More randomized controlled trials will be needed to determine if any specific regimen is most effective. At this point in time, product usage should be based on specific attributes relating to the products, such as iodophors around the eyes and/or ears to avoid irritation and aqueous-based solutions in hair bearing areas because of concern for flammability. Ultimately, it is up to the individual surgeon to tailor the optimal antiseptic regimen for their specific scope of practice.

Nuchal fibromas, uncommon benign soft tissue tumors typically arising along the posterior neck, are often associated with Gardner syndrome (GS). These tumors have rarely been reported in association with scleroderma or as secondary to trauma and diabetes. Nuchal fibromas not associated with GS have been described predominantly in men aged 30 to 50. We report a 2-year-old African American girl with multiple nuchal fibromas along the posterior aspect of her neck and upper back. Retinal examination showed no signs of congenital hypertrophy of the retinal pigment epithelium, and genetic testing for the adenomatous polyposis coli gene mutation seen in GS was negative.

No abstract

Skin cancers are common in organ transplant recipients (OTRs). In this review, we discuss the epidemiology of and risk factors for cutaneous neoplasms, particularly squamous cell carcinoma (SCC) in OTRs. The pathogenesis of SCC is reviewed, as well as the potential mechanisms for tumor progression and metastasis associated with two commonly used immunosuppressive medications: tacrolimus and cyclosporine. Finally, we discuss the mechanism of action and potential preventative use of sirolimus, a member of a newer class of immunosuppressants, the mammalian target of rapamycin inhibitors. The authors have indicated no significant interest with commercial supporters.

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