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Flatz L, Wagner NB, Denisjuk N, Do P, Nadal L, Puca E, Elia G, Covelli A, Neri D, Cozzio A. Intratumoral administration of daromun in non-melanoma skin cancer: Preliminary results from a phase 2 non-randomized controlled trial. J Eur Acad Dermatol Venereol 2024. [PMID: 38959382 DOI: 10.1111/jdv.20163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/22/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Lukas Flatz
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany
| | - Nikolaus B Wagner
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Natalja Denisjuk
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Peter Do
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lisa Nadal
- Philogen/Philochem, Otelfingen, Switzerland
| | | | | | | | - Dario Neri
- Philogen/Philochem, Otelfingen, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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2
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Bascone CM, Lin SK, Deitermann A, Raj LK, Nugent ST, Wang L, McGraw JR, Broach RB, Miller CJ, Kovach SJ. Reconstructing Nasal Defects With Acellular Dermal Matrix After Mohs Micrographic Surgery: A 12-year Experience. Dermatol Surg 2024:00042728-990000000-00804. [PMID: 38754124 DOI: 10.1097/dss.0000000000004209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Large defects of the nose after Mohs surgery pose a significant reconstructive challenge to both dermatologic and reconstructive surgeons. The authors present their 12-year experience utilizing acellular dermal matrices for nasal reconstruction. METHODS A retrospective review of patients undergoing Mohs surgery and alloplastic nasal reconstruction with acellular dermal matrices between 2010 and 2022 was performed. Patients who underwent single-stage reconstruction and dual-stage reconstruction with skin graft with at least 90 days of follow-up were included. RESULTS Fifty-one patients met criteria with a median age of 77 years. Fifty-three lesions were reconstructed with acellular dermal matrices. The most common lesion location was nasal sidewall (50%) with a mean defect size of 10.8 cm 2 . 30.8% underwent same-day acellular dermal matrix reconstruction, with 69.2% undergoing two-stage reconstruction. Acellular dermal matrices successfully reconstructed acquired defects in 94.2% of lesions. Average time to re-epithelialization was 27.6 + 6.2 days. Average time to repigmentation was 145.35 + 86 days. No recurrences were recorded. Total complication rate was 9.62%. Average size for successful healing was 10.8 cm 2 . Average defect size for complication or failure was 14.7 cm 2 . Seven sites (13.46%) underwent aesthetic improvement procedures. CONCLUSION Acellular bilayer wound matrix is an adequate reconstructive option for single or dual-stage reconstruction of the nose with low complication and revision rates.
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Affiliation(s)
- Corey M Bascone
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie K Lin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Annika Deitermann
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leela K Raj
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon T Nugent
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leo Wang
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Reed McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Meretsky CR, Schiuma AT. Comparative Analysis of Slow Mohs Surgery in Melanoma and Mohs Micrographic Surgery in Squamous Cell Carcinoma and Basal Cell Carcinoma. Cureus 2024; 16:e59693. [PMID: 38840983 PMCID: PMC11150169 DOI: 10.7759/cureus.59693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Skin cancer is one of the most common types of cancer worldwide, and it can affect people of all ages, races, and genders. Mohs micrographic surgery (MMS), a specialized type of skin cancer surgery, boasts the highest cure rates for various types of skin malignancies. Slow Mohs surgery (SMS) is a methodical and meticulous approach to MMS that involves careful and deliberate examination of tissue samples to ensure the complete removal of skin cancer while preserving as much healthy tissue as possible. Both SMS and MMS have been indicated to be effective treatment options for skin cancer, depending on the type and stage of cancer. This case-control study analysis compares the efficacy of SMS for melanoma with that of MMS for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). We analyzed data from the past two decades to assess recurrence rates and treatment-related complications. Our findings suggest that SMS for melanoma achieves comparable outcomes to MMS in SCC and BCC. Both approaches demonstrated similar cure rates and complication profiles. However, further prospective studies are necessary to solidify these findings and refine the specific role of SMS in melanoma therapy.
