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Lee J, Longino ES, Desisto NG, Sharma RK, Stephan SJ, Yang SF, Patel PN. Prophylactic Antibiotic Use in Reconstruction of Nasal Mohs Defects. Otolaryngol Head Neck Surg 2024; 171:702-707. [PMID: 38881398 DOI: 10.1002/ohn.842] [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: 11/12/2023] [Revised: 03/12/2024] [Accepted: 05/04/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To evaluate the effect of prophylactic antibiotics on outcomes and complications following surgical reconstructions of nasal Mohs defects in the outpatient setting. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care center, July 2021 to June 2023. METHODS All adult patients who underwent reconstruction of nasal Mohs defects in an outpatient office setting were examined. Patient demographics, surgical details, prophylactic postprocedural antibiotic use, and postprocedural complications (infection, flap or graft necrosis, wound dehiscence) were collected. Outcomes and complications were compared between patients who received and did not receive prophylactic antibiotics using χ2, Kruskal-Wallis, and multivariable logistic regression. RESULTS A total of 211 patients met inclusion criteria. A majority of reconstructions utilized a local flap (70%), followed by a skin or composite graft (22%), then an interpolated flap (8%). Over half of patients (55%) were prescribed prophylactic antibiotics. Postprocedural complications were documented in 16 patients (7.6%), including infection (3.3%) and flap or graft loss or necrosis (1.4%). The rate of complications did not differ based on receipt of antibiotics. The only factors independently associated with the development of complications were history of chemoradiation and reconstruction with skin or composite grafts. CONCLUSION Prophylactic antibiotics after nasal Mohs reconstructions performed in the office setting were not associated with any differences in the rate of postprocedural complications, including surgical site infections.
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Affiliation(s)
- Jaclyn Lee
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole G Desisto
- School of Medicine, Texas A&M University College of Medicine, Bryan, Texas, USA
| | - Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Onyemachi J, Pinto-Cuberos J, Miller D, Wagner RF, Winsett F. 3D models for mohs micrographic surgery: a review on its use in patient education. Arch Dermatol Res 2024; 316:470. [PMID: 39001895 DOI: 10.1007/s00403-024-03211-w] [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: 06/08/2024] [Revised: 06/08/2024] [Accepted: 06/26/2024] [Indexed: 07/15/2024]
Abstract
The use of a 3D model for patient education has shown encouraging results in surgical specialties like plastic surgery and neurosurgery, amongst many others; however, there is limited research on the clinical application of 3D models for Mohs Micrographic Surgery. This study delves into the utilization of 3D models for patient education in Mohs Surgery by juxtaposing different 3D modalities, highlighting their differences, and exploring potential avenues for future integration of 3D models into clinical practice. A literature search in the scientific database MEDLINE through PubMed and OVID and on the ProQuest Health & Medical Collection database was performed on the use of a 3D model for patient education. We limited the search to articles available in English and considered those mentioning the educational use of 3D models, especially for patient education, after excluding duplicate titles. We did not exclude articles based on publication year due to limited availability of literature. Utilizing 3D models for patient education within the framework of Mohs Micrographic surgery, including a 3D multicolored clay model and a 3D model accompanied by an educational video intervention, presents substantial advantages. 3D models offer a visual and tactile means to improve patients' comprehension of the Mohs procedure, the affected area, and possible outcomes. They hold the potential to reduce patient anxiety and improve decision-making. Currently, literature on the use of 3D models for patient education in Mohs Micrographic Surgery is limited, warranting further research in this area.
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Affiliation(s)
- Jane Onyemachi
- School of Medicine, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-1317, USA.
| | - Juan Pinto-Cuberos
- Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Danielle Miller
- School of Medicine, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-1317, USA
| | - Richard F Wagner
- Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Frank Winsett
- Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
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Zürcher S, Martignoni Z, Hunger RE, Benzaquen M, Seyed Jafari SM. Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:2394. [PMID: 39001454 PMCID: PMC11240455 DOI: 10.3390/cancers16132394] [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] [Received: 05/01/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The first-line treatment of the localized form of cutaneous squamous cell carcinoma (cSCC) remains surgical excision. Either conventional excision (CE) with margins or Mohs micrographic surgery (MMS) may be preferred, depending on the risk factors of cSCC, the characteristics of the tumor, and the available technical facilities. METHODS This article presents a systematic review of the current literature spanning from 1974 to 2023, comparing outcomes of cSCC treated with MMS versus cSCC treated with conventional excision. RESULTS Out of the 6821 records identified through the database search, a total of 156 studies were screened, of which 10 were included in the review. The majority of the included studies showed that treatment of cSCC with MMS consistently exhibits a significantly lower risk of recurrence compared to treatment with CE. In addition, MMS is emerging as the preferred technique for the resection of cSCC located in aesthetically or functionally challenging anatomical areas. CONCLUSION The studies generally demonstrate that MMS is a safer and more effective treatment of cSCC than CE. Nevertheless, outcomes such as recurrence rates and cost-effectiveness should be assessed more precisely, in order to allow for a more tailored approach in determining the appropriate indication for the use of MMS.
