Considerations for Management of Longitudinal Melanonychia During the COVID-19 Pandemic: An International Perspective

To the editor: 34 Longitudinal melanonychia (LM) is the presenting sign of nail unit melanoma (NUM) in 2/3 35 of cases and is therefore among the most important conditions managed by dermatologists. In 36 normal times, referral for LM would prompt an expedited appointment for clinical 37 examination and dermoscopy.1 However, due to SARS-CoV-2, dermatologists have been 38 asked to reconsider “urgent/emergency” conditions. The COVID-19 pandemic has propelled 39 physicians to unexpectedly adopt telemedicine without adequate guidance for managing LM 40 patients

Commentary: how much is too much? Tourniquets and digital ischemia

Comment on: Effects of digital tourniquet ischemia: a single center study. [Dermatol Surg. 2013

Escharotic and other botanical agents for the treatment of skin cancer: a review

A growing era of alternative medicine is upon us. All who practice medicine have a small population of patients who eschew Western medicine and prefer alternative approaches, including botanical remedies, to treat their medical problems. Many alternative practitioners advertise and sell products on the Internet. Indeed, this trend now includes a growing number of topical treatments for skin cancer, including escharotic agents. Self-treatment of skin cancer requires a substance that will destroy tissue, usually indiscriminately. Escharotic agents are caustic, corrosive substances that produce a thick coagulated crust (an eschar) and subsequently a scar. The following case illustrates one representative situation

Surgical pearl: The use of endarterectomy scissors in dermatologic surgery

Surgical scissors are a necessary component of the surgical tray. It is optimal to maintain one plane of cutting or dissection when excising a lesion or undermining tissue. This is particularly important when removing a melanoma, large lesion, or Mohs micrographic surgery layer. Traditionally iris, gradle, and Stevens tenotomy scissors have been the preferred instruments for cutaneous surgery in small shallow areas. These instruments accommodate more delicate anatomic areas well. Many dermatologic surgeons use Metzenbaum or Mayo scissors when undermining larger, deeper defects and cutting thicker, more resilient skin (such as that on the scalp, back, or extremities). These scissors have a longer shank and tips than the aforementioned instruments and are more efficient in cutting and manipulating deeper tissue and larger lesions. In certain situations, however, their long tips may feel clumsy and provide less precise cutting and undermining. When used to cut the subcutaneous tissue, these scissors tend to catch a nodule of fat deep in the defect instead of maintaining a level, even cutting surface through the fat

Advancement flap for the reconstruction of nasal ala and lateral nasal tip defects

Repair of nasal ala and lateral nasal tip defects provide unique reconstructive challenges. This article describes a one-staged advancement flap for repair of such defects. The flap may be medially-based, laterally-based, or bilaterally-based. Sharp undermining is recommended, and a standing cone must be removed superior to the defect, perpendicular to the alar rim. Temporary alar rim flattening is accepted, and normalizes with time. This reconstruction has provided excellent functional and cosmetic results for defects measuring tip

A Retrospective Study of Nail Squamous Cell Carcinoma at 2 Institutions

BACKGROUND: Squamous cell carcinoma (SCC) of the nail is infrequently reported in the medical literature and its causes are poorly understood. Studies have shown strong associations with immunosuppression, tobacco use, toxin/radiation exposure, and trauma. Common treatments include Mohs surgery and digital amputation. OBJECTIVE: Review a series of nail SCCs treated at 2 institutions. Outcomes evaluated included rates of recurrence and disease progression/metastasis after treatment. MATERIALS AND METHODS: A retrospective review of patients treated between 2005 and 2008. Medical record review and phone call follow-up using a standardized questionnaire were used. RESULTS: Forty-two tumors were identified in 34 patients. Twenty-seven patients were male (79% CI, 62%-91%) and most tumors were located on the fingernails (39/42; 91% CI, 81%-99%). Twenty-four of 39 tumors (62% CI, 45%-77%) were on the nondominant hand. The middle third finger was the most frequent digit affected (16/42). Common symptoms reported were nail dystrophy (31/42; 74% CI, 58%-86%), followed by onycholysis (22/42; 52% CI, 36%-68%). Most tumors (35/42; 83% CI, 69%-93%) were treated with Mohs surgery. CONCLUSION: Nail SCC is found nearly exclusively in adults and predominantly in men. There are multiple effective treatment possibilities including Mohs surgery, distal digital amputation, and early evidence suggesting radiotherapy

Diagnosis and Management of Longitudinal Erythronychia: A Clinical Review by an Expert Panel

Longitudinal erythronychia (LE) is defined as a longitudinal red band of the nail(s) and is classified as localized (involvement of one nail) or polydactylous (involvement of more than one nail). The differential diagnosis is distinct for these classifications. The etiologies of localized longitudinal erythronychia (LLE) are most frequently benign subungual neoplasms, and less often malignancies. Polydactylous longitudinal erythronychia (PLE) is typically secondary to regional or systemic diseases, including lichen planus and Darier disease. LE is a common, but underrecognized clinical finding. Increased dermatologist awareness of the clinical characteristics and differential diagnosis for LE is necessary given the possibility for malignancy and associated systemic disease. In this clinical review, the clinical features, differential diagnosis, evaluation, and management of LE are described