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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5
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Maher NG, Prosser N, Aivazian K, Colebatch AJ, Ferguson PM, Karim RZ, McKenzie CA, Rawson RV, Lo SN, Scolyer RA. Inter-rater concordance of basal cell carcinoma subtypes: influences on reporting format and opportunities for further classification modifications. Pathology 2023; 55:800-805. [PMID: 37393148 DOI: 10.1016/j.pathol.2023.04.003] [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: 11/28/2022] [Revised: 03/02/2023] [Accepted: 04/03/2023] [Indexed: 07/03/2023]
Abstract
Diagnosis of basal cell carcinoma (BCC) higher risk subtypes influences management strategies because of their propensity to recur locally. Subtyping is prone to inter-observer variability, and subtyping definitions are inconsistently applied. This study sought to compare the interobserver reproducibility of individual BCC subtypes using the 4th edition World Health Organization (WHO) Classification of Skin Tumours (CoST) definitions, with classification into lower and higher risk histological subtype groups. Ninety-one BCC cases were rated by seven pathologists, noting the presence of BCC subtype(s), and providing a higher or lower risk subtype grouping per case. Raters were provided with definitions as per the 4th edition WHO CoST for 10 listed BCC subtypes. Surgical specimen type was noted. Subgroup analysis was performed to exclude cases when the tumour deep front was not well visualised, or there was tangential sectioning (n = 6). Light's kappa was used to assess inter-rater reliability. From the total group (n = 91), five BCC subtypes showed a sufficient number of ratings for computing a κ statistic. From these five subtypes, superficial subtype showed substantial inter-rater agreement (κ = 0.64), and the other four subtypes showed moderate inter-rater agreement [nodular (κ = 0.45), sclerosing/morphoeic (κ = 0.45), infiltrating (κ = 0.49) and micronodular (κ = 0.57)]. Two-tiered rating into either higher or lower risk subtype showed substantial inter-rater agreement (κ = 0.72). Our results suggest a need to more precisely define BCC subtypes. We suggest reporting BCC subtype using a two-tiered risk grouping, followed by specific subtypes present. Further studies examining the inter-rater reliability of less common BCC subtypes are required.
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Affiliation(s)
- Nigel G Maher
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Natasha Prosser
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Karina Aivazian
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J Colebatch
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Peter M Ferguson
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Rooshdiya Z Karim
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catriona A McKenzie
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robert V Rawson
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Serigne N Lo
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
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6
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Cheraghlou S, Doudican NA, Criscito MC, Stevenson ML, Carucci JA. Overall Survival After Mohs Surgery for Early-Stage Merkel Cell Carcinoma. JAMA Dermatol 2023; 159:1068-1075. [PMID: 37610773 PMCID: PMC10448369 DOI: 10.1001/jamadermatol.2023.2822] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023]
Abstract
Importance Merkel cell carcinoma (MCC) is a rare cutaneous malignant neoplasm with increasing incidence and high mortality. Although it is accepted that the optimal treatment for localized tumors is surgical, the data surrounding the optimal surgical approach are mixed, and current National Comprehensive Cancer Network guidelines state that Mohs micrographic surgery (MMS) and wide local excision (WLE) can both be used. The current National Comprehensive Cancer Network guidelines do not advocate a preference for MMS or WLE and suggest that they can be used interchangeably. Objective To evaluate the association of surgical approach with overall survival after excision of localized T1/T2 MCC. Design, Setting, and Participants This retrospective cohort study used the National Cancer Database to assess adults with T1/T2 MCC who were diagnosed between January 1, 2004, and December 31, 2018, with pathologically confirmed, negative regional lymph nodes and treated with surgery. The National Cancer Database includes all reportable cases from Commission on Cancer-accredited facilities. Data analysis was performed from October 2022 to May 2023. Exposure Surgical approach. Main Outcomes and Measures Overall survival. Results A total of 2313 patients (mean [SD] age, 71 [10.6] years; 1340 [57.9%] male) were included in the study. Excision with MMS had the best unadjusted survival, with mean (SE) survival rates of 87.4% (3.4%) at 3 years, 84.5% (3.9%) at 5 years, and 81.8% (4.6%) at 10 years vs 86.1% (0.9%) at 3 years, 76.9% (1.2%) at 5 years, and 60.9% (2.0%) at 10 years for patients treated with WLE. Patients treated with narrow-margin excision had similar survival as those treated with WLE, with mean (SE) survival rates of 84.8% (1.4%) at 3 years, 78.3% (1.7%) at 5 years, and 60.8% (3.6%) at 10 years. On multivariable survival analysis, excision with MMS was associated with significantly improved survival compared with WLE (hazard ratio, 0.59; 95% CI, 0.36-0.97; P = .04). High-volume MCC centers were significantly more likely to use MMS over WLE compared with other centers (odds ratio, 1.99; 95% CI, 1.63-2.44; P < .001). Conclusions and Relevance In this cohort study, the use of MMS (compared with WLE) was associated with significantly improved survival for patients with localized MCC with pathologically confirmed negative lymph nodes treated with surgery. These data suggest that Mohs surgery may provide a more effective treatment for MCC primary tumors than conventional WLE, although the lack of randomization and potential for selection bias in this study highlight the need for future prospective work evaluating this issue.
