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Schuh S. [Diagnosis and treatment monitoring of basal cell carcinoma in one step: BCC one-stop shop : In vivo and ex vivo monitoring of basal cell carcinoma margins]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:587-591. [PMID: 38935289 DOI: 10.1007/s00105-024-05378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Sandra Schuh
- Klinik für Dermatologie und Allergologie, Sauerbruchstr. 6, 86179, Augsburg, Deutschland.
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2
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Deußing M, Eijkenboom QL, Thamm J, Desch A, Fünfer K, Mozaffari M, Wirsching H, Mayer O, Schlingmann S, French LE, Hartmann D, Welzel J, Schuh S, Sattler EC. Unveiling the hidden boundaries: AI-assisted line-field optical coherence tomography margin mapping for precise excision of basal cell carcinoma - A step-by-step tutorial. Skin Res Technol 2024; 30:e13594. [PMID: 38297955 PMCID: PMC10831192 DOI: 10.1111/srt.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Maximilian Deußing
- Department of Dermatology and AllergyLMU University HospitalLMU MunichMunichGermany
| | | | - Janis Thamm
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Anna Desch
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Kristina Fünfer
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Marco Mozaffari
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Hanna Wirsching
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Oliver Mayer
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Sophia Schlingmann
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Lars Einar French
- Department of Dermatology and AllergyLMU University HospitalLMU MunichMunichGermany
- Department of Dermatology & Cutaneous SurgeryUniversity of MiamiMiller School of MedicineMiamiFloridaUSA
| | - Daniela Hartmann
- Department of Dermatology and AllergyLMU University HospitalLMU MunichMunichGermany
| | - Julia Welzel
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
| | - Sandra Schuh
- Department of Dermatology and AllergologyUniversity HospitalUniversity of AugsburgAugsburgGermany
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3
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Ho WYB, Zhao X, Tan WPM. Mohs micrographic surgery in Singapore: A long-term follow-up review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:922-923. [PMID: 34985106 DOI: 10.47102/annals-acadmedsg.2021309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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4
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Use of Intraoperative Frozen Section in the Surgical Management of Patients with Nonmelanoma Skin Cancer. J Skin Cancer 2021; 2021:4944570. [PMID: 34760320 PMCID: PMC8575635 DOI: 10.1155/2021/4944570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Objective To compare the outcome of NMSC patients with excision performed with and without IFS. Materials and Methods A retrospective, single-centre study was performed on all patients who had undergone resection of NMSC with and without IFS control at the National University Hospital (NUH) from 2010 to 2015. Results 116 patients were recruited, of which 86 had IFS and 30 did not. The complete excision rate of patients with IFS was higher at 87.2% (p=0.0194), need for secondary operation was lower at 1.2% (p=0.005), and need for postsurgery radiotherapy or chemotherapy was lower at 1.2% (p=0.001). The average duration of surgery in patients who underwent IFS was 95.4 minutes compared to 70.1 minutes in cases which did not undergo IFS. Conclusion Our study showed an increased complete excision rate and reduced need for secondary surgeries and adjuvant therapy in patients with IFS. However, a longer operative duration was required. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision.
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5
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Membrive Conejo I, Pera Cegarra O, Foro Arnalot P, Reig Castillejo A, Rodríguez de Dios N, Sanz Latiesas X, Pujol Vallverdú RM, Quera Jordana J, Fernandez-Velilla Cepria E, Algara Muñoz V, Algara López M. Custom 3D-printed applicators for high dose-rate brachytherapy in skin cancer. Brachytherapy 2021; 20:1257-1264. [PMID: 34384694 DOI: 10.1016/j.brachy.2021.05.164] [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: 12/17/2020] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper describes the protocol for the development of 3D-printed custom applicators in treating skin carcinoma, the evaluation of the materials used, and the methods for segmentation and rendering of the applicators. MATERIAL AND METHODS The segmentation and rendering process for the applicator had six phases: (i) determination of the volume of the lesion using a computed tomography (CT) scan; (ii) delineation of the patient surface, using the same CT images; (iii) creation of the applicator in the planner and segmentation of the mold; (iv) preliminary dosimetry and establishment of the route of the catheter from the brachytherapy unit; (v) creation of the 3D applicator using specialized software; and (vi) applicator printing. Following this process, the patient returned for a second CT to undergo the definitive dosimetry with the applicator in place. Radiation therapy was then administered. RESULTS We made a total of 16 applicators. Only three applicators had to be remade, two due to an error in the infill and the other due to incorrect catheter geometry. In all cases, correct coverage of the planning target volume was achieved with the prescribed isodose. CONCLUSIONS The creation of custom molds in plesiotherapy for skin cancer with 3D printing is feasible. Compared to manual methods, 3D printing increases precision in applicator geometry and optimization of the dosimetry.
