The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site.

BACKGROUND Wide local excision (WLE) with 2 to 5 cm margins has been conventionally used for the treatment of superficial leiomyosarcoma (LMS). Because margin control is the strongest predictor of clinical recurrence, many dermatologic surgeons have recently recommended Mohs micrographic surgery (MMS) over wide local excision (WLE) as the primary treatment modality. OBJECTIVE To determine the aggregate rate of local recurrence after treatment of superficial LMS with MMS among the few reports in the literature. METHODS A systematic literature search using the PubMed/MEDLINE database and the Cochrane Library was performed from inception to June 2017. One case report from our institution was included. RESULTS A meta‐analysis of 14 reports of 48 cases of superficial LMS treated with MMS showed a mean recurrence rate of 2.08% to 6.25% with a mean follow‐up period of 1570.9 days, compared to reported recurrence rates of 30% to 50% for WLE. Among these cases there were no reports of distant metastases. CONCLUSION Treatment of superficial leiomyosarcoma with MMS shows markedly lower rates of recurrence compared to reported rates of recurrence after WLE. Further prospective trials with larger sample sizes are needed to compare both modalities.

BACKGROUND Insurance companies have implemented new policies including excessive prior authorization (PA) requirements, high-deductible plans, and complicated billing structures in an effort to curb rising health care costs. Studies investigating the real-time impact on providers and patients are emerging, but few within the field of dermatology have been published. OBJECTIVE To assess the impact of cost-cutting policies on patients and physicians. METHODS A survey was electronically distributed to members of the American College of Mohs Surgery (ACMS). RESULTS The majority of respondents (78.2%) practiced in a private setting, with no other demographic differences. The majority of respondents (70%) dedicated 1 to 2 employees to obtaining PAs. Fifty percent reported an average time of 30 minutes spent per PA. Fifty-six percent of respondents obtained PA from private insurance before Mohs surgery, whereas only 24.5% obtained PA from Medicare. Forty-nine percent of practitioners provided patients with a financial disclosure prior to Mohs surgery. Moreover, many practitioners reported screening patients for high-deductible policies and request an advanced deposit against the deductible. Sixty percent reported difficulty obtaining payment for service in the absence of an advanced deposit. CONCLUSION The burden of restrictive health care policies will have long-term consequences for the patient–provider interaction and patient outcomes.

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