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Affiliation(s)
- Shayan Cheraghlou
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Nicole A. Doudican
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Maressa C. Criscito
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Mary L. Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
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7
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Sooksamran A, Pichai P, Suphannaphong M, Singthong S. Previous therapy and the recurrence rate of basal cell carcinoma after Mohs surgery: a meta-analysis. Arch Dermatol Res 2023; 315:1747-1754. [PMID: 36847828 DOI: 10.1007/s00403-023-02558-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: 03/08/2022] [Revised: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) is indicated for patients at high risk of recurrence; other therapies, including standard surgical excision, cryotherapy, electrodesiccation and curettage, and radiotherapy, are used in low-risk BCC and in patients who cannot undergo surgery. However, in the case of recurrence following treatment with any of these methods, MMS is indicated. This study aimed to examine how preoperative treatment before MMS affects the recurrence rate after surgery. We conducted a meta-analysis to compare the recurrence rates of primary BCC and previously treated BCC in patients undergoing MMS, with a 5-year follow-up. The secondary outcomes were the recurrence rate after MMS based on previous radiation therapy status, mean time to recurrence, and number of cases undergoing more than one stage of MMS. The recurrence rate in the previously treated group was 2.44 times greater than that of the primary BCC group. In the previous treatment group, the patients who underwent previous radiation showed a 2.52-fold higher recurrence rate than those with no previous radiation therapy. However, there was no significant difference in the mean time to recurrence and the number of cases requiring MMS > 1 stage between the previously treated and non-treated groups. Patients with previously treated BCC, especially those treated using radiation, had a higher likelihood of recurrence.
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Affiliation(s)
- Apasee Sooksamran
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand.
| | - Pitchayasak Pichai
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Mingkwan Suphannaphong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Sasathorn Singthong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
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8
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Lin A, Schmalbach CE. Surgery in the Era of Immunotherapy for Advanced Head and Neck Non-melanoma Skin Cancer. Curr Oncol Rep 2023; 25:735-742. [PMID: 37010785 DOI: 10.1007/s11912-023-01391-8] [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] [Accepted: 01/17/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE OF REVIEW Surgery remains the mainstay of treatment for non-melanoma skin cancer (NMSC). Immunotherapy (IO) has emerged as an alternative option. This review provides a contemporary summary of how to incorporate IO into the management of advanced NMSC. Evidence-based outcomes and recent clinical trials are provided with emphasis on the three most common NMSC diagnoses: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), and merkel cell carcinoma (MCC). RECENT FINDINGS Surgical resection while preserving form and function remains the standard of care for the majority of NMSCs. In recalcitrant cases failing traditional surgery and/or primary radiation, patient ineligible for such treatments, or unresectable disease, IO has emerged as a promising alternative. In the majority of cases, it is a supplanting primary chemotherapy. Surgery remains the standard of care for NMSC. Immunotherapy has emerged as an alternative option for non-surgical candidates and as a neoadjuvant means to minimize morbidity.
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Affiliation(s)
- Alice Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente School of Medicine, Pasadena, CA, USA
| | - Cecelia E Schmalbach
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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Müller CSL, Hauer N, Kofler K, Kofler L. [Micrographic controlled surgery in everyday dermatosurgery]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05158-x. [PMID: 37249657 DOI: 10.1007/s00105-023-05158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
Micrographic controlled surgery (MCS) has become established in dermatosurgery in recent years and includes various methods to enable the histologically proven complete resection of malignant cutaneous tumors, while at the same time sparing tumor-free tissue in the immediate vicinity as much as possible. MCS is of great importance in the surgical treatment of cutaneous malignancies in so-called problem locations and aggressive tumor subtypes. Indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease and Bowen's carcinoma, melanoma in chronic light-damaged skin with acral lentiginous melanoma, dermatofibrosarcoma protuberans (DFSP), and Merkel cell carcinoma. However, other tumor entities are also treated using MCS, such as extramammary Paget's disease and various cutaneous sarcomas. All procedures subsumed under MCS have in common the marking of the surgical specimen for topographical orientation, which provides assignment of remaining tumor remnants. Various methods of MCS (3D histology, the horizontal method or Mohs surgery) are presented in this article. Furthermore, this article aims to raise awareness of the possibilities and limitations of micrographically controlled surgery.
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Affiliation(s)
- Cornelia Sigrid Lissi Müller
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland.