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Affiliation(s)
- Ismael Membrive Conejo
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain.
| | - Oscar Pera Cegarra
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | - Palmira Foro Arnalot
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Ana Reig Castillejo
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | - Nuria Rodríguez de Dios
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Xavier Sanz Latiesas
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Ramón M Pujol Vallverdú
- Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Dermatology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Universitat Autónoma de Barcelona Barcelona, Spain
| | - Jaume Quera Jordana
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Enric Fernandez-Velilla Cepria
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain
| | | | - Manuel Algara López
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques Barcelona, Spain; Universitat Autónoma de Barcelona Barcelona, Spain
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Kim ES, Yang CE, Chung YK. Does reduction of the oncologic safety margin for facial basal cell carcinoma result in higher recurrence rates? Arch Craniofac Surg 2021; 22:135-140. [PMID: 34225404 PMCID: PMC8257443 DOI: 10.7181/acfs.2021.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background Wide surgical excision is the gold standard for basal cell carcinoma (BCC) treatment. Typically, resection requires a safety margin ≥ 4 mm. We aimed to confirm BCC excisions’ cancer recurrence rate and safety on the facial region with new safety margins. Methods We included patients with primary BCC on the facial region who underwent wide excision with 2- or 3-mm safety margins at our institution between January 2010 and December 2018. Medical records were reviewed to confirm the epidemiology and surgical information. Recurrence was confirmed by physical examination through regular 6-month follow-up. Results We included 184 out of 233 patients in this study after applying the exclusion criteria. The mean age and follow-up period were 71.2±10.2 years and 29.3±13.5 months, respectively. The predominantly affected area was the nose (95 cases); a V-Y advancement flap was the most commonly used surgical method. There were two cases of recurrence in the 2 mm margin group and one recurrence in the group resected with 3 mm margins. Conclusion In this large cohort study, we found 2–3 mm excision margins can yield enough safety in facial BCCs. The recurrence rates were found to be comparable with those reported after wider margins.
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Affiliation(s)
- Eon Su Kim
- Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chae Eun Yang
- Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoon Kyu Chung
- Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Dermoscopic Findings in the Presurgical Evaluation of Basal Cell Carcinoma. A Prospective Study. Dermatol Surg 2021; 47:e37-e41. [PMID: 32804889 DOI: 10.1097/dss.0000000000002471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgery is the best treatment for basal cell carcinoma (BCC); however, incomplete excisions are possible. OBJECTIVE Assessment of the accurateness of dermoscopy and clinical evaluation in the detection of borders of BCC and description of dermoscopic findings in clinically healthy tissue surrounding BCC. MATERIALS AND METHODS Eighty-eight lesions with clinical dermoscopic diagnosis of BCC were examined clinically and dermoscopically, to delineate the correct site of surgical incision, demarcating the respective margins with colred dermographic pencils. Specific dermoscopic features were searched in the skin adjacent to the demarcated clinical margin. RESULTS In 29 of 88 lesions, clinical and dermoscopic margins of the tumor coincided. In the remaining 59 (67%), 10 (16.9%) presented, in the lesion area identified under dermoscopy, classical criteria for BCC and 57 (96.6%) nonclassical criteria. Differences between clinical and dermoscopic margins were significantly more frequent in superficial BCCs (p = .006). The frequency was not significantly different (p = .85) in relation to body sites. CONCLUSION Dermoscopy improves the identification of margins for surgical excision in BCC. The observation of nontraditional dermoscopic criteria of BCC, mainly pink-white areas and short telangiectasias in the area between clinically and dermoscopically detected margins, helps to define the actual tumoral margins and to achieve a really radical excision.
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8
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Manola I, Mataic A, Drvar DL, Pezelj I, Dzombeta TR, Kruslin B. Peritumoral Clefting and Expression of MMP-2 and MMP-9 in Basal Cell Carcinoma of the Skin. In Vivo 2021; 34:1271-1275. [PMID: 32354918 DOI: 10.21873/invivo.11901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Peritumoral clefting is one of the main histologic features of basal cell carcinoma of the skin (BCC). The aim of the study was to analyze the expression of MMP-2 and MMP-9 both in cells of basal cell carcinoma and in the adjacent stroma and to correlate the findings of immunohistochemical analysis with the presence of peritumoral clefting. PATIENTS AND METHODS The study was made on archival material comprising 48 cases of BCC. These were scanned for the presence of peritumoral clefts. The results of immunohistochemical staining for MMP-2 and MMP-9 were determined semiquantitatively using immunohistochemical staining index (ISI). RESULTS Peritumoral retractions were found in 40 BCC cases. Positive immunohistochemical reaction for MMP-2 in tumor cells was found in 47 cases and in all cases in the adjacent stroma. Positive immunostaining for MMP-9 in BCC tumor cells was observed in 37 cases and in all cases in the adjacent stroma. There was no statistically significant association between peritumoral retractions and expression of MMPs. A statistically significant correlation was found in the expression of both MMP-2 and MMP-9 between the tumor and the stroma. CONCLUSION Tumor cells elaborate MMP-2 and -9, but they also produce some other factors that may induce production of MMPs in adjacent stromal cells. The role of MMPs in the development of peritumoral clefts could not be confirmed.