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Affiliation(s)
- Sven Zürcher
- Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
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Williams GJ, Quinn T, Lo S, Guitera P, Scolyer RA, Thompson JF, Ch'ng S. Mohs micrographic surgery for the treatment of invasive melanoma: A systematic review with meta-analyses. J Eur Acad Dermatol Venereol 2024. [PMID: 38842170 DOI: 10.1111/jdv.20138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/13/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The use of Mohs micrographic surgery (MMS) in melanoma treatment has divided opinion and evidence-based guidelines are lacking. OBJECTIVES This systematic review aimed to analyse clinical outcomes for patients with invasive melanomas treated with Mohs rather than wide local excision (WLE). METHODS Embase, MEDLINE and Cochrane databases (to 30 August 2023) were searched for studies using Mohs to treat invasive melanoma. Outcomes of interest were local recurrence and death from melanoma. RESULTS Thirty-five articles involving 41,499 patients with invasive melanoma treated with Mohs were identified. Sixteen studies compared Mohs with WLE and 19 were Mohs-only, non-comparative studies. Patients treated with Mohs differed significantly from those undergoing WLE, in particular Mohs patients were older and had thinner melanomas. Two comparative studies using the same data source reported adjusted hazard ratios for melanoma-specific death and both showed no significant difference between Mohs and WLE-treated patients; 0.87 (95% CI 0.55-1.35) and 1.20 (95% CI 0.71-20.36). There was also no statistically significant difference in local recurrence risk; the unadjusted risk ratio for patients treated with Mohs was 0.46 (95% CI 0.14-1.51 p = 0.20) with moderate heterogeneity (I2 = 62%). No studies reported multivariable analyses for risk of local recurrence. Many studies generated from relatively few and often overlapping data sets have reported the use of Mohs to treat patients with invasive melanoma. Fewer studies were comparative between Mohs and WLE and these reported substantially different baseline risks of recurrence and death from melanoma between the groups. Mohs has generally been used for thinner melanomas in older patients; therefore, comparisons based on univariable analyses are likely to have been misleading. CONCLUSIONS On the basis of currently available data, it is not possible to reliably assess whether outcomes differ if invasive melanomas with comparable features are treated with Mohs or WLE, and randomized trial evidence will be required for reliable conclusions to be reached.
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Affiliation(s)
- G J Williams
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - T Quinn
- The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - P Guitera
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Mater Hospital, North Sydney, Sydney, New South Wales, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - S Ch'ng
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Mater Hospital, North Sydney, Sydney, New South Wales, Australia
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Pulumati A, Algarin YA, Kim S, Latta S, Li JN, Nouri K. 3D bioprinting: a review and potential applications for Mohs micrographic surgery. Arch Dermatol Res 2024; 316:147. [PMID: 38698273 DOI: 10.1007/s00403-024-02893-6] [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: 03/14/2024] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
Mohs Micrographic Surgery (MMS) is effective for treating common cutaneous malignancies, but complex repairs may often present challenges for reconstruction. This paper explores the potential of three-dimensional (3D) bioprinting in MMS, offering superior outcomes compared to traditional methods. 3D printing technologies show promise in advancing skin regeneration and refining surgical techniques in dermatologic surgery. A PubMed search was conducted using the following keywords: "Three-dimensional bioprinting" OR "3-D printing" AND "Mohs" OR "Mohs surgery" OR "Surgery." Peer-reviewed English articles discussing medical applications of 3D bioprinting were included, while non-peer-reviewed and non-English articles were excluded. Patients using 3D MMS models had lower anxiety scores (3.00 to 1.7, p < 0.0001) and higher knowledge assessment scores (5.59 or 93.25% correct responses), indicating better understanding of their procedure. Surgical residents using 3D models demonstrated improved proficiency in flap reconstructions (p = 0.002) and knowledge assessment (p = 0.001). Additionally, 3D printing offers personalized patient care through tailored surgical guides and anatomical models, reducing intraoperative time while enhancing surgical. Concurrently, efforts in tissue engineering and regenerative medicine are being explored as potential alternatives to address organ donor shortages, eliminating autografting needs. However, challenges like limited training and technological constraints persist. Integrating optical coherence tomography with 3D bioprinting may expedite grafting, but challenges remain in pre-printing grafts for complex cases. Regulatory and ethical considerations are paramount for patient safety, and further research is needed to understand long-term effects and cost-effectiveness. While promising, significant advancements are necessary for full utilization in MMS.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA.
| | - Yanci A Algarin
- Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Sarah Kim
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Steven Latta
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Jeffrey N Li
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
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Singh H, Chopra H, Singh I, Mohanto S, Ahmed MG, Ghumra S, Seelan A, Survase M, Kumar A, Mishra A, Mishra AK, Kamal MA. Molecular targeted therapies for cutaneous squamous cell carcinoma: recent developments and clinical implications. EXCLI JOURNAL 2024; 23:300-334. [PMID: 38655092 PMCID: PMC11036065 DOI: 10.17179/excli2023-6489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/14/2024] [Indexed: 04/26/2024]
Abstract
Cutaneous Squamous Cell Carcinoma (cSCC) is a common and potentially fatal type of skin cancer that poses a significant threat to public health and has a high prevalence rate. Exposure to ultraviolet radiation on the skin surface increases the risk of cSCC, especially in those with genetic syndromes like xerodermapigmentosum and epidermolysis bullosa. Therefore, understanding the molecular pathogenesis of cSCC is critical for developing personalized treatment approaches that are effective in cSCC. This article provides a comprehensive overview of current knowledge of cSCC pathogenesis, emphasizing dysregulated signaling pathways and the significance of molecular profiling. Several limitations and challenges associated with conventional therapies, however, are identified, stressing the need for novel therapeutic strategies. The article further discusses molecular targets and therapeutic approaches, i.e., epidermal growth factor receptor inhibitors, hedgehog pathway inhibitors, and PI3K/AKT/mTOR pathway inhibitors, as well as emerging molecular targets and therapeutic agents. The manuscript explores resistance mechanisms to molecularly targeted therapies and proposes methods to overcome them, including combination strategies, rational design, and optimization. The clinical implications and patient outcomes of molecular-targeted treatments are assessed, including response rates and survival outcomes. The management of adverse events and toxicities in molecular-targeted therapies is crucial and requires careful monitoring and control. The paper further discusses future directions for therapeutic advancement and research in this area, as well as the difficulties and constraints associated with conventional therapies.
