UK National Mohs Surgeon Survey 2020

Abstract

The most important aspect of management in these cases is immediate withdrawal of the suspected agent, because small pustules in a localized patch may progress to a more generalized pustular rash. 5 Treatment is supportive, and because of the self-limiting nature of the disease, no specific treatments are usually needed. However, topical or systemic corticosteroids can be used to hasten resolution. 2 We discontinued enoxaparin for our patient, and prescribed topical corticosteroid (betamethasone) cream to be used twice daily. The pustules resolved rapidly over several days.In conclusion, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred after enoxaparin. This case highlights enoxaparin as a novel causative agent for this type of drug reaction.

An international survey characterizing Mohs tissue processing techniques and Mohs margin thresholds: how close is too close?

“…As we highlight from the open free‐text responses, additional factors such as MMS training tenets, or a desire to account for errors and to have ‘safety margins’ also caused some additional variability in the margin threshold. Other technical factors related to MMS sections that have been reported to influence margin thresholds included the presence of scar tissue, inflammation, perineural invasion and slide quality 5 . From our model scenarios, the most common threshold assessment for a 20‐mm nodular BCC on the cheek would be to have either one or three (each preferred by 27.6% of respondents) 50‐μm‐spaced tumour‐free 7‐μm sections being clear.…”

“…From our responses the gender composition within MMS surgery continues to have an overall male preponderance, as has been demonstrated elsewhere, but that does significantly vary by country of practice with the Netherlands respondents identifying as 71.4% female (Table 2). 5,10–12 Notably, respondents were also provided the option of not declaring their gender or of reporting a nonbinary option (total 4.4%; 5 of 114). Notably in the USA, over a third of the American College of Mohs Surgeons (ACMS) members and roughly 50% of ACMS fellows are female 13,14 …”

“…Whereas in the UK (75%) and Australia (85%), fellowship‐trained Mohs surgeons were the predominant respondents, the Dutch respondents had a significantly different composition and were equally as likely to have received their MMS training during residency (42.9%) as they were to have had formal fellowships (42.9%) (Table 2). Certainly in the UK and Australia, fellowship training is now the established route of training for MMS surgery 5,12 . Overall, the survey attracted respondents with a good range of experience, with both recently qualified Mohs surgeons and a handful of veteran Mohs surgeons with over 30+ years experience represented (Table 2).…”

“…Confirmation of tumour clearance using the number of tumour‐free sections (or distance in μm) has been described as the ‘margin threshold’ 4 . This assessment is further complicated in practice by large variations in tissue processing of MMS specimens 4–6 …”

“…4 This assessment is further complicated in practice by large variations in tissue processing of MMS specimens. [4][5][6] We have noticed significant regional and national variation both margin thresholds and tissue processing. Similarly, nearly 10 years ago Cartee and Monheit 4 assessed 'margin thresholds' from an American cohort of Mohs surgeons, and noted substantial heterogeneity in practice.…”