Lip SCC is an overlapping entity that poses many challenges to clinicians. Specialists should be aware of current staging modalities as well as imaging and treatment recommendations to optimize patient outcomes.

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The authors have indicated no significant interest with commercial supporters. D abigatran etexilate (Pradaxa, Boehringer-Ingelheim Pharmeceuticals, Ridgefield, CT) is a novel anticoagulant recently approved by the Food and Drug Administration for prevention of thrombi in patients requiring long-term anticoagulation. In dermatologic surgery, patients are frequently stratified for bleeding risk in the preoperative setting with questions concerning the use of anticoagulants, including platelet inhibitors and herbal supplements with known anticoagulant properties. Current data suggest that patients taking traditional anticoagulants (e.g., aspirin, warfarin, clopidogrel) may be at higher risk of baseline bleeding. The clinical decision to discontinue anticoagulants before surgery varies depending on other patient factors including age, comorbidities, and the specific dermatologic procedure performed, but this general set of guidelines was developed only with respect to traditional anticoagulants. There are no guidelines on preoperative cessation of dabigatran etexilate based on the experience of dermatologic surgeons. Dabigatran etexilate offers notable benefits over previous anticoagulants in that it may be administered orally, is rapidly reversible, provides a predictable dose-dependent response, and does not require regular monitoring. 1 Mechanism of ActionDabigatran etexilate is a direct competitive inhibitor of free and bound thrombin, preventing the conversion of fibrinogen to fibrin and subsequent thrombus formation. 2,3 It is a substrate of the Pglycoprotein (P-gp) transporter and is affected by inducers and inhibitors of the P-gp system, such as rifampin (inducer) and ketoconazole (inhibitor). The P-gp transporter is a member of the ATP-binding cassette superfamily and is also known as ABCB1 and CD243. It is an efflux pump encoded by the ABCB1 gene. Dabigatran etexilate is renally excreted, and the half-life ranges from 13 to 18 hours, based on creatinine clearance. The anticoagulant effects of dabigatran etexilate are most sensitively evaluated according to a prolongation of the ecarin clotting time (ECT), although partial thromboplastin time (aPTT) can be used as an approximation. The international normalized ratio (INR) is not recommended for evaluation. In some institutions and laboratory settings, including that of the authors, the ECT assay may not be readily available. 4 Clinical ImplicationsThe manufacturer of dabigatran etexilate recommends that it be discontinued before surgery but also cautions about risks for thromboembolic events in those who do so. 2 Caution should also be taken with patients who have low creatinine clearance, because they may require prolonged abstinence from dabigatran etexilate to effectively reduce bleeding risks. It is recommended that

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The Surveillance, Epidemiology, and End Results (SEER 18) database is the largest national registry for cancer-related patient data in the United States. Despite these advances, Black populations consistently have shown poorer survival statistics, possibly due to later stages of presentation, increased tumor aggressiveness, treatment noncompliance, among other debated causes. Our goal in this study is to look at a socioeconomic marker that may link all of these causes, namely median income level, and derive the extent of influence a patient's financial resources can have on overall survival. Study Design: Retrospective cohort study. Setting: Surveillance, Epidemiology, and End Results (SEER 18) Database, April 2015 Update. Methods: Original cases from the aforementioned database were identified, with unknown racial status cases excluded from the final dataset. Survival Data by geographical county was collected from the SEER database and correlated to US Census Bureau median income data to uncover meaningful statistical relationships. Results: Whites were found to overall fare better than Blacks for all time intervals (Year 1 to Year 5) following diagnosis, based on mean survival data (p<0.05). Blacks were noted to have higher survival rates for the same time intervals (Year 1 to Year 5) when survival statistics adjusted for income (p<0.05). Conclusion: Significance correlations were seen between income and overall survival. When race was accounted for, blacks were noted to have a higher survival rate than whites. These findings accentuate a major socioeconomic issue to address within the policy-making framework and endorse earlier intervention for underprivileged populations.