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Affiliation(s)
- Harpreet Singh
- School of Pharmaceutical Sciences, IFTM University, Moradabad, U.P., India, 244102
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai - 602105, Tamil Nadu, India
| | - Inderbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sourav Mohanto
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Center, Yenepoya (Deemed to be University), Mangalore, Karnataka, 575018, India
| | - Mohammed Gulzar Ahmed
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Center, Yenepoya (Deemed to be University), Mangalore, Karnataka, 575018, India
| | - Shruti Ghumra
- Department of Biological Sciences, Sunandan Divatia School of Science, NarseeMonjee Institute of Management Studies (NMIMS), Pherozeshah Mehta Rd, Mumbai, India, 400056
| | - Anmol Seelan
- Mahatma Gandhi Mission, Institute of Biosciences and Technology, Aurangabad, India
| | - Manisha Survase
- Mahatma Gandhi Mission, Institute of Biosciences and Technology, Aurangabad, India
| | - Arvind Kumar
- School of Pharmaceutical Sciences, IFTM University, Moradabad, U.P., India, 244102
| | - Amrita Mishra
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India, 110017
| | - Arun Kumar Mishra
- SOS School of Pharmacy, IFTM University, Moradabad, U.P., India, 244102
| | - Mohammad Amjad Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, China
- King Fahd Medical Research Center, King Abdulaziz University, Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Bangladesh
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770; Novel Global Community Educational Foundation, Australia
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Govas P, Ha MV, Wessel CB, Hurst A, Gordon BR, Carroll BT. Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review. Dermatol Surg 2023; 49:1116-1121. [PMID: 37962132 DOI: 10.1097/dss.0000000000004013] [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: 11/15/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional surgical excision. Competing performance measures have fostered numerous histologic techniques for MMS. OBJECTIVE To analyze differences in primary outcomes in the published literature regarding the technique of tissue processing and embedding during the MMS process. METHODS A systematic review was performed of the published literature in MEDLINE, PubMed, Embase, and Cochrane library that included a description of the manipulation of tissue during the grossing and embedding steps of MMS. RESULTS Inclusion criteria were met by 61 articles. Of these studies, the cure/recurrence rate was assessed in 1 article (1.6%), tissue conservation was assessed in 47 (77%), time-saving was assessed in 35 (57%), cost-saving was assessed in 6 (10%), and decreased artifact were assessed in 20 (33%). CONCLUSION There is a lack of standardization for assessing clinical outcomes in the published literature regarding MMS process techniques. Cure is a critical outcome in studies comparing MMS processing methodologies.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles B Wessel
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania
| | - Anne Hurst
- Atlantic Skin Cancer Surgery, Virginia Beach, Virginia
| | - Beth R Gordon
- Department of Internal Medicine, NYU Langone Health, New York, New York
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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8
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Berl A, Shir-Az O, Mann D, Weiss E, Bilal BS, Shalom A. The Mastoid Skin Graft: A Fast, Efficient Donor Site for Auricle Reconstruction After Mohs Surgery. J Cutan Med Surg 2023; 27:589-593. [PMID: 37584522 DOI: 10.1177/12034754231191495] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND Mohs micrographic surgery has been considered the gold standard for treating nonmelanoma skin cancers. Approximately 8% to 10% of skin cancers requiring Mohs surgery occur on the auricle. Skin grafts can be used to achieve optimal functional and cosmetic results. OBJECTIVES To describe a skin graft technique using the mastoid area as a donor site for auricular reconstruction following Mohs micrographic surgery, to achieve optimal esthetic results in functionally important areas. METHODS This retrospective study assessed the outcomes of patients who underwent MMS in an out-patient Mohs surgery clinic from 2010 to 2021. All patients had MMS of the auricle with reconstruction using a split thickness skin graft harvested from the mastoid area. RESULTS A total of 154 patients were included. The average lesion diameter was 13.7 mm (range 5-30 mm), excised in an average of 1.9 rounds of MMS. Skin graft success rate was 96%. Complications included one patient with a hypertrophic scar. The cosmetic appearance of the recipient site was rated as excellent by 87.5% of patients. All patients rated the cosmetic appearance of the donor area as excellent and well-concealed. CONCLUSIONS Split thickness skin grafts harvested from the mastoid area are a quick and efficient reconstruction method for post-Mohs auricular defects.
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Affiliation(s)
- Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Shir-Az
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Din Mann
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitam Weiss
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biader Samih Bilal
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Desai AD, Behbahani S, Soliman Y, Samie FH. Factors associated with Mohs micrographic surgery in dermatofibrosarcoma protuberans of the head and neck: A cohort study. Indian J Dermatol Venereol Leprol 2023; 0:1-3. [PMID: 37436022 DOI: 10.25259/ijdvl_991_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/12/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Amar D Desai
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, NJ
| | - Sara Behbahani
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Yssra Soliman
- Department of Dermatology, Columbia University Irving Medical Center, NY
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, NY
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10
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Ansaf RB, Ziebart R, Gudapati H, Simoes Torigoe RM, Victorelli S, Passos J, Wyles SP. 3D bioprinting-a model for skin aging. Regen Biomater 2023; 10:rbad060. [PMID: 37501679 PMCID: PMC10369216 DOI: 10.1093/rb/rbad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/16/2023] [Accepted: 06/04/2023] [Indexed: 07/29/2023] Open
Abstract
Human lifespan continues to extend as an unprecedented number of people reach their seventh and eighth decades of life, unveiling chronic conditions that affect the older adult. Age-related skin conditions include senile purpura, seborrheic keratoses, pemphigus vulgaris, bullous pemphigoid, diabetic foot wounds and skin cancer. Current methods of drug testing prior to clinical trials require the use of pre-clinical animal models, which are often unable to adequately replicate human skin response. Therefore, a reliable model for aged human skin is needed. The current challenges in developing an aged human skin model include the intrinsic variability in skin architecture from person to person. An ideal skin model would incorporate innate functionality such as sensation, vascularization and regeneration. The advent of 3D bioprinting allows us to create human skin equivalent for use as clinical-grade surgical graft, for drug testing and other needs. In this review, we describe the process of human skin aging and outline the steps to create an aged skin model with 3D bioprinting using skin cells (i.e. keratinocytes, fibroblasts and melanocytes). We also provide an overview of current bioprinted skin models, associated limitations and direction for future research.
