28 Dermatologic Surgery S KIN & ALLERGY N EWS • October 2005 Simpler Alternative May Work in Place of Mohs

BY JEFF EVANS Weatherhead said in an interview. about 3-4 mm. The specimen obtained tologist chooses a method to close the Senior Writer At the dermatology clinic at the Ottawa from that excision is then sent for patho- wound depending on the location and Hospital, Dr. Weatherhead has not had logic analysis of the margin. The derma- size of the defect. ■ Q UEBEC C ITY — A quasi-Mohs mi- positive margins in any patient who has crographic surgery procedure involving undergone the procedure. excision and curettage with pathologic “In my hands it’s been a very good tool, analysis of margins may be a practical way but there’s always risk, when you do any of treating skin cancer patients in areas surgical procedure, that you might have a that do not have access to Mohs surgeons, margin that’s still involved,” he said, “in Louis Weatherhead, M.B., said at the an- which case, then, many times in [basal cell nual conference of the Canadian Derma- carcinomas] you have to determine the tology Association. amount of involvement and whether or “In many areas in Canada, we do not not you’re going to go back and do have access to Mohs surgery,” said Dr. surgery or just observe, because in many Weatherhead, director of surgical derma- instances the healing gets rid of residual tology at the University of Ottawa. tumor.” “Many plastic surgeons in the Ottawa re- The first step of the procedure is “like gion will not deal with a skin malignancy,” doing your first Mohs cut,” Dr. Weather- Skin cancer patient undergoing a quasi-Mohs procedure. From left to right: malignant he said. head said, because it involves tangentially lesion is excised; curettage ensures clear margins; a rotational flap closes wound. The alternative to Mohs surgery, which excising the lesion and submitting the Dr. Weatherhead teaches to his residents in specimen for pathologic—but not imme- Ottawa, is easy to learn and provides “clin- diate—analysis. But the similarity between ically good results in clearance of tumor as the procedure and Mohs stops there, be- well as postoperative appearance,” he said. cause “we don’t have the facility to con- The “poor man’s Mohs procedure” has tinue it.” had a recurrence rate of about 2%-4% Curettage is performed to remove any

residual tumor up to normal tissue and to EATHERHEAD over a 5-year period, he said. The relatively W simple technique involves simple shaving delineate the borders of the tumor. Fol- and curettage plus excision, which most lowing hemostasis of the wound, Dr. OUIS . L R HOTOS COURTESY dermatologists know how to do, Dr. Weatherhead excises a surgical margin of P D Final cosmetic result seen 1 year after having a quasi-Mohs Salex™ (6% Salicylic Acid) Lotion Rotational flap is sutured in place (left). Good healing micrographic surgery Rx Only of the wound is seen after 1 week (right). procedure. FOR TOPICAL USE ONLY. NOT FOR OPHTHALMIC, ORAL OR INTRAVAGINAL USE. INDICATIONS AND USAGE II. Drugs changing salicylate levels by altering Carcinogenesis, Mutagenesis, renal tubular reabsorption: Impairment of Fertility: No data are For Dermatologic Use: Salex™ Lotion is a topical available concerning potential carcinogenic or aid in the removal of excessive keratin in hyperker- DRUG DESCRIPTION OF INTERACTION reproductive effects of Salex™ Lotion. It has been atotic skin disorders, including verrucae, and the Radio Frequency Plus Vacuum shown to lack mutagenic potential in the Ames various ichthyoses (vulgaris, sex-linked and lamel- Corticosteroids Decreases plasma salicylate Salmonella test. lar), keratosis palmaris and plantaris, keratosis level; tapering doses of pilaris, pityriasis rubra pilaris, and psoriasis steroids may promote ADVERSE REACTIONS (including body, scalp, palms and soles). salicylism. Excessive erythema and scaling conceivably could May Lessen Wrinkle Tx Pain Acidifying Agents Increases plasma salicylate For Podiatric Use: Salex™ Lotion is a topical aid in result from use on open skin lesions. the removal of excessive keratin on dorsal and level. plantar hyperkeratotic lesions. Topical prepara- Alkanizing Agents Decreased plasma salicylate OVERDOSAGE tions of 6% salicylic acid have been reported to be levels. See Warnings. BY PATRICE WENDLING “I think because we’re taking up the useful adjunctive therapy for verrucae plantares. III. Drugs with complicated interactions with CONTRAINDICATIONS salicylates: DOSAGE AND ADMINISTRATION Chicago Bureau skin and compressing the nerves or the cir- Salex™ Lotion should not be used in any patient DRUG DESCRIPTION OF The preferable method of use is to apply Salex™ INTERACTION culation affecting those nerves, we’re do- known to be sensitive to salicylic acid or any other Lotion thoroughly to the affected area and occlude listed ingredients. Salex™ Lotion should not be Heparin Salicylate decreases platelet the area at night. Preferably, the skin should be PARIS — A new device that uses vacu- ing something. We’re just not sure what, used in children under 2 years of age. adhesiveness and interferes hydrated for at least five minutes prior to applica- with hemostasis in heparin- tion. The medication is washed off in the morning um suction in combination with radio fre- but it is effective and doesn’t hurt,” Dr. WARNINGS treated patients. and if excessive drying and/or irritation is observed a bland cream or lotion may be applied. quency painlessly treats facial lines and Gold said in an interview. Prolonged use over large areas, especially in chil- Pyrazinamide Inhibits pyrazinamide- Once clearing is apparent, the occasional use of dren and those patients with significant renal or induced hyperuricemia. Salex™ Lotion will usually maintain the remission. wrinkles, Michael H. Gold, M.D., report- In a study of 46 patients aged 30-65 hepatic impairment, could result in salicylism. Uricosuric Agents Effect of probenemide, In those areas