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Background. Vertical mattress sutures are used in skin surgery to produce eversion of the wound edges, which produces a better, cosmetically acceptable scar. The disadvantages of this closure include the risk of wound hypereversion if tied too tightly, longer time to perform the stitch, and difficulties with grasping the externalized loops during suture removal. Objective. To examine and discuss the new modification of running vertical mattress sutures, which can overcome the disadvantages. Methods. Running combined simple and vertical mattress suture techniques are presented in a series of schematic diagrams that follow. Results. The running combined simple and vertical mattress is easier and quicker to close the wound than the classic interrupted or running vertical mattress suture. Whereas the mattress suture everts the wound edges, the simple suture coapts the sides, preventing undue inversion or hypereversion of the wound. Suture removal is less uncomfortable for the patient and is performed faster by the medical staff owing to a reduction in the number of externalized loops by half compared with the classic vertical mattress stitch. Conclusion. Alternation of the vertical mattress and simple running suture saves the surgeon's time without lessening the advantages of good wound eversion and hence the formation of a less apparent, cosmetically more appealing scar after wound contraction.

BACKGROUND Histopathologic differentiation between benign and malignant tissue is of utmost importance for the Mohs surgeon. Folliculocentric basaloid proliferation (FBP) shares many histologic features with basal cell carcinoma (BCC). It is most commonly associated with tumors of areas with abundant hair follicles such as nasal and perinasal skin. Residual BCC incorrectly identified as a horizontally sectioned hair follicle undoubtedly increases the risk of tumor recurrence. Excision of additional layers of normal tissue to remove “funny looking follicles” may have profound impacts on tissue conservation, preservation of function, and cosmesis. Electron microscope studies of BCC revealed a significant reduction of desmosomes compared with normal basal cells and hair follicle keratinocytes. OBJECTIVE This study has assessed the potential of rapid staining with monoclonal antidesmoglein antibody (33-3D) to discriminate between BCC, horizontally sectioned hair follicles, and FBP. METHODS A rapid immunoperoxidase technique with 33-3D antidesmoglein antibody was performed on Mohs frozen sections. We selected 18 patients with BCC of nasal and perinasal locations where histologic discrimination between residual tumor and tumor-free margins with FBP or horizontally sectioned hair follicle was equivocal. RESULTS Fourteen sections disclosed the preservation of desmoglein marker delineating the cell membranes (“perimembranous” pattern) consistent with normal hair follicles. The sections were identified as tumor-free and no additional stages were performed. The remaining four sections revealed absent perimembranous pattern but presence of diffuse cytoplasmic staining. These were diagnosed as positive for residual BCC requiring the excision of another layer of tissue to obtain tumor-free margins. A follow-up period ranging from 6 to 24 months revealed no instance of recurrent disease. CONCLUSION Rapid detection of desmoglein with 33-3D antibody is a promising tool for discrimination between residual BCC and FBP or horizontally sectioned hair follicles. It may enhance the sensitivity of Mohs surgery by disclosing the hidden foci of BCC, thus preventing tumor recurrence and unnecessary excision of normal tissue.

Primary cutaneous adenoid cystic carcinoma is a rare skin neoplasm with a high potential for recurrence after local excision. We present a case of a 45-year-old white female with recurrent primary cutaneous adenoid cystic carcinoma of the scalp. The tumor was resected with Mohs surgery in two stages and defect repaired with split-thickness skin graft. There has been no recurrence of the tumor in the 12-month follow-up period.