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Affiliation(s)
- Ryeim B Ansaf
- Department of Biology, Colorado State University Pueblo, Pueblo, CO 81001, USA
| | - Rachel Ziebart
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
| | | | | | - Stella Victorelli
- Mayo Clinic Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
- Mayo Clinic Robert and Arlene Kogod Center on Aging, Rochester, MN 55905, USA
| | - Joao Passos
- Mayo Clinic Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
- Mayo Clinic Robert and Arlene Kogod Center on Aging, Rochester, MN 55905, USA
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Khan N, Halaseh FF, Pillai K, Zaki DP, Sayadi LR, Widgerow AD. Hyperbaric and topical oxygen therapies in thermal burn wound healing: a review. J Wound Care 2023; 32:S20-S30. [PMID: 36724086 DOI: 10.12968/jowc.2023.32.sup2.s20] [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: 02/02/2023]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of the two most commonly used oxygen delivery methods for the treatment of thermal burn wound healing: hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT). METHOD The PubMed database was searched for articles discussing the use of HBOT or TOT in the treatment of thermal burns. RESULTS The search yielded 43,406 articles, of which 28 (23 HBOT, 5 TOT) met the inclusion criteria. Both experimental and clinical studies have demonstrated conflicting results after treating thermal burns with HBOT or TOT. Overall, 14/23 studies demonstrated positive results for HBOT on the healing of burn wounds and associated complications, such as oedema and pain. Findings from these studies showed it can reduce morbidity and mortality in certain high-risk groups such as those with diabetes or extensive burns. Although the five studies (one human and four animal trials) reviewing TOT showed promising outcomes, this therapeutic modality has not been well investigated. CONCLUSION Therapeutic use of HBOT in thermal burns has been popular in the past but its use remains controversial due to inconsistent results, serious side-effects, lack of convenience and high costs. The use of TOT in the management of burns needs further exploration by scientists and clinicians alike, in addition to the implementation of a standardised treatment protocol.
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Affiliation(s)
- Nawal Khan
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
| | - Faris F Halaseh
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
| | - Kathryn Pillai
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
| | - Daniel P Zaki
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
| | - Lohrasb R Sayadi
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
| | - Alan D Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, US
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Somani AK. Application expansion of small intestinal submucosa extracellular matrix in complex and surgical wounds. J Wound Care 2023; 32:S20-S27. [PMID: 36744601 DOI: 10.12968/jowc.2023.32.sup1a.s20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A wound is hard-to-heal or complex when the defect fails to progress through the normal stages of wound healing in a timely fashion. Hard-to-heal wounds such as diabetic foot or venous leg ulcers can be long-lasting conditions. Alternatively, complex acute wounds that occur from trauma, burns, postoperative, necrosis and some dermatological diseases can also result in hard-to-heal wounds. This article reviews important considerations in the management of complex acute wounds, such as time to wound closure, pain, scarring, patient satisfaction and identification of options that can promote healing of grafts and flaps, while reducing donor-site morbidity. Primary research has demonstrated the inherent benefits of small intestinal submucosa extracellular matrix (SIS-ECM), a naturally occurring porcine matrix that promotes development of dermis-like tissue in both complex acute and hard-to-heal wounds. Presently, the literature provides mostly case studies demonstrating the benefits of SIS-ECM in the management of complex acute wounds. The available case series suggest emerging clinical benefits including rapid time to coverage, avoidance of donor-site complications and development of granulation tissue in locations of low circulation, which improves poor graft sites, potentially reducing dehiscence and providing support for reconstruction flaps and grafts.
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Affiliation(s)
- Ally-Khan Somani
- Assistant Professor of Clinical Dermatology, Indiana University, Indiana, US
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Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a widely used technique for removal of cutaneous tumors. The procedure is well-tolerated with little surgical or postoperative pain. OBJECTIVE This study examined pain levels after Mohs surgery throughout the first week of recovery and the relation to patient demographics, lesion characteristics, surgery details, and postoperative analgesia. METHODS A 2-year prospective observational study included patients who underwent MMS. Patients rated the severity of postoperative pain once daily until removal of sutures and documented analgesics used. Analyses of patient and lesion characteristics along with reconstruction methods were conducted. RESULTS A total of 2,178 patients were included in the study. Pain levels were strongest on the first postoperative day (POD) and were significantly different between genders on POD 3. Site of skin lesion, method of reconstruction, and number of stages of MMS were significantly related to postoperative pain levels on univariate and multivariate analyses. Postoperative consumption of analgesics differed significantly between men and women and was not correlated to age. CONCLUSION Mohs surgery is generally nonpainful and is well-tolerated by men and women across all ages. The site of the lesion and method of reconstruction are the major determinants affecting the perception of pain.