- Medizinische Fakultät, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | - Nina Hauer
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland
| | - Katrin Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
| | - Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
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Mortada H, Aldihan R, Alhindi N, Abu alqam R, Alnaim MF, Kattan AE. "Basal cell carcinoma of the hand: A systematic review and meta-analysis of incidence of recurrence". JPRAS Open 2022; 35:42-57. [PMID: 36685723 PMCID: PMC9851839 DOI: 10.1016/j.jpra.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hand basal cell carcinoma is a rare and complex disorder. Due to the hand's anatomical features, managing hand BCC is challenging. Therefore, we have conducted this systematic review to investigate various clinical characteristics, investigations, and treatment options related to hand BCC. Furthermore, a meta-analysis was used to provide pooled recurrence rates. Methods We conducted this review per the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. This study performed a systematic literature review in February 2022 using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Key terms include hand basal cell carcinoma, basal cell carcinoma, management, outcome, and recurrence. We evaluated articles according to predefined quality criteria. Results The study included 9725 patients and 51 published articles. A total of 35 case reports, 2 case series, 1 prospective study, and the remaining retrospective studies were evaluated. An asymptomatic skin lesion was the main complaint. In 10 studies, Moh surgery was the most frequently used treatment method. In the seven studies included in the meta-analysis, the overall incidence rate of recurrence among the included patients was 1.49 cases per year. Conclusion The optimal extent of surgical treatment is still controversial, though an early biopsy can help identify lesions at an early stage. It is the first study to provide occurrence rates based on a meta-analysis. Developing treatment guidelines for BCC of the hand will be the focus of future research.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rema Aldihan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Corresponding author at: College of medicine, King Saud University, Riyadh, Saudi Arabia 12445, Riyadh, Saudi Arabia.
| | - Nawaf Alhindi
- College of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Rakan Abu alqam
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdullah E. Kattan
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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11
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Hyperpigmented nodule on a young Black man. JAAD Case Rep 2022; 27:153-155. [PMID: 36090385 PMCID: PMC9449643 DOI: 10.1016/j.jdcr.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Hunt WTN, Nelson TG. An international survey characterizing Mohs tissue processing techniques and Mohs margin thresholds: how close is too close? Clin Exp Dermatol 2022; 47:1472-1479. [PMID: 35279862 DOI: 10.1111/ced.15178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND From practice, we identified heterogeneity in Mohs micrographic surgery (MMS) specimen tissue processing techniques and specifications, and in the Mohs surgeons' assessment of MMS specimen histological tumour clearance. AIM By surveying an international cohort of Mohs surgeons, we determined to characterize variation in margin threshold assessment (number of wafers/sections free of tumour to declare tumour clearance). METHODS An online questionnaire was distributed to Mohs surgeons in the UK, European countries, Australia and New Zealand, assessing the background demographics of the surgeons and the technical factors involved in MMS tissue processing and posing three MMS scenarios to define margin thresholds. RESULTS In total, 114 consultant/attending-level Mohs surgeons responded, giving a response rate of 33.5% from 20 countries (including UK nations). The first scenario posed was a 20-mm cheek basal cell carcinoma (BCC) excised by MMS with a fully complete first wafer (7 μm) clear of tumour and the second wafer (after trimming interval of 50 μm) demonstrating a small dermal focus of nodular BCC; of the 58 surgeons, 16 (27.6%) would not take another stage. With a follow-up question, 16 of the 58 (27.6%) surgeons specified wanting three clear sections to declare tumour clearance. When the same scenario had a change to a 20-mm infiltrative BCC, 84.2% (48 of 57 surgeons) required a second MMS stage, with a follow-up question clarifying that a third (19 of 57) wanted three clear sections to determine clearance. For a well-differentiated 15-mm squamous cell carcinoma with the same factors there was no majority consensus, with the same proportion of surgeons (22.6%; 12 of 53) calling tumour clearance after one, two and three clear section(s) respectively. For MMS specimen processing specifications, routine sections/wafers of 5-10 μm were reported by 77.4% of respondents (48 of 62) and for trimming interval values, 78.6% (48 of 61) specified a range between 20 and 200 μm. CONCLUSION By surveying international Mohs surgeons, we highlight surgeon background characteristics, peer-compare assessment of margin thresholds for tumour clearance across three scenarios, and delineate tissue processing and intraoperative approaches.
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Affiliation(s)
- William T N Hunt
- Mohs Surgery Unit, Department of Dermatology, Rowan House, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Toby G Nelson
- Mohs Surgery Unit, Department of Dermatology, Rowan House, University Hospitals Plymouth NHS Trust, Plymouth, UK
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13
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Fraga SD, Besaw RJ, Murad F, Schmults CD, Waldman A. Complete Margin Assessment Versus Sectional Assessment in Surgically Excised High-Risk Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis. Dermatol Surg 2022; 48:704-710. [PMID: 35778249 DOI: 10.1097/dss.0000000000003462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Keratinocyte carcinomas (KCs) are the most diagnosed cancers worldwide and are commonly excised via complete margin assessment (CMA) or excision with sectional assessment (SA). National Comprehensive Cancer Network guidelines encourage CMA for KC with high-risk features. OBJECTIVE To systematically compare recurrence outcomes for CMA vs SA in high-risk KC based on National Comprehensive Cancer Network guidelines criteria. MATERIALS AND METHODS EMBASE and MEDLINE were searched for articles reporting recurrences of high-risk KC undergoing excision using CMA or SA. High-risk KCs were defined as recurrent, having perineural invasion (PNI), or basal cell carcinomas (BCC) with aggressive histology. Chi-squared tests and risk ratios evaluated differences between CMA and SA groups, and a random-effects meta-analysis was performed. RESULTS Twenty-eight studies met inclusion criteria. Pooled percentages of locoregional recurrences were significantly lower with CMA vs SA for all KCs (3.9% [95% CI: 2.9-4.9] vs 13.5% [7.7, 19.2, p = .001]), cutaneous squamous cell carcinoma with PNI (9.8% [5.4-14.1] vs 32.0% [25.0-39.0], p < .001), and recurrent BCC (4.4% [2.9-5.9] vs 11.9% [8.0-15.8], p < .001). CONCLUSION For high-risk KCs, recurrence risk was over 3-times greater with SA compared with CMA. Expanded access to CMA for high-risk KC is likely to reduce recurrence risk and improve clinical outcomes.
