BACKGROUNDHigh perioperative patient anxiety is predictive of worse postoperative pain and quality of life. Several Mohs micrographic surgery (MMS) patient characteristics influence anxiety; however, the contributions of certain factors remain uncertain.OBJECTIVEInvestigate factors influencing perioperative MMS patient anxiety, especially those with debated impact or unclear data.METHODSThe authors surveyed 145 adult patients receiving MMS performed by a single MMS surgeon from 2018 to 2020. Patients self-reported demographics, history, and 10-point visual analog scale anxiety assessments at multiple stages. Health care provider (HCP)–perceived anxiety assessments were queried. A stepwise multiple regression modeling approach was used to explore potential factors.RESULTSYounger age, female sex, and a self-reported history of anxiety confirmed by prior HCP diagnosis were significant predictors of pre-MMS anxiety. Postoperative anxiety increased with more layers removed and higher pre-MMS anxiety. HCP–perceived patient anxiety increased with younger patient age, more layers removed, prior skin cancer removal, and HCP-perceived pre-MMS patient anxiety.CONCLUSIONAnxiety-reducing interventions should target young female patients with a history of HCP-diagnosed anxiety, and patients with more layers removed. Prior skin cancer removal is associated with increased HCP-perceived intraoperative patient anxiety; however, it is not significant for patient-reported anxiety. Pre-MMS consultation may not be effective for anxiety reduction.

Fibromatoses are soft tissue tumors composed of fibroblasts which commonly appear in the muscular aponeurosis of the abdomen. Mammary fibromatoses occur in only 0.2% of breast neoplasms and have been reported in association with prior breast augmentation and Gardner's syndrome. Multiple imaging modalities have been used to characterize the appearance of breast fibromatosis; however, it remains a tissue diagnosis given the variability both within and across modalities. We present the case of a 25-year-old female with a history of palpable breast mass who was evaluated with ultrasound, diagnostic mammography, MRI, and CT. Ultrasound-guided biopsy revealed fibromatosis, and MRI ultimately revealed that the mass was arising from the pectoralis major muscle and extensively involved the chest wall.

A previously healthy 2-year-old female patient presented with a 2-day history of a pruritic rash, which appeared as annular and polycyclic erythematous and edematous wheals with central clearing over the face, chest, back, arms, legs, palms, and soles (Figures 1,2).She had mild edema of the dorsal hands and feet and dermatographism on examination. All individual lesions were transient, lasting <24 hours. She was otherwise well with no fever or systemic symptoms.One week prior to onset, the patient was hiking in the woods with her family and received numerous mosquito bites which elicited a robust cutaneous reaction. In the month prior to presentation, she received no new medications or vaccinations, and parents denied antecedent respiratory or gastrointestinal infections. She had no previous relevant dermatologic history.Prior to presenting to us, she was given oral diphenhydramine and oral corticosteroids at an urgent care center with minimal change.We initiated treatment with scheduled antihistamines and an overthe-counter lotion containing menthol and camphor as needed for pruritus. The development of pruritic plaques resolved within 2 days of initiating antihistamines.