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Chuchvara N, Rao B, Liu X. Manually scanned single fiber optical coherence tomography for skin cancer characterization. Sci Rep 2021; 11:15570. [PMID: 34330974 PMCID: PMC8324861 DOI: 10.1038/s41598-021-95118-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Optical coherence tomography (OCT) is a cross-sectional imaging modality based on low coherence light interferometry. Within dermatology, it has found applications for in vivo diagnostic imaging purposes, as well as to guide Mohs micrographic surgery (MMS), due to its ability to visualize skin morphology up to several millimeters in depth. However, standard OCT probes have a large footprint and capture an extended area of the skin, making it difficult to precisely pinpoint clinically relevant location being imaged. Mohs surgeons stand to benefit from a handheld in vivo imaging device that can accurately trace surgical margins. In this study, we demonstrate the use of a single fiber OCT (sfOCT) instrument. Our imaging system features a miniature common path single fiber probe, and a novel speckle decorrelation technique that generates distortion free 2D images from manual scanning.By manually moving the single-fiber probe across the region of interest, the user can perform a lateral OCT scan while visualizing the location of the probe during data acquisition. Using the sfOCT, we have identified normal skin morphology, qualitatively correlated features of basal cell carcinoma and squamous cell carcinoma with histopathology, and quantified the disruption of the dermo-epidermal junction OCT pattern in skin tumors-each demonstrating the potential of utilizing sfOCT to differentiate tumor from normal skin. Using this imaging tool, a Mohs surgeon can enhance determination of surgical margins for the first stage of MMS, potentially decreasing the time and number of stages required for complete tumor removal.
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Affiliation(s)
- Nadiya Chuchvara
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, 1 Worlds Fair Drive, Somerset, NJ, 08873, USA
| | - Babar Rao
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, 1 Worlds Fair Drive, Somerset, NJ, 08873, USA
- Rao Dermatology, 95 First Avenue, Atlantic Highlands, NJ, 07716, USA
- Department of Dermatology, Weill Cornell Medicine, 1305 York Ave 9th Floor, New York, NY, 10021, USA
| | - Xuan Liu
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07102, USA.
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Gogineni E, Cai H, Carillo D, Rana Z, Bloom B, Potters L, Gaballa H, Ghaly M. Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face. J Contemp Brachytherapy 2021; 13:51-58. [PMID: 34025737 PMCID: PMC8117709 DOI: 10.5114/jcb.2021.103587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Non-melanoma skin cancers of the face are at high-risk for local recurrence and metastatic spread. While surgical interventions such as Mohs microsurgery are considered the standard of care, this modality has the potential for high rates of toxicity in sensitive areas of the face. Catheter flap high-dose-rate (HDR) brachytherapy has shown promising results, with high rates of local control and acceptable cosmetic outcomes. MATERIAL AND METHODS Patients with non-melanoma skin cancers (NMSC) located on the face were treated with 40 Gy in 8 fractions, given twice weekly via catheter flap HDR brachytherapy. Clinical target volume (CTV) included the visible tumor plus a margin of 5 mm in all directions, with no additional planning target volume (PTV) margin. RESULTS Fifty patients with 53 lesions on the face were included, with a median follow-up of 15 months. All were considered high-risk based on NCCN guidelines. Median tumor size and thickness were 18 mm and 5 mm, respectively. Median PTV volume and D90 were 1.7 cc and 92%, respectively. Estimated rate of local control at twelve months was 92%. Three patients (5%) experienced acute grade 2 toxicity. Two patients (4%) continued to suffer from chronic grade 1 skin toxicity at 12 months post-radiotherapy (RT), with an additional two patients (4%) experiencing chronic grade 2 skin toxicity. Forty-nine lesions (92%) were found to have a good or excellent cosmetic outcome with complete tumor remission. CONCLUSIONS CT-based flap applicator brachytherapy is a valid treatment option for patients with NMSC of the face. This modality offers high rates of local control with acceptable cosmetic outcomes and low rates of toxicity.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Haocheng Cai
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Dawn Carillo
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Beatrice Bloom
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Hani Gaballa
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
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16
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Zargham H, Gabrielli S, Giordano CN, Higgins HW. Beyond Skin Tumors: A Systematic Review of Mohs Micrographic Surgery in the Treatment of Deep Cutaneous Fungal Infections. Dermatol Surg 2021; 47:94-97. [PMID: 32932265 DOI: 10.1097/dss.0000000000002761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options. OBJECTIVE To review the benefits, limitations, and practicality of MMS in patients with DCFIs. METHODS A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS. RESULTS Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months. CONCLUSION Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.
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Affiliation(s)
- Hanieh Zargham
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cerrene N Giordano
- Penn Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold William Higgins
- Penn Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Patrinely JR, Darragh C, Frank N, Danford BC, Wheless L, Clayton A. Risk of adverse events due to high volumes of local anesthesia during Mohs micrographic surgery. Arch Dermatol Res 2020; 313:679-684. [PMID: 33125528 DOI: 10.1007/s00403-020-02155-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/08/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
General guidelines for the maximum amounts of locally injected lidocaine exist; however, there is a paucity of data in the Mohs micrographic surgery (MMS) literature. This study aimed to determine the safety and adverse effects seen in patients that receive larger amounts of locally injected lidocaine. A retrospective chart review of 563 patients from 1992 to 2016 who received over 30 mL of locally injected lidocaine was conducted. Patient records were reviewed within seven postoperative days for complications. The average amount of anesthesia received was 40 mL, and the average patient weight was 86.69 kg. 1.4% of patients had a complication on the day of surgery, and 4.4% of patients had a complication within 7 days of the surgery. The most common complications were excessive bleeding/hematoma formation and wound infection. Only two complications could be attributable to local anesthetics. Gender, heart disease, hypertension, diabetes, and smoking were not significant risk factors for the development of complications. MMS is a safe outpatient procedure for patients that require over 30 mL of locally injected anesthesia. The safety of high volumes of lidocaine extends to patients with risk factors such as heart disease, hypertension, diabetes, and smoking.