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Affiliation(s)
| | - Ana Mataic
- Clinical Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Daniela Ledic Drvar
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Dermatology and Venereology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Pezelj
- Department of Urology, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia
| | - Tihana Regovic Dzombeta
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Clinical Department of Pathology and Cytology "Ljudevit Jurak", University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia
| | - Bozo Kruslin
- School of Medicine, University of Zagreb, Zagreb, Croatia .,Clinical Department of Pathology and Cytology "Ljudevit Jurak", University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia
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9
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Shin K, Kim HJ, Ko HC, Kim BS, Kim MB, Kim HS. Dermoscopy-guided Mohs micrographic surgery in post-laser basal cell carcinomas: is dermoscopy helpful for demarcation of the surgical margin? J DERMATOL TREAT 2021; 33:433-436. [PMID: 32345116 DOI: 10.1080/09546634.2020.1762839] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) in cases where the tumor margin is poorly defined to the naked eye can lead to the need to take an increased number of Mohs stages. OBJECTIVE To evaluate the usefulness of dermoscopy in determining MMS surgical margins of BCCs with a history of ablative laser treatment. METHODS Patients were randomly allocated to naked eye (n = 69) or dermoscopy (n = 64) groups by the surgical margin detection method. Surgical outcomes of 133 post-laser BCC patients treated with MMS were analyzed. RESULTS The lateral margin involvement rate at the first MMS stage was significantly lower in the dermoscopy group than in the naked eye group (4.7% vs. 29.0%; p < .001). However, the deep margin involvement rate at the first and mean MMS stages were not significantly different between the groups. The ablative laser treatment duration correlated to the number of MMS stages (p = .026). CONCLUSION The results demonstrated that lateral margin was mostly controlled within the first MMS stage with dermoscopy. Dermatosurgeons could focus on the deep margin after the first MMS stage; thus, the performance of MMS could be improved with dermoscopic assistance in post-laser BCC patients.
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Affiliation(s)
- Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hak-Jun Kim
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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10
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Peters M, Smith JD, Kovatch KJ, McLean S, Durham AB, Basura G. Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16-Year Institutional Experience. OTO Open 2020; 4:2473974X20964735. [PMID: 33150296 PMCID: PMC7580161 DOI: 10.1177/2473974x20964735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma. Study Design Retrospective chart review. Setting Tertiary academic center. Methods Retrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics. Results The median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction. Conclusion Periauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.
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Affiliation(s)
- Mallory Peters
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Alison B Durham
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Gregory Basura
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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11
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Kant SB, Mosterd K, Kelleners-Smeets NWJ, Van der Hulst RRWJ, Piatkowski A. Measuring aesthetic results after facial skin cancer surgery by means of the FACE-Q. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01625-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Skin cancer is the most commonly occurring type of cancer. However, the influence of facial skin cancer surgery on patients’ perceived aesthetic appearance is poorly understood. The objective of this study was to provide an insight into how patients perceive the aesthetic outcome of facial skin cancer surgery by means of a specialised patient-reported outcome measure designed for the aesthetic evaluation of the face: the FACE-Q.
Methods
A total of 47 patients with non-melanoma skin cancer who were scheduled for Mohs’s micrographic surgery (MMS) or standard surgical excision (SE) were included. These patients filled out three different FACE-Q questionnaires: satisfaction with facial appearance, social function, and satisfaction with outcome. Follow-up was conducted after baseline at 1 month and 3 months post-surgery.
Results
No significant differences were detected between baseline and follow-up regarding social function and satisfaction with facial appearance. However, after 3 months, patients were significantly more satisfied with the result of surgery when compared with the 1-month post-surgery follow-up.
Conclusions
The perceived aesthetic appreciation of patients does not seem to be significantly influenced by facial skin cancer SE or MMS surgery in this 3-month follow-up study.
Level of evidence: Not ratable.
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12
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Litaiem N, Karray M, Jones M, Rammeh S, Zeglaoui F. Effectiveness of dermoscopy in the demarcation of surgical margins in slow Mohs surgery. Dermatol Ther 2020; 33:e14196. [PMID: 32798257 DOI: 10.1111/dth.14196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
There is a need for adjuvant imaging techniques that would allow reducing the number of slow Mohs stages. This study aimed to evaluate the use of dermoscopy in the demarcation of basal cell carcinoma (BCC) surgical margins for slow Mohs surgery. This was a retrospective study over 3 years (2016-2019), including patients with BCC excised using slow Mohs surgery. On the basis of the treatment received, the patients were divided into 2 groups: group 1 (28 BCC) and group 2 (26 BCC). In group 2, BCC margins were demarcated using dermoscopy. A total of 54 patients were enrolled in the study. The number of positive lateral margins was significantly lower in the group where BCC margins were demarcated using dermoscopy (19% vs 53%, P = .012). In this group, the number of Mohs stages needed to achieve complete clearance was significantly lower. However, the mean interval between the first Mohs excision and Mohs clearance was not significantly different between the 2 groups (9 ± 4 vs 12 ± 7 days). In conclusion, preoperative dermoscopy is useful for reducing the number of positive lateral margins and the number of slow Mohs stages in treating BCC especially pigmented tumors.
