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Guest editor's remarks
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Mysore V. Guest editor's remarks. Indian J Dermatol Venereol Leprol 2009;75:65-66
This is the second report of the Taskforce on dermatosurgery of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL). The previous report published in 2008 was well received by our members. It received recognition by several international groups also. In particular, the approach of drafting guidelines according to the evidence available was well appreciated.
Evidence-based approach continues to be the basis of the guidelines in the current issue also. Several new topics, of relevance to dermatologists and dermatosurgeons have been dealt in detail in this issue. The guidelines on radiofrequency surgery, cryosurgery and local anesthesia refer to issues relevant to the routine practice of all dermatologists. The guidelines on laser theater and dermatosurgery theatre deal with two important problems faced by dermatologists while establishing practice. Guidelines for lasers for pigmented lesions deal with an exciting and rapidly advancing area of laser surgery. I convey my most sincere thanks and appreciation to all the members of the taskforce who cooperated by writing authoritative, scholarly and evidence-based articles and completing the work on time.
It is emphasized that the guidelines are framed to suit the Indian situation and are based on the available evidence and the consensus opinion of the taskforce members. It must be emphasized that the objective of these guidelines is to recommend minimum standards for practice of dermatosurgery by our IADVL members. The taskforce emphasizes that each patient has to be treated on his/her own merit and that these guidelines do not limit the physician from making an appropriate choice or the necessary innovation for a given patient.
Publication of these guidelines is the realization of an effort started in 2006, a plan of action for developing such guidelines, was approved in the AGM of IADVL in Chennai. I, therefore, wish to thank all members of IADVL for choosing me to coordinate this effort and thereby participate in and contribute to such a unique exercise. In particular, on behalf of the taskforce members, the guest editor would like to thank the president Dr. VK Sharma, past president Dr. S Sacchidanand, president elect Dr. Hemangi Jerajani, General Secretary Dr. Rajeev Sharma and all the office bearers of IADVL for making this publication possible. The taskforce would also like to express its sincere gratitude and appreciation to the editor of IJDVL, Dr. DM Thappa and past editor Dr. Uday Khopkar, all the referees of IJDVL, and many IADVL members who contributed to the formulation of these guidelines.
The taskforce welcomes any suggestions from the readers. I sincerely hope that these guidelines will provide a framework for conducting evidence-based dermatosurgery practice by all IADVL members and contribute to establishing the subspecialty of dermatosurgery in India in the years to come.
Guidelines for Dermatosurgery
Recommendations of the IADVL Dermatosurgery Taskforce were developed by the 2008-09 IADVL taskforce for standards of care in dermatosurgical procedures which was constituted in January 2008, with the following members:
Dr. Venkataram Mysore (coordinator)
Dr. SC Rajendran
Dr. Sharad Mutalik
Dr. Niteen Dhepe
Dr. Sujay Khandpur
Dr. Sanjeev Aurangabadkar
Ex officio members:
Dr. S. Sachidanand, President IADVL
Dr. VK Sharma, President elect IADVL
Dr. Chetan Oberai, Past president, IADVL
Dr. Rajeev Sharma, Secretary IADVL
Format of the Guidelines
The taskforce adopted the following format for drafting guidelines:
- Abstract of recommendations
- Definition, rationale and scope
- Physician′s qualifications and facility
- Methodology of the procedure
- References (evidence): wherever essential and considered feasible, evidence was classified as per the following guidelines:
Level of Evidence
The guidelines are based on various types of evidence (source literature) which is classified as
Level A: Strong research-based evidence; multiple, relevant, high-quality scientific studies with homogeneous results.
Level B: Moderate research-based evidence; at least one relevant, high-quality study or multiple adequate studies.
Level C: Limited research-based evidence; at least one adequate scientific study.
Level D: No research-based evidence; expert panel evaluation of other information.
These guidelines include the most commonly performed procedures for which evidence is available. However, they should not be considered inclusive of all known methods or exclusive of other reasonable methods in obtaining similar results. The principles outlined in these guidelines are of a general nature and as in any aesthetic treatment or surgery, individual variations may occur from patient to patient, and hence, appropriate modifications may be needed. Hence these guidelines do not in any way, restrict the treating physician from choosing an appropriate treatment as he deems fit. Each patient has to be treated on his/her own merit and adherence to these guidelines alone will not ensure successful treatment in all situations.
The ultimate judgement regarding the choice of surgical procedures should be made by the physician, considering the individual patient and training and experience of the treating physician. As in the correct and ethical practice of any surgical procedure, the physicians must exercise their judgement in light of all the circumstances of the individual patient.
These guidelines have been prepared as a service to the members of IADVL, with the sole purpose of guiding the uninitiated.
Neither the taskforce members nor IADVL should be held responsible, either directly or indirectly, for any legal claims.
Financial Disclosure and Conflict of Interest
The IADVL Dermatosurgery Taskforce has no financial interests to declare. None of the members have declared any conflict of interest for any of the articles contributed by them.
The taskforce gratefully acknowledges the assistance and information provided by several dermatologists across the country during the preparation of these guidelines.
While it is not possible to mention all names here, particular mention is made of the following doctors whose suggestions and expertise was invaluable in preparation of these guidelines:
Dr. VK Sharma, President IADVL, whose keen interest and support made this publication possible, Dr. Sacchidanand S, whose continuous active role, interest and wide-ranging expertise in dermatosurgery was instrumental in framing the guidelines, Dr. Hema Jerajani and Dr CR Sreenivas, who gave valuable suggestions for the guidelines on cryosurgery, Dr. Rajeev Sharma for his continuous support and cooperation during the preparation of the manuscript, Dr. Omprakash and Dr. KC Nischal, who in addition to authoring guidelines in their topics, helped in correction of manuscripts and reference search, Dr. Apratim Goel and Dr. Krupashankar, who gave many valuable suggestions for the article on lasers for pigmented lesions, Dr. Ragini Ghiya for her role in the proof correction of the article on radiofrequency, IJDVL reviewers who cannot be named.