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Affiliation(s)
- Sophia D Fraga
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Besaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Amos-Arowoshegbe EO, Varghese R, Joseph AB, Kanu-Ivi C, Sadi N, Sadana S, Latif F, Abdul A, Ratra R, Blume K, Tiesenga F. Basal Cell Cancer of the Scalp. Cureus 2022; 14:e26469. [PMID: 35919367 PMCID: PMC9338841 DOI: 10.7759/cureus.26469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/05/2022] Open
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15
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Brown AC, Brindley L, Hunt WTN, Earp EM, Veitch D, Mortimer NJ, Salmon PJM, Wernham A. A review of the evidence for Mohs micrographic surgery in the treatment of basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794-1804. [PMID: 35596540 DOI: 10.1111/ced.15266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
MMS is considered the gold standard treatment for basal cell carcinoma (BCC) particularly for sites with a high-risk of incomplete excision such as the central face, tumours with an aggressive growth pattern and consequent unpredictable sub-clinical extension and recurrent tumours. However, the process is more time consuming and the magnitude of benefit is uncertain. This article aims to provide a more complete picture of current evidence, including a review of cosmetic outcomes, tissue sparing ability and cost-effectiveness of MMS. Whilst robust evidence is lacking, there is a large volume of observational data supporting a low recurrence rate after MMS. The risk of incomplete excision and higher recurrence rate of standard excision favours the use of MMS at high-risk sites. There is some low certainty evidence that MMS results in a smaller defect size than SE and that incomplete excision with SE results in larger defects. Larger defects may affect cosmetic outcome but there is no direct evidence that MMS improves cosmetic outcome compared to SE. There is conflicting evidence regarding the cost of MMS in comparison to SE with some studies recognising MMS as less expensive than SE and others more which may reflect the healthcare setting. A multi-centre 10 year RCT comparing MMS and SE in the treatment of high-risk BCC would be desirable, but is unlikely to be feasible or ethical. Collection of robust registry data capturing both MMS and SE outcomes would provide additional long-term outcomes.
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Affiliation(s)
- Alistair C Brown
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Luke Brindley
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - William T N Hunt
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - David Veitch
- Department of Dermatology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Neil J Mortimer
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Paul J M Salmon
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Aaron Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK.,Department of Dermatology, University Hospitals Leicester NHS Trust, Leicester, UK
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16
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Sekulic A, Yoo S, Kudchadkar R, Guillen J, Rogers G, Chang ALS, Guenthner S, Raskin B, Dawson K, Mun Y, Chu L, McKenna E, Lacouture M. Real-world assessment and treatment of locally advanced basal cell carcinoma: Findings from the RegiSONIC disease registry. PLoS One 2022; 17:e0262151. [PMID: 35030185 PMCID: PMC8759646 DOI: 10.1371/journal.pone.0262151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Limited information is available regarding real-world treatment patterns and their effectiveness and safety in patients with locally advanced basal cell carcinoma, including patients not typically represented in clinical trials. The purpose of the current study was to describe how clinicians diagnose and treat locally advanced basal cell carcinoma in the United States. METHODS This prospective, multicenter, observational registry study included patients with newly diagnosed, Hedgehog pathway inhibitor-naive locally advanced basal cell carcinoma without basal cell carcinoma nevus syndrome (n = 433) treated at 75 US academic and community practices, including dermatology, Mohs surgery, and medical oncology sites. The main outcomes of this study were treatment patterns and associated effectiveness and safety for patients with locally advanced basal cell carcinoma in real-world settings. RESULTS Determination of locally advanced basal cell carcinoma was mainly based on lesion size (79.6% of patients), histopathology (54.3%), extent of involvement (49.0%), and location (46.2%). Within 90 days of determination of locally advanced disease, 115 patients (26.6%) received vismodegib, 251 (58.0%) received surgery/other (non-vismodegib) treatment, and 67 (15.5%) had not yet received treatment (observation). Vismodegib-treated patients had a higher prevalence of high-risk clinical features predictive for locoregional recurrence than those with non-vismodegib treatment or observation. Clinical response rate was 85.1% with vismodegib and 94.9% with non-vismodegib treatment (primarily surgery). The most common adverse events with vismodegib were ageusia/dysgeusia, muscle spasms, alopecia, and weight loss. Rates of cutaneous squamous cell cancers were comparable between vismodegib and non-vismodegib treatment. CONCLUSIONS This prospective observational study offers insight on real-world practice, treatment selection, and outcomes for a nationally representative sample of US patients with locally advanced basal cell carcinoma. For patients with lesions that were not amenable to surgery, vismodegib treatment was associated with effectiveness and safety that was consistent with that observed in clinical trials.