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Affiliation(s)
- Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Manel Karray
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Meriem Jones
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Rammeh
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of Pathology, UR17ES15, Charles Nicolle Hospital, Tunis, Tunisia
| | - Faten Zeglaoui
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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13
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Bailey A, Vasicek B, Tao J, Janeczek M, Mitri A, Tung R. Management of keratinocyte carcinoma - Special considerations in the elderly. Int J Womens Dermatol 2019; 5:235-245. [PMID: 31700979 PMCID: PMC6831749 DOI: 10.1016/j.ijwd.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 02/06/2023] Open
Abstract
Keratinocyte carcinomas (KCs) are now an epidemic in The United States of America, especially in elderly patients. KCs, including basal cell carcinoma and squamous cell carcinoma, can lead to disfigurement and occasionally death. However, the lower mortality rate associated with KC compared with melanoma allows for increased flexibility in the selection of treatment. Flexibility in treatment is particularly important in the elderly given that this patient population often has medical comorbidities that should be considered. These patients may have multiple KCs, higher risk tolerance to recurrence, and different concerns about cosmetic outcomes compared with their younger counterparts. We review treatment options for KCs and how the selection of each option may affect the elderly patient.
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Affiliation(s)
- Alison Bailey
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Brooke Vasicek
- Loyola University Chicago, Division of Dermatology, Chicago, Illinois
| | - Joy Tao
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Monica Janeczek
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Andia Mitri
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Rebecca Tung
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
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14
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Gallouj S, Aqil N, Harmouch T, Mernissi FZ. [The role of the micrographic surgery in the management of basal cell carcinoma: experience in the Department of Dermatology, at the Hassan II University Hospital, Fes, Morocco]. Pan Afr Med J 2019; 33:245. [PMID: 31692779 PMCID: PMC6814934 DOI: 10.11604/pamj.2019.33.245.18562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022] Open
Abstract
Mohs micrographic surgery (MMS) is a technique allowing for intraoperative histologic assessment of surgical margin of malignant tumors. This study aims to highlight the role of MMS in the achievement of radical healing of basal cell carcinoma (BCC) in our patients. We conducted a study of 29 patients with basal cell carcinoma of the face over a period of 5 years. The median age of patients was 45.8 years (12-80). The sex-ratio M/F was 1.23. One-stage surgical procedure was sufficient to obtain complete resection in 51% of cases. Three-stage surgical procedure was needed in 14% of the cases. The mean duration of one-stage surgical procedure was 1 hour. No complications were reported in the postoperative period and sequelae were simple. The aesthetic and functional result was satisfactory. No recurrence was noted. BCC accounts for approximately 80% of all skin cancers. The decision to use MMS to treat BCC is based on three variables: the seat and the size of the tumor, its histological appearance with the identification of resection margin and its recurrent nature. MMS is currently the most effective method in the treatment of BCC and allows maximum healthy tissue preservation. It is a safe and repeatable surgical procedure based on team work and adapted to the treatment of patients with BCC who are at high risk of recidivism. The aesthetic and functional results are satisfactory. Recurrence rate at 5 years is 10 times lower than with the other methods.
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Affiliation(s)
- Salim Gallouj
- Service de Dermatologie, CHU Hassan II de Fès, Maroc
| | - Niema Aqil
- Service de Dermatologie, CHU Hassan II de Fès, Maroc
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15
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Aluma-Tenorio MS, Ávila-Álvarez A, Jaimes N, Caballero-Uribe N, González A, Terzian LR, Ocampo-Candiani J, Zuluaga MA, Garza-Rodríguez V, Tamayo-Betancur MC, Cuesta-Castro DP, Garcés JR, Ruiz-Salas V, Goldberg L, Kimyai-Asadi A. Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients. Int J Dermatol 2018; 57:1447-1453. [PMID: 30168850 DOI: 10.1111/ijd.14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined. OBJECTIVE To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). MATERIALS AND METHODS A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. RESULTS The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. CONCLUSIONS This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.
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Affiliation(s)
| | | | - Natalia Jaimes
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Natalia Caballero-Uribe
- Aurora, Centro Especializado en Cáncer de Piel, Medellín, Colombia.,Universidade do federal do ABC, Santo André, SP, Brazil
| | - Abel González
- Instituto Médico Especializado Alexander Fleming, Buenos Aires, Argentina.,Instituto de Oncologia, Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Jorge Ocampo-Candiani
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | - María Alejandra Zuluaga
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | - Verónica Garza-Rodríguez
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | | | | | - Joan Ramón Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Catalunya, Spain
| | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Catalunya, Spain
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Chen ELA, Srivastava D, Nijhawan RI. Mohs Micrographic Surgery: Development, Technique, and Applications in Cutaneous Malignancies. Semin Plast Surg 2018; 32:60-68. [PMID: 29765269 DOI: 10.1055/s-0038-1642057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mohs micrographic surgery (MMS) is a specialized technique for treating skin malignancies that offers the highest cure rate by allowing histological evaluation of the entire peripheral and deep margins. MMS also maximally preserves as much uninvolved, normal adjacent tissue as possible, allowing for the best cosmetic and functional outcomes. When used for appropriate indications, this technique is also more cost-effective than other treatment modalities. In this article, the authors will discuss the development of MMS, the steps involved in this procedure, and the indications for this technique. They will also review the use of MMS for basal cell carcinoma, squamous cell carcinoma, melanoma in situ, and some less common skin malignancies.
