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Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.

SUMMARY Measurement of cutaneous thermal thresholds is a valuable technique for detecting small fibre neuropathy. A robust and portable microcomputer controlled system, which separately measures thresholds for warming and cooling, is described. Thresholds at three sites have been measured; the cheek, the dorsum of the hand and the sole of the foot. Regional variability and a correlation with age have been found, indicating the sensitivity of this system. Psychophysical estimates of cutaneous thresholds for thermal sensation are now recognised as a valuable means of assessing small nerve fibre function.'-5 In mammalian peripheral nerve, small (0-5-6p diameter) myelinated and unmyelinated nerve fibres are four times more numerous than the large (7-13 p diameter) myelinated fibres.6 Disease of these small fibres is common in diabetes7 8 and is also a feature of some painful neuropathies,9 but stimulation and direct measurement of electrical responses in them is not possible under clinical conditions. Nerve conduction studies are therefore of limited diagnostic value in small fibre disease. Since cutaneous thermal sensations of cold are conveyed in the small myelinated fibres and sensations of warmth in the unmyelinated fibres,'0 the integrity of each of these nerve fibre groups may be tested by psychophysical estimates of thresholds for thermal sensation.Pure thermal stimuli can be conveniently given by means of thermoelectric modules in contact with the skin. First introduced in a device for physiological research, " a thermoelectric module was then incorporated in the clinically used "Marstock" thermal testing system.' In 1978 Dyck et al2 described a computer assisted method for measuring thresholds for cooling with a thermoelectric module, which measured both the temperature change and the amount of heat exchange the subject detects. The ingenious psychophysical testing routines and design concepts for computer controlled sensory testing devices introduced by those authors, have greatly influenced subsequent workers.We describe a system which can measure thresholds for both warming and cooling. The testing routine employed is quick and easily performed by untrained subjects. Following each dynamic ramp of temperature change, spontaneous thermal reequilibration occurs, so that it has been possible to exclude the water cooling arrangements which other designs have incorporated.'" Thus our system has been made simple and portable.We present here our results from a series of control subjects tested for both sensory modalities at three sites, the face, hand and foot.Method

guidelines for melanoma have consistently recommended wide local excision as the standard of care since their inception. Although surgery with more comprehensive margin assessment (eg, Mohs surgery) has been advocated for certain subsets of melanoma, how often these techniques are used in clinical practice is uncertain. OBJECTIVE To examine trends in the use of comprehensive margin assessment surgery for melanoma by tracking claims data for Mohs surgery. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional analysis examined claims data from the Optum Clinformatics Data Mart, a nationally representative database.