Search

BACKGROUND Lidocaine is often used in conjunction with epinephrine and sodium bicarbonate for local anesthesia. Compounding lidocaine as needed can be highly disruptive to clinic flow, which has led many dermatology clinics to prefill syringes with these solutions, but current regulations recommend the disposal of these preparations within 12 hours, creating medical waste. OBJECTIVE To evaluate the safety of buffered lidocaine with and without epinephrine drawn from multiuse vials and stored for up to 4 weeks. METHODS Syringes were filled with lidocaine 1%, lidocaine 1% with 1:100,000 epinephrine, lidocaine 1% with bicarbonate (10:1 ratio), or lidocaine 1% with 1:100,000 epinephrine with bicarbonate (10:1 ratio). The samples were stored for 4 weeks either at controlled room or controlled cold temperature. They were then centrifuged and cultured for anaerobic bacteria, aerobic bacteria, and fungus. RESULTS Prefilled lidocaine syringes are not subject to bacterial or fungal growth after being stored for 4 weeks. CONCLUSION Prefilled syringes of lidocaine remain safe to use for up to 4 weeks, and the current regulations placed on the disposal of these solutions should be revisited. [ABSTRACT FROM AUTHOR]

Background Perineural invasion ( PNI) is an important histologic finding and may be a negative prognostic factor for squamous cell carcinoma ( SCC). It may be associated with more-aggressive tumor behavior. Mohs surgeons encounter microscopic PNI regularly and must be able to diagnose it accurately to guide care decisions. Objective To describe benign histologic mimickers of PNI and neural structures in SCC commonly encountered on frozen, hematoxylin and eosin-stained sections and to review how to differentiate them from PNI. Methods and Materials Review of the literature regarding histologic mimickers of PNI and additional contributions to frozen section PNI and nerve tissue mimickers. Results We describe benign findings, including arrector pili muscles, eccrine muscles, vessels, granulomatous inflammation, and eddies of SCC, that may each be mistaken for nerves or PNI. We discuss the ways in which they may be distinguished on frozen sections and review other commonly encountered entities that resemble PNI. Conclusion Perineural inflammation and peritumoral fibrosis are common mimickers of PNI on frozen section, although other mimickers exist on permanent sections. Normal structures may appear 'neural' by way of frozen tissue orientation, processing, or inflammation and thus must be differentiated from nerve tissue and PNI during Mohs surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND Squamous cell carcinoma in situ (SCCIS) is thought to be a precursor to squamous cell carcinoma. It should be treated before invasive cancer develops, especially in transplant recipients, who may develop more aggressive skin cancers. Treatment can involve surgical and nonsurgical methods. OBJECTIVE To review the evidence available in the English medical literature for different treatment options of SCCIS on nongenital skin and evaluate the efficacy of each option. METHODS AND MATERIALS A Pubmed search of articles describing the treatment of SCCIS was conducted. Keywords were 'treatment,' 'Bowen's disease,' and 'squamous cell carcinoma in situ.' Articles describing the use of surgical excision, curettage and electrodesiccation, cryotherapy, 5-fluorouracil, imiquimod, radiation, photodynamic therapy, lasers, and rarer methods were reviewed. RESULTS No single treatment can be said to be superior for any one situation. Most studies are small, limiting the power of each. Further studies are needed to clarify optimal treatment protocols for nonsurgical methods such as cryotherapy, photodynamic therapy, and topical chemotherapy. CONCLUSION There are many methods available to treat SCCIS. Physicians should consider each patient's situation while keeping in mind that treatment protocols have not been fully defined for most options. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

The article presents a case study of 12 patients aging 44 to 83 years who were presented for Mohs micrographic surgery due to basal and squamous cell carcinoma. The surgery that was conducted to the patients used full-thickness skin grafts (FTSGs) secured with 2-octylcyanocrylate and adhesive strips. The study shows the advantages of using 2-octylcyanoacrylate in Mohs micrographic surgery.

The article offers information on the effect on not using tie-over bolster dressings after full-thickness skin grafts (FTSGs). It mentions that the study was conducted by performing FTSGs with bolsters using tie-over sutures and FTSGs without bolsters using peripheral sutures. It says that the FTSGs without the use of bolsters have no noticeable effect on the graft success and it decreases trauma to the surrounding tissue.

The article discusses the development of reusable model using commonly available materials to teach invasive procedures to trainees and increase their skill level. Cadavers can be used but are not reusable and readily accessible for repeated practice. The article highlights the technique used to create the different parts of the model. Nail disorders requiring surgical intervention are presented to dermatology clinics and the new models aims to provide practice material to the dermatologists.

A letter to the editor is presented about the use of zinc oxide paste as postoperative sunscreen to scars.