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Affiliation(s)
- Eillen Luisa A Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
PURPOSE OF REVIEW To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit. RECENT FINDINGS Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered. SUMMARY A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.
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Goździalska A, Wojas-Pelc A, Drąg J, Brzewski P, Jaśkiewicz J, Pastuszczak M. Expression of metalloproteinases (MMP-2 and MMP-9) in basal-cell carcinoma. Mol Biol Rep 2016; 43:1027-33. [PMID: 27406386 PMCID: PMC5025502 DOI: 10.1007/s11033-016-4040-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare the expressions of mRNA for metalloproteinases (MMP-2 and MMP-9) and type IV collagen in two different histological types of basal-cell carcinoma (BCCs; nodular and infiltrative) and in normal tissues from the tumor interface. The study included biopsy specimens of the skin involved with BCC and normal skin adjacent the lesion. The expressions of mRNA for MMP-2, MMP-9 and type IV collagen were determined by means of RT-PCR (Reverse transcription polymerase chain reaction). The level of type IV collagen mRNA in nodular and infiltrative BCCs turned out to be significantly lower, and the expressions of MMP-2 and MMP-9 mRNA significantly higher than in normal tissues adjacent to these tumors. The expression of mRNA for MMP-9 but not for MMP-2 was significantly higher in infiltrative BCCs than in the nodular BCCs. In turn, normal tissues adjacent to nodular BCCs showed significantly higher levels of mRNA for MMP-2 and significantly lower levels of type IV collagen mRNA than the normal tissues from the interface of infiltrative BCCs. The findings suggest that MMP-2 and MMP-9 could be used as prognostic factors of BCCs.
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Affiliation(s)
- Anna Goździalska
- Department of Health and Medical Sciences, Andrzej Frycz Modrzewski Krakow University, 1 G. Herlinga-Grudzińskiego St, 30-705, Krakow, Poland.
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Jagoda Drąg
- Department of Health and Medical Sciences, Andrzej Frycz Modrzewski Krakow University, 1 G. Herlinga-Grudzińskiego St, 30-705, Krakow, Poland
| | - Paweł Brzewski
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Jaśkiewicz
- Department of Health and Medical Sciences, Andrzej Frycz Modrzewski Krakow University, 1 G. Herlinga-Grudzińskiego St, 30-705, Krakow, Poland
| | - Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
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de Boer E, Moore LS, Warram JM, Huang CC, Brandwein-Gensler MS, van Dam GM, Rosenthal EL, Schmalbach CE. On the horizon: Optical imaging for cutaneous squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E2204-13. [PMID: 25899874 DOI: 10.1002/hed.24079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Surgical resection with negative margins remains the standard of care for high-risk cutaneous squamous cell carcinoma (SCC). However, surgical management is often limited by poor intraoperative tumor visualization and inability to detect occult nodal metastasis. The inability to intraoperatively detect microscopic disease can lead to additional surgery, tumor recurrence, and decreased survival. METHODS A comprehensive literature review was conducted to identify studies incorporating optical imaging technology in the management of cutaneous SCC (January 1, 2000-December 1, 2014). RESULTS Several innovative optical imaging techniques, Raman spectroscopy, confocal microscopy, and fluorescence imaging, have been developed for intraoperative surgical guidance. Fifty-seven studies review the ability of these techniques to improve cutaneous SCC localization at the gross and microscopic level. CONCLUSION Significant advances have been achieved with real-time optical imaging strategies for intraoperative cutaneous SCC margin assessment and tumor detection. Optical imaging holds promise in improving the percentage of negative surgical margins and in the early detection of micrometastatic disease. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2204-E2213, 2016.
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Affiliation(s)
- Esther de Boer
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lindsay S Moore
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason M Warram
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Conway C Huang
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret S Brandwein-Gensler
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gooitzen M van Dam
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eben L Rosenthal
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cecelia E Schmalbach
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin. Dermatol Surg 2015; 41:768-74. [DOI: 10.1097/dss.0000000000000378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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21
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Abstract
Skin cancer accounts for most hand cancers. Prompt recognition of lesions with malignant potential can lead to early treatment and decreased disease burden. Understanding the appropriate diagnostic algorithm for a given lesion facilitates accurate staging, which guides therapy. A multidisciplinary approach that includes hand surgeons, dermatologists, oncologists, and radiation oncologists is often necessary to manage advanced disease. For most invasive tumors, the primary treatment modality remains surgical excision; however, several effective nonsurgical treatments exist for management of unresectable or low-grade cancers.
