To the Editor.
—For the most part, the updated recommendations by the American Heart Association (AHA)1 for the prevention of bacterial endocarditis are thoughtful and comprehensive. Unlike the 1990 recommendations,2 the subject of antibiotic prophylaxis for cutaneous surgery is at least briefly mentioned although not specifically discussed. In the current statement, endocarditis prophylaxis is not recommended for "incision or biopsy of surgically scrubbed skin."1 Unfortunately, the meaning of "surgically scrubbed skin" is not clarified. Does this refer to "sterile" prepared skin as in the operating room setting or to "clean" prepared skin as in the outpatient office setting?Dermatologic surgery, which is performed predominantly in a "clean" outpatient office setting, is becoming a more frequent phenomenon because of the increasing number of dermatologists performing these procedures. Furthermore, with third-party payers giving increasing emphasis to outpatient surgery, plastic surgeons, otolaryngologists, and other surgical specialists are performing a greater