases, anatomic accuracy and the extent of soft tissue invasion were observed. The histologic subtype of the BCC appears to affect the ability of FDG-PET detection, with the nodular histologic subtype more likely to test positive on PET. This is a preliminary study, and future investigation is needed to evaluate the role of PET imaging in the management of patients with BCC.
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Affiliation(s)
- Scott W Fosko
- Department of Dermatology, Saint Louis University Health Sciences Center, MO 63104, USA.
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Margenthaler JA, Johnson DY, Virgo KS, Fosko SW, Chan D, Goshima K, Handler BS, Johnson FE. Evaluation of patients with clinically suspected melanoma recurrence: current practice patterns of plastic surgeons. Int J Oncol 2002; 21:591-6. [PMID: 12168104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
The optimal extent-of-disease evaluation for patients with clinically suspected melanoma recurrence is not known. The available modalities are numerous and many are expensive. We documented the extent of work-up carried out by plastic surgeons when their patients with melanoma develop clinical recurrence. A custom-designed questionnaire was mailed to a random sample (n=3,032) of the 4,320 members of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Subjects were asked which specific laboratory tests and imaging studies they would order for a patient with initial T2N0M0 disease treated with curative intent who later presented with either regional nodal metastases or pulmonary metastases. We measured the variability in practice patterns among surgeons and estimated the effects of physician age, U.S. census region, health maintenance organization (HMO) penetration rates, and type of recurrence (regional versus systemic) on work-up intensity. Of the 1,142 questionnaires completed (38%), 395 (35%) were evaluable. Non-evaluability was usually due to lack of melanoma patient follow-up in surgeons' practices. Lesion biopsy, chest X-ray, complete blood count, liver function tests, and computed tomography were frequently used, but there was no consensus for most modalities. More tests, particularly computed tomography, were utilized for evaluating systemic recurrence than for regional recurrence (p<0.05). The intensity of work-up differed significantly (p<0.05) by surgeon age for three diagnostic tests but not by U.S. census region or HMO penetration rate. This is the first empirical data on this subject from a large sample of an international society of highly credentialed experts. The lack of consensus for most tests in current practice is presumably due to multiple factors, including the lack of evidence supporting any particular strategy.
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Affiliation(s)
- Julie A Margenthaler
- Departments of Surgery and Dermatology, Saint Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, USA
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Fosko SW, Glaser DA, Rogers CJ. Eradication of angiolymphoid hyperplasia with eosinophilia by copper vapor laser. Arch Dermatol 2001; 137:863-5. [PMID: 11453802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- S W Fosko
- Department of Dermatology, Saint Louis University School of Medicine, 1402 S Grand Blvd-ABI, St Louis, MO 63104, USA.
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32
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Affiliation(s)
- A L Allen
- Department of Dermatology, St. Louis University School of Medicine, Missouri 63104, USA
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33
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Affiliation(s)
- S W Fosko
- Department of Dermatology, Saint Louis University School of Medicine, Missouri 63104, USA
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34
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Abstract
BACKGROUND The administration of a local anesthetic is often painful. OBJECTIVE The purpose of this study was to determine whether rapidly shaking and pinching the skin during local anesthetic administration decreases pain perception. METHODS The skin at the intended site of lidocaine injection was rapidly pinched between the thumb and forefinger just before the injection. Control patients received no intervention. Patients reported their pain perception using a visual analog scale (0 to 10). In the feasibility phase, patients were assigned to receive the pinching technique or no intervention, then randomized in the second phase. RESULTS In phase 1, 34 patients received 42 excisions. Pain was significantly reduced (p=0.001) in the treatment group. In phase 2, 69 patients had 91 excisions. When adjusted for age and sex (data combined from phases 1 and 2), the treatment significantly reduced pain (p=0.03) when compared with no intervention. CONCLUSION We describe a simple, noninvasive technique that significantly lowered perceived pain during the administration of unbuffered lidocaine with epinephrine local anesthetic.
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Affiliation(s)
- S W Fosko
- Department of Dermatology, St. Louis University School of Medicine, Missouri 63104, USA
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35
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Abstract
The most commonly occurring cutaneous malignancies are basal cell and squamous cell carcinoma. There are, however, other rare malignancies that are encountered and should be included in the differential, in which both the clinical and the histological diagnosis may be difficult. Here, the clinical and histological features, management, and prognostic factors of merkel cell carcinoma, microcystic adnexal carcinoma, leiomyosarcoma, dermatofibrosarcoma protuberans, and angiosarcoma are reviewed.
