Health Outcome Studies in Skin Cancer Surgery

Review of sociodemographic risk factors for presentation with advanced non-melanoma skin cancer

PURPOSE

Non-melanoma skin cancers (NMSC) are often localized and associated with an excellent prognosis but a minority present with locally advanced or metastatic disease requiring extensive resection or systemic treatment. Medical factors that increase the risk of advanced skin cancers such as tobacco use, systemic immunosuppression or genetic syndromes have been described but the sociodemographic risk factors are relatively uninvestigated and under reported. In this review a cohort of patients presenting with periorbital NMSC is reviewed for social determinants of health correlated with presentation with advanced disease.

METHODS

Patients presenting with periorbital NMSC during a 10-year period are categorized as advanced (those tumors requiring extensive local resection, sacrifice of the globe or systemic therapy) or non-advanced and demographic features are compared between the two groups.

RESULTS

274 cases of periorbital NMSC were classified as either non-advanced (177) or advanced (97). Patients with public safety net health insurance were twice as likely to present with advanced disease (25% vs 13%). Patients with advanced disease were significantly less likely to be under the care of a primary care physician, lived in economically depressed areas with lower mean household incomes, and lived further from tertiary medical care.

CONCLUSION

Financial and sociodemographic features are strongly associated with presentation with advanced NMSC. Further work is needed to determine which sociodemographic features are independent risk factors. A better understanding of the relevant barriers to care may reduce the burden of advanced disease at presentation in the future.

Does Preventive Negative Pressure Wound Therapy (NPWT) reduce local complications following Lymph Node Dissection (LND) in the management of metastatic skin tumors?

INTRODUCTION

Axillary and inguinal lymph node dissection (LND) are performed in metastatic skin tumors with several local complications, such as lymphorrhea, lymphoceles, and lymphedema. The purpose of this study is to determine whether negative pressure wound therapy (NPWT) applied as a preventive measure could improve outcomes.

MATERIALS AND METHODS

A monocentric study included patients who underwent axillary or inguinal LND from May 2010 to March 2020, with a retrospective evaluation of prospectively collected data. Patients were divided into two groups: the conventional wound care (CWC) and the NPWT groups. Patients were systematically reviewed at D7, D30, and at 1 year postoperative, and data regarding lymphorrhea, lymphoceles, and lymphedema were collected.

RESULTS

A total of 109 axillary and inguinal LND were performed. NPWT was applied on 68 LND and CWC on 41 LND. The variables, diabetes, smoking, gender, associated treatments, and primary pathology (melanoma, squamous cell carcinoma, or Merkel tumors) were similar in both groups. Analyses have shown a significant difference in the rate of scar disunion during the first month between the two groups (p=0.045 between D1 and D7; p=0.011 between D8 and D30), as well as the presence of lymphorrhea (p=0.000 between D1 and D7; p=0.002 between D8 and D30). The rate of lymphoedema was significantly reduced in the NPWT group versus CWC (p=0.000 between D8 and D30; p=0.034 between D31 and 1 year).

CONCLUSION

NPWT reduces local complications (scar disunion, lymphorrhea, and lymphedema) during the first year following LND in the management of node metastatic skin tumors.

Multimodal imaging of skin lesions by using methylene blue as cancer biomarker

This study aimed the optical imaging of malignant and normal skin tissues with multimodal wide-field fluorescence polarization imaging (WF) technique, by using methylene blue as fluorescence dye. We present optical imaging of skin tissues by different techniques, including reflectance, fluorescence, and polarization imaging for early detection of skin cancer. We collected the reflectance confocal images at 390 and 500 nm. For wide-field fluorescence images, specimens were stimulated at 640 nm and images were collected between 670 and 710 nm. The correlation of the regarded optical modalities with histopathology (H&E), their potentials, capabilities, and limitations to detect skin lesions are discussed. The advantages of multimodal imaging of skin tissues are analyzed to divulge possibilities for precise tumor boundary detection and their classification for malignant and nonmalignant skin tissues. Prior to imaging, the cells were stained in aqueous MB (a dye approved by FDA).