D R e q Eu i s i Rt e s i Mn Dermatologic Surgery A Edited by T Allison T Vidimos, RPh, MD, FAAD, FACMS O Chair, Department of Dermatology Cleveland Clinic Foundation Cleveland, OH, USA L Christie T Ammirati, MD, FAAD, FACMS O Associate Professor, Department of Dermatology Penn State Milton S. Hershey Medical Center Hershey, PA, USA G Christine Poblete-Lopez, MD, FAAD, FACMS Y Associate Staff, Department of Dermatology Cleveland Clinic Foundation Series editor Cleveland, OH, USA DIRK M ELSTON Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2009 An imprint of Elsevier Limited © 2009, Elsevier Limited. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103- 2899, USA: phone: (+1) 215 239 3804; fax: (+1) 215 239 3805; or, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier. com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. First published 2009 ISBN: 978-0-7020-3049-9 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Neither the Publisher nor the Editors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. The Publisher Printed in China Acknowledgments We would like to thank our mentors and teachers better physicians every day. Special thanks go who have taught us the art and science of to the the art and photography departments at dermatologic surgery, our residents, fellows and Cleveland Clinic, especially Joe Pangrace, Bill medical students who have given us the privilege Garriott, Beth Halasz, and our dermatology and pleasure of teaching them, and our patients department photographer, Flora Williams. who put their trust in us and challenge us to be Dermatologic surgery dedications This text is dedicated to my parents Al and This text is dedicated to my husband, Seevee, Audrey Vidimos, my brothers Scott, David and who has given me unconditional love and the Dan, my husband Todd Stultz, and daughters support to pursue what I truly enjoy, most evident Katherine and Kristen for their love, support, in this endeavor; to my children, Veto, Samee, encouragement, and inspiration. and Neo, who are the source of my strength Allison T Vidimos and inspiration; to my parents, who taught me the value of education; to all my mentors, from This text is dedicated to my children Emma and whom I learned the art of surgical technique; and Nicholas and my parents Bob and Bee Travelute, to all the residents and fellows to whom I’ve tried who inspired me to always reach higher, and to to teach the importance of this art. my husband Chris, who held the ladder so I could Christine Poblete-Lopez climb. Christie T Ammirati Contributors Erin J. Allen, md Theresa Dressler Conologue, do Providence Dermatologic Surgery Director, Cosmetic Dermatology Service Portland, OR Geisinger Medical Center Danville, PA Christie T. Ammirati, md Associate Professor of Dermatology Daihung Vu Do, md Department of Dermatology Instructor in Dermatology Penn State Milton S. Hershey Medical Center Associate Director of Dermatologic Surgery Hershey, PA Department of Dermatology Beth Israel Deaconess Medical Center Philip L. Bailin, md Boston, MA Program Director, Dermatologic Surgery and Cutaneous Oncology John Ebner, do Department of Dermatology Department of Dermatology Cleveland Clinic Foundation Cleveland Clinic Foundation Cleveland, OH Cleveland, OH Ashish C. Bhatia, md Gregory J. Fulchiero Jr, md, MSBioEng Department of Dermatology and Dermatologic Surgery and Cutaneous Dermatologic Surgery Oncology DuPage Medical Group, Department of Dermatology Naperville, IL UT Southwestern Medical Center Assistant Professor of Clinical Dermatology Dallas, TX Department of Dermatology Northwestern University – Feinberg School Christopher Charles Gasbarre, DO of Medicine Department of Dermatology Chicago, IL Cleveland Clinic Foundation Cleveland, OH Elizabeth Magill Billingsley, md Associate Professor of Dermatology Lisa M. Grandinetti, md Department of Dermatology Department of Dermatology Penn State Milton S. Hershey Medical Center Cleveland Clinic Foundation Hershey, PA Cleveland, OH Lisa B. Campbell, md Joseph F. Greco, md Chief of Dermatology and Dermatologic Clinical Instructor Surgery UCLA Division of Dermatology Geisinger Health System Western Region Department of Medicine Geisinger Medical Group David Geffen School of Medicine at UCLA State College, PA Los Angeles, CA T. Minsue Chen, md Fellow, Mohs Research in Advanced Dermatologic Surgery Education Mohs and Dermasurgery Unit Department of Dermatology University of Texas, M. D. Anderson Cancer Center Houston, TX viii Contributors Christine M. Hayes, md Christine Poblete-Lopez, md Associate Professor of Dermatology Associate Program Director Department of Dermatology Department of Dermatology Boston University School of Medicine Cleveland Clinic Foundation Boston, MA Cleveland, OH Christopher Riddell Jones, md Matthew R. Ricks, md Department of Dermatology LtCol, USAF, MC, SFS Penn State Milton S. Hershey Medical Center Chief of Mohs Surgery Hershey, PA Wilford Hall Medical Center Lackland AFB, TX Ken K. Lee, md Director of Dermatologic and Laser Surgery Christopher B. Skvarka, md Associate Professor of Dermatology, Surgery, Department of Dermatology Otolarynogology – Head and Neck Surgery Hahnemann Hospital Oregon Health and Science University Drexel University College of Medicine Portland, OR Philadelphia, PA Victor