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Nugent ST, Lukowiak TM, Cheng B, Stull C, Miller CJ, Aizman L, Perz AM, Etzkorn J, Sobanko JF, Shin TM, Giordano CN, Lukens JN, Miura JT, Modi MB, Higgins HW. High compliance with National Comprehensive Cancer Network guidelines and no local recurrences for patients receiving Mohs micrographic surgery for Merkel cell carcinoma: A single-center retrospective case series. J Am Acad Dermatol 2023; 88:920-922. [PMID: 36336150 DOI: 10.1016/j.jaad.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/06/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shannon T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tess M Lukowiak
- Department of Dermatology, Rutgers Robert Wood Johnson, Somerset New Jersey.
| | - Brian Cheng
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Carolyn Stull
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leora Aizman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison M Perz
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jeremy Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Nicholas Lukens
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John T Miura
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitul B Modi
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Veerabagu SA, Perz AM, Lukowiak TM, Lee MP, Neal D, Aizman L, Miller CJ, Golda N, Albertini JG, Chen D, Bar A, Leitenberger J, Maher IA, Sobanko JF, Hollmig T, Aasi S, Sutton A, Higgins Ii HW, Shin TM, Weinberger C, Mattox A, Wysong A, Nugent ST, Etzkorn JR. Patient-Reported Nasal Function and Appearance After Interpolation Flap Repair Following Skin Cancer Resection: A Multicenter Prospective Cohort Study. Facial Plast Surg Aesthet Med 2023; 25:113-118. [PMID: 35950993 DOI: 10.1089/fpsam.2021.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Among patients undergoing two-stage interpolated flap repair of nasal defects, nasal function, and appearance before surgery and at 16 weeks after flap takedown were compared using the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ). Design: Multicenter prospective cohort study. Methods: Adult patients with a nasal skin cancer anticipated to require two-stage interpolation flap repair completed the NAFEQ before surgery, at 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Results: One hundred sixty-nine patients were enrolled, with 138 patients completing both presurgical and 16-week post-takedown NAFEQs. Overall NAFEQ score increased by 1.09 points (1.91% improvement, confidence interval [95% CI -0.34 to 2.53]). NAFEQ functional subscale increased by 0.72 points (2.58% increase; 95% CI [0.10-1.35]) and appearance subscale increased by 0.37 points (1.28% improvement, 95% CI [-0.65 to 1.39]). Conclusion: At 16 weeks after flap takedown, patients' perceptions of their nasal function and appearance are similar to or slightly improved when compared with their presurgical assessments.
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Affiliation(s)
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael P Lee
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Donald Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia, Missouri, USA
| | | | - David Chen
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Justin Leitenberger
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler Hollmig
- Division of Dermatology, University of Texas Dell Medical Center, Austin, Texas, USA
| | - Sumaira Aasi
- Department of Dermatology, Stanford University, Stanford, California, USA
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - H William Higgins Ii
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Weinberger
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shannon T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lukowiak TM, Perz AM, Veerabagu SA, Lee MP, Neal D, Aizman L, Miller CJ, Golda N, Albertini JG, Holmes T, Bar A, Leitenberger J, Maher IA, Sobanko JF, Chen D, Aasi S, Sutton A, Higgins HW, Shin TM, Weinberger C, Mattox A, Wysong A, Etzkorn JR. Patient Quality of Life After Interpolated Flap Repair of Nasal Mohs Surgery Defects: A Multicenter Prospective Cohort Study. JAMA Dermatol 2021; 157:1213-1216. [PMID: 34431977 DOI: 10.1001/jamadermatol.2021.3161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Single-center studies have shown that patients report better skin cancer-specific quality of life (QOL) after Mohs micrographic surgery (MMS), but it is unclear whether this improved QOL applies to patients after MMS and complex reconstruction in cosmetically sensitive areas. Objective To evaluate patient QOL after MMS and interpolation flap reconstruction for patients with nasal skin cancers. Design, Setting and Participants This multicenter prospective survey study used the Skin Cancer Index (SCI), a validated, 15-question QOL questionnaire administered at 4 time points: before MMS, 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Patients age 18 years or older with a nasal skin cancer who presented for MMS and were anticipated to undergo 2-stage interpolated flap repair by a Mohs surgeon were recruited from August 9, 2018, to February 2, 2020, at 8 outpatient MMS locations across the United States, including both academic centers and private practices. Main Outcomes and Measures Mean difference in overall SCI score before MMS vs 16 weeks after flap takedown. Results A total of 169 patients (92 men [54.4%]; mean [SD] age, 67.7 [11.4] years) were enrolled, with 147 patients (75 men [51.0%]; mean [SD] age, 67.8 [11.7] years) completing SCI surveys both before MMS and 16 weeks after flap takedown. Total SCI scores improved significantly 16 weeks after flap takedown compared with pre-MMS scores, increasing by a mean of 13% (increase of 7.11 points; 95% CI, 5.48-8.76; P < .001). All 3 SCI subscale scores (emotion, appearance, and social) improved significantly (emotion subscale, increase of 3.27 points; 95% CI, 2.35-4.18; P < .001; appearance subscale, increase of 1.65 points; 95% CI, 1.12-2.18; P < .001; and social subscale, increase of 2.10 points; 95% CI, 1.55-2.84; P < .001) 16 weeks after flap takedown compared with pre-MMS. Conclusions and Relevance Removal of a nasal skin cancer and repair of the resulting defect can be distressing for patients. However, this cohort study suggests that physicians referring patients for MMS can be reassured that their patient's QOL will improve on average after surgery, even when a complex reconstruction is required.
