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Rahman SM, Hooper PB, Rohrer TE. Basal cell carcinoma has greater subclinical extension than squamous cell carcinoma: a cohort study. Arch Dermatol Res 2024; 316:180. [PMID: 38761227 DOI: 10.1007/s00403-024-02916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/08/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Syed Minhaj Rahman
- College of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Perry B Hooper
- Skin Care Physicians, 1244 Boylston St, Chestnut Hill, MA, 02467, USA.
| | - Thomas E Rohrer
- Skin Care Physicians, 1244 Boylston St, Chestnut Hill, MA, 02467, USA
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Peirano D, Vargas S, Hidalgo L, Donoso F, Abusleme E, Sanhueza F, Cárdenas C, Droppelmann K, Castro JC, Uribe P, Zoroquiain P, Navarrete-Dechent C. Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study. An Bras Dermatol 2024; 99:202-209. [PMID: 37989688 PMCID: PMC10943309 DOI: 10.1016/j.abd.2023.05.004] [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: 03/14/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. OBJECTIVE To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. METHODS A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. RESULTS One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. STUDY LIMITATIONS Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. CONCLUSION The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
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Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenia Abusleme
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Sanhueza
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Consuelo Cárdenas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherine Droppelmann
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Camilo Castro
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Zoroquiain
- Department of Pathology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Hope RH, Dowdle TS, Hope L, Pruneda C. Mohs micrographic surgery for keratinocyte carcinomas: clinicopathological predictors of the number of stages. Proc AMIA Symp 2023; 36:608-615. [PMID: 37614851 PMCID: PMC10444016 DOI: 10.1080/08998280.2023.2236478] [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: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/25/2023] Open
Abstract
Background The number of Mohs stages needed to remove a keratinocyte carcinoma affects resource use, expenses, and repair complexity. This study aimed to identify clinicopathological predictors associated with increased or decreased stages and areas for further research. Methods A retrospective review was conducted from a single private practice with two Mohs surgeons of 2788 consecutive Mohs cases between January 2017 and December 2021, analyzing the average number of stages taken versus national norms (P = 0.21) and subgroups using unpaired t tests (*<0.05). Results Several tumor features were significantly associated with fewer stages: squamous cell carcinomas, Mohs appropriate use criteria score of 7 or 8, preoperative size <0.25 cm2, tumors on the lips and extremities (including hands/fingers), and smoking. Clinicopathological features significantly associated with more stages included Mohs appropriate use criteria score of 9, recurrent skin cancers, basal cell carcinomas, tumor size of 2.25-3.99 cm2, cancers on ears, solid organ transplant patients, treatment delays >180 days, and patients ≥90 years old. Conclusions Significant predictors exist for both increased and decreased numbers of Mohs micrographic surgery stages required to eradicate a tumor, which may help Mohs surgeons facilitate, plan, and allocate resources more effectively. Areas for further research in Mohs micrographic surgery are identified.
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Affiliation(s)
- Richard H. Hope
- Lubbock Dermatology and Skin Cancer Center, Lubbock, Texas, USA
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Travis S. Dowdle
- Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Landon Hope
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corley Pruneda
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Liang JF, Feng MC, Wang J, Chen DX, Guan JY, Luo PP. Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:971-976. [PMID: 36149339 DOI: 10.1002/jum.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/29/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM). METHODS 10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups. RESULTS The elasticity ratio (Eratio ) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P = .000), while other parameters show no difference. The Eratio of RTB and OSM were 1.22 ± 0.14 and 0.99 ± 0.07. The area under the ROC curve was .947. Taking 1.075 as the threshold of Eratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB + 5 mm (P = .000). CONCLUSIONS The Eratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing.
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Affiliation(s)
- Jian-Feng Liang
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Ming-Chu Feng
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Jing Wang
- Department of Pathology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Dong-Xiang Chen
- Department of Dermatology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Jian-Ying Guan
- Department of Dermatology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Ping-Ping Luo
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
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Design and Validation of a Handheld Optical Polarization Imager for Preoperative Delineation of Basal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14164049. [PMID: 36011042 PMCID: PMC9406425 DOI: 10.3390/cancers14164049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Skin cancer is the most common malignancy in humans. The goal of this study was to design, implement, and clinically test a novel handheld optical polarization imaging (OPI) system for rapid and noninvasive detection of basal cell carcinoma (BCC) margins. The device is compact, lightweight, and can be operated with minimal training. To validate the handheld imager, 10 subjects with biopsy-confirmed BCC were imaged prior to Mohs surgery. The optical images were processed using a spectral encoding method to increase the accuracy of the tumor boundary delineation. Preoperative margin assessment results from the OPI were compared to the surgeon’s clinical evaluation and to the gold standard of histopathology. Our findings indicate that OPI may be a valuable tool for optimizing surgical treatment of skin cancer. Abstract Background: Accurate removal of basal cell carcinoma (BCC) is challenging due to the subtle contrast between cancerous and normal skin. A method aiding with preoperative delineation of BCC margins would be valuable. The aim of this study was to implement and clinically validate a novel handheld optical polarization imaging (OPI) device for rapid, noninvasive, in vivo assessment of skin cancer margins. Methods: The handheld imager was designed, built, and tested. For clinical validation, 10 subjects with biopsy-confirmed BCC were imaged. Presumable cancer margins were marked by the study surgeon. The optical images were spectrally encoded to mitigate the impact of endogenous skin chromophores. The results of OPI and of the surgeon’s preoperative visual assessment were compared to clinical intraoperative histopathology. Results: As compared to the previous prototype, the handheld imager incorporates automated image processing and has 10-times shorter acquisition times. It is twice as light and provides twice as large a field of view. Clinical validation demonstrated that margin assessments using OPI were more accurate than visual assessment by the surgeon. The images were in good correlation with histology in 9 out of 10 cases. Conclusions: Handheld OPI could improve the outcomes of skin cancer treatments without impairing clinical workflows.
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