J. Marks, md Aashish Taneja, md Department of Dermatology Department of Dermatology Geisinger Medical Center Wayne State University Danville, PA Dearborn, MI Edward V. Maytin, md, PhD Leonid Benjamin Trost, md Staff, Dermatology Department of Dermatology Cleveland Clinic Foundation Cleveland Clinic Foundation Assistant Professor of Molecular Medicine Cleveland, OH Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Allison T. Vidimos, RPh, md Cleveland, OH Chair, Dermatology Cleveland Clinic Foundation Susan Teri McGillis, md Cleveland, OH Director, Dermasurgery Center Lancaster, PA Paula S. Vogel, md Col (Ret), USA, MC Jon G. Meine, md Mohs Surgeon Staff, Department of Dermatology, Section Dermatology Associates of Dermatologic Surgery and Cutaneous San Antonio, TX Oncology Cleveland Clinic Foundation Rungsima Wanitphakdeedecha, md Cleveland, OH Department of Dermatology Faculty of Medicine Siriraj Hospital Allison Jo Moosally, md Mahidol University Clinical Associate Staff Bangkok, Thailand Department of Dermatology Cleveland Clinic Foundation Andrea Willey, md Cleveland, OH Assistant Clinical Professor Department of Dermatology Tri H. Nguyen, md University of California, Davis Director of Mohs/Dermatologic Surgery Davis, CA Associate Professor Mohs and Dermasurgery Unit Brittany Wilson, md Department of Dermatology Department of Dermatology University of Texas, M. D. Anderson Cancer Oregon Health and Science University Center Portland, OR Houston, TX Contributors ix Oliver J. Wisco, do Summer R. Youker, md Maj, USAF, MC, FS Assistant Professor of Dermatology Department of Dermatology Saint Louis University Wilford Hall Medical Center St Louis, MO Lackland AFB, TX Justin G. Woodhouse, md University Dermatologists, Inc. South Euclid, OH Also in the series Requisites in Dermatology Series Editor: Dirk M Elston Dermatopathology Dirk M Elston and Tammie Ferringer Cosmetic Dermatology Murad Alam, Hayes B Gladstone, and Rebecca C Tung Pediatric Dermatology Howard B Pride, Albert C Yan, and Andrea L Zaenglein Dermatologic Surgery Allison T Vidimos, Christie T Ammirati, and Christine Poblete-Lopez general Dermatology Kathryn Schwarzenberger, Andrew E Werchniak, and Christine J Ko Series foreword The Requisites in Dermatology series of textbooks have contributed their time and energy to create is designed around the principle that learning the sort of texts we wish we had had during our and retention are best accomplished when own training and each of the texts in the series the forest is clearly delineated from the trees. is accompanied by an innovative on-line module. Topics are presented with an emphasis on the Each on-line module is designed to complement key points essential for residents and practicing the text, providing lecture material not possible clinicians. Each text is designed to stand alone as in print format, including video and lectures with a reference or to be used as part of an integrated voice-over. These books have been a labor of love teaching curriculum. Many gifted physicians for all involved. We hope you enjoy them. Series dedication This series of textbooks is dedicated to my wife Kathy and my children, Carly and Nate. Thank you for your love, support and inspiration. It is also dedicated to the residents and fellows it has been my privilege to teach and to the patients who have taught me so much. Dirk M Elston Volume preface This text is designed to cover the essentials of lecture. In this manner, the text acts as an over- dermatologic surgery in a style that is straight view for students learning the surgical aspects forward and easily understood. Each topic is of dermatology, a focused study guide for presented as a concise, yet thorough, review, dermatology residents, and a ready reference for and each chapter is paired with an on-line those in practice. Acknowledgments We would like to thank our mentors and teachers better physicians every day. Special thanks go who have taught us the art and science of to the the art and photography departments at dermatologic surgery, our residents, fellows and Cleveland Clinic, especially Joe Pangrace, Bill medical students who have given us the privilege Garriott, Beth Halasz, and our dermatology and pleasure of teaching them, and our patients department photographer, Flora Williams. who put their trust in us and challenge us to be Dermatologic surgery dedications This text is dedicated to my parents Al and This text is dedicated to my husband, Seevee, Audrey Vidimos, my brothers Scott, David and who has given me unconditional love and the Dan, my husband Todd Stultz, and daughters support to pursue what I truly enjoy, most evident Katherine and Kristen for their love, support, in this endeavor; to my children, Veto, Samee, encouragement, and inspiration. and Neo, who are the source of my strength Allison T Vidimos and inspiration; to my parents, who taught me the value of education; to all my mentors, from This text is dedicated to my children Emma and whom I learned the art of surgical technique; and Nicholas and my parents Bob and Bee Travelute, to all the residents and fellows to whom I’ve tried who inspired me to always reach higher, and to to teach the importance of this art. my husband Chris, who held the ladder so I could Christine Poblete-Lopez climb. Christie T Ammirati