Background Hurricane Maria struck Puerto Rico on Sept 20, 2017, devastating the island. Controversy surrounded the official death toll, fuelled by estimates of excess mortality from academics and investigative journalists. We analysed all-cause excess mortality following the storm. Methods We did a time-series analysis in Puerto Rico from September, 2017, to February, 2018. Mortality data were from the Puerto Rico Vital Statistics System. We developed two counterfactual scenarios to establish the population at risk. In the first scenario, the island's population was assumed to track the most recent census estimates. In the second scenario, we accounted for the large-scale population displacement. Expected mortality was projected for each scenario through over-dispersed log-linear regression from July, 2010, to August, 2017, taking into account changing distributions of age, sex, and municipal socioeconomic development, as well as both long-term and seasonal trends in mortality. Excess mortality was calculated as the difference between observed and expected deaths.

Background Mohs Micrographic Surgery (MMS) with melanoma antigen recognized by T cells (MART-1) immunostaining is an effective treatment for cutaneous melanoma. Objective Determine the efficacy of MMS with MART-1 immunostains in the management of invasive and in-situ melanoma. Methods and Materials A retrospective cohort study evaluated 2, 114 melanomas in 1,982 patients excised using MMS and MART-1 immunostains. Margins required for excision were calculated based on Breslow thickness, location and size. Survival and local recurrence rates were calculated and compared with those of historical controls. Results The mean follow-up was 3.73 years. Local recurrence was identified in 0.49 % (7/1,419) of primary melanomas. ~82% of melanomas were excised with ≤6mm margins. The surgical margin was significantly related to tumor location and size, but not to Breslow thickness. The five-year Kaplan-Meier local recurrence and disease-specific survival were 0.59 ± 0.30 and 98.53 ± 0.42, respectively. MMS with MART-1 immunostains achieved lower local recurrence rates, and equivalent or higher Kaplan-Meier survival rates when compared with conventional wide local excision. Conclusion MMS with MART-1 immunostain is an effective treatment for melanoma as evidenced by low local recurrence rates. It offers the advantage of more tissue conserving margins than those recommended for conventional excision.