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Introduction: Filmmakers use dermatologic findings to help the audiences decipher between ‘good’ and ‘bad’ characters by portraying villains with recognizable skin findings. The objective of this study was to analyze 18 Disney live-action movies in relation to their earlier animated releases to determine whether there were changes or correlation about how the industry portrayed certain characters based on their roles as heroes or villains. Methods: To better understand how the use of dermatological findings are changing in the film industry, eighteen Disney live-action movies in relation to their earlier animated releases were compared for changes or correlation on how the industry portrays certain characters based on their roles as heroes or villains. Results: Film antagonists were depicted with significantly more dermatologic findings than protagonists (p

Background: Patients are reported to understand less than half of the information communicated to them by physicians. In an effort to better promote patient education, instructional videos have been implemented in surgical specialties, with demonstrable improvement in patient satisfaction and knowledge. In Mohs micrographic surgery (MMS), Mohs surgeons have begun to implement educational videos to supplement the traditional informed consent discussion and wound care demonstration. Objective: To review published literature to determine if video education in MMS can improve patient satisfaction and comprehension of their procedure. Methods: A review of literature was performed using the PubMed database from 2000 to 2020. The articles selected focused on the implementation of educational videos in Mohs surgery for the improvement of the informed consent process, post-surgical wound care instructions, and overall patient satisfaction and comprehension. Results: A total of seven articles met the criteria for review. The videos were noted to improve certain aspects of the informed consent discussion, including patients knowledge on the procedural risks. In regard to wound care education, some patients preferred video education to surgeon instruction. While patient comprehension was similar between the intervention and control groups, most studies demonstrated overall patient satisfaction. In addition, the results noted that most patients who watched a video would recommend it to a peer undergoing MMS. Conclusion: Educational videos have demonstrated promise for patient education in MMS and patients are receptive to learn from them.

The COVID-19 pandemic has impacted the practice of Mohs micrographic surgery (MMS). We sought to determine the characteristics of skin cancers treated by MMS during the pandemic compared with prepandemic controls. A retrospective chart review was conducted. Tumors included were all treated in accordance with best practice guidelines set forth by state- and national-level professional governing bodies. Bivariate and multivariate analyses were performed to compare outcome variables. Changes in tumor characteristics during the pandemic are of clinical significance, potentially affecting extent of reconstructive surgery, cost, operating time, and future tumor characteristics.

The use of absorbable epicuticular sutures is highlighted as a measure to decrease the number of patient visits, eliminating the risk of additional exposures for patients and medical staff during the COVID-19 pandemic. We present a case where the use of absorbable epicuticular sutures was preferred over non-absorbable sutures. Studies have shown no significant difference in cosmetic outcomes between non-absorbing suture and absorbable suture. Many patients express anxiety over the thought of suture removal, and often ask if the sutures will “dissolve on their own” during the surgery. Use of absorbable top sutures is one way surgeons can help allay this fear, and studies have shown similar patient satisfaction between absorbable and non-absorbable sutures. Additional stress may be prominent during the current pandemic. Dermatologic surgeons should strongly consider the use of absorbable cutaneous sutures during this pandemic, as this likely improves patient and staff safety, and studies have shown similar cosmetic outcomes and patient satisfaction.

Spitting sutures are a common complication of dermatologic surgery following closure of a cutaneous defect using buried sutures. This development can be distressing and uncomfortable for patients and may lead to further complications, such as surgical-site infection and abscess. Presented here is a straightforward and reliable algorithm to guide management of spitting sutures and their complications.

Reconstruction of defects involving the upper lip can be challenging. The purpose of this review was to analyze the anatomy and function of the upper lip and provide an approach for reconstruction of upper lip defects. The primary role of the upper lip is coverage of dentition and animation, whereas the lower lip is critical for oral competence, speech, and eating. The orbicularis oris (OO) and several other muscles contribute to upper lip function. There are various insertion points for animation muscles, including the upper lip dermis, OO, and modiolus. Special attention should be paid to the philtrum, Cupid's bow, and vermilion border during reconstruction. Advantages and disadvantages of the Abbe, Estlander, and Karapandzic flaps are presented. Knowledge of mechanics, indications, and properties of local flaps while considering unique characteristics of upper lip anatomy and function are crucial for optimal aesthetic and functional outcomes.

The fields of dermatology and psychiatry have overlap in the patient populations and diseases they treat. However, there are not currently fellowship opportunities for dermatologists or psychiatrists specifically interested in gaining expertise in psychodermatology. We discuss the logistics of a one-year psychodermatology fellowship, open to residents after completing either dermatology or psychiatry residencies, and the potential benefits that it could bring to both dermatology and psychiatry training programs across the county.

