BACKGROUND The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.

Vacuum-assisted delivery has been associated with several complications, including rare vesicular eruptions. Herpes simplex virus has been cultured in a substantial portion of these cases. A case of vesicular eruption from vacuum-assisted delivery is presented in a 1-day-old neonate. The patient was placed on empiric acyclovir until viral cultures and polymerase chain reaction for herpes simplex virus were found to be negative. The lesions resolved without sequelae. The vesicular eruption of vacuum-assisted delivery is probably secondary to mechanical trauma. Clinicians should be aware of the possible risk of herpes simplex virus infection, instituting antiviral therapy until this is excluded.