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Demography accounted for no variance, religion 4% of variance, the self-assessment variables 19% of variance and media consumption no variance. It showed that nonreligious people with low self-esteem and low perceived self-attractiveness were most willing to undergo cosmetic surgery. The second factor on the benefits of cosmetic surgery showed the predictor variables accounted for 41% of the variance. The stepwise regression showed that sex accounted for 9% of the variance, religiousness 32%, life satisfaction 3% and media consumption 6%. The regression showed that women, with few religious beliefs, low life satisfaction and high overall media consumption, were more accepting of the benefits of cosmetic surgery. DISCUSSION The findings of the current study showed that lower ratings of self-esteem and life satisfaction, increased media exposure to cosmetic surgery via television shows, time spent watching television and religiosity were all significant predictors of the likelihood of undergoing cosmetic surgery. While the correlations between the various measures and the two-factor scores were similar, the regressions showed that different measures predicted the two different factors. The second factor (concerning the benefits of cosmetic surgery) was most strongly predicted by the two unique features of the present study, namely religious beliefs and media consumption.Both correlations and regressions indicated that, although women were more likely to say they would have surgery, it was the sex difference in perceived benefits (factor 2) that was strongest. The finding that women did not significantly report a greater likelihood of undergoing cosmetic surgery than men is inconsistent with nearly all previous studies (5,13). It was expected that the greater sociocultural pressure on women to conform to societal ideals of attractiveness (shown by the prevalence of body image and eating disorders among women) would serve to normalize their pursuit of cosmetic surgery. Studies have also shown real-life biases for attractive women, and discrimination against less attractive women, in several different domains of society (26,27). Considering these findings, the results of the current study are surprising. intention - delayed wound closure after several days 24 1. Intentional interruption of healing started as secondary intention 2. May proceed any time after granulation tissue has formed in wound 3. Delayed closure should be performed when wound is not infected. Quantitative culture should demonstrate 2cm, or size >6mm in the central face, ears, scalp, genitalia, hands/feet 4. Margins a. Low-risk: 4-6mm b. High-risk: 10mm or Mohs micrographic surgery 5. May metastasize (most often with lesions on the ear or lip, lesions > 2 cm in size, and in the immunosuppressed population) 6. Bowen’s Disease – SCC in-situ (full- thickness epidermal atypia that presents as a thin eczematous, erythematous plaque) 7. Erythroplasia of Queyrat – SCC in-situ of the glans penis C. Basal Cell Carcinoma (Figure 3) 1. Presents as a pink, pearly papule with overlying telangiectasia and rolled borders. Ulceration may be present, giving a characteristic “rodent bite” ulcer 2. Arises on sun-damaged skin of the head, neck, and upper extremities, with an increasing incidence with age, fair skin, chronic sun exposure, and a history of tanning bed use 43 3. High risk – poorly defined borders, recurrent lesion, immunosuppressed patient, site of previous radiation, peri-neural involvement, aggressive histology (morpheaform, sclerosing, mixed infiltrative, basosquamous, or micronodular), >2cm in the trunk/extremities, or >1cm in the head and neck 4. Treatment options include surgical excision, Moh’s, ED&C, cryosurgery, Imiquimod (for 6 mm) e. Enlarging or evolving 4. Superficial spreading melanoma a. Most common subtype of melanoma b. Occur particularly on sun-exposed skin and often arise in preexisting nevi c. Have a prolonged radial growth phase before developing a vertical growth phase d. Initially flat, but can become irregular or raised as the lesions grow 5. Nodular melanomas a. Second most common form of melanoma b. Commonly seen on the trunk, head, and neck, males > females c. Domed-shaped, dark, and may resemble a blood blister 6. Lentigo maligna melanoma a. Rare subtype seen in only 4 percent of melanomas b. Often arise from pre-existing lentigo maligna lesions, which can be present for many years, growing in a slow, radial fashion, before the vertical growth phase develops c. Women>men, often located on the face, head, and neck of older individuals d. Commonly present as large, tan lesions with convoluted patterns and multiple amelanotic patches 7. Acral Lentiginous Melanoma a. Rarest form of melanoma in Caucasians but 30-60 % of melanoma in darkskinned individuals b. Commonly occur in the palms, soles of the feel, and under the nails 8. Amelanotic a. Lack pigment and are often mistaken for other lesions 9. Desmoplastic Melanoma a. Has aggressive local growth and less frequent nodal metastases b. Often confused with common nevi, blue nevi, Spitz nevi, pyogenic granulomas, or hemangiomas 10.Diagnosis a. Gold standard is excisional biopsy b. Shave biopsy is often performed by dermatologists but can under-estimate depth, although this hasn’t been shown to affect prognosis/survival 11.Treatment is surgical excision, margins are dictated by Breslow depth a. Melanoma in-situ (MIS) – 5mm b. < 1mm – 1cm c. 1.01-2mm – 1-2cm (generally 2cm where allowable such as the trunk and extremities, and 1cm in more aesthetically sensitive areas like the head and neck) d. >2.01mm – 2cm 12.Sentinel Lymph Node Biopsy (SLNB) a. Indicated for intermediate thickness (1-4mm) melanomas 45 b. May also be indicated for high-risk thin melanomas 0.75-1mm thick and thick melanomas 13.Completion Lymph Node Dissection (CLND) a. Currently indicated in cases of a positive SLN, or a clinically palpable node 14.Medical treatment for melanoma is currently used for advanced melanoma only (usually Stage 3 or 4) and consists of immunomodulation and targeted molecular therapy toward mutations found in melanocytic lesions a. Vemurafenib and dabrafenib (BRAF inhibitors, improved survival but develops rapid resistance with associated relapse) b. Interleukin-2 (immunomodulator that activates the host immune system to attack malignant cells, severe side effect profile) c. Ipilimumab (monoclonal antibody that suppresses CTLA-4, small but durable response, significant immunologic side effects) d. Nivolimumab (anti-PD-1 monoclonal antibody) Figure 4. ABCDE signs of melanoma. A 75-year-old man with a left cheek lesion presenting with asymmetry, borders irregularity, color variation, and diameter of 2.5 cm evolving over an 8-year period. From Dzwierzynski W. Managing malignant melanoma. Plast Reconstr Surg 2013;132(3):446e-60e. E. Merkel Cell 1. Presents as a firm, painless nodule (up to 2 cm in diameter) or a mass (>2 cm in diameter), usually in the head and neck region, classically red in color, but may be flesh-colored or blue, and often enlarges rapidly 2. Risk factors include exposure to sun and ultraviolet light, immunosuppression, and the Merkel cell polyomavirus 3. Treatment is surgical excision (1-2cm margins down to investing fascia) and sentinel node biopsy, combined with adjuvant radiation therapy to decrease local recurrence rates F. Verrucous carcinoma 46 1. A variant of squamous cell carcinoma – requires wide local excision with negative margins for treatment G. Paget’s Disease of the
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