Bailey, Alison M. MD*; Jansen, Chandler MD*; Zitelli, John A. MD†; Hsia, Ling-Lun Bob MD* Author Information

Chu, Sherman DO; Christensen, Luisa MD; Howald, Rachel Redenius MD; Honda, Kord MD Author Information

Wang, Jordan V. MD, MBE, MBA; Lopez, Adriana MD; Geronemus, Roy G. MD Author Information

Full-thickness skin grafts (FTSGs) are useful repairs for reconstructing nasal alar defects. Traditional donor sites include the preauricular, postauricular, and supraclavicular skin. To evaluate esthetic outcomes and complications of nasal alar defects repaired with FTSGs from the medial cheek. A retrospective chart review of Mohs surgery patients who had FTSG repair of the nasal ala between January 2015 and August 2020 was performed. Demographic, surgery, and follow-up visit data were reviewed. Cosmesis was rated by a facial plastic surgeon, a Mohs surgeon, and a plastic surgeon using baseline, defect, and follow-up visit photographs. Sixty-nine patients with FTSG repairs of nasal alar defects were identified. 51 of 69 patients (73.9%) had the cheek donor site, and 18 of 69 patients (26.1%) had a noncheek donor site. The mean (SD) rater visual analog score for both cohorts was good with no significant difference (cheek: 65.9 [13.8]; noncheek: 66.1 [15.3]; p = .96). A notable difference in the complication rate by donor site was observed (cheek: 6.9%, noncheek: 16.7%; p = .13), although it did not reach significance. The cheek is a reliable FTSG donor site for nasal alar defects after Mohs micrographic surgery, with a trend toward fewer complications.

*Zitelli & Brodland Skin Cancer Center, University of Pittsburgh Medical Center, Shadyside Hospital, Pittsburgh, Pennsylvania The authors have indicated no significant interest with commercial supporters.

Watchmaker, Jacqueline MD*; Rohrer, Thomas A. MD*,†; Dover, Jeffrey MD, FRCPC*,†; Arndt, Kenneth A. MD*,‡ Author Information

Advanced Dermatology, Skinfo, Northwestern University Medical School, Lincolnshire, Illinois The author has indicated no significant interest with commercial supporters.

Namazi, Mohammad Reza MD*,†; Khosravi, Yasaman MD‡; Ketabi, Yasaman MD§ Author Information

The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. To identify differences in perceived scar outcomes by different stakeholders. Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.

BACKGROUNDAdjuvant computed tomography–based conformal electron beam radiation therapy (RT) for patients with keloids enables radiation oncologists to customize the target volume with precision and deliver the maximal prescription dose while sparing normal surrounding tissues.OBJECTIVETo report treatment and cosmetic outcomes by the patient's self-assessment survey.METHODSMedical records of patients with keloids, who were treated with postoperative electron beam RT between January 2015 and December 2020, were reviewed. A total of 85 consecutive patients with 136 keloids were included in this study. Subjective cosmetic outcomes were scored by each patient using a 5-point Likert scale survey.RESULTSThe median follow-up time was 29.0 months (range, 12.1–77.9 months), and local recurrence was observed in 10 lesions (7.4%). The recurrence rate of keloids occurring in the ear was 5.4%, whereas the recurrence rate of keloids occurring at other body sites was 11.4%. Among the patients who responded to the questionnaire about the cosmetic outcome, 70.2% of patients declared being either very satisfied (44.7%) or satisfied (25.5%).CONCLUSIONSurgical excision, followed by CT-based conformal electron beam RT, for patients with keloids ensures a high degree of local control resulting in good cosmetic outcomes.