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BACKGROUND Medical spas have experienced a recent rise in popularity by consumers. Their regulations vary from state to state, especially concerning oversight and credentialing. A majority of aesthetic physicians were shown to have a medical spa within 5 minutes of their workplace. OBJECTIVE Our study investigated the current market distribution of medical spas and physician practices in the aesthetic field. MATERIALS AND METHODS For the 30 most populous cities, data were collected for medical spas and aesthetic physicians. Descriptive ratios were calculated, and various local factors were examined. RESULTS The cities with the greatest number of medical spas were New York (374), Houston (297), and Los Angeles (227). The cities with the greatest number of aesthetic physicians were New York (365), Houston (135), and Chicago (122). Population size had significant relationships with number of medical spas (p < .000001) and aesthetic physicians (p < .000001). For ratio of medical spas to aesthetic physicians, the top cities were Las Vegas (9.17), Denver (3.86), and San Jose (3.65). In total, 73.3% of cities had more medical spas than aesthetic physicians. CONCLUSION Certain cities have experienced an unequal distribution of medical spas. Further research should examine how this affects consumer decision-making for the selection of practice settings.

PURPOSE To evaluate the palliative treatment benefit of surface-mold computer-optimized high-dose-rate brachytherapy (SMBT) for in-transit cutaneous metastases of Merkel cell carcinoma (MCC). PATIENTS & METHODS Tenpatients with in-transit cutaneous MCC metastases were treated with SMBT at the Dana-Farber/Brigham & Women’s Cancer Center (DFBWCC) between 2006 and 2012. RESULTS The median age at diagnosis was 76 years (range 63–87 years). Seven patients had in-transit metastases on the lower extremities (70%), 2 patients on the head & neck (20%), and 1 patient on an upper extremity (10%). A total of 152 metastatic MCC lesions were treated with SMBT. All SMBT treated lesions resolved clinically within a few weeks of therapy. The median follow-up was 34 months (range 22–85 months). Two of 152 treated lesions recurred during the study period for a local control rate of 99%. Eight patients (80%) developed additional in-transit metastases outside the original SMBT fields. Five of these 8 patients underwent additional SMBT. At study conclusion, 3 patients (30%) are alive without disease, 3 patients (30%) are alive with disease, and 4 patients (40%) died of MCC. DISCUSSION SMBT offers effective and durable palliation for cutaneous metastases of MCC, although it does not appear to alter disease course.

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strength of such relationships could be significant to one's success in the match, as these mentors will be the one vouching for the applicant's work ethic, ability to work well and get along with others, and will be writing supportive letters of recommendations-all of which were rated important by program directors in their selection process. 2,3 Interestingly, only 23.8% of successful applicants with a home fellowship program matched into their home fellowship (Table 2). This finding suggests that the benefits of having a home fellowship program may involve the resources offered by such program more so than the fellowship slot necessarily being "reserved" for its own dermatology residency graduates.Important limitations of our study include that our data does not include fellows who were selected into their programs outside of the SF Match. In the current match cycle and moving forward, the ACGME does not allow for match exemptions. We anticipate that this change will further strengthen the correlation between dermatology residency and chance of success in the fellowship match and plan to follow these data in the coming years.

In recent years, the field of cosmetic medicine has continued to expand, especially with the increasing popularity and availability of minimally and non-invasive treatments. In particular, body contouring modalities have experienced remarkable growth with the advent of techniques that utilize bulk cooling, bulk heating, and electromagnetic muscle stimulation (EMMS). [1][2][3][4][5][6] According to the most recent member survey of the American Society for Dermatologic Surgery (ASDS), there has been a fourfold increase in body contouring procedures in the past 7 years. 7 This can likely be explained by the latest ASDS consumer survey, which found that 84% of respondents were most bothered by excess weight on any part of the body. 8 In an attempt to meet the growing demand for cosmetic treatments, this field has witnessed a surge in the number of medical spas and non-physician operators. They can offer many procedures that were once only performed by physicians and which are often marketed at significantly reduced prices. As of 2018, there were over

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