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P6755 Direct brow lift following Mohs-induced temporal nerve transection David Kurlander, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Jeremy Bordeaux, MD, MPH, Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, University Hospitals Case Medical Center Department of Dermatology, Cleveland, OH, United States Background: Surgical removal of skin cancer invading the temporal nerve can lead to ipsilateral brow ptosis, decreased visual field, and aesthetic complaints. A direct brow lift may be used to address these conditions. Methods: The indications, contraindications, surgical technique, complications, and experiences of a single surgeon are discussed. Conclusion: The direct brow lift is a relatively simple surgical procedure that yields high rates of functional correction and patient satisfaction. Commercial support: None identified. P6679 Does Mohs micrographic surgery preserve tissue and key structures in the periocular area? Waseem Bakkour, MD, Salford Royal NHS Foundation Trust, Salford, United Kingdom; Vindy Ghura, MBBS, Salford Royal NHS Foundation Trust, Salford, United Kingdom Background: Basal cell carcinomas (BCCs) in the periocular area are particularly challenging. Ideal treatment aims to fully remove the tumor with maximal preser- vation of tissue and key structures. This is offered by Mohs micrographic surgery (MMS), considered the criterion standard treatment with the highest cure rates. We present our experience in treating periocular BCCs using MMS, focusing on whether MMS helped to preserve tissue and ‘‘key structures’’ (structures of functional or structural importance defined as the medial canthal tendon (MCT), canaliculi, tarsal plate and eyelid margin) compared to standard surgical excision with predeter- mined margins. Methods: A retrospective review was performed of patients who had had periocular basal cell carcinoma treated with MMS in our department between June 2011 and June 2012. Age, sex, anatomic site, histologic subtype, number of MMS stages required, size of defect and damage to key structures were all evaluated. Results: 72 patients were included. Male:female ratio 34:38 patients with mean age 72 and 68 years respectively. The commonest tumor site was the right lower eyelid (n ¼ 18; 25%), followed by left medial canthus (n ¼ 16; 22.2%). 50 patients (69.4%) had tumor cleared with 1 stage of MMS; 17 patients (23.6%) with 2 stages; 4 patients (5.5%) with 3 stages and 1 patient required 4 stages. The defect was smaller than expected compared with standard surgery in the majority of patients (n ¼ 55; 76.3%), and larger in 17 (23.6%). Where smaller, key structures were not at risk in 17 patients (30.9%). Where at risk, key structures were preserved more often than lost, analysis showing that the MCT was preserved in 23 patients and not lost in any: canaliculi preserved in 17 and lost in 2, tarsal plate preserved in 9 and lost in 7, and eyelid margin preserved in 17 and lost in 12. Where the defect was larger, key structures were not at risk in 4 patients (23.5%). In those where key structures were at risk, the MCT was preserved in 6 cases (not lost in any); canaliculi preserved in 5 and lost in 3; tarsal plate lost in 7 and preserved in 6 patients, eyelid margin lost in 8 and preserved in 4. Conclusion: Our results indicate that MMS helps preserve tissue and key structures in the periocular area. Commercial support: None identified. P7095 Hypnotically induced relaxation and self-guided imagery effectively re- duces anxiety during dermatologic procedures Philip Shenefelt, MD, University of South Florida, Tampa, FL, United States Rapid eye-roll induction hypnosis and self-guided imagery was demonstrated to be effective in alleviating anxiety associated with dermatologic procedures in this randomized, controlled trial. When patients chose their own imagery, they remained absorbed in something that they personally enjoyed and were able to remain focused on for the duration of the procedure. In this study of 39 patients, data analysis of live induction versus audio-recorded induction versus controls revealed that the live induction group had significantly (P ¼.033) less anxiety by 20 minutes than the control group. The audio-recorded group was intermediate in anxiety, much closer to the control group than to the live induction group. Commercial support: None identified. P6102 Keloid core excision with a suction-assisted cartilage shaver: 4 cases Jong-Keun Seo, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Hyo-Jin Kim, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Jai-Kyoung Koh, MD, Department of Dermatology, Haeundae Paik, College of Medicine, Inje University, Busan, South Korea; Jeong-Hoon Park, MD, Department of Dermatology, Haeundae Paik, College of Medicine, Inje University, Busan, South Korea; Jeong-Nan Kang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; So-Young Jung, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea; Sung-Hwan Hwang, MD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea Surgical excision of keloids is generally not accepted as a first treatment option, but there have been many reports of form specialized surgical methods such as intralesional/intramarginal excision. This procedure leaves the active peripheral portion of the keloid and excise the central bulky lesions. Suprakeloidal flap and keloid core excision are kinds of intralesional excision of keloids. These methods are known to involve low possibility of recurrence or exacerbation of the lesions as the remaining keloidal lesion acts as a barrier. But several complications have been reported such as partial necrosis and flap congestion, especially in large lesions. We describe 4 patients with keloids on the chest or abdomen. All the patients complained of pain or itching related to the keloids. The patients aged from 20 years to 54 years and the numbers of lesions ranged from 1 to 7. The largest lesion measured 10 3 8 cm. We treated the lesions of them with keloid core excision using a suction-assisted cartilage shaver and the lesions were markedly flattened in all cases. As procedures were performed through an incision for cannula, it provides more rapid healing, less postoperative pain and severe complication. It also has the advantage of requiring less effort and time due to using a motorized curretage with suction. Herein, we report the first 4 patients of keloids treated with keloid core excision using a suction assisted cartilage shaver. Commercial support: None identified. AB220 JAM ACAD DERMATOL APRIL 2013