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Affiliation(s)
| | - Charles Darragh
- Carolina Dermatology of Greenville, Greenville, SC, USA
- Clinical Faculty, University of South Carolina SOM- Greenville, Greenville, SC, USA
| | | | | | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Clayton
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Miller MQ, Stevens JS, Park SS, Christophel JJ. Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery? Laryngoscope 2020; 131:E434-E439. [PMID: 32401393 DOI: 10.1002/lary.28700] [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: 11/04/2019] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. STUDY DESIGN Retrospective, single-institution cohort study. METHODS This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. RESULTS A total of 900 defects in 800 patients (mean age [range] = 65.3 [21-96], 54.60% female) were identified over the 7-year period. Patient-specific variables reviewed included comorbidities, age, and smoking status. Surgery-specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri-incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1-20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09-21.30; P = .001), full-thickness defects (OR: 1.2; 95% CI: 1.0-3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0-11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23-14.21; P = .568). CONCLUSIONS We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E434-E439, 2021.
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Affiliation(s)
- Matthew Q Miller
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | | | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - J Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
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Ashrafzadeh S, Metlay JP, Choudhry NK, Emmons KM, Asgari MM. Using Implementation Science to Optimize the Uptake of Evidence-Based Medicine into Dermatology Practice. J Invest Dermatol 2019; 140:952-958. [PMID: 31862108 DOI: 10.1016/j.jid.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022]
Abstract
An estimated 17-year lag exists between evidence generation and its integration into routine clinical care. The field of implementation science has emerged to close this gap by applying rigorous methods to systematically study the obstacles and facilitators of the uptake of evidence-based practices. However, implementation science has not gained wide traction in dermatology. In this narrative review, we use literature and expert input to introduce implementation science and key frameworks for implementing interventions and evaluating their uptake. We then highlight opportunities for dermatology-specific interventions at the patient-, provider-, system-, and population-levels, and advocate for the field's expansion into dermatology.
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Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joshua P Metlay
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
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20
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Puyana C, Zimmerman L, Tsoukas MM. Mohs micrographic surgery as treatment option for non-basal cell or squamous cell carcinomas in the United States. J DERMATOL TREAT 2019; 31:567-570. [PMID: 31474170 DOI: 10.1080/09546634.2019.1654074] [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: 10/26/2022]
Abstract
Background: Skin cancer has the highest incidence of all cancers in the United States. Conventional surgical excision (CSE) and Mohs micrographic surgery (MMS) are among the most common surgical treatment options for skin cancer.Objective: The purpose of this study was to examine utilization patterns of MMS compared to CSE in the United States for non-basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) skin cancers.Methods: Data from the NCI SEER program, collected from 1973 to 2015, were retrospectively analyzed. Cases were separated into MMS and CSE. Patient characteristics were analyzed. Multivariate models were fitted to evaluate significant predictors for MMS.Results: Of the total procedures performed during the years 1988-2015, a total of 12,654 MMS cases and 267,291 CSE were considered for analysis. Females, white, and non-Hispanic patients of increasing age were more likely to undergo MMS compared to CSE. Cases diagnosed in the pacific coast, east, and southwest regions were more likely to be treated with MMS compared to those in the northern plains Additionally, in situ cases and of the face had the highest likelihood of being treated with MMS.Conclusions: Studying demographics and tumor characteristics aid in understanding the utilization patterns of MMS.
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Affiliation(s)
- Carolina Puyana
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Lacey Zimmerman
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
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21
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Johnson-Jahangir H, Agrawal N. Perioperative Antibiotic Use in Cutaneous Surgery. Dermatol Clin 2019; 37:329-340. [DOI: 10.1016/j.det.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Memar OM, Caughlin B. Nasal Reconstruction of Post-Mohs Defects >1.5 cm in a Single Cosmetic Subunit Under Local Anesthesia by a Combination of Plastic Surgeon and Mohs Surgeon Team: A Cross-sectional Study and Review of Algorithmic Nasal Defect Closures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2277. [PMID: 31624682 PMCID: PMC6635188 DOI: 10.1097/gox.0000000000002277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We present an algorithmic approach to the reconstruction of larger post-Mohs defects treated in a practice with both a plastic surgeon and Mohs surgeon. The aim of the study is to present post-Mohs reconstructive choices made by our team compared with closures done by solo dermatologists. METHODS A cross-sectional study was designed. Participants were 66 consecutive cases of nasal Mohs repairs performed under local anesthesia. For each Mohs case, data were collected on the age of the patient, smoking status, tumor type, tumor location, tumor diameter, the number of Mohs stages needed to clear the surgical margins of any remaining cancer, final defect diameter, reconstructive methods used, and postoperative complications. RESULTS Basal cell carcinoma was the most common tumor treated on the nose, and post-Mohs basal cell carcinoma defects were closed predominantly with full-thickness skin grafts (FTSGs), rotation flap (RF), or a combination of both. The sidewall was the cosmetic unit most affected by skin cancer, and defects were commonly closed by FTSG and RF. Fifty percent of the sidewall defects required more than 1 closure method, compared with 24% of the nasal tip defects. FTSG combination closure was performed on 20 cases, usually with an advancement flap. CONCLUSIONS The addition of a plastic surgeon shifted the nasal reconstructive techniques when compared with dermatologists alone. Post-Mohs defect >1.5 cm in a single cosmetic subunit was reconstructed under local anesthesia with either RF or a combination of FTSG and an advancement flap, whereas dermatologists most commonly chose a primary closure.