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22
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Tuerdi M, Mijiti A, Moming A. Response to: 'Standard excision and reconstruction as an alternative to MMS for giant basal cell carcinoma? - Commentary'. J Eur Acad Dermatol Venereol 2015; 30:1204-5. [PMID: 25845560 DOI: 10.1111/jdv.13125] [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]
Affiliation(s)
- M Tuerdi
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Li YU-Shan Road, Urumqi, Xinjiang, 830054, China
| | - A Mijiti
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Li YU-Shan Road, Urumqi, Xinjiang, 830054, China
| | - A Moming
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Li YU-Shan Road, Urumqi, Xinjiang, 830054, China
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23
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Suzuki HS, Serafini SZ, Sato MS. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery. An Bras Dermatol 2014; 89:38-43. [PMID: 24626646 PMCID: PMC3938352 DOI: 10.1590/abd1806-4841.20142400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/18/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique.
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Affiliation(s)
- Heliane Sanae Suzuki
- Board-certified dermatologist, Brazilian Society of Dermatology, Physician in private practice, Curitiba (PR), Brazil
| | - Sérgio Zuñeda Serafini
- Universidade Federal do Paraná, Hospital de Clínicas, Department of Dermatology, CuritibaPR, Brazil, Board-certified dermatologist, Brazilian Society of Dermatology - Professor, Department of Dermatology, Hospital de Clínicas - Universidade Federal do Paraná (HC UFPR) - Curitiba (PR), Brazil
| | - Maurício Shigueru Sato
- Universidade Federal do Paraná, Hospital de Clínicas, CuritibaPR, Brazil, Board-certified dermatologist, Brazilian Society of Dermatology - Staff physician, Outpatient Mohs Surgery Clinic - Hospital de Clínicas - Universidade Federal do Paraná (HC UFPR) - Curitiba (PR), Brazil
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24
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Tuerdi M, Yarbag A, Maimaiti A, Mijiti A, Moming A. Standard surgical excision and reconstruction of giant basal cell carcinoma of the face: may be an alternative to the Mohs micrographic surgery. J Eur Acad Dermatol Venereol 2014; 28:1572-3. [PMID: 24397256 DOI: 10.1111/jdv.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Tuerdi
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Stomatological Research Institute of Xinjiang Uyghur Autonomous Region, Urumqi, China
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25
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Schell AE, Russell MA, Park SS. Suggested Excisional Margins for Cutaneous Malignant Lesions Based on Mohs Micrographic Surgery. JAMA FACIAL PLAST SU 2013; 15:337-43. [DOI: 10.1001/jamafacial.2013.1011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Amy E. Schell
- School of Medicine, University of Virginia, Charlottesville
| | - Mark A. Russell
- Department of Dermatology, University of Virginia, Charlottesville
| | - Stephen S. Park
- Department of Otolaryngology–Head and Neck Surgery, University of Virginia, Charlottesville
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26
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Nonmelanoma skin cancer of the head and neck: current diagnosis and treatment. Facial Plast Surg Clin North Am 2013; 20:415-7. [PMID: 23084293 DOI: 10.1016/j.fsc.2012.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An overview of where nonmelanoma cancers appear in the hierarchy of cancers is succinctly presented, as well as their incidence, etiology, and costs. The examination and treatment of these cancers are summarized.
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27
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Muehleisen B, Jiang SB, Gladsjo JA, Gerber M, Hata T, Gallo RL. Distinct innate immune gene expression profiles in non-melanoma skin cancer of immunocompetent and immunosuppressed patients. PLoS One 2012; 7:e40754. [PMID: 22808251 PMCID: PMC3396607 DOI: 10.1371/journal.pone.0040754] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 06/12/2012] [Indexed: 12/28/2022] Open
Abstract
Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most frequent skin cancers in humans. An intact immune system is critical for protection against SCC since organ transplant recipients (OTR) have a 60- to 100-fold higher risk for developing these tumors. The role of the innate immune system in tumor immunosurveillance is unclear. Our aim was to determine the expression of selected innate immune genes in BCC and SCC arising in immunocompetent and OTR patients. Lesional and peri-lesional skin from 28 SCC and 19 BCC were evaluated for mRNA expression of toll-like receptors (TLR) 1-9, downstream TLR signaling molecules, and antimicrobial peptides. 11 SCC occurring in OTR patients were included in the analysis. We found that SCC but not BCC showed significantly elevated expression of TLRs 1-3, 5-8, TRIF and TRAF1. TNF was increased in SCC compared to normal skin. BCC showed increased IFNγ. hBD1, hBD2 and psoriasin mRNA and protein expression were significantly higher in SCC than in normal skin and higher than in BCC. SCC from OTR showed only an increase in hBD2 but no increase in hBD1 or psoriasin. We conclude that innate immune gene expression in SCC is distinct from normal skin and BCC. BCC shows lesser induction of innate immune genes. SCC from OTR patients have depressed expression of hBD1 and psoriasin compared to SCC from immunocompetent patients.