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Affiliation(s)
- Aleksandar Sekulic
- Dermatology, Mayo Clinic, Scottsdale, Arizona, United States of America
- * E-mail:
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ragini Kudchadkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Julie Guillen
- UCSF Dermatology and Laser Surgery Center, University of California, San Francisco, California, United States of America
| | - Gary Rogers
- Surgical Dermatology, Tufts New England Medical Center, Boston, Massachusetts, United States of America
| | - Anne Lynn S. Chang
- Dermatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Scott Guenthner
- Dermatology Center of Indiana/Indiana Clinical Trials Center, Plainfield, Indiana, United States of America
| | - Bernard Raskin
- Dermatology, UCLA School of Medicine, Los Angeles, California, United States of America
| | - Keith Dawson
- Medical Affairs, Genentech, South San Francisco, California, United States of America
| | - Yong Mun
- Biostatistics, Genentech, South San Francisco, California, United States of America
| | - Laura Chu
- Oncology, Genentech, South San Francisco, California, United States of America
| | - Edward McKenna
- Medical Affairs, Genentech, South San Francisco, California, United States of America
| | - Mario Lacouture
- Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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17
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Tomás-Velázquez A, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, De Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Gil P, Delgado-Jiménez Y, Sanchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, De la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa-Rull E, Sanchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Gonzalez-Sixto B, Martorell-Calatayud A, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, García-Doval I, Redondo P. Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery). Acta Derm Venereol 2021; 101:adv00602. [PMID: 34694418 PMCID: PMC9455311 DOI: 10.2340/actadv.v101.544] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patientyears for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1– 1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.
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Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra / Fundación Piel Sana, ES-28008 Madrid, Spain.
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18
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Leow LJ, Teh N. Clinical clearance of complex basal cell carcinoma in patients receiving sonidegib: A case series. Dermatol Ther 2021; 35:e15217. [PMID: 34816547 PMCID: PMC9285371 DOI: 10.1111/dth.15217] [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: 12/18/2020] [Revised: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cancer worldwide. While most BCC cases respond to surgical management, complex BCC often presents treatment challenges for patients unsuitable for, or refractory to, surgery and radiotherapy—limiting treatment options. Hedgehog pathway inhibitors (HHI) have emerged as an important treatment option for patients with complex BCC—providing a durable treatment modality and improved clinical outcomes. We present a case series of 10 patients with complex BCC treated with sonidegib, an oral HHI, at a dose of 200 mg once daily for a mean duration of 6 months and a mean follow‐up of 7 months. Of these patients, sonidegib monotherapy was curative in eight cases. Of the remaining two patients, treatment with sonidegib arrested tumor progression and decreased tumor size to a point where surgical removal was straightforward. The positive treatment response we observed supports use of sonidegib as an effective treatment option for patients with complex BCC.