Many women report improvement in psoriasis during pregnancy; others report that psoriasis becomes worse during pregnancy. Balancing effective management of psoriasis against potential risk in pregnancy is important, especially because the severity of psoriasis can have an impact on the pregnancy experience and possibly the outcome. This article discusses current understanding of pregnancy risk profiles of medications used to treat psoriasis.

Herpes simplex and basal cell carcinoma (BCC) can have similar clinical presentations due to overlapping lesional morphology. We describe the unusual case of a BCC masquerading as herpes labialis due to a possible false-positive Tzanck smear. The confounding diagnosis led to a failed trial of valacyclovir and subsequent loss of the patient for 1 year before the lesion was biopsied and diagnosed as a BCC. This case report highlights the importance of careful inspection of herpetic lesions and that further investigation should be pursued if the etiology is uncertain or if the treatment is not yielding the expected results.

Common challenges associated with split-thickness skin graft (STSG) donor site wounds include slow healing times and poor scar cosmesis. The technique described here improves these shortcomings by utilizing a Weck knife with adjustable thickness controls to harvest STSGs from the scalp.

Dermatology is a specialty with fewer residency positions each year than total applicants, leading to increased competition in the match. Applicants tend to have substantial research experience and high national board scores. This study sought to explore whether there is a difference in the percentage of graduates matching into dermatology residencies based on the rank of the medical school. Publicly available match lists from highly ranked medical schools were compared to match lists from other allopathic schools to determine the proportion of graduates matching into dermatology. The data was analyzed using a chi square test and a significant difference was found between the percentage of students matching into dermatology from top schools (5.19%) compared to control schools (1.92%), (P0.0001).

Julie A Croley,1 C Helen Malone,1 Brandon P Goodwin,1 Linda G Phillips,2 Eric L Cole,2 Richard F Wagner1 1Department of Dermatology, 2Division of Plastic Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA Background: Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents’ ability to plan surgical reconstructions.Materials and methods: The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale.Results: Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50–2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00–3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25–0.50 Likert scale points among all residents participating in the educational activity and 0.50–1.00 Likert scale points in the dermatology resident subset. All residents participating in the educational activity somewhat or completely agreed with the statement, “I am faster at planning reconstructions after my Mohs rotation.” In addition, 88% of participants “somewhat or completely agreed” that the exercise was a good educational experience.Conclusion: The Mohs Surgical Reconstruction Educational Activity is a valuable novel tool for learning reconstructive planning that is easy to incorporate into existing dermatology residency curricula, inexpensive, and utilizes active learning. Keywords: flaps, grafts, resident education, dermatologic surgery, Mohs surgery

Dermatology is a specialty with fewer residency positions each year than total applicants, leading to increased competition in the match. Applicants tend to have substantial research experience and high national board scores. This study sought to explore whether there is a difference in the percentage of graduates matching into dermatology residencies based on the rank of the medical school. Publicly available match lists from highly ranked medical schools were compared to match lists from other allopathic schools to determine the proportion of graduates matching into dermatology. The data was analyzed using a chi square test and a significant difference was found between the percentage of students matching into dermatology from top schools (5.19%) compared to control schools (1.92%), (P

Deepithelialized flaps and grafts have been widely used by reconstructive surgeons in a diverse array of surgical specialties and have more recently made an appearance in dermatologic surgery. These techniques may be advantageous in their enabling of contour preservation of deep defects, reconstructions in areas of high mechanical tension, single-stage repairs, auricle reconstruction requiring tissue transfer, and reconstruction requiring free margins in areas with a paucity of local soft tissue. This article provides a review of the literature on deepithelialized flaps and grafts. We also highlight the use of these techniques in the field of dermatology and encourage appropriate application of deepithelialized flaps and grafts in dermatologic surgery.

Dermatologic depictions in film are often used to symbolize evil. To ascertain whether certain dermatologic characteristics are more representative of evil in movies, skin findings in film characters before and after evil transformation were compared using the Good Movie Characters Turned Bad poll courtesy of The Internet Movie Database (IMDb). The poll ranked the 35 most remarkable moral transformations in cinema. Data was analyzed from 27 characters who met study criteria and there was a statistically significant, greater number of dermatologic features seen in characters after an evil transformation. Periorbital hyperpigmentation, infraorbital edema, alopecia, pallor, and nonspecific hyperpigmented skin abnormalities (telangiectasias, ecchymosis) were dermatologic traits that were found at a statistically significantly higher frequency post-evil transformation. This work suggests an effort should be made to educate audiences and film makers that skin conditions in reality are not a marker of evil intent.

A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection.