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Jing L, Zhuang F, Feng W, Huang H, Chen Y, Huang B. Doping-Engineered Piezoelectric Ultrathin Nanosheets for Synergistically Piezo-Chemocatalytic Antitumor and Antibacterial Therapies Against Cutaneous Melanoma. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2401171. [PMID: 38847567 DOI: 10.1002/smll.202401171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/01/2024] [Indexed: 10/04/2024]
Abstract
The post-surgical melanoma recurrence and wound infections have persistently troubled clinical management. Piezocatalytic therapy features high efficiency in generating reactive oxygen species (ROS) for tumor therapy, but it faces limitations in piezoelectricity and redox-active site availability. Herein, Fe-doped ultrathin Bi4Ti3O12 nanosheets (designated as Fe-UBTO NSs) with synergistically piezo-chemocatalytic activity are engineered for antitumor and antibacterial treatment against cutaneous melanoma. The doping-engineered strategy induces oxygen vacancies and lattice distortions in Fe-UBTO NSs, which narrows bandgap to enhance piezocatalytic 1O2 and H2O2 generation by improving the electron-hole pairs separation, hindering their recombination, and increasing oxygen adsorption. Moreover, Fe doping establishes a piezo-chemocatalytic system, in which the piezocatalysis enables the self-supply of H2O2 and expedites electron transfer in Fenton reactions, inducing increased ·OH production. Besides, the atomic-level thickness and expanded surface area enhance the sensitivity to ultrasound stimuli and expose more redox-active sites, augmenting the piezo-chemocatalytic efficiency, and ultimately leading to abundant ROS generation. The Fe-UBTO-mediated piezo-chemocatalytic therapy causes intracellular oxidative stress, triggering apoptosis and excessive autophagy of tumor cells. Moreover, this strategy accelerates wound healing by facilitating sterilization, angiogenesis, and collagen deposition. This work provides distinct options to develop doping-engineered ultrathin nanosheets with augmented piezo-chemocatalytic activity for postoperative management of cutaneous melanoma.
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Affiliation(s)
- Luxia Jing
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, P. R. China
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, 200032, P. R. China
| | - Fan Zhuang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, P. R. China
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, 200032, P. R. China
| | - Wei Feng
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai, 200444, P. R. China
| | - Hui Huang
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai, 200444, P. R. China
| | - Yu Chen
- Materdicine Lab, School of Life Sciences, Shanghai University, Shanghai, 200444, P. R. China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Institute of Shanghai University, Wenzhou, Zhejiang, 325088, P. R. China
- Shanghai Institute of Materdicine, Shanghai, 200051, P. R. China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, P. R. China
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, 200032, P. R. China
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Shah P, Trepanowski N, Grant-Kels JM, LeBoeuf M. Mohs micrographic surgery in the surgical treatment paradigm of melanoma in situ and invasive melanoma: A clinical review of treatment efficacy and ongoing controversies. J Am Acad Dermatol 2024; 91:499-507. [PMID: 38768857 DOI: 10.1016/j.jaad.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/06/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM).
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Affiliation(s)
- Payal Shah
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire
| | - Nicole Trepanowski
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire
| | - Jane M Grant-Kels
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida; Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Matthew LeBoeuf
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire.
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Trischman T, Bangalore Kumar A, Asamoah EM, Todd A, Vidal NY, Demer AM. Risk factors associated with tumor upstaging in melanomas treated with Mohs micrographic surgery with melanocytic immunohistochemistry. JAAD Int 2024; 16:3-8. [PMID: 38756446 PMCID: PMC11096738 DOI: 10.1016/j.jdin.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Mohs micrographic surgery with melanocytic immunohistochemistry (MMS-I) is increasingly utilized for special site melanoma treatment. Yet, frequency and risk factors associated with upstaging of all-stage cutaneous melanomas treated with MMS-I remain undefined. Objective Determine upstaging frequency and factors associated with tumor upstaging for all-stage melanomas treated with MMS-I. Methods In this retrospective, single-center case series, all cases of invasive and in situ melanoma treated with MMS-I between 2008 and 2018 were reviewed. Patient and tumor characteristics were recorded and compared between tumors that were and were not upstaged from their initial T stage. Results Of the 962 melanoma MMS-I cases identified, 44 (4.6%) were upstaged, including 5.6% of in situ and 2.5% of invasive tumors. Risk factors for upstaging included lack of excisional intent at the time of initial biopsy (P < .01), nonlentigo maligna subtype (P = .03), female sex (P = .02), and initial in situ diagnosis (P = .03). Nonstatistically significant characteristics evaluated included patient age (P = .97), initial Breslow depth (P = .18), and biopsy type (P = .24). Limitations Retrospective study design. Conclusions All-stage cutaneous melanomas treated with MMS-I are associated with low upstaging rates. Tumor upstaging is associated with lack of excisional intent, female sex, and in situ tumors.
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Affiliation(s)
| | | | | | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Nahid Y. Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M. Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Sun C, Lim A, De’Ambrosis B, Yong-Gee S, Pool L, Muir J. Recurrence Rate of Small Melanoma In Situ on Low-Risk Sites Excised With 5-mm Excisional Margin. JAMA Dermatol 2024; 160:874-877. [PMID: 38922604 PMCID: PMC11209174 DOI: 10.1001/jamadermatol.2024.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 06/27/2024]
Abstract
Importance The incidence of melanoma in situ (MIS) has increased significantly over the past decades, and traditional guidelines for treatment of MIS have been excision with a 5-mm clinical margin; however, current Australian and other guidelines now recommend 5- to 10-mm margins. This changed recommendation was largely driven by the outcomes of studies using Mohs micrographic surgery, and recent studies using Mohs micrographic surgery are advocating for even wider excisions up to 18 mm for clearance. Objective To assess the rate of recurrence of MIS excised with a 5-mm margin. Design, Setting, and Participants This case series studied all MIS lesions from a single private dermatology clinic between January 1, 2011, and November 30, 2018. The criteria for inclusion were a documented 5-mm excisional margin on operation report and more than 5 years of site-specific follow-up after wide local excision. Lesions were excluded if the excisional margin was more than 5 mm or undocumented, there was less than 5 years of follow-up, or they required more than 1 wide local excision. Data analysis was performed January 30 to February 25, 2024. Intervention Wide local excision with 5-mm margin. Results A total of 351 MISs were identified from 292 patients (mean [SD] age, 60.3 [11.8] years; 162 females [55.5%]). Superficial spreading melanoma was the most common subtype diagnosed (177 lesions [50.4%]), followed by lentigo maligna (107 lesions [30.5%]) and lentiginous MIS (67 lesions [19.1%]). The trunk was the most common location of lesions (168 lesions [47.9%]), followed by upper limb (96 lesions [27.4%]) and lower limb (59 lesions [16.8%]). Scalp was the least common location (2 lesions [0.6%]). Most of the lesions were small, with 274 lesions (78.1%) having a length less than 10 mm and 312 lesions (88.9%) having a width less than 10 mm. A total of 348 lesions (99.1%) did not have clinical recurrence after excision with a 5-mm clinical margin following then current guidelines. A total of 3 lesions (0.9%) experienced local recurrence with no metastatic spread. Conclusions and Relevance This case series found that excision with a 5-mm margin for MIS of smaller size (<10 mm) on low-risk body sites had a low rate of recurrence. Conservative 5-mm excisional margin is likely to be suitable for small MIS on lower-risk body sites.
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Affiliation(s)
- Cong Sun
- Mater Hospital Brisbane Raymond Terrace, South Brisbane, Queensland, Australia
| | - Alvin Lim
- South East Dermatology Unit 9, Annerley, Queensland, Australia
| | - Brian De’Ambrosis
- South East Dermatology Unit 9, Annerley, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Simon Yong-Gee
- South East Dermatology Unit 9, Annerley, Queensland, Australia
| | - Louis Pool
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - James Muir
- Mater Hospital Brisbane Raymond Terrace, South Brisbane, Queensland, Australia
- South East Dermatology Unit 9, Annerley, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Prusinski Fernung LE, Micklus NE, Potter KA. Low Rate of Upstaging of Melanoma in Situ When Central Debulk Sent for Permanent Sections During Mohs Micrographic Surgery. Dermatol Surg 2024:00042728-990000000-00872. [PMID: 38984533 DOI: 10.1097/dss.0000000000004321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
| | - Nicole E Micklus
- Medical College of Georgia at Augusta University, Augusta, Georgia
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Contestable JJ, Lim GFS, Willenbrink T, Zitelli JA, Brodland DG. Mohs for Melanoma: A Review of MART-1 Frozen Section Interpretation. Dermatol Surg 2024:00042728-990000000-00867. [PMID: 38975654 DOI: 10.1097/dss.0000000000004312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Mohs surgery for melanoma has been performed for many decades, but advances in the use of immunohistochemistry with frozen sections during Mohs surgery have allowed for more accurate, reliable, and efficient margin assessment with improved local control of the disease. OBJECTIVE To describe the use of MART-1 in treating melanoma with Mohs surgery and serve as a primer for the Mohs surgeon adding melanoma cases to their repertoire. MATERIALS AND METHODS Review of the literature and discussion of experience with Mohs for melanoma. RESULTS Practical approach and pitfalls when assessing margins using MART-1 immunohistochemistry during Mohs surgery for the treatment of melanoma. CONCLUSION Mohs for melanoma is an expanding field-education of Mohs surgeons and increasing the practice of this technique has the potential to improve patient outcomes.
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Affiliation(s)
- James J Contestable
- Department of Dermatology, Uniformed Services University, Bethesda, Maryland
| | - Geoffrey F S Lim
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tyler Willenbrink
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John A Zitelli
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David G Brodland
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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O'Hern K, Crum OM, Demer AM, Brewer JD. Intraoperative Immunohistochemistry During Mohs Micrographic Surgery and Staged Excision Decreases Local Recurrence Rates for Invasive Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Dermatol Surg 2024; 50:601-610. [PMID: 38530980 DOI: 10.1097/dss.0000000000004164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves surgical outcomes. OBJECTIVE To determine whether intraoperative IHC during MMS and staged excision is associated with a decreased risk of poor surgical outcomes. MATERIALS AND METHODS Search of 6 databases identified comparative and noncomparative studies that reported local recurrence after MMS or staged excision with or without IHC for melanoma. Random-effects meta-analysis was used to estimate pooled local recurrence rates, nodal recurrence, distant recurrence, and disease-specific mortality. RESULTS Overall, 57 studies representing 12,043 patients with cutaneous melanoma and 12,590 tumors met inclusion criteria. Combined MMS and staged excision with IHC was associated with decreased local recurrence in patients with invasive melanoma (0.3%, 95% CI: 0-0.6) versus hematoxylin and eosin alone (1.8%, 95% CI: 0.8%-2.8%) [ p < .001]. Secondary outcomes including nodal recurrence, distant recurrence, and disease-specific mortality were not significantly different between these 2 groups. Study heterogeneity was moderately-high. CONCLUSION Local recurrence of invasive melanoma is significantly lower after MMS and staged excision with IHC as opposed to without IHC. These findings suggest that the use of intraoperative IHC during MMS or staged excision should strongly be considered, particularly for invasive melanoma.Trial Registration PROSPERO Identifier: CRD42023435630.
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Affiliation(s)
- Keegan O'Hern
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Olivia M Crum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M Demer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
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McInnis-Smith KM, Asamoah EM, Demer AM, Sharma K, Yu CY, Bradley EA, Tooley AA, Wagner LH. Mohs Micrographic Surgery With Immunohistochemistry for the Treatment of Periocular Melanoma In Situ. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00417. [PMID: 38884530 DOI: 10.1097/iop.0000000000002729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
PURPOSE Mohs micrographic surgery with immunohistochemistry allows for same-day comprehensive margin assessment of melanoma in situ prior to subspecialty reconstruction. This study describes the oncologic and reconstructive outcomes of eyelid and periorbital melanoma in situ and identifies risk factors for complex reconstructive demands. METHODS Retrospective case series of all patients treated with Mohs micrographic surgery with immunohistochemistry for melanoma in situ affecting the eyelids or periorbital region from 2008 to 2018 at a single institution. Tumors were assigned to the eyelid group if the clinically visible tumor involved the skin inside the orbital rim. Reconstructive variables were compared between the eyelid and periorbital cohorts. RESULTS There were 24 eyelid and 141 periorbital tumors included. The initial surgical margin for all tumors was 5.34 ± 1.54 mm and multiple Mohs stages were required in 24.2% of cases. Eyelid tumors included more recurrences (p = 0.003), and the average defect size was larger (14.0 ± 13.3 cm2 vs. 7.7 ± 5.4 cm2, p = 0.03). Risk factors for complex reconstruction included: initial tumor diameter >2 cm (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 1.95-7.57) and eyelid involved by initial tumor (OR: 4.88, 95% CI: 1.94-12.28). At an average follow-up of 4.8 years, there were no melanoma-related deaths and 1 local recurrence (0.6% recurrence rate). CONCLUSIONS Mohs micrographic surgery with immunohistochemistry achieves excellent local control rates for periocular melanoma in situ. An initial surgical margin of 5 mm is frequently insufficient to achieve clear margins. The resulting defects are large, and the complexity of reconstruction can be predicted by tumor size and clinical involvement of eyelid skin.
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Affiliation(s)
| | | | | | - Kannan Sharma
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A
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Wink JD, Rhemtulla IA, Fix W, Enriquez F, Mauch J, Barbieri J, Miller CJ, Chang B, Lin IC, Kovach SJ. Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function. J Hand Microsurg 2024; 16:100001. [PMID: 38854376 PMCID: PMC11127536 DOI: 10.1055/s-0040-1714649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma. Materials and Methods A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits. Quality of life (QOL) survey was performed to assess function after the procedure. Results Thirty-two patients (13 hand, 19 foot, Age: 65.03 +/-17.78 years) who were undergoing Mohs surgery were identified. No recurrence was identified with an average follow-up of 16.1 months (1-95 months). The average defect size was 5.79 +/-4.54 cm2. Reconstruction was performed 0-4 days after resection. The most common techniques included full-thickness skin graft (FTSG) (N = 7), collagen matrix + FTSG (N = 4), and volar advancement flap (N = 7). The reconstructive technique choice appears correlated with defect size (p = 0.0125). Neuro-QOL upper extremity survey results showed a difference that approached statistical significance between patients who underwent digit-sparing treatment (n = 7) versus direct to amputation controls (n = 5) (p = 0.072). No survey differences between digit-sparing treatment (n = 10) and amputation (n = 8) were identified in the lower extremity (p = 0.61). Conclusion Our results show digit-sparing treatment can confirm clear surgical margins and a trend toward improvement in upper extremity function compared with immediate amputation.
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Affiliation(s)
- Jason D. Wink
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Irfan A. Rhemtulla
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - William Fix
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Fabiola Enriquez
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jaclyn Mauch
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - John Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Christopher J. Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Benjamin Chang
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ines C. Lin
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Stephen J. Kovach
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Crum OM, Campbell EH, Chelf CJ, Demer AM, Brewer JD. Disease-specific survival of malignant melanoma after Mohs micrographic surgery is not impacted by initial margins: A systematic review and meta-analysis. JAAD Int 2023; 13:140-149. [PMID: 37823046 PMCID: PMC10562175 DOI: 10.1016/j.jdin.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 10/13/2023] Open
Abstract
Background During Mohs surgery for melanoma, evidence has demonstrated that many surgeons opt for smaller initial margins than traditionally recommended (0.5 cm for in situ and 1 cm for invasive). Literature regarding surgical outcomes based on initial margin is sparse. Objective To determine differences in disease-specific survival of melanoma after Mohs micrographic surgery for varied initial surgical margins. Methods A literature search was conducted on February 14, 2022, from MEDLINE via PubMed (1946-present), Embase (1974-present), Central (1991-present), and Scopus (1960-present). The primary outcome was disease-specific mortality. Results Nineteen studies were included for final analysis. The overall disease-specific mortality rate of melanoma in all included studies was 0.5% (CI, 0.1-0.8; P, .010). Disease-specific mortality for 1 to 5, 5, and 6 to 10 mm categories were 0.4% (CI, 0.0-0.9; P, .074), 0.7% (CI, 0.2-1.3; P, .2-1.3), and 0.4% (CI, -0.9 to 1.8; P, .524), respectively. None of the variances across initial margin categories were statistically significant. Limitations Early-stage melanomas have low overall mortality rates. In our associated article, initial margins of 5 to 10 mm were shown to have the lowest rates of local recurrence. Conclusions In this systematic review and meta-analysis, melanoma-specific mortality was not significantly impacted by the initial surgical margin taken during Mohs micrographic surgery.
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Affiliation(s)
- Olivia M. Crum
- Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Elliott H. Campbell
- Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | | | - Addison M. Demer
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jerry D. Brewer
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Abrantes T, Robbins A, Kahn B, Yumeen S, Bukoski RS, Wisco O, Robinson-Bostom L, Kawaoka J, Libby T, Goldbach H, Imbriano D, Lizbinski L, Tran M, Wahood S, Mehta A, Miner T. Understanding melanoma in situ: Lentigo maligna surgical treatment terminology and guideline adherence, a targeted review. J Am Acad Dermatol 2023; 89:734-744. [PMID: 37307991 DOI: 10.1016/j.jaad.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Malignant melanoma in-situ, lentigo maligna (MMIS-LM) can be successfully treated with several different surgical techniques; however, the literature is inconsistent in defining them. OBJECTIVE To comprehensively define and describe the national guideline recommended surgical techniques used to treat MMIS-LM to help clarify and standardize this terminology to ensure compliance with the guidelines. METHODS A targeted literature review was performed from 1990 to 2022 focusing on articles that discussed the national guideline recommended surgical techniques of wide local excision, Mohs micrographic surgery (MMS), modified Mohs surgery, and staged excision/Slow-Mohs for MMIS-LM, as well as the related methods of tissue processing. National Comprehensive Cancer Network and American Academy of Dermatology guidelines were reviewed to identify how the techniques need to be employed to be compliant with guideline recommendations. RESULTS We describe the various surgical and tissue processing techniques and discuss advantages and disadvantages of each. LIMITATIONS This paper was styled as a narrative review defining and clarifying terminology and technique and does not investigate these topics more broadly. CONCLUSION Understanding the methodology and terminology for these surgical procedures and tissue processing methods is critical so that both general dermatologists and surgeons can employ these techniques effectively for optimal patient care.
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Affiliation(s)
- Tatiana Abrantes
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Allison Robbins
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Benjamin Kahn
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sara Yumeen
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - R Scott Bukoski
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Oliver Wisco
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie Robinson-Bostom
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John Kawaoka
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tiffany Libby
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hayley Goldbach
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dillon Imbriano
- University of New England, College of Osteopathic Medicine, Biddeford, Maine
| | - Leonardo Lizbinski
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Megan Tran
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Samer Wahood
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Aakash Mehta
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas Miner
- Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Martínez-Fernández S, González-Sixto B, Espasandín-Arias M, Soto-García D, Flórez Á. Topical and Intralesional Immunotherapy for Melanoma In Situ: A Review. Cancers (Basel) 2023; 15:4468. [PMID: 37760438 PMCID: PMC10526313 DOI: 10.3390/cancers15184468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The incidence of in situ melanoma (MIS) has increased over the last decades. The mainstay of treatment for MIS, including lentigo maligna (LM), is complete surgical excision with clear margins (0.5 to 1.0 cm). Nevertheless, MIS lesions often affect elderly patients with comorbidities and involve large lesions in cosmetically sensitive areas, which means surgery is not always appropriate. Non-surgical treatments have a role in these cases, and include radiotherapy, cryosurgery, immunotherapy, laser therapy, and other topical medications. This study aims to review the applications of immunotherapy in MIS, either in monotherapy or in combination with other therapeutic alternatives. The main forms of immunotherapy used are imiquimod and, to a lesser extent, intralesional interferon-α (IL-INF-α) and ingenol mebutate (IM). IL-INF-α and IM have not been studied as extensively as imiquimod, whose results in real-life practice are encouraging. The clearance and recurrence rates reported in MIS treated with imiquimod as monotherapy, or as an adjuvant after surgery with affected or narrow margins, make imiquimod a reliable therapeutic alternative in selected cases. Also, its use as a neoadjuvant therapy before surgery was shown to reduce the final surgical defect size required to confirm negative histologic margins. In conclusion, local immunotherapy is frequently used in clinical practice and experience confirms it to be an excellent option for certain patients.
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Affiliation(s)
- Sandra Martínez-Fernández
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Beatriz González-Sixto
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Martina Espasandín-Arias
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Diego Soto-García
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Ángeles Flórez
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
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13
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Alsharif SH, AlFada M, Alaqeel AA. A retrospective review of Mohs micrographic surgery trends over more than 10 years in Saudi Arabia. Saudi Med J 2023; 44:667-673. [PMID: 37463713 PMCID: PMC10370377 DOI: 10.15537/smj.2023.44.7.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To review Mohs micrographic surgery (MMS) trends in Saudi Arabia.Mohs micrographic surgery is a precise surgical technique that has been proven to have the highest cure rate with maximum normal tissue preservation. It is the treatment of choice for non-melanoma skin cancer (NMSC), especially the aggressive histopathological forms, and tumors located in high-risk regions or where tissue preservation is a mandate. METHODS A multicentric retrospective study was performed on patients who underwent MMS between January 2010 and September 2022. The information was extracted from the database of King Saud University Medical City and Prince Sultan Military Medical City in Saudi Arabia. RESULTS A total of 70 participants were enrolled in this study. Two-thirds (67%) of the tumors that were treated using MMS were basal-cell carcinomas (BCC), 18.6% were squamous cell carcinomas (SCC), 5.7% were sebaceous carcinoma, 4.3% were dermatofibrosarcoma protuberans (DFSP), and 1.4% were rare tumors such as primary mucinous carcinoma. The most common type of reconstruction used to repair post-MMS defect was primary closure in more than half of the patients followed by secondary intention healing (20%). There were no side effects apart from a hematoma in one patient and wound infection in two patients. CONCLUSION Although MMS is still generally underutilized in Saudi Arabia, its use has increased in the last decade.
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Affiliation(s)
- Sahar H. Alsharif
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed AlFada
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah A. Alaqeel
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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14
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Burningham KM, Le K, He A, O'Brian M, Shi K, Srivastava D, Nijhawan RI. Cost effectiveness of melanoma in situ resection and repair by dermatology compared to non-dermatology specialties at a single institution. Arch Dermatol Res 2023; 315:661-663. [PMID: 36269395 DOI: 10.1007/s00403-022-02405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/05/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
Melanoma-in-situ (MIS) is treated with surgical resection by many specialties. Dermatologists perform these procedures in outpatient settings while others often employ operating rooms and general anesthesia. We hypothesized that MIS managed by dermatology was less costly than that managed by other specialties. All cases of MIS treated at our institution over a 3-year period were evaluated retrospectively for demographic and clinical characteristics and categorized by treating specialty. Estimated cost information was determined using records of charges billed. The mean total cost for MIS treated with wide local excision (WLE) by dermatologists was $1089 (CI = $941-1237) versus all other specialties at $5172 (CI = $2419-7925) (p < 0.001). MIS treated with Mohs micrographic surgery and repaired by dermatology (mean = $2325, CI = $2241-2409) was also less expensive than MIS treated by other specialties with WLE (p < 0.001). The results suggest MIS is significantly less costly to patients and the health care system when treatment is performed by dermatologists compared to other surgical specialties. This is likely due to dermatologists performing the procedures in less expensive outpatient settings.
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Affiliation(s)
- Kevin M Burningham
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kim Le
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Annie He
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madeleine O'Brian
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin Shi
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor Suite 100, Dallas, TX, 75390, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor Suite 100, Dallas, TX, 75390, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor Suite 100, Dallas, TX, 75390, USA.
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15
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Adalsteinsson JA, Stoj VJ, Algzlan H, Swede H, Torbeck RL, Ratner D. Limitations in the literature regarding Mohs surgery and staged excision for melanoma: A critical review of quality and data reporting. J Am Acad Dermatol 2023; 88:404-413. [PMID: 33872715 DOI: 10.1016/j.jaad.2021.02.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES The literature supporting Mohs micrographic surgery and staged excision in treating primary cutaneous melanoma is growing but has not been critically reviewed for bias. METHODS Articles concerning Mohs micrographic surgery and staged excision for melanoma were assessed using modified "Risk of Bias in Non-randomized Studies of Interventions" (ROBINS-I) criteria, which measures bias in 7 categories. RESULTS Forty-seven of 48 (97.9%) studies reviewed had serious or critical bias. None were randomized controlled trials. The most frequent cause of critical bias was poorly defined outcomes. The least frequent form of bias observed was change in intervention. LIMITATIONS The modified ROBINS-I criteria cannot account for all study limitations. Modification of the criteria leads to some degree of subjectivity. CONCLUSION The current body of literature suffers from limitations due to serious or critical bias in 1 or more ROBINS-I criteria. Local recurrence rate definitions are often poorly defined or not defined at all. Longer follow-up times, clear tumor classifications, and prospective, randomized study designs are necessary to improve the quality of future research.
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Affiliation(s)
| | - Victoria J Stoj
- University of Connecticut Department of Dermatology, Farmington, Connecticut
| | - Haitham Algzlan
- Icahn School of Medicine Department of Dermatology at Mt Sinai, New York, New York
| | - Helen Swede
- Department of Community Medicine, School of Medicine, Farmington, Connecticut
| | - Richard L Torbeck
- Icahn School of Medicine Department of Dermatology at Mt Sinai, New York, New York
| | - Désirée Ratner
- New York University Langone Health, Department of Dermatology, New York, New York
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16
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Approaches to Tumors of the Nail Unit and Genitalia. Dermatol Clin 2022; 41:163-174. [DOI: 10.1016/j.det.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Venturi F, Pellacani G, Farnetani F, Maibach H, Tassone D, Dika E. Non – Invasive diagnostic techniques in the preoperative setting of Mohs micrographic surgery: a review of the literature. Dermatol Ther 2022; 35:e15832. [DOI: 10.1111/dth.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/28/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Federico Venturi
- Section of Dermatology, Department of Health Sciences University of Florence Florence Italy
| | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I Sapienza University of Rome Rome Italy
| | | | - Howard Maibach
- Dermatology University of California San Francisco, San Francisco California
| | - Daniela Tassone
- IRCCS di Policlinico Sant'Orsola, via Massarenti 9 Bologna Italia
| | - Emi Dika
- IRCCS di Policlinico Sant'Orsola, via Massarenti 9 Bologna Italia
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
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18
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Gaetano L, Domenico B, Lo SN, Hamed T, Potter AJ, Thompson JF, Scolyer RA, Guitera P. Association between excision margins and local recurrence in 1407 patients with primary in situ melanomas. JAAD Int 2022; 8:102-108. [PMID: 35875393 PMCID: PMC9305371 DOI: 10.1016/j.jdin.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Reliable evidence to guide the management of melanoma in situ (MIS) and minimize the risk of recurrence is lacking. Objective To identify clinicopathological predictors of local recurrence (LR) in patients with MIS and evaluate long-term outcomes according to pathological excision margins. Methods A case-control study of patients with MIS treated at a large Australian melanoma treatment center from January 2008 to December 2012 was undertaken. Clinicopathological characteristics of patients who developed LR and those who did not were compared. Results LR developed in 34 of 1407 patients with MIS (2.5%). Median time to LR was 20 months. The primary lesion was removed with pathological margins <4 mm (P < .001) in 67.6 % of patients with LR. Four patients died of metastatic melanoma following LR. Comparing patients with pathological margins <4 mm and ≥4 mm, the former were older (>60y, P < .001), more frequently had MIS on the head or neck (P < .001), had a greater LR rate (P < .001), and had a higher mortality from all causes (P < .001). Limitations Retrospective, single-institution study. Conclusions Pathological margins of ≥4 mm should be considered for patients with MIS who are treated with standard surgical excision and assessed by examining serial slices taken from the formalin-fixed, paraffin-embedded specimen.
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19
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Céspedes-Valenzuela DN, Sánchez-Rentería S, Cifuentes J, Gómez SC, Serna JA, Rueda-Gensini L, Ostos C, Muñoz-Camargo C, Cruz JC. Novel Photo- and Thermo-Responsive Nanocomposite Hydrogels Based on Functionalized rGO and Modified SIS/Chitosan Polymers for Localized Treatment of Malignant Cutaneous Melanoma. Front Bioeng Biotechnol 2022; 10:947616. [PMID: 35875496 PMCID: PMC9300866 DOI: 10.3389/fbioe.2022.947616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Melanoma is an aggressive type of skin cancer that accounts for over 75% of skin cancer deaths despite comprising less than 5% of all skin cancers. Despite promising improvements in surgical approaches for melanoma resection, the survival of undetectable microtumor residues has remained a concern. As a result, hyperthermia- and drug-based therapies have grown as attractive techniques to target and treat cancer. In this work, we aim to develop a stimuli-responsive hydrogel based on chitosan methacrylate (ChiMA), porcine small intestine submucosa methacrylate (SISMA), and doxorubicin-functionalized reduced graphene oxide (rGO-DOX) that eliminates microtumor residues from surgically resected melanoma through the coupled effect of NIR light-induced photothermal therapy and heat-induced doxorubicin release. Furthermore, we developed an in silico model to optimize heat and mass transport and evaluate the proposed chemo/photothermal therapy in vitro over melanoma cell cultures.
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Affiliation(s)
- Daniela N Céspedes-Valenzuela
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Santiago Sánchez-Rentería
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Javier Cifuentes
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Saul C Gómez
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Julian A Serna
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Laura Rueda-Gensini
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Carlos Ostos
- Grupo CATALAD, Instituto de Química, Universidad de Antioquia, Medellín, Colombia
| | - Carolina Muñoz-Camargo
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Juan C Cruz
- Grupo de Investigación en Nanobiomateriales, Ingeniería Celular y Bioimpresión (GINIB), Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
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20
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Pride RLD, Miller CJ, Murad MH, Erwin PJ, Brewer JD. Local Recurrence of Melanoma Is Higher After Wide Local Excision Versus Mohs Micrographic Surgery or Staged Excision: A Systematic Review and Meta-analysis. Dermatol Surg 2022; 48:164-170. [PMID: 34889212 DOI: 10.1097/dss.0000000000003309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complete removal of melanoma is a primary goal of excision, and local recurrence is one measure to evaluate the efficacy of surgical technique. OBJECTIVE To compare published local recurrence rates for melanoma treated with Mohs micrographic surgery (MMS) or staged excision versus wide local excision (WLE). METHODS AND MATERIALS Search of 6 databases identified comparative and noncomparative studies that reported local recurrence rates after MMS, staged excision, or WLE for melanoma. Random-effects meta-analysis was used to estimate odds ratios and 95% confidence interval (CI) from comparative studies and event rates from noncomparative studies. RESULTS Of the 71 studies included (16,575 patients), 12 were comparative studies (2,683 patients) and 56 were noncomparative studies (13,698 patients). Comparative studies showed increased recurrence after WLE compared with MMS or staged excision (odds ratio [OR], 2.5; 95% CI, 1.4-4.6) and compared with MMS alone (OR, 3.3; 95% CI, 1.8-5.9). Pooled data from comparative and noncomparative studies showed a local recurrence rate of 7% after WLE (95% CI, 5%-11%), 3% after staged excision (95% CI, 2%-4%), and less than 1% after MMS (95% CI, 0%-1%). Statistical heterogeneity was moderate to high. CONCLUSION Local recurrence of melanoma is significantly lower after MMS (<1%) and staged excision (3%) compared with WLE (7%).
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Affiliation(s)
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | | | - Jerry D Brewer
- Department of Dermatology Mayo Clinic, Rochester, Minnesota
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21
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Newcomer K, Robbins KJ, Perone J, Hinojosa FL, Chen D, Jones S, Kaufman CK, Weiser R, Fields RC, Tyler DS. Malignant melanoma: evolving practice management in an era of increasingly effective systemic therapies. Curr Probl Surg 2022; 59:101030. [PMID: 35033317 PMCID: PMC9798450 DOI: 10.1016/j.cpsurg.2021.101030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Ken Newcomer
- Department of Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, MO
| | | | - Jennifer Perone
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - David Chen
- e. Department of Medicine, Washington University, St. Louis, MO
| | - Susan Jones
- f. Department of Pediatrics, Washington University, St. Louis, MO
| | | | - Roi Weiser
- University of Texas Medical Branch, Galveston, TX
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX.
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22
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Charalambides M, Yannoulias B, Malik N, Mann J, Celebi P, Veitch D, Wernham A. A review of Mohs Micrographic Surgery for skin cancer: Part 1 - melanoma and rare skin cancers. Clin Exp Dermatol 2021; 47:833-849. [PMID: 34939669 DOI: 10.1111/ced.15081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
Mohs micrographic surgery is a precise and effective method commonly used to treat high risk basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the head and neck. Whilst the majority of evidence for Mohs relates to keratinocyte cancers, there is published evidence for other types of skin cancer. This review aims to discuss the evidence for using MMS to treat six different types of skin cancer, including melanoma, lentigo maligna, dermatofibrosarcoma protuberans, atypical fibroxanthoma, microcystic adnexal carcinoma and pleomorphic dermal sarcoma, particularly in the context of survival rates and cancer recurrence. These cancers were chosen as there was sufficient literature for inclusion and given MMS is most useful when cancers are contiguous, rather than for cancers with marked metastatic potential such as angiosarcoma or merkel cell carcinoma. We searched Medline, Pubmed and Embase using the keywords: 'melanoma', 'mohs micrographic surgery', 'lentigo maligna', 'dermatofibrosarcoma protuberans', 'atypical fibroxanthoma', 'microcystic adnexal carcinoma' and 'pleomorphic dermal sarcoma' along with their appropriate synonyms, to identify the relevant English-language articles from the year 2000 onwards given that literature for Mohs on non-keratinocyte is sparse prior to this date. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess the validity of systematic reviews. Further high-quality, multi-centre randomised trials are necessary to establish the indications and efficacy of MMS for rarer cancers, particularly for AFX and PDS, where limited studies were identified.
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Affiliation(s)
| | | | - Nabiah Malik
- Watford General Hospital, West Hertfordshire Hospitals NHS trust, UK
| | - Jasmine Mann
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Perin Celebi
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - David Veitch
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
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23
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Krausz AE, Higgins HW, Etzkorn J, Sobanko J, Shin T, Giordano C, McMurray SL, Golda N, Maher IA, Leitenberger JJ, Bar A, Nijhawan RI, Srivastava D, Brewer JD, Baum CL, Holmes TE, Goldman GD, Bordeaux J, Carroll B, Macarthur K, Miller CJ. Systematic Review of Technical Variations for Mohs Micrographic Surgery for Melanoma. Dermatol Surg 2021; 47:1539-1544. [PMID: 34743123 DOI: 10.1097/dss.0000000000003268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) for cutaneous melanoma is becoming more prevalent, but surgical technique varies. OBJECTIVE To define variations in published techniques for MMS for melanoma. METHODS AND MATERIALS A systematic review was performed of PubMed, EMBASE, and Scopus databases to identify all articles describing surgical techniques for MMS for melanoma. Technical details were recorded for the preoperative, intraoperative, and postoperative phases of MMS. RESULTS Twenty-four articles were included. Mohs surgeons vary in how they assess clinical margins, how wide a margin they excise on the first MMS layer, and how they process tissue to determine tumor stage and margin clearance during MMS for melanoma. CONCLUSION Mohs micrographic surgery for melanoma is performed with varied surgical techniques. To establish best practices, additional research is necessary to determine how different techniques affect outcomes.
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Affiliation(s)
- Aimee E Krausz
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Etzkorn
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Sobanko
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar Shin
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbus, Missouri
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Justin J Leitenberger
- Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Anna Bar
- Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Todd E Holmes
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont
| | - Glenn D Goldman
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont
| | - Jeremy Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bryan Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kelly Macarthur
- Divison of Dermatology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Christopher J Miller
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
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24
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Abstract
Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma in situ and thus confined to the epidermis. LM lesions that invade the dermis are termed lentigo maligna melanoma, 1 of the 4 subtypes of malignant melanoma.
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Affiliation(s)
- Jacob D Franke
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Katlyn M Woolford
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
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25
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Bittar PG, Bittar JM, Etzkorn JR, Brewer JD, Aizman L, Shin TM, Sobanko JF, Higgins HW, Giordano CN, Cohen JV, Pride R, Wan MT, Leitenberger JJ, Bar AA, Aasi S, Bordeaux JS, Miller CJ. Systematic review and meta-analysis of local recurrence rates of head and neck cutaneous melanomas after wide local excision, Mohs micrographic surgery, or staged excision. J Am Acad Dermatol 2021; 85:681-692. [PMID: 33961921 DOI: 10.1016/j.jaad.2021.04.090] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prospective trials have not compared the local recurrence rates of different excision techniques for cutaneous melanomas on the head and neck. OBJECTIVE To determine local recurrence rates of cutaneous head and neck melanoma after wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision. METHODS A systematic review of PubMed, EMBASE, and Web of Science identified all English case series, cohort studies, and randomized controlled trials that reported local recurrence rates after surgery for cutaneous head and neck melanoma. A meta-analysis utilizing a random effects model calculated weighted local recurrence rates and confidence intervals (CI) for each surgical technique and for subgroups of MMS and staged excision. RESULTS Among 100 manuscripts with 13,998 head and neck cutaneous melanomas, 51.0% (7138) of melanomas were treated by WLE, 34.5% (4826) by MMS, and 14.5% (2034) by staged excision. Local recurrence rates were lowest for MMS (0.61%; 95% CI, 0.1%-1.4%), followed by staged excision (1.8%; 95% CI, 1.0%-2.9%) and WLE (7.8%; 95% CI, 6.4%-9.3%). LIMITATIONS Definitions of local recurrence varied. Surgical techniques included varying proportions of invasive melanomas. Studies had heterogeneity. CONCLUSION Systematic review and meta-analysis show lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS or staged excision compared to WLE.
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Affiliation(s)
- Peter G Bittar
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Julie M Bittar
- Section of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Leora Aizman
- George Washington University School of Medicine, Washington, DC
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold W Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee Pride
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Marilyn T Wan
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna A Bar
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Sumaira Aasi
- Department of Dermatology, Stanford Medicine, Stanford, California
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Theunissen CCW, Lee MH, Murad FG, Waldman AH. Systematic Review of the Role of Mohs Micrographic Surgery in the Management of Early-Stage Melanoma of the Head and Neck. Dermatol Surg 2021; 47:1185-1189. [PMID: 34148999 DOI: 10.1097/dss.0000000000003126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of Mohs micrographic surgery (MMS) in the management of melanoma of the head and neck (HNM) has been controversial. The authors systematically reviewed the local recurrence rate of melanoma in situ (MIS) and T1a melanomas using MMS compared with conventional wide local excision (WLE) and staged excision (SE). OBJECTIVE To systematically review the local recurrence rate of early-stage melanomas of the HNM treated with MMS versus WLE or SE. METHODS AND MATERIALS A search of English medical literature was conducted through the common databases until November 26, 2019. Using PRISMA guidelines for the treatment of MIS and T1a melanoma with MMS, WLE, or SE, our search yielded a total of 32 articles. RESULTS Mohs micrographic surgery has a lower local recurrence rate for early-stage melanomas over both SE and WLE {pooled recurrence risk 0.8% (95% confidence interval [CI] 0.4-1.1) versus 2.5% (95% CI 1.5-3.4) versus 8.7% (95% CI 5.1-12.2) (p < .001), respectively}. CONCLUSION Mohs micrographic surgery may offer a lower recurrence rate than SE or WLE in the management of early-stage melanomas of the face or HNM. Further clinical validation in a randomized controlled trial is required.
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Affiliation(s)
| | - Ming Hua Lee
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Fadi G Murad
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abigail H Waldman
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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27
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Margins of Melanoma Excision and Modifications to Standards. Surg Oncol Clin N Am 2021; 29:339-347. [PMID: 32482312 DOI: 10.1016/j.soc.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Surgery with wide local excision is the mainstay of treatment for primary melanoma. Surgical margins differ depending on the depth of the primary lesion, subtype, and anatomic, cosmetic, or functional considerations. Adjuncts or alternative treatments to wide local excision are limited to specific patient populations and mainly experimental in nature.
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28
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Kwak R, Joyce C, Werchniak AE, Lin JY, Tsibris HC. Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment. J DERMATOL TREAT 2021; 33:1995-1999. [PMID: 34315342 DOI: 10.1080/09546634.2021.1962001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence. OBJECTIVES To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod. METHODS We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution. RESULTS We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02). CONCLUSIONS Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
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Affiliation(s)
- R Kwak
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | - J Y Lin
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H C Tsibris
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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29
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[Mohs micrographic surgery for skin cancers: A 10 year - single-center series of 548 patients treated by formalin-fixed tissue Mohs surgery assessing the impact of reduced margins]. ANN CHIR PLAST ESTH 2021; 66:429-439. [PMID: 34330553 DOI: 10.1016/j.anplas.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
AIM Only few robust studies specify the indications of Mohs Surgery techniques in skin tumors. The aim of this work was to carry out a review of almost 10 years of experience, assessing the impact of reduced margins on reconstruction, and proposing a management algorithm in the light of the literature. PATIENT AND METHODS All the records of patients having benefited from a Mohs technique in our center were retrospectively compiled from January 2011 until January 2020. A formalin-fixed tissue Mohs surgery was used. An impact assessment of reduced margins was made both on the excisional surface but also on the improvement of the reconstruction. RESULTS 548 patients were included. Complete tumour clearance was achieved with one surgical stage in 71% of cases. The excisional surface of tumours located in the periorbital and nasal areas was significantly more often reduced compared to other areas (P=0,020). The improvement of the reconstruction was deemed significant in the periorbital and nasal areas; as well as for tumours located on limbs and trunk linked with Dermatofibrosarcoma management. CONCLUSION This study underlines the interest of assessing the clinical relevance of reducing margins depending on the tumor location. Our single-center experience feedback on a large series allows to clarify Mohs technique indications by means of a literature review.
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30
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Lallas A, Moscarella E, Kittler H, Longo C, Thomas L, Zalaudek I, Kyrgidis A, Manoli SM, di Meo N, Papageorgiou C, Apalla Z, Argenziano G. Real-world experience of off-label use of imiquimod 5% as an adjuvant therapy after surgery or as a monotherapy for lentigo maligna. Br J Dermatol 2021; 185:675-677. [PMID: 33894006 DOI: 10.1111/bjd.20407] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 01/17/2023]
Affiliation(s)
- A Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,DERMOMEDICA Dermatology Unit, Thessaloniki, Greece
| | - E Moscarella
- Dermatology Unit, University of Campania, Naples, Italy
| | - H Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unita Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - L Thomas
- Department of Dermatology, Hospital Lyon Sud, France.,Lyon 1 University, Lyon, France.,Lyons cancer research center INSERM U1052-CNRS UMR5286, France
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Italy
| | - A Kyrgidis
- Department of Oral & Maxillofacial Surgery, Aristotle University of Thessaloniki, Greece
| | - S M Manoli
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,DERMOMEDICA Dermatology Unit, Thessaloniki, Greece
| | - N di Meo
- Department of Dermatology, University of Trieste, Italy
| | - C Papageorgiou
- DERMOMEDICA Dermatology Unit, Thessaloniki, Greece.,Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Z Apalla
- DERMOMEDICA Dermatology Unit, Thessaloniki, Greece.,Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
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31
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Hult J, Merdasa A, Pekar-Lukacs A, Tordengren Stridh M, Khodaverdi A, Albinsson J, Gesslein B, Dahlstrand U, Engqvist L, Hamid Y, Larsson Albèr D, Persson B, Erlöv T, Sheikh R, Cinthio M, Malmsjö M. Comparison of photoacoustic imaging and histopathological examination in determining the dimensions of 52 human melanomas and nevi ex vivo. BIOMEDICAL OPTICS EXPRESS 2021; 12:4097-4114. [PMID: 34457401 PMCID: PMC8367235 DOI: 10.1364/boe.425524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 05/21/2023]
Abstract
Surgical excision followed by histopathological examination is the gold standard for the diagnosis and staging of melanoma. Reoperations and unnecessary removal of healthy tissue could be reduced if non-invasive imaging techniques were available for presurgical tumor delineation. However, no technique has gained widespread clinical use to date due to shallow imaging depth or the absence of functional imaging capability. Photoacoustic (PA) imaging is a novel technology that combines the strengths of optical and ultrasound imaging to reveal the molecular composition of tissue at high resolution. Encouraging results have been obtained from previous animal and human studies on melanoma, but there is still a lack of clinical data. This is the largest study of its kind to date, including 52 melanomas and nevi. 3D multiwavelength PA scanning was performed ex vivo, using 59 excitation wavelengths from 680 nm to 970 nm. Spectral unmixing over this broad wavelength range, accounting for the absorption of several tissue chromophores, provided excellent contrast between healthy tissue and tumor. Combining the results of spectral analysis with spatially resolved information provided a map of the tumor borders in greater detail than previously reported. The tumor dimensions determined with PA imaging were strongly correlated with those determined by histopathological examination for both melanomas and nevi.
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Affiliation(s)
- Jenny Hult
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Aboma Merdasa
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Magne Tordengren Stridh
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Azin Khodaverdi
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - John Albinsson
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bodil Gesslein
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ulf Dahlstrand
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Linn Engqvist
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Yousef Hamid
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Douglas Larsson Albèr
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bertil Persson
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
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32
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Utilization Patterns of Fellowship-Trained Mohs Surgeons in the Treatment of Melanoma in Situ and Melanoma. Dermatol Surg 2021; 47:814-815. [PMID: 32932262 DOI: 10.1097/dss.0000000000002668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Emanuel PO, Patel R, Zwi J, Cheng D, Izzard M. Utility of teledermatopathology for intraoperative margin assessment of melanoma in situ, lentigo maligna type: A 6 year community practice experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1140-1144. [PMID: 32994100 DOI: 10.1016/j.ejso.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Achieving negative margins for melanoma in situ, lentigo maligna type can be challenging, particularly on cosmetically sensitive areas. OBJECTIVE To assess the utility of intraoperative frozen section margin assessment using a teledermatopathology system in the treatment of head and neck lentigo maligna. METHODS AND MATERIALS Over a 6 year period, 96 patients with lentigo maligna had surgical excisions. The margins were assessed intraoperatively with frozen sections prepared in the manner used in Mohs surgery. The surgeon guided the frozen section slides around the margin while a dermatopathologist assessed the margin remotely. RESULTS In 2/96 (2.1%) cases, the safety margin was positive (frozen sections were false negative). In 1 further case (1%) there was a recurrence of the melanoma 13 months following the excision. CONCLUSION The described method is effective in treating melanoma in situ, lentigo maligna type with clearance rates similar to previous studies for Mohs surgery.
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Affiliation(s)
- Patrick O Emanuel
- Mount Sinai Medical Center, Division of Dermatopathology, New York, USA.
| | | | - Jonathan Zwi
- Auckland District Health Board, Department of Pathology, Auckland, New Zealand
| | - Du Cheng
- Weill Cornell/Rockefeller U/Sloan-Kettering, NY, USA
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34
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Scalp Reconstruction after Mohs Cancer Excision: Lessons Learned from More Than 900 Consecutive Cases. Plast Reconstr Surg 2021; 147:1165-1175. [PMID: 33890900 DOI: 10.1097/prs.0000000000007884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author's approach and the cases assessed. METHODS The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. RESULTS The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients' defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence. CONCLUSIONS Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
BACKGROUND Obtaining conventional wide surgical margins is challenging in melanomas occurring at anatomically complex sites (e.g., hands and feet). OBJECTIVE We investigated the potential benefits of slow Mohs micrographic surgery (MMS) for acral melanomas. MATERIALS AND METHODS This single-center retrospective study investigated 210 patients who underwent slow MMS (n = 66) or wide local excision (WLE, n = 144) for melanomas during 2005 to 2015. Slow MMS was used for melanomas in anatomically complex locations and for high-risk lesions. RESULTS Acral melanoma (166/210) was the most common lesion observed in patients, in addition to head and neck (21/210) and trunk (23/210) melanomas. Slow MMS was more commonly performed for acral, and head and neck melanomas (32.5% and 52.4%, respectively) than for trunk melanomas (4.3%, p = .002). Local recurrence of acral melanomas occurred in 3.7% of patients after slow MMS and in 10.7% of patients after WLE. Multivariate analysis showed comparable prognostic outcomes between slow MMS and WLE used for acral melanomas. Compared with WLE, slow MMS resulted in a smaller postoperative defect after acral lesion excision (p < .001). CONCLUSION Slow MMS is an effective alternative to WLE for acral melanomas in anatomically complex sites, as evidenced by superior outcomes and maximum tissue conservation.
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36
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Namin AW, Oudin EM, Tassone PT, Galloway TLI, Dooley LM, Zitsch RP. Treatment of Cutaneous Melanoma of the Head and Neck With Wide Local Excision Versus Mohs. Laryngoscope 2021; 131:2490-2496. [PMID: 33844289 DOI: 10.1002/lary.29570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Determine if Mohs micrographic surgery (MMS) is associated with improved overall survival compared to wide local excision (WLE) when treating cutaneous melanoma of the head and neck (CMHN) and to report the proportion of patients treated with MMS versus WLE who also underwent sentinel lymph node biopsy (SLNB). METHODS Retrospective cohort study of the National Cancer Database (NCDB) analyzing the overall survival of patients diagnosed with T1 to T4 CMHN between 2004 and 2016 who were treated with either WLE or MMS. RESULTS On multivariable analysis, treatment with WLE versus MMS was not significantly associated with overall survival (HR, 1.094; 95% CI, 0.997-1.201). On multivariable analysis, lower Charlson-Deyo score (HR, 0.489; 95% CI, 0.427-0.560), negative margins (HR, 0.754; 95% CI, 0.705-0.807), and N0 classification (HR 0.698; 95% CI, 0.668-0.730) were associated with improved overall survival. Seventy-seven percent of patients treated with MMS did not undergo SLNB, while 45% of patients treated with WLE did not undergo SLNB (P < .001). CONCLUSIONS No difference in overall survival between MMS and WLE when treating CMHN. Patients treated with MMS were significantly less likely to undergo SLNB, suggesting an opportunity for enhancement of multidisciplinary care. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Arya W Namin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Edouard M Oudin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Patrick T Tassone
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Tabitha L I Galloway
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Laura M Dooley
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
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37
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Demer AM, Hanson JL, Maher IA, Liszewski W. Association of Mohs Micrographic Surgery vs Wide Local Excision With Overall Survival Outcomes for Patients With Melanoma of the Trunk and Extremities. JAMA Dermatol 2021; 157:84-89. [PMID: 33084853 DOI: 10.1001/jamadermatol.2020.3950] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although previous database studies suggest that Mohs micrographic surgery (MMS) treatment is associated with improved overall survival (OS) for head and neck melanomas, outcomes for trunk and extremity (T&E) tumors have not been adequately evaluated. Objective To assess survival outcomes for patients with melanomas of the T&E treated with MMS vs wide local excision (WLE). Design, Setting, and Participants This retrospective cohort study examined deidentified data from the National Cancer Database between 2004 and 2015. Inclusion criteria for the analysis included diagnosis of trunk, upper extremity, or lower extremity melanoma; known Breslow depth; removal by MMS or WLE; and known last date of survival status. Main Outcomes and Measures Five-year all-cause mortality (ACM) rates. Results A total of 188 862 in situ and invasive melanomas were included in the analysis (MMS, 2.3%; WLE, 97.7%); the mean (SD) age of patients included was 58.8 (16.0) years, and 52.7% were male. Multivariate analysis demonstrated no OS difference among trunk (WLE hazard ratio [HR], 1.097; 95% CI, 0.950-1.267; P = .21), upper extremity (WLE HR, 1.013; 95% CI, 0.872-1.176; P = .87), lower extremity (WLE HR, 0.934; 95% CI, 0.770-1.134; P = .49), or combined T&E (WLE HR, 1.031; 95% CI, 0.941-1.130; P = .51) tumors. Factors associated with increased risk of ACM on multivariate analysis of all tumors included increasing age (HR, 1.043; 95% CI, 1.042-1.044; P < .001), no insurance or nonprivate insurance (none: HR, 1.921 [95% CI, 1.782-2.071]; Medicaid: HR, 2.410 [95% CI, 2.242-2.591]; Medicare: HR, 1.237 [95% CI, 1.194-1.281]; other government insurance: HR, 1.279 [95% CI, 1.117-1.465]; P < .001 for all), positive surgical margins (HR, 1.609; 95% CI, 1.512-1.712; P < .001), a Charlson-Deyo comorbidity score greater than 0 (Charlson-Deyo score of 1: HR, 1.340; 95% CI, 1.295-1.385; P < .001; Charlson-Deyo score of ≥2: HR, 2.044; 95% CI, 1.934-2.159; P < .001), tumor ulceration (HR, 2.175; 95% CI, 2.114-2.238; P < .001), and increasing Breslow depth (HR, 1.002 [per 0.1 mm]; P < .001). Female sex (HR, 0.698; 95% CI, 0.680-0.716; P < .001) and nonnodular subtype (lentigo maligna/lentigo maligna melanoma: HR, 0.743; 95% CI, 0.686-0.805; P < .001; superficial spreading: HR, 0.739; 95% CI, 0.710-0.769; P < .001; other subtype: HR, 0.817; 95% CI, 0.790-0.845; P < .001; nodular: HR, 1 [reference]) were associated with improved OS. Conclusions and Relevance This cohort study of patients surgically treated for melanomas of the trunk and/or extremities found that, compared with WLE, MMS was not associated with significantly different OS for T&E melanomas.
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Affiliation(s)
- Addison M Demer
- Department of Dermatology, University of Minnesota, Minneapolis.,Now with Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jamie L Hanson
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, Illinois
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The Current State of Mohs Surgery for the Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons. Dermatol Surg 2021; 46:1267-1271. [PMID: 32740213 DOI: 10.1097/dss.0000000000002645] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines. OBJECTIVE The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma. MATERIALS AND METHODS A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery. RESULTS A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS. CONCLUSION Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.
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Invasive Melanoma and Melanoma in Situ Treated With Modified Mohs Micrographic Surgery With En Face Permanent Sectioning: A 10-Year Retrospective Review. Dermatol Surg 2021; 46:1004-1013. [PMID: 31714384 DOI: 10.1097/dss.0000000000002246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Successful surgical treatment of cutaneous melanoma is dependent on margin control. OBJECTIVE To determine efficacy of modified Mohs micrographic surgery (mMMS) with en face permanent margins in management of invasive melanoma (IM) and melanoma in situ (MIS). METHODS A retrospective cohort study evaluating local recurrence, 5-year recurrence-free survival, and 5-year melanoma-specific survival. Overall, 657 melanomas (128 IM and 529 MIS) from 631 patients were treated using mMMS during a 10-year period. Follow-up information was obtained from medical records and telephone encounters. RESULTS The median follow-up time was 5.18 years. Most melanomas were located on the head and neck 93.6% (615/657). Margins required for clearance were 0.77 ± 0.44 cm (mean ± SD). Local recurrence was identified in 1.98% (13/657) of melanomas with no local recurrences in IM. Five-year local recurrence-free and melanoma-specific survival rates were estimated to be 96.9% (95% confidence interval [CI]: 94.6%-98.2%) and 99.0% (95% CI: 97.7%-99.6%). There were 5 melanoma-related deaths. CONCLUSION Modified Mohs micrographic surgery is an effective treatment of melanoma as evidenced by low local recurrence rates and high melanoma-specific survival.
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Mohs Surgery for SEER Registry-Captured Melanoma In Situ and Rare Cutaneous Tumors: Comparing National Utilization Patterns Before and After Implementation of the Affordable Care Act (2010) and Appropriate Use Criteria (2012). Dermatol Surg 2021; 46:1021-1029. [PMID: 31929340 DOI: 10.1097/dss.0000000000002316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Affordable Care Act (ACA) and the appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) had the potential to increase utilization rates of MMS for indicated skin cancers, but it is unknown whether this has occurred. OBJECTIVE To determine whether rates of MMS utilization for head and neck melanoma in situ (MIS) and rare cutaneous tumors (RCTs) increased after the implementation of the ACA and AUC publication. MATERIALS AND METHODS Retrospective review using data from the SEER database. Melanoma in situ and RCT tumor cases from before and after the ACA and AUC publication were compared. RESULTS Twenty-four thousand six hundred seventy-eight cases were analyzed. Mohs micrographic surgery utilization for MIS decreased from 13.9% before the ACA to 12.3% after the ACA (odds ratio 0.87; p = .012). There was no significant change in MMS utilization for MIS after publication of the AUC. There was also no significant change in MMS utilization for treatment of RCT after the ACA or AUC publication. Stratification of patients into age groups younger or older than 65 years did not change utilization rates. CONCLUSION Rates of MMS for treatment of MIS and RCT have not increased since the advent of the ACA or AUC. This finding highlights the need for continued efforts to improve access to MMS and to increase education of its utility in treating skin cancer.
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Daniel VT, Crawford A, Kiefe CI, Mahmoud BH. Recurrence and Mortality of Melanoma In Situ of the Trunk or Extremities: A Surveillance, Epidemiology, and End Results Analysis. Dermatol Surg 2021; 47:1-5. [PMID: 32271178 DOI: 10.1097/dss.0000000000002417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck. OBJECTIVE The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2000-2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed. RESULTS Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56-1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12-6.47), nor overall mortality (HR 1.10, 95% CI 0.82-1.48) between MMS versus LE. CONCLUSION There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.
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Affiliation(s)
- Vijaya T Daniel
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts; and
| | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Bassel H Mahmoud
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts; and
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Wu W. Commentary on Recurrence and Mortality of Melanoma in Situ of the Trunk or Extremities. Dermatol Surg 2021; 47:8-9. [PMID: 32769525 DOI: 10.1097/dss.0000000000002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wesley Wu
- Department of Dermatology, Veterans Affairs Medical Center, Seattle, Washington
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Commentary on Recurrence and Mortality of Melanoma in Situ of the Trunk or Extremities. Dermatol Surg 2021; 47:6-7. [PMID: 33347001 DOI: 10.1097/dss.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tejera-Vaquerizo A, Fernández-Figueras M, Santos-Briz Á, Ríos-Martín J, Monteagudo C, Fernández-Flores Á, Requena C, Traves V, Descalzo-Gallego M, Rodríguez-Peralto J. Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tejera-Vaquerizo A, Fernández-Figueras MT, Santos-Briz A, Ríos-Martín JJ, Monteagudo C, Fernández-Flores A, Requena C, Traves V, Descalzo-Gallego MA, Rodríguez-Peralto JL. Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:32-43. [PMID: 33038295 PMCID: PMC7540207 DOI: 10.1016/j.ad.2020.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España; Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España.
| | - M T Fernández-Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo Quironsalud, Sant Cugat del Vallès, Barcelona, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - A Fernández-Flores
- Servicio de Anatomía Patológica, Hospital del Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, España
| | - J L Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
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46
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Tejera-Vaquerizo A, Fernández-Figueras MT, Santos-Briz Á, Ríos-Martín JJ, Monteagudo C, Fernández-Flores Á, Requena C, Traves V, Descalzo-Gallego MÁ, Rodríguez-Peralto JL. [Protocol for the histologic diagnosis of cutaneous melanoma: consensus statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:29-40. [PMID: 33455691 DOI: 10.1016/j.patol.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022]
Abstract
This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España; Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España.
| | - María Teresa Fernández-Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo Quironsalud, Sant Cugat del Vallès, Barcelona, España
| | - Ángel Santos-Briz
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Juan José Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Carlos Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - Ángel Fernández-Flores
- Servicio de Anatomía Patológica, Hospital del Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España
| | - Celia Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - Victor Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision. J Skin Cancer 2020; 2020:8813050. [PMID: 33178463 PMCID: PMC7644340 DOI: 10.1155/2020/8813050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. Aim This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. Methods A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. Results 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease (p > 0.05). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm (p=0.049). Conclusion A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period.
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Crouch G, Sinha S, Lo S, Saw RPM, Lee KK, Stretch J, Shannon K, Guitera P, Scolyer RA, Thompson JF, Ch'ng S. Clinical outcomes following surgical treatment of lentigo maligna of the head and neck. Eur J Surg Oncol 2020; 47:1145-1151. [PMID: 33023795 DOI: 10.1016/j.ejso.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Lentigo maligna (LM), a subtype of melanoma in-situ commonly occurring in the head and neck region, often presents a treatment challenge due to anatomical constraints, particularly on the face of mostly elderly patients. This study sought to assess the clinical outcomes of wide local excision of head and neck LM, identify predictors of recurrence and define optimal excision margins. MATERIALS AND METHODS Patients with LM treated between January 1997 and December 2012 were identified from the large institutional database of a tertiary center and their data were analyzed. RESULTS In 379 patients, 382 lesions were eligible for analysis. Median maximal lesion diameter was 10.5 mm. The mean surgical excision and histopathological clearance margins were 6.2 mm and 4.0 mm, respectively. Median follow-up was 32 months. The LM recurrence rate was 9.9%, and subsequent invasive melanoma developed in 2.3% of cases (mean Breslow thickness 0.7 mm). The recurrence rate was 27.2% if the histological margin was <3.0 mm (median time to recurrence 46.5 months) compared with 2.6% if the margin was ≥3.0 mm. The mean surgical margin required to achieve a histological clearance of ≥3.0 mm was 6.5 mm. CONCLUSIONS Our data suggest that to minimize recurrence, a histological margin of ≥3.0 mm is required. To achieve this, a surgical margin of ≥6.5 mm was required. This is greater than the 5 mm margin recommended in some national guidelines. Careful long-term follow-up is required for all patients because of the risk of recurrence.
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Affiliation(s)
- Gareth Crouch
- Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Shiba Sinha
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Robyn P M Saw
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kenneth K Lee
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jonathan Stretch
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kerwin Shannon
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Center, Sydney, Australia
| | - Pascale Guitera
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Sydney Melanoma Diagnostic Center, Royal Prince Alfred Hospital, Sydney, Australia(-)
| | - Richard A Scolyer
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - John F Thompson
- Sydney Medical School, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
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The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020. Cancers (Basel) 2020; 12:cancers12061543. [PMID: 32545409 PMCID: PMC7352543 DOI: 10.3390/cancers12061543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.
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Prassinos A, Glusac EJ, Leffell DJ. Melanoma in situ: Don't make the cure worse than the disease. J Am Acad Dermatol 2020; 85:520. [PMID: 32387662 DOI: 10.1016/j.jaad.2020.04.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/30/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandre Prassinos
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Earl J Glusac
- Section of Dermatopathology, Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Section of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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