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Affiliation(s)
- Liang Joo Leow
- Aesthetic Dermatology, Sydney and Griffith, New South Wales, Australia.,Department of Dermatology, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Natalie Teh
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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19
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Gaitanis G, Bassukas ID. A Review of Immunocryosurgery and a Practical Guide to Its Applications. Diseases 2021; 9:71. [PMID: 34698134 PMCID: PMC8544578 DOI: 10.3390/diseases9040071] [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: 08/03/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Immunocryosurgery is a minimally invasive combinational therapeutic procedure that has been designed, developed, and evaluated in the Dermatology Department of the University of Ioannina from 2004. In a fixed time protocol, this approach combines immune stimulatory therapy with imiquimod and cryosurgery, i.e., cryosurgery is applied during continuous imiquimod treatment. Laboratory findings in tissue and blood level credit the efficacy to the synergy of imiquimod and cryosurgery. The synergy has been established through clinical trials and the excellent feasibility and efficacy demonstrated in clinical practice. Immunocryosurgery has extensive proof of excellent efficacy, comparable to surgery, in the treatment of basal cell carcinoma. It has also been evaluated in cases of Bowen's disease, keratoacanthoma, Merkel cell carcinoma, lentigo maligna, and cutaneous squamous cell carcinoma with or without the addition of adjuvants. The aims of this review are to detail the immunocryosurgery protocol with the addition of daily practice clinical tips, compile data on the mechanism of action of immunocryosurgery, and delineate indications and possible future applications. Most of the available data originate from the treatment of BCC, of all histological types and localizations, and the principles reported mainly reflect on evidence related to the treatment of this common skin cancer.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
- Delc Clinique, 2502 Biel/Bienne, Switzerland
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
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20
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Markowitz O, Bressler MY. Combining Nd:YAG laser with optical coherence tomography for nonsurgical treatment of basal cell carcinoma. Lasers Surg Med 2021; 54:105-112. [PMID: 34289512 DOI: 10.1002/lsm.23455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Effective and aesthetically appealing management options are needed for basal cell carcinoma (BCC), the most common skin cancer. The Nd:YAG laser shows promise, but most studies use biopsy to demonstrate tumor clearance. Optical coherence tomography (OCT) could allow good tumor margin control while enabling recurrence monitoring. OBJECTIVE Determine the efficacy of the Nd:YAG laser to treat BCCs while controlling for tumor margin with OCT. METHODS A 1064-nm Nd:YAG laser was applied to treat 119 BCCs in 102 patients, where tumor margins were approximated using OCT. Lesions were treated every 2 months until no residual tumor remained; patients were monitored for 1 year after treatment completion for clinical and subclinical recurrences. Outcomes were analyzed retrospectively. RESULTS Most BCCs cleared after one treatment (85/119, 70.4%). Several factors were significantly associated with a suboptimal response, that is, those with recurrence or requiring ≥2 treatments: lesion size >5 mm (p = 0.03), focal sclerosing subtype (p = 0.018), and immunosuppression (p = 0.039). Midface location, patient compliance, and diagnosis method were codependent variables (r2 = 0.2011, p = 0.0008). All BCCs (119/119) demonstrated complete clinical and subclinical tumor clearance 2 months after final laser treatment. By 1 year, overall clinical recurrence rate (RR) was 1.7% (2/119) and cumulative subclinical RR was 4.2% (5/119). Upon excluding immunosuppressed patients, clinical RR and combined subclinical RR for primary BCC were 1% (1/98) and 2% (2/98), respectively, and 0% (0/17) and 11.8% (2/17), respectively, for recurrent BCC. CONCLUSIONS The Nd:YAG nonablative laser can offer an effective treatment for BCCs when used with noninvasive diagnostic tools such as OCT.
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Affiliation(s)
- Orit Markowitz
- Divison of Clinical Research, OptiSkin Medical, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Y Bressler
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Research, New York Institute of Technology College of Osteopathic Medicine, New York, New York, USA
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21
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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22
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Castanheira A, Vieira MJ, Pinto M, Dias C, Prada L, Macedo S, Fernandes MS, Vieira F, Soares P, Mota A, Lopes JM, Boaventura P. TERTp mutations and p53 expression in head and neck cutaneous basal cell carcinomas with different aggressive features. Sci Rep 2021; 11:10395. [PMID: 34001963 PMCID: PMC8129122 DOI: 10.1038/s41598-021-89906-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Cutaneous basal cell carcinoma (cBCC) is an economic burden to health services, due to its great morbidity and increasing incidence in old people. Infiltrative cBCCs and cBCCs with micronodular pattern are considered as more aggressive. The role of p53 expression and TERTp mutation on cBCC behavior remains to be clarified. We aimed to assess TERTp mutations and p53 expression in relation to the cBCC histological subtype in a cohort of patients referred to an ENT Department of a tertiary Hospital of Northern Portugal. We performed a retrospective clinicopathological and histological review of the head and neck cBCCs followed-up at the otorhinolaryngology department of Trás-os-Montes e Alto Douro hospital (January 2007–June 2018). We assessed TERTp mutations in 142 cBCCs and p53 protein expression, through immunohistochemistry, in 157 cBCCs. We detected TERTp mutations in 43.7% of cBCCs and p53 overexpression in 60.5% of cBCCs. We spotted association of p53 overexpression and TERTp mutation with necrosis. In the infitrative-growth pattern cBCCs, there was no significant association with the clinical and histological features evaluated, except for necrosis. In the indolent-growth cBCCs, we identified a significant association of TERTp mutation status with female sex, necrosis, multiple cBCCs, and p53 positive expression. Our results suggest that TERTp mutation may be useful to identify more aggressive features in the indolent-growth pattern cBCCs (nodular and superficial subtypes). Further studies with larger cohorts are warranted to clarify the relevance of TERTp mutation in cBCCs.