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Affiliation(s)
- Omeed M. Memar
- From the Academic Dermatology & Skin Cancer Institute, Chicago, Ill
| | - Benjamin Caughlin
- Department of Surgery, Division of Otolaryngology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Ill
- Division of Facial Plastic and Reconstructive Surgery, Jesse Brown VAMC, Chicago, Ill
- Division of Facial Plastic and Reconstructive Surgery, University of Illinois Health Hospital System, Chicago, Ill
- Kovak Cosmetic Center, Oakbrook Terrace, Ill
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Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms. OBJECTIVE To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions. METHODS A literature search was conducted using PubMed to identify articles pertaining to MMS. RESULTS The fresh frozen technique led to widespread use of MMS in the 1970s. One randomized controlled trial and several large prospective studies have demonstrated low recurrence rates for treatment of nonmelanoma skin cancer (NMSC). MMS, when compared with surgical excision, also achieved a statistically significant higher cure rate for treatment of recurrent NMSC. Studies have demonstrated low recurrence for the treatment of melanoma and melanoma in situ with MMS. MMS has also been shown to effectively treat several rare cutaneous neoplasms. The future of MMS is likely to include the adoption of noninvasive imaging, immunostaining, and digital technology. CONCLUSION Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.
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Affiliation(s)
- Diana K Cohen
- Skin Laser & Surgical Specialists of NY and NJ, Hackensack, New Jersey
| | - David J Goldberg
- Skin Laser & Surgical Specialists of NY and NJ, Hackensack, New Jersey
- Icahn School of Medicine at Mt. Sinai, New York, New York
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Basu P, Goldenberg A, Cowan N, Eilers R, Hau J, Jiang SIB. A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery. J Am Acad Dermatol 2018; 80:1594-1601. [PMID: 30502411 DOI: 10.1016/j.jaad.2018.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet postoperative complications associated with different types of immunosuppression are largely unstudied. OBJECTIVE To determine the incidence and nature of postoperative complications in immunosuppressed patients undergoing Mohs micrographic surgery. METHODS A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications. RESULTS Univariable analysis showed that compared with immunocompetence, immunosuppression was associated with 9.6 times the odds of postoperative complication (P = .003), with solid organ transplant recipients having 8.824 times higher odds (P = .006) and immunosuppressive therapy use displaying 5.775 times higher odds (P = .021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in the immunosuppressed population. Multivariable analysis of the association between immunosuppression and postoperative complication closely trended toward, but did not meet, significance (P = .056). LIMITATIONS This was a single-center, retrospective study. Other limitations include lack of non-solid organ transplants, limited medication-related data on nontransplant patients, and exclusion of cases involving patients with double transplants or multiple sources of immunosuppression. CONCLUSIONS Immunosuppression overall, particularly owing to solid organ transplant and immunosuppressive therapy use, places patients at higher risk for postoperative complications, including surgical site infection and wound dehiscence following MMS.
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Affiliation(s)
- Pallavi Basu
- School of Medicine, University of California San Diego, San Diego, California
| | - Alina Goldenberg
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Natasha Cowan
- School of Medicine, University of California San Diego, San Diego, California
| | - Robert Eilers
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Jennifer Hau
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Shang I Brian Jiang
- Department of Dermatology, University of California San Diego, San Diego, California.
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Rohani P, Yaroslavsky AN, Feng X, Jermain P, Shaath T, Neel VA. Collagen disruption as a marker for basal cell carcinoma in presurgical margin detection. Lasers Surg Med 2018; 50:902-907. [PMID: 29900551 DOI: 10.1002/lsm.22948] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVE Nonmelanoma skin cancers (NMSCs) are the most common malignancies in the United States. Surgery is the most common treatment for these tumors, but pre-operative identification of surgical margins is challenging. The objective in this study was to determine whether optical polarization imaging (OPI) could be used prior to surgery to detect the extent of subclinical tumor spread by monitoring disruption in collagen. MATERIALS AND METHODS OPI is a non-invasive and rapid imaging modality that highlights the structure of dermal collagen. OPI was used preoperatively at wavelengths of 440 and 640 nm to perform imaging of NMSCs on six patients scheduled to undergo Mohs surgery for biopsy-proven basal cell carcinoma. This pilot study did not alter the course of routine MMS for any of the patients. The surgeon was blinded from the preoperative imaging results and completed the entire procedure without relying on the new technology. The study was conducted in an outpatient surgical setting. Patients over 18 years of age with biopsy-proven basal cell carcinoma participated. RESULTS AND CONCLUSION OPI accurately predicted the presence or absence of tumor at the surgical margin in six out of six cases, as confirmed on histology. OPI may allow efficient surgical planning by identifying tumor extension beyond visibly involved skin. Lasers Surg. Med. 50:902-907, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Pooyan Rohani
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Anna N Yaroslavsky
- Advanced Biophotonics Laboratory, University of Massachusetts, Lowell, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Xin Feng
- Advanced Biophotonics Laboratory, University of Massachusetts, Lowell, Massachusetts
| | - Peter Jermain
- Advanced Biophotonics Laboratory, University of Massachusetts, Lowell, Massachusetts
| | - Tarek Shaath
- Florida State University College of Medicine, Tallahassee, Florida
| | - Victor A Neel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Tchernev G, Pidakev I. Transposition cutaneous flap and split skin mesh graft as combined optimal treatment approach for giant neglected multicentric BCC of the shoulder. J Eur Acad Dermatol Venereol 2018; 33:e12-e13. [PMID: 29852533 DOI: 10.1111/jdv.15105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Tchernev
- Department of Dermatology and Dermatologic Surgery, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
| | - I Pidakev
- Department of General, Vascular and Abdominal Surgery, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
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Recurrent Tumors Referred for Mohs Micrographic Surgery: A 12-Year Experience at a Single Academic Center. Dermatol Surg 2018; 43:1418-1422. [PMID: 28595252 DOI: 10.1097/dss.0000000000001220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is used for treatment of primary and recurrent tumors. Compared with primary tumors, recurrent tumors are often more aggressive. OBJECTIVE To understand differing characteristics between primary versus recurrent tumors treated by MMS. MATERIALS AND METHODS The authors conducted a retrospective review of a 12-year period at 1 academic center. Recurrent tumors were defined as recurrent if previously treated with cryotherapy, topical chemotherapeutics, electrodesiccation and curettage, or excision. Statistical analysis was conducted with p ≤ .05 considered significant. RESULTS A total of 17,971 cases were reviewed, of which 10.5% represented recurrent tumors. Recurrent tumors occurred more commonly in men (ratio 2.2:1). They presented in older individuals (p < .01) and occurred more commonly on the scalp (p < .0001), neck (p < .0001), and trunk (p < .0001). Primary tumors were more commonly located on the periocular (p < .0001), nose (p < .0001), and perioral areas (p < .0001). Squamous cell carcinoma more commonly presented as primary tumors (p = .02) while squamous cell carcinoma in situ more commonly presented as recurrent tumors (p < .001). CONCLUSION Distinct characteristics separate primary and recurrent tumors treated by MMS. Primary tumors were more commonly located in Area H, compared with recurrent tumors, which were more commonly located in Area M. This suggests appropriate usage of MMS based on appropriate use criteria.
