Identifying critical quality metrics in Mohs Surgery: A national expert consensus process.

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.

Clinical spectrum of atypical fibroxanthoma and undifferentiated pleomorphic sarcoma in solid organ transplant recipients: a collective experience.

Background: Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are uncommon, spindle cell cutaneous malignancies. Solid organ transplant recipients (SOTRs) are immunosuppressed and therefore have a higher incidence of cutaneous malignancies.

Objective: We describe the clinical spectrum of AFX and a more-aggressive, deeper variant, UPS, in SOTRs.

The public's perception of dermatologists as surgeons.

Background: Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons.

Objective: Our study was designed to assess the public's perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physician's specialty biases people when they assess the cosmetic appearance of a surgical scar.

Non-surgical treatments of primary, non-melanoma eyelid malignancies: a review.

The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing.

Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

Objective: To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes.

Design: We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control.

Setting: University of Connecticut dermatology clinic, a tertiary care referral center.

Northwest simulation center-sharpens clinical and communication skills for individuals and teams.

Many authorities have suggested that some variant of team training is likely to reduce human error in operating rooms, Emergency Departments, resuscitation teams and other settings within health care-where human interaction is common, and where breakdowns in communication and teamwork can have critical consequences. The Kaiser Sunnyside Medical Center Regional Simulation Center achieves this end. In particular, simulation prepares people for error-prone, high-risk, or unusual situations.

The impact of total body photography on biopsy rate in patients from a pigmented lesion clinic.

Background: Total body cutaneous photography is increasingly being used by dermatologists to monitor patients at risk for the development of melanoma, but limited evidence exists regarding the impact of such photography on melanoma and melanoma-related outcomes.

Objective: We sought to compare biopsy number in patients with multiple atypical nevi in their first year of care at our pigmented lesion clinic (PLC) between those who received total body skin examination alone and those who received total body skin examination and total body digital photography (TBDP). We sought to identify predictors of biopsy number and number of dysplastic nevi diagnosed in patients with multiple atypical nevi.

Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.

Background: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers
Objective: The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy.

Myofibrosarcoma treated with Mohs micrographic surgery.

Background: Myofibrosarcoma is a rare malignant mesenchymal tumor composed predominantly of differentiated myofibroblasts. These tumors occur in both children and adults alike and are most commonly located on the head and neck. Recurrences rates range from 44% to 75%, and metastatic disease has been reported in up to 44% of cases.

Morpheaform basal cell carcinoma in African Americans.

Background: Although it has been established that basal cell carcinoma is an uncommon diagnosis in black patients, the morpheaform subtype is very rare among these individuals.

Objective: The objective is to present two cases of morpheaform basal cell carcinoma in African-American patients.

Methods: This is a case series and a literature review using the Ovid Medline Database.

Keloids demonstrate high-level epidermal expression of vascular endothelial growth factor.

Background: Keloids are a major cause of morbidity, and arise after operation, injury, or cutaneous infection. Clinically, keloids differ from hypertrophic scars in that they grow beyond the original borders of the injury. Keloids occur most commonly for patients of African and Asian descent, and treatment options are multiple, indicating that there is no entirely satisfactory treatment for keloids.

Multiple, clustered dermatofibroma: a rare clinical variant of dermatofibroma.

Background: Although patients with one to two dermatofibromas are common, cases of "multiple" dermatofibromas (more than 15 lesions) are rare and may occur in the context of altered or normal immune function. Patients with multiple dermatofibromas clustered in one anatomic area, by contrast, are strikingly rare.

Objective: The aim of our study was to present an additional case of multiple, clustered dermatofibroma (MCDF) and to summarize the literature concerning this entity.

Acral lentiginous melanoma mimicking benign disease: the Emory experience.

Background: Plantar and subungual melanoma exhibits a higher misdiagnosis rate relative to other anatomic sites. Misdiagnosis and delay in diagnosis are statistically associated with poorer patient outcome. Awareness of atypical presentations of acral melanoma may, thus, be important to decrease misdiagnosis rates and improve patient outcome.