Direct brow lift following Mohs-induced temporal nerve transection

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P6755Direct brow lift following Mohs-induced temporal nerve transection

David Kurlander, Case Western Reserve University School of Medicine,Cleveland, OH, United States; Jeremy Bordeaux, MD, MPH, Case WesternReserve University School of Medicine, Case Comprehensive Cancer Center,University Hospitals Case Medical Center Department of Dermatology,Cleveland, OH, United States

Background: Surgical removal of skin cancer invading the temporal nerve can lead toipsilateral brow ptosis, decreased visual field, and aesthetic complaints. A directbrow lift may be used to address these conditions.

Methods: The indications, contraindications, surgical technique, complications, andexperiences of a single surgeon are discussed.

Conclusion: The direct brow lift is a relatively simple surgical procedure that yieldshigh rates of functional correction and patient satisfaction.

AB220

cial support: None identified.

Commer

P6679Does Mohs micrographic surgery preserve tissue and key structures in theperiocular area?

Waseem Bakkour, MD, Salford Royal NHS Foundation Trust, Salford, UnitedKingdom; Vindy Ghura, MBBS, Salford Royal NHS Foundation Trust, Salford,United Kingdom

Background: Basal cell carcinomas (BCCs) in the periocular area are particularlychallenging. Ideal treatment aims to fully remove the tumor with maximal preser-vation of tissue and key structures. This is offered by Mohs micrographic surgery(MMS), considered the criterion standard treatment with the highest cure rates. Wepresent our experience in treating periocular BCCs usingMMS, focusing onwhetherMMS helped to preserve tissue and ‘‘key structures’’ (structures of functional orstructural importance defined as the medial canthal tendon (MCT), canaliculi, tarsalplate and eyelid margin) compared to standard surgical excision with predeter-mined margins.

Methods: A retrospective review was performed of patients who had had periocularbasal cell carcinoma treated with MMS in our department between June 2011 andJune 2012. Age, sex, anatomic site, histologic subtype, number of MMS stagesrequired, size of defect and damage to key structures were all evaluated.

