Local anesthetics are safe and effective. With the understanding of the actions and interactions of this class of drugs, maximum patient safety and satisfaction can be achieved.

Chemosurgery and wound healing by secondary intention is an excellent method of treatment for subungual carcinoma. It allows for complete ablation of the tumour with maximal preservation of tissue, eliminating the need for amputation, in the absence of bone involvement. As most nail bed carcinomas occur on the thumb, by avoiding distal phalanx amputation one can prevent considerable disability. Because chemosurgery traces out every infiltrating band of tumour, bone involvement can be accurately detected. Amputation, if necessary, could then be carried out to achieve cure. Despite the age of our patients (averaged age 64.6 years), all surgical sites healed well with good range of motion at the adjacent interphalangeal joint.

The epidermolysis bullosa acquisita (EBA) antigen is identified as 2 chains: a 290,000-dalton protein and a less prominent 145,000-dalton protein. The 290,000-dalton chain is synthesized by human keratinocytes in culture. In this study, we show that the 290,000-dalton chain is synthesized by human skin fibroblasts and cutaneous human tumors. In contrast, HT1080 cells, a human sarcoma cell line known to produce matrix molecules (such as laminin and type IV collagen), does not synthesize the EBA antigen. Further, the EBA antigen is absent from serum and blood components, placenta, amnion, lung, and the EHS tumor, a murine sarcoma that produces large amounts of laminin, type IV collagen, nidogen, entactin, and basement membrane proteoglycan but is present in cutaneous tumors of adnexal and epithelial origin. These data suggest that while the EBA antigen is synthesized by both human skin keratinocytes and fibroblasts and is therefore not specific for a primordial germ layer, it does appear to be specific for tissue containing a stratified squamous epithelium.

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Floaters are not rare and can complicate MMS margin assessment. There is significant expert consensus regarding the causes of floaters and the tissue features that may predispose to them. Floaters may be prevented by minimizing their likely causes. There is less consensus on what to do with a floater.