Direct scheduling refers to patients scheduling their own appointments, often through online portals.1 This scheduling method has gained popularity among nonurgent care providers to enhance patient convenience, curtail empty patient appointments, and reduce administrative burdens.1 Despite the growing interest in and implementation of direct scheduling systems, there remains little ethical analysis of the practice. Dermatologists and other physicians in nonurgent settings should be aware of the growing use of direct scheduling and understand its benefits and limitations.

To the Editor: Long-term survivors of solid organ transplants are at an increased risk of malignancies, most commonly skin cancer.1 While the risks of heart, lung, kidney, kidney-pancreas, liver, and hematopoietic cell transplant recipients are established, there are limited data on pancreatic islet cell transplant (ICT) recipients.2 ICT is an effective beta-cell replacement therapy performed to normalize glycemic control in patients with type 1 diabetes mellitus3 and/or as a treatment for patients with chronic pancreatitis.4 This study aims to identify and compare the incidence of nonmelanoma skin cancer (NMSC) in allogeneic and autologous ICT recipients.

None

Introduction: The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology. Methods: After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation. Results: A total of 54.54% of responders had “Letters of Recommendation” in their top 3. Forty-five percent of responders had “Completed Audition Rotation at Program” in their top 3. And, 38.09% of responders had “USMLE Step 2 CK Scores” in their top 3. Conclusion: Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for.

Reconstructing surgical defects often requires various suturing techniques. Buried dermal sutures are commonly utilized for wound closures, achieving superior aesthetic outcomes and a low risk of wound infection.1,2 Suture tail length, the length of the suture beyond the knot, is an important factor in ensuring satisfactory wound healing. Excessively long suture tails can protrude through the skin and predispose to wound infections. If cut too short, the knot could be cut or unravel, decreasing surgical efficiency and efficacy. Furthermore, using tissue scissors to cut sutures results in dulling and decreased life of tissue scissors.

BACKGROUND: Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen. OBJECTIVE: We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy. METHODS: A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed. RESULTS: Of 91 cases of clinically diagnosed postoperative infection, 82.4% (n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73-0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA). CONCLUSION: Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities.

Epidermodysplasia verruciformis (EDV) is a rare inherited or acquired dermatosis associated with an increased risk of squamous cell carcinoma (SCC).1 We describe, for the first time to our knowledge, its frozen section pathologic characteristics and specific benefits of the use of Mohs micrographic surgery (MMS) in its setting.

Suture end length is an important indicator of knot integrity. Knots with an end length between 3 and 10 mm are less likely to come unraveled than knots with an end length of <3 mm.1 It is important, however, to cut the sutures short enough to prevent the ends from entangling. This can be achieved by cutting the sutures to a length that is less than the distance between sutures.2 For new learners and surgical assistants, measuring each knot end length before cutting is time consuming and laborious. Thus, this standardized method could be used to help teach and replicate appropriate suture tail length. Equipment that is needed includes a sterile, standard-sized cotton-tipped applicator (approximately with 3-mm head diameter) and suture scissors.

Dupilumab is a fully human monoclonal antibody that functions as an interleukin (IL) 4α receptor antagonist, inhibiting the activity of both IL-4 and IL-13, drivers of T helper 2 mediated inflammation. Although injection-site reactions are the most reported side effect, there have been several reported cases of adverse dermatologic reactions, including facial and neck erythema.1,2 We present a case of a patient with severe eosinophilic asthma and chronic sinusitis with nasal polyps in whom drug-induced erythema nodosum (EN) developed after 8 weeks of dupilumab therapy.

Amidst the novel coronavirus infection (COVID-19) pandemic, the United States has enacted utilitarian public health policies to mitigate the spread of cases and related deaths. Indeed, as of the 1905 Jacobson vs. Massachusetts court ruling, the US government possesses the authority to enact paternalistic laws that supersede individuals’ autonomy in order to protect both the individual citizens and the whole of the population from harm.1 Other countries have enacted similar directives.