Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study BACKGROUND Glomus tumors are rare benign painful tumors, frequently found in the subungual region. Complete surgical excision is essential for relief of symptoms. The main postoperative complications are tumor recurrence and nail dystrophy. OBJECTIVE To evaluate the long-term outcome and the impact on quality of life (QoL) of glomus tumors after a transungual approach. MATERIALS AND METHODS A retrospective cohort study was conducted. Twenty-six patients underwent transungual excision of subungual glomus tumors. A self-administered questionnaire was sent to evaluate the postoperative outcome. Glomus tumor-related QoL was investigated using modified nail psoriasis (NPQ10) and onychomycosis questionnaires. RESULTS A response rate of 85% was achieved. After a mean follow-up of 63 months after transungual excision of the tumor, the mean Numeric Pain Rating Score had improved from 7.9 (±SD 1.8) preoperatively, to 0.8 (±SD 1.9) (p < .000). Quality of life improved significantly: the mean NPQ10-score improved from 5.5 (±SD 3.4) to 0.64 (±SD 2.1) (p < .000). Nail-related sequelae were not reported in any of the patients. CONCLUSION Our study showed that glomus tumors cause impairment on QoL, mostly due to severe pain. Surgical excision with the transungual approach is an effective treatment, without permanent damage to the nail unit that gives relief of pain and improves QoL. Address correspondence and reprint requests to: Marcel C. Pasch, MD, PhD, Department of Dermatology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands, or e-mail: marcel.pasch@radboudumc.nl The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Successful Treatment of Multiple Common Warts With Intralesional Ozone BACKGROUND Although there are multiple treatments for warts, wart management remains a challenge. Ozone therapy is an emerging treatment for infectious and noninfectious dermatological diseases. OBJECTIVE To assess intralesional ozone gas safety and efficacy in multiple warts management. MATERIALS AND METHODS Seventy-four adult patients with multiple common warts were included in this study. They were randomly assigned into 2 groups: first group comprised 44 patients treated with intralesional ozone gas, and the second group comprised 30 patients who received intralesional saline injection. In both groups, warts in all patients were directly injected weekly until complete clearance occurred or for a maximum of 10 treatment sessions. The subjects were followed for 6 months to record any recurrences. RESULTS In the ozone group, 25 patients (56.8%) had a complete response with an excellent cosmetic outcome, 15 patients (34.1%) showed a partial response, and 4 patients (9.1%) had no response. More subjects responded to ozone than to saline (p < .001). Ozone therapy was associated with mild side effects, including pain at time of injection, numbness, and fatigue. CONCLUSION Intralesional ozone is effective and safe for the treatment of multiple warts. Address correspondence and reprint requests to: Shrook A. Khashaba, MD, Zagazig University Building, Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt, or e-mail: shrook_khashaba@yahoo.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Commentary on Noncollagen Dermal Fillers: A Summary of the Clinical Trials Used for Their FDA Approval No abstract available

Development of Merkel Cell Carcinoma and Squamous Cell Carcinoma During Treatment With Pembrolizumab for Metastatic Mucosal Melanoma No abstract available

Intrasubunit V-Y Muscle Sling Myocutaneous Island Advancement Flap for Small Defects Isolated to the Nasal Ala BACKGROUND The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae. OBJECTIVE To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects. MATERIALS AND METHODS A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS). RESULTS A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm2. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes. CONCLUSION The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala. Address correspondence and reprint requests to: Christopher J. Miller, MD, 3400 Civic Center Boulevard, Suite 1-330S, Philadelphia, PA 19104, or e-mail: christopher.miller@uphs.upenn.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

The Effect of Vitamin D Deficiency on Hypertrophic Scarring No abstract available

Excessive and Persistent Local Bleeding at the Hair Transplant Site of a Patient Taking Warfarin and Its Effect on Hair Survival No abstract available

Munchausen Syndrome: Self-Inflicted Chronic Scalp Injury and Hints for Surgeons No abstract available

Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study BACKGROUND Antibiotic use associated with Mohs surgery is increasing. OBJECTIVE To understand variation in practice patterns and factors associated with antibiotic use. MATERIALS AND METHODS The authors conducted a retrospective cohort study of antibiotic use among patients treated with Mohs micrographic surgery between July 1, 2013, and June 30, 2017, at an academic medical center. Multivariate logistic regression was used to evaluate for associations between antibiotic prescribing and the surgeon, site, reconstruction, and patient characteristics. RESULTS The odds of prescribing antibiotics differed significantly between each surgeon evaluated; 3.35-fold variation in postoperative antibiotic use was observed. Increasing number of surgical sites (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.09–1.41), number of Mohs stages required (OR 1.18; 95% CI 1.08–1.28), and defect area (OR 1.31; 95% CI 1.25–1.37), as well as patient female sex (OR 1.14; 95% CI 1.03–1.27), were associated with increased postoperative antibiotic use, whereas age >80 was associated with decreased use (OR 0.75; 95% CI 0.64–0.87) compared with age <60. CONCLUSION Antibiotics are more commonly prescribed for repairs that are considered higher risk for infection. However, significant variation exists between surgeons, even within a single institution, suggesting a need for prospective trials and consensus guideline development. Address correspondence and reprint requests to: John S. Barbieri, MD, MBA, PCAM 7 South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, or e-mail: john.barbieri@pennmedicine.upenn.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). Funded in part through NIAMS 1P30AR069589-01. J.S. Barbieri is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number T32-AR-007465 and receives partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Reconstruction of Large Transmural Nasal Defects With a Nasolabial Turnover Interpolation Flap BACKGROUND Reconstruction of large nasal surgical defects often warrant the use of mucosal flaps to repair the inner lining. This often presents a challenge for surgical reconstruction. OBJECTIVE To describe a unique reconstructive option for the repair of large surgical wounds that necessitate mucosal nasal lining. MATERIALS AND METHODS This study is a retrospective review of 10 patients who underwent surgical reconstruction of large nasal and/or heminasal surgical defects following Mohs micrographic surgery. A nasolabial turnover interpolation flap was used to repair missing nasal mucosal lining, coupled with a cutaneous flap which typically involved a paramedian forehead flap. The duration of follow-up was 8 months. An aesthetic and functional surgical outcomes measure was used to assess the final repair. RESULTS Favorable aesthetic outcomes were obtained in all patients and without need of revision surgery by the use of a nasolabial turnover interpolation flap. CONCLUSION The nasolabial turnover interpolation flap offers a reliable and effective method of repair for large transmural nasal surgical wounds. We typically paired this nasal lining flap with a paramedian forehead flap with reliable and aesthetic outcomes. This technique is straightforward, reproducible, and with both good aesthetic and functional outcomes. Address correspondence and reprint requests to: Joshua E. Lane, MD, MBA, 1210 Brookstone Centre Parkway, Columbus, GA 31904, or e-mail: jlane@lanederm.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.