According to the best evidence, recurrence rates of BCC treated with cryosurgery are low (less than 10%). Except in one study, recurrence rates are calculated based on clinical, rather than histologic diagnosis, which may cause the rates to appear somewhat lower than they actually are, especially with a short follow-up period. Cosmetic results of cryosurgery treatment reported in literature are described as good by most investigators. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodessication and curretage so that no conclusion can be made whether cryosurgery is as efficacious as other methods. Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment.

Patient acceptance of the teledermatology system was high (93%). Teledermatology may prove a viable means of evaluating dermatologic complaints in the emergency department.

Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medical record for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medical records, and assessing how having multimedia data available might affect care.

No abstract

A 14-year-old boy presented with a 5-mm wart on his ankle (Figure). His mother was given the option of various destructive measures. She chose cryosurgery. Liquid nitrogen was applied to the area with a Brymill Mini-Cryogun (Brymill Cryogenic Systems, Ellington, CT) in three 10-second bursts, with intervals of total tissue thawing. One month later, there was only residual mild macular erythema, but no wart was present in the area where the wart had been.No treatment eradicates all warts in all cases, and 20%-40% of verruca vulgaris (VV) will disappear over 1-2 years without treatment. Since VV causes morbidity and can spread, treatment is medically necessary. Treatment does not prevent wart dissemination, because the papilloma virus remains in the skin. 1 As straightforward as the use of liquid nitrogen could be, controversy exists surrounding its optimal use. For example, a 10-second cryogun application of liquid nitrogen to VV is more effective than shorter applications. 2 According to one study, cryogen gun and cotton tip with liquid nitrogen are equally effective. 3 The use of a double freeze-thaw cycle confers little or no advantage over a single freeze in hand VV treatment, but may be useful in plantar VV treatment. 4 Two freeze-thaw cycles and paring before freezing in one study improved the cure rate for plantar warts but not hand VV. 5,6 The optimal therapeutic interval between VV treatments is unclear, although one study noted that cure relates to the number of treatments rather than the frequency of treatments.Salicylic acid is an initial therapy for flat warts on the face, plantar warts, and flat and common warts on the hands. An evidencebased study 7 identified topical therapy with salicylic acid as safe and effective and reports that no clear evidence exists to prove that other therapies have an advantage in regard to higher cure rates or fewer adverse effects. Also noted was that six randomized clinical trials demonstrated a cure rate of 75% in those treated with salicylic acid compared with 48% in the control group. Salicylic acid-podophyllin-cantharidin combinations can be helpful for treating warts in children (81% effectiveness in one study). 8 Duct tape may have a role in treating VV. A study noted that of 51 patients, 26 (51%) were treated with duct tape and 25 (49%) were treated with cryotherapy; 22 patients (85%) in the duct tape arm vs. 15 (60%) in the cryotherapy arm had complete resolution of their VV; however, this has not been the case for me. 9 Electrodesiccation, pulse dye laser, and photodynamic therapy can treat VV, but they have not been shown to be more effective than cryotherapy.Several studies using imiquimod, which is only indicated for the condyloma, note high cure rates when applied twice daily for 2-12 months or once a day and occluded for 4 weeks. I have never found imiquimod useful in treating VV. Using a bifurcated needle, bleomycin sulfate (1 mg/mL sterile saline solution) can be introduced into warts with excellent effectiveness, but with many possible side effects. Or...