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Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria. J Am Acad Dermatol 2017; 76:1131-1138.e1. [PMID: 28365039 DOI: 10.1016/j.jaad.2016.12.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 12/09/2016] [Accepted: 12/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate. OBJECTIVE We sought to compare recurrence rates after different treatments in tumors judged appropriate for MMS. METHODS We used data from an observational prospective cohort study and retrospectively categorized consecutive tumors as appropriate for MMS according to the AUC. Among appropriate tumors, we used survival analyses to compare 5-year recurrence rates after treatments. RESULTS Among tumors appropriate for MMS (N = 1483), adjusted 5-year recurrence rates were 2.9% (range, 1.4-4.3%) after MMS, 5.5% (range, 3.1-7.9%) after excision, 4.0% (range, 0.6-7.2%) after destruction, and 5.9% (range, 1.5-10.2%) after other treatments. In tumors treated only with MMS or excision (the most similar subgroups), the adjusted hazard ratio of 5-year recurrence after MMS was 0.6 (95% confidence interval, 0.3-1.0; P = .06). LIMITATIONS This study is limited by its uncertain generalizability, lack of randomization, and unmeasured characteristics. CONCLUSION The AUC identified tumors for which recurrence would be less common after MMS than after excision, but the absolute difference in recurrence rates was small.
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Underutilization of Mohs Micrographic Surgery for Less Common Cutaneous Malignancies in the United States. Dermatol Surg 2016; 42:653-62. [DOI: 10.1097/dss.0000000000000705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Rationalizing Outcome Measures in Dermatologic Surgery. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moncrieff MD, Shah AK, Igali L, Garioch JJ. False-negative rate of intraoperative frozen section margin analysis for complex head and neck nonmelanoma skin cancer excisions. Clin Exp Dermatol 2015; 40:834-8. [DOI: 10.1111/ced.12743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. D. Moncrieff
- Department of Plastic and Reconstructive Surgery; The Norfolk and Norwich Skin Tumour Unit; Norfolk UK
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. K. Shah
- Department of Plastic and Reconstructive Surgery; The Norfolk and Norwich Skin Tumour Unit; Norfolk UK
| | - L. Igali
- Norwich Medical School; University of East Anglia; Norwich UK
- Department of Cellular Pathology; The Norfolk and Norwich Skin Tumour Unit; Norfolk UK
| | - J. J. Garioch
- Norwich Medical School; University of East Anglia; Norwich UK
- Department of Dermatology; Norfolk and Norwich Skin Tumour Unit; Norwich Norfolk UK
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Puig S, Berrocal A. Management of high-risk and advanced basal cell carcinoma. Clin Transl Oncol 2015; 17:497-503. [PMID: 25643667 PMCID: PMC4495248 DOI: 10.1007/s12094-014-1272-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.
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Affiliation(s)
- S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain,
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Saco M, Howe N, Nathoo R, Cherpelis B. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis. J DERMATOL TREAT 2014; 26:151-8. [DOI: 10.3109/09546634.2014.906547] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kropp L, Balamucki CJ, Morris CG, Kirwan J, Cognetta AB, Stoer CB, Mendenhall WM. Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion. Am J Otolaryngol 2013; 34:373-7. [PMID: 23415573 DOI: 10.1016/j.amjoto.2012.12.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/17/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To update our experience treating cutaneous squamous cell carcinoma (SCC) and basal cell carcinomas (BCC) of the head and neck with incidental perineural invasion (PNI) using Mohs resection followed by radiotherapy (RT). We compare outcomes between head and neck patients with incidental PNI who received Mohs surgery and those who did not. MATERIALS AND METHODS From 1987 to 2009, 36 patients were treated with Mohs resection followed by postoperative RT; 82 patients were treated with resection other than Mohs followed by postoperative RT. RESULTS The 5-year overall survival and cause-specific survival rates for patients who received Mohs resection plus RT and those who received a non-Mohs resection plus RT were 53% versus 56% (p=0.809) and 84% versus 68% (p=0.0329), respectively. The 5-year local control rates for Mohs and non-Mohs patients were 86% versus 76% (p=0.0606), respectively. The 5-year local-regional control and freedom from distant metastases rates for the Mohs group were 77% and 92%, respectively. The 5-year overall neck control, neck control with elective neck RT, and neck control without elective RT treatment rates for the Mohs group were 91%, 100%, and 82% (p=0.0763), respectively. The rate of grade 3 or higher complication in the Mohs group was 22%, which included bone exposure (N=3), cataract (N=2), chronic non-healing wound (N=2), wound infection (N=1), fistula (N=1), and/or radiation retinopathy (N=1). CONCLUSIONS Mohs surgery appears to result in improved local control and cause-specific survival in patients with incidental PNI who receive postoperative RT. Elective nodal RT improves regional control in patients with SCC.
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Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Smith Begolka W, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol 2012; 67:531-50. [DOI: 10.1016/j.jaad.2012.06.009] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
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