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Affiliation(s)
- Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | | | | | - Donald Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia
| | | | - Todd Holmes
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - David Chen
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Sumaira Aasi
- Department of Dermatology, Stanford University, Stanford, California
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | | | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia.,Associate Editor, JAMA Dermatology
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Aizman L, Barbieri JS, Feit EM, Lukowiak TM, Perz AM, Shin TM, Miller CJ, Golda N, Leitenberger JJ, Carr DR, Nijhawan RI, Hasan A, Eisen DB, Etzkorn JR. Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment. Dermatol Surg 2021; 47:1214-1219. [PMID: 34081047 DOI: 10.1097/dss.0000000000003113] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood. OBJECTIVE To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions. MATERIALS AND METHODS Multi-center, prospective discrete choice experiment (DCE). RESULTS Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics. CONCLUSION Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.
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Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - John S Barbieri
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elea M Feit
- LeBow College of Business, Drexel University, Philadelphia, Pennsylvania
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
| | - Justin J Leitenberger
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - David R Carr
- Division of Dermatology, the Ohio State University Medical Center, Columbus, Ohio
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aliza Hasan
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Daniel B Eisen
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Aizman L, Perz AM, Lukowiak TM, Sobanko JF, Miller CJ, Etzkorn JR. Reverse Dorsal Metacarpal Artery Flaps to Repair Distal Hand and Dorsal Finger Defects After Mohs Micrographic Surgery. Dermatol Surg 2021; 47:1130-1132. [PMID: 33941730 DOI: 10.1097/dss.0000000000002970] [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: 11/25/2022]
Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Lukowiak TM, Aizman L, Perz A, Miller CJ, Sobanko JF, Shin TM, Giordano CN, Higgins HW, Etzkorn JR. Association of Age, Sex, Race, and Geographic Region With Variation of the Ratio of Basal Cell to Cutaneous Squamous Cell Carcinomas in the United States. JAMA Dermatol 2021; 156:1192-1198. [PMID: 32845319 DOI: 10.1001/jamadermatol.2020.2571] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Defining which populations are affected by basal cell carcinoma (BCC) vs cutaneous squamous cell carcinoma (cSCC) may inform targeted public health strategies. Incidence of BCC and cSCC is not reported to national cancer registries, but claims data for the treatment of BCC and cSCC provide insights into the epidemiology of keratinocyte carcinoma. Objective To define differences in the ratio of BCC to cSCC in adults (age, ≥18 years) in a large database of patients with commercial insurance and Medicare Advantage coverage. Design, Setting, and Participants This cross-sectional analysis used deidentified data derived from the Optum Clinformatics Data Mart to perform a retrospective evaluation of a large commercially insured cohort based on treatment claims from January 1, 2012, to December 31, 2016. Patients with a diagnosed and treated BCC or cSCC as determined by codes from the International Classification of Diseases, Ninth Revision, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology were included. Data were analyzed from November 30, 2019, to March 20, 2020. Exposure Diagnosis and treatment of BCC or cSCC. Main Outcomes and Measures The ratio of BCC to cSCC based on age, sex, race, and geographic location. Multivariable logistic regression was used to assess how demographics were associated with the odds of a treated keratinocyte carcinoma being a BCC. Results Among the 985 317 claims for patients included in the analysis (61.59% for men; mean [SD] age, 69.82 [12.58] years), BCCs were 1.69 (95% CI, 1.6899-1.6901) times more likely than cSCCs to be treated in the United States from 2012 to 2016. Basal cell carcinomas were significantly more prevalent than cSCCs in younger patients (18-39 years, 9.63 [95% CI, 9.6088-9.6574] BCCs per cSCC; 40-64 years, 2.92 [95% CI, 2.9171-2.9187] BCCs per cSCC; and ≥65 years, 1.33 [95% CI, 1.3289-1.3291] BCCs per cSCC; P < .001). Basal cell carcinomas were significantly more prevalent than cSCCs in women vs men, except in adults 65 years or older (odds ratios [ORs], 0.98 [95% CI, 0.97-0.99] vs 1.67 [95% CI, 1.47-1.88] for those aged 18-39 and 1.15 [95% CI, 1.12-1.19] for those aged 40-64 years; P < .001). The difference in BCC:cSCC ratios between men and women diminished with increasing age (OR, 1.67 for 18-39 years, 1.15 for 40-64 years, and 0.98 for 65 years or older). Basal cell carcinoma was more prevalent than cSCC in all races, including Black patients (BCC:SCC ratios, 1.60 for Asian patients, 1.45 for Black patients, 2.00 for Hispanic patients, and 1.69 for White patients of all ages). The BCC:cSCC ratio varied based on geography, with the highest ratio in the West North Central census division (2.12) and the lowest ratio in the South Atlantic census division (1.35). Conclusions and Relevance In the absence of a national registry, claims data can improve our understanding of the epidemiology of keratinocyte carcinomas. In this cross-sectional study, basal cell carcinomas were more common than cSCCs for all demographics, including in Black patients. In populations younger than 40 years, BCCs were 12.6 times more likely for women and 7.2 times more likely for men. These demographic groups may benefit from public health education focused on the presentation and management of BCCs.
