A Post-COVID Population-Based Analysis of Mohs Micrographic Surgeon Distribution in the United States.

Background: Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States.

Objective: To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility.

Methods And Materials: Medicare claims data were utilized to identify micrographic surgery providers.

Narcotic Use for Acute Postoperative Pain Management in Mohs Micrographic Surgery Patients With End Stage Renal Disease: A Review of the Literature.

Background: Uncontrolled acute postoperative pain presents a significant management challenge when opioids are used in patients with end-stage renal disease (ESRD). Currently, there is a lack of quality pharmacokinetic and pharmacodynamic data regarding opioid medication use in ESRD patients to optimize safe and effective management.

Objective: To review the published literature on pharmacologic evidence for and against the use of opioid medications for acute postoperative pain following Mohs micrographic surgery in ESRD patients.

Canthal Rotation Flap: Analysis of Flap Mechanics.

Background: Surgical defects of the medial canthus lack reconstructive options that are reproducible, precise, and uncomplicated. The canthal rotation flap is a simple rotation flap that respects the geometry of this anatomic location.

Objective: To describe the authors' experience with reconstructive planning, flap mechanics, and geometric analysis of the medial canthus to achieve the best cosmetic outcome when using the canthal rotation flap.

Two Suturing Techniques for the Prevention and Treatment of Nasal Valve Collapse After Mohs Micrographic Surgery.

Background: Tumor extirpation of nonmelanoma skin cancer (NMSC) adjacent to the alar groove, using Mohs micrographic surgery (MMS), may risk causing internal nasal valve (INV) collapse, resulting in reduced airflow during inspiration. There are many surgical options described in the literature to repair INV collapse as a postoperative corrective procedure, but few exist as an intra-operative preventative procedure.

Objective: The authors present 2 distinct methods to prevent and treat INV collapse during the repair of a perialar surgical defect caused by MMS.

The use of botulinum toxin in the treatment of a parotid duct injury during Mohs surgery and review of management options.

Background: Aggressive skin cancers on the cheeks may involve the parotid duct. For such tumors to be successfully removed, at least part of the parotid duct must be excised as well. Failure to properly address parotid duct injuries that result from Mohs micrographic surgery exposes the patient to a variety of adverse sequelae.

A better technique for taking Mohs sections involving cartilage.

Background: When excising Mohs layers involving skin and cartilage in the conventional manner, it can be difficult to flatten the entire margin onto a single plane because of the inelasticity of the cartilage. This is undesirable, because it prevents a complete examination of the surgical margin.

Objective: We describe a modified technique for excising cartilaginous specimens that allows the entire margin of the specimen to be more easily flattened onto a single plane, so that a complete examination of the surgical margin can be performed.

Repair of a glabellar and inferior forehead defect.

This 44-year-old healthy white male was referred to our office for the treatment of a recurrent basal cell carcinoma clinically involving the left inferior forehead extending down to the left glabellar region of the face. The preoperative size of the tumor was 1.5 x 1.