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Affiliation(s)
- T F Cook
- Department of Dermatology, St Louis University Health Sciences Center, MO 63104, USA
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36
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Gibney MD, Fosko SW, Segal RJ. Traumatic tattoo from battery-operated earrings. Cutis 1998; 61:34-6. [PMID: 9466080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Traumatic tattoos result from accidental deposition of pigmented particles in the dermis. Battery-operated devices should be added to the list of situations in which traumatic tattoos may arise. In this case, an iron-containing tattoo was removed by Mohs' micrographic surgery with an acceptable cosmetic result.
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Affiliation(s)
- M D Gibney
- Department of Dermatology, Saint Louis University Health Sciences Center, Missouri, USA
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37
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Abstract
The increased number of patients with implantable cardiac devices presents a unique challenge to physicians performing office-based electrosurgical procedures. Electrosurgery can be performed safely if the electrosurgical techniques and potential risks from these devices are understood. We present an overview of the most common types of implantable cardiac devices, potential complications associated with them, and recommendations for preoperative evaluation, intraoperative monitoring, and postoperative follow-up.
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Affiliation(s)
- A T Riordan
- Department of Dermatology, St. Louis University Health Science Center, USA
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38
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Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelid and periocular tissues but rarely involves the lacrimal system. In addition, BCC in this location frequently recur due to inadequate margin control. A further understanding of the pathophysiology of periocular BCC was addressed. OBJECTIVE To report two rare cases of BCC involving the lacrimal system and to account for subtle clinical features yet extensive tissue spread of periocular BCC. METHODS Using the Mohs micrographic surgical technique, we describe two patients with a BCC involving the lacrimal system that histologically tracked beyond clinically apparent margins. RESULTS Spread of BCC along mucosal surfaces is documented. CONCLUSION Rare involvement of the lacrimal system by a BCC is reported in two patients. Superficial histologic involvement can explain the ability of BCC to extend locally and escape adequate treatment.
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Affiliation(s)
- S W Fosko
- Department of Dermatology, Saint Louis University Health Sciences Center, Missouri 63104, USA
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39
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Abstract
BACKGROUND Reconstruction of the lower third of the nose can be challenging. Maintaining the nasal subunit symmetry and providing good tissue match with regard to color, sebaceous quality, and thickness is essential. For extensive defects in this area, paramedian forehead flaps are often considered. OBJECTIVE Our purpose was to develop the technique of preparing and executing the cheek island pedicle flap, as well as to define the limitations and "pitfalls" of the flap. METHODS The cheek island pedicle flap is described. RESULTS The cheek island pedicle flap can provide excellent cosmetic results in reconstructing defects of the lower third of the nose. The flap dynamics are predictable, and anticipated complications are described. CONCLUSION The cheek island pedicle flap provides an excellent alternative to the paramedian forehead flap for reconstruction of extensive defects of the lower third of the nose.
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Affiliation(s)
- S W Fosko
- Department of Dermatology, Saint Louis University, USA
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40
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Fosko SW, Adams SR. A tissue block organizer during Mohs surgery. Dermatol Surg 1996; 22:191-2. [PMID: 8608384 DOI: 10.1111/j.1524-4725.1996.tb00508.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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41
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Fosko SW, Stecher JC. The role of home health nursing: a dermatologic case study. Dermatol Nurs 1995; 7:185-7. [PMID: 7779521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The role of home health nursing is described in managing a postoperative wound infection. An 87-year-old woman underwent Mohs' cutaneous micrographic excision of an extensive basal cell carcinoma of the nose, with immediate reconstruction using a bilobed transposition flap. Her postoperative course was notable for an extensive wound infection characterized by cellulitis and local abscess formation. Inpatient admission was averted by using extensive home health nursing resources.
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42
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Affiliation(s)
- S W Fosko
- Mohs Surgery Unit, St. Louis University Health Sciences Center, MO 63104, USA
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Fosko SW, Cuono CB, Leffell DJ. Allograft skin as an adjunct in the repair of radiation-compromised wound. Arch Dermatol 1993; 129:293-5. [PMID: 8447665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S W Fosko
- Yale University School of Medicine, New Haven, Conn
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44
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45
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Affiliation(s)
- S W Fosko
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510
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46
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Abstract
Several clinical syndromes are characterized by ectodermal dysplasia (ED) in association with clefting of the lip and/or palate. The three most commonly recognized entities are (1) the EEC syndrome (ectodermal dysplasia, ectrodactyly, cleft lip/palate); (2) the Rapp-Hodgkin syndrome with ectodermal dysplasia, cleft lip/palate, and mid facial hypoplasia; and (3) the Hay-Wells or AEC syndrome (ankyloblepharon, ectodermal defects, cleft lip/palate). The clinical characteristics of these entities as well as several less common syndromes are reviewed and summarized. The presence of scalp dermatitis in patients with the AEC syndrome and less often the Rapp-Hodgkin syndrome is emphasized.
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Affiliation(s)
- S W Fosko
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510
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