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Affiliation(s)
- Tess M Lukowiak
- Currently a medical student at Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Leora Aizman
- currently a medical student at George Washington School of Medicine and Health Sciences, Washington, DC
| | - Allison Perz
- currently a medical student at Cooper Medical School of Rowan University, Washington, DC
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
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7
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Aizman L, Miller CJ, Perz AM, Lukowiak TM, Cohen OG, Bean E, Hitchner MK, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, Cohen JV, Miura JT, Sobanko JF. Low recurrence rates for challenging squamous cell carcinomas using Mohs micrographic surgery with AE1/AE3 cytokeratin immunostaining. J Am Acad Dermatol 2021; 84:1453-1455. [PMID: 32622892 DOI: 10.1016/j.jaad.2020.06.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Olivia G Cohen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eric Bean
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michaela K Hitchner
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Justine V Cohen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John T Miura
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
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8
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Aizman L, Damavandy AA, Snider CK, Lukowiak TM, Perz AM, Etzkorn JR, Beer J, Shin TM, Sobanko JF, Giordano CN, Higgins HW, Fischer J, Brody RM, Rogers H, Miller CJ. Incidence of and risk factors for neighboring synchronous skin cancers during Mohs micrographic surgery: A prospective cohort study. J Am Acad Dermatol 2021; 86:1112-1114. [PMID: 33852924 DOI: 10.1016/j.jaad.2021.03.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, District of Columbia
| | | | - Christopher K Snider
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Beer
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Fischer
- Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert M Brody
- Department of Otorhinolaryngology - Head & Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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9
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Bhatt MD, Perz AM, Moioli E, Sobanko JF, Shin TM, Etzkorn JR, Elenitsas R, Chu EY, Higgins HW, Giordano CN, McMurray S, Krausz A, Aizman L, Lukowiak TM, Miller CJ. The accuracy of detecting melanoma on frozen section melanoma antigen recognized by T cells 1 (MART-1) stains and on permanent sections of previously frozen tissue: A prospective cohort study. J Am Acad Dermatol 2021; 84:1764-1766. [PMID: 33453343 DOI: 10.1016/j.jaad.2020.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Mehul D Bhatt
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Eduardo Moioli
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold W Higgins
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy McMurray
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
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10
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Lukowiak TM, Perz AM, Aizman L, Kovell RC, Kovach S, Fischer JP, Krausz A, Giordano C, Higgins HW, Shin TM, Sobanko JF, Etzkorn JR, McMurray S, Chelluri R, Guzzo T, Miller CJ. Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes. J Am Acad Dermatol 2020; 84:1030-1036. [PMID: 33279645 DOI: 10.1016/j.jaad.2020.11.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/18/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Local recurrence rates (LRRs) after Mohs micrographic surgery (MMS) for male genital cancers have been reported in only a few small case series, and patient-reported outcomes (PROs) have not been studied. OBJECTIVE To determine the LRR and PROs after MMS for male genital skin cancers. METHODS Retrospective review of all male genital skin cancers removed with MMS between 2008 and 2019 at an academic center. LRR was determined by chart review and phone calls. PROs were assessed by survey. RESULTS A total of 119 skin cancers in 108 patients were removed with MMS. Tumors were located on the penis (90/119) and scrotum (29/119). Diagnoses included squamous cell carcinoma in situ (n = 71), invasive squamous cell carcinoma (n = 32), extramammary Paget disease (n = 13), melanoma (n = 2), and basal cell carcinoma (n = 1). The LRR was 0.84% (1/119), with a mean follow-up time of 3.25 years (median, 2.36 years). The majority of survey respondents reported no changes in urinary (66%) or sexual functioning (57.5%) after surgery. LIMITATIONS Retrospective single-center experience; short follow-up time; low survey response rate; no baseline functional data. CONCLUSION MMS for male genital skin cancer has a low LRR and high patient-reported satisfaction with urinary and sexual function.
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Affiliation(s)
- Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Leora Aizman
- George Washington School of Medicine and Health Sciences, Washington, DC
| | - Robert Caleb Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Stephen Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raju Chelluri
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thomas Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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