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Affiliation(s)
- Beda Muehleisen
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
- Department of Dermatology, Zurich University Hospital, Zurich, Switzerland
| | - Shang Brian Jiang
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
| | - Julie A. Gladsjo
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
| | - Monika Gerber
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
| | - Tissa Hata
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
| | - Richard L. Gallo
- Division of Dermatology, University of California San Diego, La Jolla, California, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- Veterans Administration San Diego Healthcare System, San Diego, California, United States of America
- * E-mail:
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Verhaeghe E, Ongenae K, Dierckxsens L, Bostoen J, Lambert J. Nonablative fractional laser resurfacing for the treatment of scars and grafts after Mohs micrographic surgery: a randomized controlled trial. J Eur Acad Dermatol Venereol 2012; 27:997-1002. [DOI: 10.1111/j.1468-3083.2012.04639.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Gareau DS, Jeon H, Nehal KS, Rajadhyaksha M. Rapid screening of cancer margins in tissue with multimodal confocal microscopy. J Surg Res 2012; 178:533-8. [PMID: 22721570 DOI: 10.1016/j.jss.2012.05.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Complete and accurate excision of cancer is guided by the examination of histopathology. However, preparation of histopathology is labor intensive and slow, leading to insufficient sampling of tissue and incomplete and/or inaccurate excision of margins. We demonstrate the potential utility of multimodal confocal mosaicing microscopy for rapid screening of cancer margins, directly in fresh surgical excisions, without the need for conventional embedding, sectioning, or processing. MATERIALS AND METHODS A multimodal confocal mosaicing microscope was developed to image basal cell carcinoma margins in surgical skin excisions, with the resolution that shows nuclear detail. Multimodal contrast is with fluorescence for imaging nuclei and reflectance for cellular cytoplasm and dermal collagen. Thirty-five excisions of basal cell carcinomas from Mohs surgery were imaged, and the mosaics analyzed by comparison with the corresponding frozen pathology. RESULTS Confocal mosaics are produced in about 9 min, displaying tissue in fields of view of 12 mm with ×2 magnification. A digital staining algorithm transforms black and white contrast to purple and pink, which simulates the appearance of standard histopathology. Mosaicing enables rapid digital screening, which mimics the examination of histopathology. CONCLUSIONS Multimodal confocal mosaicing microscopy offers a technology platform to potentially enable real-time pathology at the bedside. The imaging may serve as an adjunct to conventional histopathology to expedite screening of margins and guide surgery toward more complete and accurate excision of cancer.
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Affiliation(s)
- Daniel S Gareau
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York 10022, New York, USA.
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30
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Mori S, Di Monta G, Marone U, Chiofalo MG, Caracò C. Half forehead reconstruction with a single rotational scalp flap for dermatofibrosarcoma protuberans treatment. World J Surg Oncol 2012; 10:78. [PMID: 22559860 PMCID: PMC3447680 DOI: 10.1186/1477-7819-10-78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 05/06/2012] [Indexed: 12/05/2022] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate to low-grade malignancy. Although metastasis rarely occurs, DFSP has a locally aggressive behavior with a high recurrence rate. In the head and neck area, resection involving a wide margin of healthy tissue can be difficult because of functional and cosmetic considerations. We describe a novel reconstructive method for half forehead defects with an innovative single local wide scalp flap following excision of DFSP with a 3 cm margin of healthy tissue. Methods Two patients underwent wide resection of forehead DFSP and reconstruction with a single rotational scalp flap. The scalp flap blood supply was provided from three main vessels: the superficial temporal artery, occipital artery and posterior auricular artery. Results No early or late complications were observed in either patient with no local recurrence after 18 months of follow-up. The donor area could be closed primarily in both cases and the flaps survived completely. Conclusion This innovative technique allowed a radical excision of forehead DFSP with sufficient healthy margins, thus potentially decreasing tumor recurrence rate. Reconstruction was achieved avoiding microsurgery, skin expanders and large skin grafts. Moreover, all main reconstructive criteria, such as functional and cosmetic tissue characteristics, were completely fulfilled.
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Affiliation(s)
- Stefano Mori
- Department of Surgery "Melanoma - Soft Tissues - Head & Neck - Skin Cancers", National Cancer Institute, Via Mariano Semmola, 80131 Naples, Italy
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Roscher I, Brevig T, Mørk G, Helsing P, Gjersvik P. [Mohs surgery in basal cell carcinoma on the face]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 131:2475-9. [PMID: 22170133 DOI: 10.4045/tidsskr.11.0343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Basal cell carcinoma may have a locally aggressive growth pattern. This type of cancer is often located on the face and is difficult to limit clinically. Normal excision and tumour destructive treatment often lead to recurrence of the tumour. Mohs surgery is a radical technique for removing this type of lesion. MATERIAL AND METHOD This review article is based on articles identified by searching in PubMed with the search words "Mohs surgery" and "basal cell carcinoma", as well as personal experience. RESULTS 10-15 % of all basal cell carcinomas have an aggressive growth pattern with sub clinical ramifications. Mohs surgery involves use of peroperative histological assessment of horizontal frozen sections, meaning that 100 % of the resection surface can be assessed. The objective is to reduce the risk of recurrence. Since the method saves tissue, simpler reconstruction can often be chosen. Mohs surgery is resource-demanding, but with the lower risk of recurrence, the method can be cost-effective when used for the correct indications. INTERPRETATION Mohs surgery should be considered in basal cell carcinoma with an aggressive growth pattern on the face.
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Affiliation(s)
- Ingrid Roscher
- Seksjon for hudsykdommer, Oslo universitetssykehus, Rikshospitalet, Norway.
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Veronese F, Farinelli P, Zavattaro E, Zuccoli R, Bonvini D, Leigheb G, Colombo E. Basal cell carcinoma of the head region: therapeutical results of 350 lesions treated with Mohs micrographic surgery. J Eur Acad Dermatol Venereol 2011; 26:838-43. [PMID: 21707774 DOI: 10.1111/j.1468-3083.2011.04165.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is a non-melanocytic skin tumour with a high risk of recurrence after incomplete treatment, especially the aggressive subtypes (basosquamous, micronodular and morphea BCC). The percentage of recurrence also depends on the anatomical site of the tumour. Nose-cheek fold, paranasal fold, retroauricular fold and internal canthus are considered to be critical sites. OBJECTIVE The aim of this study was to report on recurrence rates for BCC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS We retrospectively studied 350 BCCs of the head region treated with MMS. Results were analysed with chi-squared test and Fisher test and were considered significant when P value was ≤0.05. RESULTS In our study, the percentage of BCC recurrence rate after MMS was of 3.4% for primary BCC and 4.9% for recurrent BCC; these were similar to the recurrence rates reported in the literature. CONCLUSIONS Low recurrence rate can be achieved when treated with MMS; it is the treatment of choice for many BCC of the head. Aggressive histopathological subtypes, critical head sites and recurrence after incomplete excision are the most important indications for MMS.
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Affiliation(s)
- F Veronese
- Dermatology Unit, Università degli Studi del Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy.
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Tan E, Elliott T, Yu L, Litterick K. Mohs surgery histopathology concordance in Australia. Australas J Dermatol 2011; 52:245-7. [DOI: 10.1111/j.1440-0960.2011.00755.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Revenaugh PC, Seth R, Lucas J, Fritz MA. Multidisciplinary approach to large cutaneous tumors of the head and neck. Dermatol Clin 2011; 29:319-24, x. [PMID: 21421155 DOI: 10.1016/j.det.2011.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Large cutaneous tumors of the head and neck provide challenges for complete excision and optimal reconstruction. Collaborative intraoperative Mohs micrographic surgery offers efficient and reliable extirpation of large cutaneous malignancies of the head and neck and immediate reconstruction of resultant defects.
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Affiliation(s)
- Peter C Revenaugh
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A71, Cleveland, OH 44195, USA
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Ohtsuka H. Statistical Survey of Deaths from Nonmelanoma Skin Cancer in Japan during 54 Years. J Skin Cancer 2011; 2011:293926. [PMID: 21318043 PMCID: PMC3026968 DOI: 10.1155/2011/293926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/19/2010] [Accepted: 12/13/2010] [Indexed: 11/18/2022] Open
Abstract
The author analyzed the annual trends in the number of deaths from nonmelanoma skin cancer (NMSC) from 1955 to 2008 in Japan on the basis of the data from the Vital Statistics of Japan. The general trends in the number of deaths from NMSC were downward between 1979 to 1994, but upward after 1995. The general trends in age-standardized death rates were roughly downward, although the death rates plateaued after 1995. The recent annual increased ratio of deaths from NMSC was 3.8% (95% confidence interval: 2.7 ∼ 4.9%). The number and proportion of deaths from NMSC among the elderly were increasing in Japan. For females, more than 50% of the deaths occurred recently at or after 85 years of age, whereas, for males, this proportion was at or after 75 years of age, nearly reaching at or after 80 years of age.
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Affiliation(s)
- Hisashi Ohtsuka
- Department of Plastic and Reconstructive Surgery, Saiseikai Imabari 2nd Hospital, 1-7-43, Kita-hiyoshi-cho, Imabari-shi, Ehime 794-0054, Japan
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Svanberg K, Bendsoe N, Axelsson J, Andersson-Engels S, Svanberg S. Photodynamic therapy: superficial and interstitial illumination. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:041502. [PMID: 20799780 DOI: 10.1117/1.3466579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Photodynamic therapy (PDT) is reviewed using the treatment of skin tumors as an example of superficial lesions and prostate cancer as an example of deep-lying lesions requiring interstitial intervention. These two applications are among the most commonly studied in oncological PDT, and illustrate well the different challenges facing the two modalities of PDT-superficial and interstitial. They thus serve as good examples to illustrate the entire field of PDT in oncology. PDT is discussed based on the Lund University group's over 20 yr of experience in the field. In particular, the interplay between optical diagnostics and dosimetry and the delivery of the therapeutic light dose are highlighted. An interactive multiple-fiber interstitial procedure to deliver the required therapeutic dose based on the assessment of light fluence rate and sensitizer concentration and oxygen level throughout the tumor is presented.
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