Results: 72 patients were included. Male:female ratio 34:38 patients with mean age72 and 68 years respectively. The commonest tumor site was the right lower eyelid(n ¼ 18; 25%), followed by left medial canthus (n ¼ 16; 22.2%). 50 patients (69.4%)had tumor cleared with 1 stage of MMS; 17 patients (23.6%) with 2 stages; 4 patients(5.5%) with 3 stages and 1 patient required 4 stages. The defect was smaller thanexpected compared with standard surgery in the majority of patients (n ¼ 55;76.3%), and larger in 17 (23.6%). Where smaller, key structures were not at risk in 17patients (30.9%). Where at risk, key structures were preserved more often than lost,analysis showing that the MCT was preserved in 23 patients and not lost in any:canaliculi preserved in 17 and lost in 2, tarsal plate preserved in 9 and lost in 7, andeyelid margin preserved in 17 and lost in 12. Where the defect was larger, keystructures were not at risk in 4 patients (23.5%). In those where key structures wereat risk, the MCTwas preserved in 6 cases (not lost in any); canaliculi preserved in 5and lost in 3; tarsal plate lost in 7 and preserved in 6 patients, eyelid margin lost in 8and preserved in 4.

Conclusion: Our results indicate that MMS helps preserve tissue and key structuresin the periocular area.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P7095Hypnotically induced relaxation and self-guided imagery effectively re-duces anxiety during dermatologic procedures

Philip Shenefelt, MD, University of South Florida, Tampa, FL, United States

Rapid eye-roll induction hypnosis and self-guided imagery was demonstrated to beeffective in alleviating anxiety associated with dermatologic procedures in thisrandomized, controlled trial. When patients chose their own imagery, they remainedabsorbed in something that they personally enjoyed and were able to remainfocused on for the duration of the procedure. In this study of 39 patients, dataanalysis of live induction versus audio-recorded induction versus controls revealedthat the live induction group had significantly (P ¼.033) less anxiety by 20 minutesthan the control group. The audio-recorded group was intermediate in anxiety,much closer to the control group than to the live induction group.

cial support: None identified.

Commer

P6102Keloid core excision with a suction-assisted cartilage shaver: 4 cases

Jong-Keun Seo, MD, Department of Dermatology, Busan Paik Hospital, College ofMedicine, Inje University, Busan, South Korea; Hyo-Jin Kim, MD, Department ofDermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan,South Korea; Jai-Kyoung Koh, MD, Department of Dermatology, Haeundae Paik,College of Medicine, Inje University, Busan, South Korea; Jeong-Hoon Park, MD,Department of Dermatology, Haeundae Paik, College of Medicine, InjeUniversity, Busan, South Korea; Jeong-Nan Kang, MD, Department ofDermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan,South Korea; So-Young Jung, MD, Department of Dermatology, Busan PaikHospital, College of Medicine, Inje University, Busan, South Korea; Sung-HwanHwang, MD, Department of Dermatology, Busan Paik Hospital, College ofMedicine, Inje University, Busan, South Korea

Surgical excision of keloids is generally not accepted as a first treatment option, butthere have been many reports of form specialized surgical methods such asintralesional/intramarginal excision. This procedure leaves the active peripheralportion of the keloid and excise the central bulky lesions. Suprakeloidal flap andkeloid core excision are kinds of intralesional excision of keloids. These methods areknown to involve low possibility of recurrence or exacerbation of the lesions as theremaining keloidal lesion acts as a barrier. But several complications have beenreported such as partial necrosis and flap congestion, especially in large lesions. Wedescribe 4 patients with keloids on the chest or abdomen. All the patientscomplained of pain or itching related to the keloids. The patients aged from 20years to 54 years and the numbers of lesions ranged from 1 to 7. The largest lesionmeasured 103 8 cm.We treated the lesions of themwith keloid core excision usinga suction-assisted cartilage shaver and the lesions were markedly flattened in allcases. As procedures were performed through an incision for cannula, it providesmore rapid healing, less postoperative pain and severe complication. It also has theadvantage of requiring less effort and time due to using a motorized curretage withsuction. Herein, we report the first 4 patients of keloids treated with keloid coreexcision using a suction assisted cartilage shaver.

cial support: None identified.

Commer

APRIL 2013