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Cosmetic surgeons, recognizing the increasing number of men undergoing cosmetic surgery in recent years, may no longer be specifically targeting women in their advertising. Therefore, the contemporary view of cosmetic surgery, as propagated by the media, may in fact account for the unusual findings of the current study.Confirming the results of Brown et al (5), it was found that self-ratings of physical attractiveness did have a significant effect on the likelihood of undergoing cosmetic surgery.The current study showed that self-esteem was negatively associated with the likelihood of undergoing cosmetic surgery. Individuals with low self-esteem may be more willing to have cosmetic alteration to improve their own self-perceptions, thus boosting their self-esteem, although it is unclear whether that will indeed occur. Individuals with exceptionally low self-esteem and low life satisfaction may, in fact, suffer from depression, meaning that cognitive therapy, as opposed to cosmetic surgery, would be more beneficial. Most plastic surgeons are acutely aware of patients whose hope for the effects of surgery is unrealistic and could, in time, lead both to litigation and increased depression.The present study particularly examined media exposure/consumption and attitudes toward cosmetic surgery. The significant effect of media exposure is inconsistent with the study by Brown et al (5), but is consistent with results from other studies (13,25). The current study showed that exposure to media was not related to the first factor (likelihood) but was related to the second factor (benefits) in the regressions. Those who consumed more media believed that cosmetic surgery brought more benefitsThe present study also focused on religious beliefs and attitudes toward cosmetic surgery. More religious individuals may be likely to perceive cosmetic alteration as a direct contravention to their religious beliefs. Christian religious authorities strongly advocate the view that people should be less concerned with physical appearance (Philippians 2:3–4) and more concerned with religious issues (Proverbs 31:30) and that true beauty lies within an individual’s spirit (1 Peter 3:4) (28). Religiosity is a powerful determinant of an individual’s attitude toward several controversial topics (21–23) and therefore it is perhaps not surprising that it determines attitudes toward cosmetic surgery. Further research could explore whether this effect is found in all religions, because this study examined religiousness, not a particular religion per se. The role of religious beliefs and values on shaping attitudes to cosmetic surgery deserves greater research attention. REFERENCES 1. Swami V. Breast 1. Presents with eczematous skin changes of the nipple areolar complex 2. Often associated with ipsilateral breast cancer H. Extramammary Paget Disease 1. Intraepithelial carcinoma involving the vulvar, perianal, perineal, scrotal, and penile regions 2. Presents as well-defined, moist, erythematous plaques associated with pruritis 3. 7 to 40% rate of associated malignancy – treated with wide local excision I. Dermatofibrosarcoma protuberans (DFSP) 1. Malignant mesenchymal tumor that arises in the dermis and is characterized by latency in its initial detection, slow infiltrative growth, and local recurrence if not adequately treated 2. 90% of DFSP tumors have the chromosomal translocation t(17;22) that fuses the collagen gene COL1A1 with the platelet-derived growth factor gene 3. Most common on the trunk followed by the proximal extremities 4. Treatment is wide surgical excision (2-3 cm margins). Mohs can be used 5. Molecular targeted therapy with imatinib mesylate (Gleevec) is indicated for unresectable, recurrent, or metastatic DFSP J. Angiosarcoma 1. Appears as a purple plaque, commonly found in the face and scalp in older Caucasian men 2. 50% in the head and neck, and also commonly found in the breast and extremities, particularly in patients with a history of lymphedema or radiation therapy 3. Treatment is wide local excision, but it is frequently multifocal, and local recurrences are common K. Stewart-Treves Syndrome 1. Lymphangiosarcoma in post-mastectomy patients 2. Diagnosis is via incisional biopsy 3. Treatment includes WLE if possible with margins of at least 1cm, or isolated limb perfusion with tumor necrosis factor and melphalan III. VASCULAR ANOMALIES Vascular anomalies may be divided into hemangiomas and vascular malformations. Hemangiomas are vascular tumors characterized by increased cellular proliferation. Classically, they exhibit rapid growth and slow regression. Approximately 80% of hemangiomas are noted in the first month of life, and 60% occur in the head and neck region. Vascular malformations are present at birth and grow slowly. A. Infantile hemangiomas 1. May be present at birth (30-50%) but usually appear in the first two weeks of life, with 80% appearing in the first month of life 47 a. Proliferating phase – 0-9 months (with most of the growth achieved by 3 months) b. Involuting phase – 9 months to 12 years, but is completed usually by age 4 2. Involution leaves some scar or discoloration in 50% of patients 3. Biopsy is rarely indicated, but IHs are GLUT-1 positive on immunostaining 4. Treatment a. Small (less than 2-3cm) well localized IHs can use intralesional corticosteroid b. Larger problematic lesions can be treated with medical therapy (oral prednisolone or oral propanolol) c. Surgery is indicated in the case of: i. Failure or contraindication to pharmacotherapy ii. A well-localized tumor in an anatomically favorable area iii. If resection will be necessary in the future and the scar would be the same iv. Lesions (of any stage) that are compromising function or destroying vital structures B. Congenital hemangiomas 1. Arise in the fetus, are fully grown at birth, and do not have post-natal growth 2. Red-violaceous with coarse telangiectasias, central pallor, and a peripheral pale halo 3. More common in the extremities, have an equal sex distribution, and are solitary with an average diameter of 5 cm 4. Two forms: a. Rapidly involuting congenital hemangioma (RICH) i. Involutes rapidly after birth ii. 50% of lesions have completed regression by 7 months of age; the remaining tumors are fully involuted by 14 months iii. Affects the head or neck (42%), limbs (52%) or trunk (6%) iv. Rarely requires treatment but may leave behind atrophic skin b. NICH (Non-involuting congenital hemangioma) i. Does not regress (remains unchanged with persistent fast-flow) ii. Involves the head or neck (43%), limbs (38%), or trunk (19%) iii. Resection can be considered if the scar will be less noticeable than the lesion C. Kaposiform Hemangioendothelioma 1. Presents as a large (>5cm), superficial, and diffuse lesion, with the overlying skin deep red-purple, tense, painful, and shiny 2. Typically involves the trunk and extremities, 50% present at birth (but can appear in childhood) 3. Kasabach-Merritt phenomenon (thrombocytopenia INTRODUCTION AND GENERAL SUMMARY A minimum of 24.5 weeks/955 (18.5 weeks/722 hours for the Classes of 2021 and 2022) hours are required for the M.D. degree. This provides a valuable opportunity for advanced study in the fields of medicine and the biological sciences through a process that is, as far as possible, open to the students' election. The chief constraint sets in when too many students ask for the same course at the same time. The sequence of electives can often be arranged to meet a student's desires and needs. In addition to the 24.5 weeks of elective credit, students must also complete two required electives. These two electives include: one advanced clerkship (either the Advanced Clerkship in Critical Care or the Advanced Ambulatory Clerkship), and one approved Subinternship experience. Each of these clerkships is 4.5 weeks (3.5 weeks in AY2020-21) in length. Students should consult freely with members of the faculty, the Associate Dean for Medical Student Affairs and Colleges Advisors in developing their programs. The ultimate responsibility for arranging the
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