Opioid Prescribing Recommendations After Mohs Micrographic Surgery and Reconstruction: A Delphi Consensus.

Background: Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence.

Objective: To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction.

Opioid Prescribing Patterns After Micrographic Surgery: A Follow-up Retrospective Chart Review.

Background: The abuse of opioids has reached epidemic proportions in the United States, and leftover medications are a primary source for nonmedical pain relievers. A past study at the University of Utah showed that micrographic surgeons were likely overprescribing opioids, with 35% of patients receiving a postoperative prescription.

Objective: To examine the current opioid prescribing habits of the micrographic surgeons at the University of Utah compared with those in 2010.

Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split-face controlled trial.

Background And Objective: Based on reports of poor wound healing and scarring, it is currently recommended that patients wait 6 months after completion of oral isotretinoin therapy before the safe initiation of laser treatment. Our aim was to evaluate the safety of non-ablative fractional laser (NAFL) treatment for acne scars within 1 month after isotretinoin therapy.

Study Design/methods: This was a randomized split-face controlled trial involving 10 patients with acne scars who had completed isotretinoin treatment.

Mohs appropriate use criteria: retrospectively applied to nonmelanoma skin cancers at a single academic center.

Background: In September 2012, appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) were released by a collaboration of dermatology organizations including the American College of Mohs Surgery.

Objective: The group sought to determine adherence to the Mohs AUC at the academic institution.

Materials And Methods: The authors performed a retrospective chart review of all nonmelanoma skin cancers (NMSCs) treated within the University of Utah, Department of Dermatology, from January through March of 2012.

Chemoprevention of nonmelanoma skin cancer.

Chemoprevention is suitable for patients who are at high risk of development of numerous or invasive nonmelanoma skin cancers (NMSCs). Various substances have been studied as potential chemopreventive agents for NMSC. Oral retinoids have been proven to be effective in the suppression of new squamous cell carcinoma (SCC) development.

Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients.

Objective: To better understand postoperative opioid use after dermatologic surgery.

Design: Prospective observational study.

Setting: Academic dermatology department.

A randomized trial of the off-label use of imiquimod, 5%, cream with vs without tazarotene, 0.1%, gel for the treatment of lentigo maligna, followed by conservative staged excisions.

Objective: To determine if the complete response rates of lentigo maligna (LM) to imiquimod, 5%, cream can be improved by the addition of a topical retinoid.

Design: Prospective randomized study of patients treated with imiquimod alone vs imiquimod plus a topical retinoid, followed by conservative staged excisions.

Setting: Mohs surgical clinic in an academic institution.

Results of an investigator-initiated single-blind split-face comparison of photodynamic therapy and 5% imiquimod cream for the treatment of actinic keratoses.

Background: Topical photodynamic therapy (PDT) with aminolevulinic acid (ALA) and 5% imiquimod cream are effective therapies for the treatment of actinic keratoses (AKs), but no split-face studies directly comparing these treatment options are available in the literature.

Objective: To compare the efficacy and tolerability of ALA-PDT and imiquimod 5% cream for the treatment of AKs.

Results: Sixty-one patients were enrolled from the Salt Lake City Veterans Affairs Hospital; 51 completed the study and were included in the analysis.

Use of proliferation rate, p53 staining and perforating elastic fibers in distinguishing keratoacanthoma from hypertrophic lichen planus: a pilot study.

Background: Distinguishing keratoacanthoma (KA) and hypertrophic lichen planus (LP) histopathologically can be difficult, and the challenge is compounded by the tendency of KA to arise in association with hypertrophic LP.

Methods: In this pilot study, we compared 18 cases each of KA and hypertrophic LP for proliferation index (MIB-1), p53 staining and the presence of perforating elastic fibers (elastic Verhoeff-van Gieson) to determine the utility of these staining modalities in distinguishing KA from hypertrophic LP.

Results: Proliferation index in KA compared to hypertrophic LP is 88.

Topical modalities for treatment and prevention of postsurgical hypertrophic scars.

There is no universally accepted treatment regimen and no evidence-based literature to guide management of hypertrophic scars. This article summarizes the existing literature regarding topical treatments such as silicone gel sheeting and ointment, onion extract, vitamin E, pressure garment therapy, massage therapy, and topical imiquimod 5% cream in the management of hypertrophic scars.

Nonmelanoma skin cancers of the ear: correlation between subanatomic location and post-Mohs micrographic surgery defect size.

Background: Nonmelanoma skin cancer (NMSC) of the ear can result in large defects with significant morbidity.

Objective: To determine whether subanatomic location of NMSCs, based on ease of visualization of the ear, correlated with post-Mohs micrographic surgery (MMS) defect size.

Methods: A retrospective chart review of 142 post-MMS ear lesions was performed and categorized according to subanatomic location: the helix, antihelix, and tragus (Location 1); retroauricular (Location 2); and conchal bowl, scapha, and triangular fossa (Location 3).

Unsuitability of organ donation from a patient with a history of melanoma?

A 52-year-old man with a history of melanoma presented to the emergency department with a massive intracranial hemorrhage. The patient deteriorated rapidly and was being considered as a potential organ donor. Three years before presentation, the patient had undergone wide excision of a 3.

Case reports: treatment of nevirapine-associated dress syndrome with intravenous immune globulin (IVIG).

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction most commonly associated with aromatic antiepileptic agents. It is characterized by the triad of skin eruption, fever, and systemic involvement, with the latter usually manifesting as hepatitis and lymphadenopathy. Mortality is primarily due to hepatic failure and can be as high as 10%.

Treatment of toxic epidermal necrolysis with intravenous immunoglobulin in children.

Background: Toxic epidermal necrolysis (TEN) is an acute illness characterized by rapid onset of skin necrosis and high mortality. Standard treatment is primarily aimed at supportive care in a burn unit setting.

Objective: We evaluated the outcome of 8 pediatric patients treated for TEN with intravenous immunoglobulin (IVIg) over a 3-year period.