where occlusion is difficult or Concomitant use of other drugs which may con- ed at the Fourth International Academy of years with periorbital and nasal labial wrin- sulfinpyrazone and impossible, application may be made more fre- tribute to elevated serum salicylate levels should phenylbutazone inhibited. quently; hydration by wet packs or baths prior to be avoided where the potential for toxicity is pres- Cosmetic Dermatology World Congress. kles, 1%-2% of patients reported pain The following alterations of laboratory tests have been report- application apparently enhances the effect. Unless ent. In children under 12 years of age and those ed during salicylate therapy: hands are being treated, hands should be rinsed Radio frequency (RF) devices have been with the first two treatments. Patients re- patients with renal or hepatic impairment, the area thoroughly after application. to be treated should be limited and the patient LABORATORY TESTS EFFECT OF SALICYLATES used successfully over the last 5 years to ported pain of 0 or 1 on a 4-point scale, monitored closely for signs of salicylate toxicity: Thyroid Function Decreased PBI; increased HOW SUPPLIED nausea, vomiting, dizziness, loss of hearing, tinni- improve skin texture and laxity, but their with 0 being no pain and 4 being in- T3 uptake. tus, lethargy, hyperpnea, diarrhea, and psychic Salex™ Lotion is available in 14 fl oz (414 ml) disturbances. In the event of salicylic acid toxicity, Urinary Sugar False negative with glucose (NDC 0064-4011-14) bottles. use has been limited because patients com- tractable pain, he said. Seven patients were oxidase; false positive with the use of Salex™ Lotion should be discontinued. Store at controlled room temperature Clinitest with high-dose plain the treatments are too painful, said lost to follow-up. No one dropped out of Fluids should be administered to promote urinary salicylate therapy (2-5g q.d.). 20° - 25°C (68° - 77°F). Do not freeze. excretion. Treatment with sodium bicarbonate Dr. Gold of Nashville, Tenn. the study because of pain or an adverse (oral or intravenous) should be instituted as 5-Hydroxyindole False negative with appropriate. acetic acid fluorometric test. Efforts have been made with varying de- event, said Dr. Gold. All of the 39 patients Due to potential risk of developing Reye’s syn- Acetone, ketone False positive FeCl3 in grees of success to reduce the pain by who completed the study had at least a 50% drome, salicylate products should not be used in bodies Gerhardt reaction; red color persists with boiling. children and teenagers with varicella or influenza, changing machine parameters, using mul- improvement in wrinkling based on evalu- unless directed by a physician. 17-OH corticosteroids False reduced values with > 4.8g q.d. salicylate. tiple passes at lower power, or by incorpo- ation by blinded clinicians. Patients were PRECAUTIONS Vanilmandelic acid False reduced values. For external use only. Avoid contact with eyes and rating RF with intense pulsed light devices. able to maintain the improvements 6 Uric acid May increase or decrease other mucous membranes. depending on dose. General anesthesia or intravenous medica- months posttreatment. DRUG INTERACTIONS Prothrombin Decreased levels; slightly Marketed by: tions have been used, but few patients have The maximum benefit is seen after the The following interactions are from a published increased prothrombin time. Coria Laboratories, Ltd. Fort Worth, TX 76107 been willing to incur the associated risks. fifth or sixth treatment. The optimal num- review and include reports concerning both oral Pregnancy (Category C): Salicylic acid 1-800-441-8227 and topical salicylate administration. The relation- has been shown to be teratogenic in rats and mon- The new bipolar RF device, Aluma Skin ber and best interval between treatments ship of these interactions to the use of Salex™ keys. It is difficult to extrapolate from oral doses of Manufactured by: Lotion is not known. acetylsalicylic acid used in these studies to topical DPT Laboratories, Ltd. Renewal System (Lumenis Inc.), uses vac- have yet to be determined. Studies are I. Due to the competition of salicylate with administration as the oral dose to monkeys may San Antonio, TX 78215 other drugs for binding to serum albumin the represent six times the maximal daily human dose uum suction to pull the skin about one- planned to evaluate the device to reduce tis- PATENT NO. 6,709,663 following drug interactions may occur: of salicylic acid when applied topically over a large REORDER NO. Salex™ Lotion: 0064-4011-14 quarter inch into the vacuum, where there sue laxity on the jowls, upper arms, stom- DRUG DESCRIPTION OF body surface. There are no adequate and well-con- 14 fl oz (414 ml) INTERACTION trolled studies in pregnant women. Salex™ Lotion are RF electrodes on either side. ach, and thighs. The device will be launched should be used during pregnancy only if the poten- Salex is a trademark of Healthpoint, Ltd. Sulfonylureas Hypoglycemia potentiated. tial benefit justifies the potential risk to the fetus. The device holds the skin for 1 second of in the United States and Europe this month. Methotrexate Decreases tubular reabsorption; clinical toxicity from Nursing Mothers: Because of the potential vacuum at 20-mm Hg suction and delivers Dr. Gold is an investigator, advisory ethotrexate can result. for serious adverse reactions in nursing infants from the mother’s use of Salex™ Lotion, a decision about 10 W of RF energy, he said. The over- board member, consultant, and stock- Oral Anticoagulants Increased bleeding. should be made whether to discontinue nursing or to discontinue the drug, taking into account the all treatment takes 15-30 minutes and treat- holder with Lumenis Inc., and has re- importance of the drug to the mother. 137077-0205 ments occur once weekly for 5-8 weeks. ceived honoraria to speak on behalf of the How the device reduces pain is unclear. company. ■