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Affiliation(s)
- António Castanheira
- Department of Otorhinolaryngology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal.,FMUP-Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Vieira
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Mafalda Pinto
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Carolina Dias
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Luísa Prada
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sofia Macedo
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | | | | | - Paula Soares
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Alberto Mota
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatology, Centro Hospitalar São João, Porto, Portugal
| | - José Manuel Lopes
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.,Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Boaventura
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal. .,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal. .,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal.
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23
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Azzopardi EA, Abdelrahman W, Azzopardi E, O’Leary B, Yarrow J, Miles N, Barbara C, Camilleri L, Clementoni MT, Murison M. Treatment of cutaneous basal cell carcinoma with combined laser extirpation and methyl aminolevulinic acid: five-year success rates. Ann R Coll Surg Engl 2021; 103:263-271. [PMID: 33557701 PMCID: PMC10752010 DOI: 10.1308/rcsann.2020.7020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
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Affiliation(s)
| | - W Abdelrahman
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - E Azzopardi
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - B O’Leary
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - J Yarrow
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - N Miles
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | | | | | | | - M Murison
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
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24
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van Zon MCM, van der Waa JD, Veta M, Krekels GAM. Whole-slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma. Exp Dermatol 2021; 30:733-738. [PMID: 33656186 DOI: 10.1111/exd.14306] [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: 10/11/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common type of skin cancer with incidence rates rising each year. Mohs micrographic surgery (MMS) is most often chosen as treatment for BCC on the face for which each frozen section has to be histologically analysed to ensure complete tumor removal. This causes a heavy burden on health economics. OBJECTIVES To develop and evaluate a deep learning model for the automated detection of BCC-negative slides and classification of BCC in histopathology slides of MMS based on whole-slide image (WSI). METHODS Two deep learning models were developed on the basis of 171 digitized H&E frozen slides from 70 different patients. The first model had a U-Net architecture and was used for the segmentation of BCC. A subsequent convolutional neural network used the segmentation to classify the whole slide as BCC or BCC-negative. RESULTS Quantitative evaluation over manually labelled ground truth data resulted in a Dice score of 0.66 for the segmentation of BCC and an area under the receiver operating characteristic curve (AUC) of 0.90 for the slide-level classification. CONCLUSIONS This study demonstrates that through WSIs deep learning models may be a feasible option to improve the clinical workflow and reduce costs in histological analysis of BCC in MMS.
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Affiliation(s)
- Mike C M van Zon
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Mitko Veta
- Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, The Netherlands
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25
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Abstract
Mohs micrographic surgery (MMS) represents an excellent means to address basal cell carcinoma and some squamous cell carcinomas (cSCCs) of the head and neck region, achieving excellent outcomes with respect to local recurrence rates and disease-specific survival. MMS by virtue of its technique maximally preserves uninvolved tissues of the head and neck, thereby maintaining form, cosmesis, and function to the greatest extent as dictated by the disease. However, the application of MMS for managing high-risk cSCC and melanoma requires additional investigation. MMS may also prove beneficial in treating rare cutaneous diseases such as Merkel cell carcinoma and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Gina D Jefferson
- Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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26
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Castanheira A, Boaventura P, Soares P, Vieira F, Lopes JM, Mota A. MOHS micrographic surgery for head and neck nonmelanoma skin cancer: An approach for ENT surgeons. Dermatol Ther 2020; 34:e14661. [PMID: 33301226 DOI: 10.1111/dth.14661] [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: 10/12/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
Surgery is the main approach for skin cancer, with Mohs micrographic surgery (MMS) allowing the highest cure rates, best esthetics and superior functional outcomes. Ear, nose, and throat (ENT) surgeons are often challenged with patients presenting skin cancer, needing appropriate expertise to its adequate management. This paper highlights the most important aspects of MMS, enabling ENT surgeons to become familiar with its fundamental aspects. A review of the literature was performed, concomitantly presenting the author's outcomes as an ENT surgeon. A total of 51 MMSs were performed in 41 patients, and 78.4% of the tumors were cutaneous basal cell carcinomas (cBCCs), 19.6% were cutaneous squamous cell carcinomas (cSCCs), and one case was a microcystic adnexal carcinoma. Most tumors were located in high-risk areas (88.2%), and 84.3% of them were ≥10 mm in diameter. Most tumors (90.2%) required no more than two MMS excision steps to be completely removed. All cases were managed by reconstruction either using flaps or grafts. Recurrence occurred in only 2% of the cases. This study addressed the main issues of MMS, which may be important in ENT surgeons' daily practice.
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Affiliation(s)
- António Castanheira
- Department of Otorhinolaryngology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.,FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Paula Boaventura
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Soares
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | | | - José Manuel Lopes
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Alberto Mota
- FMUP-Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatology, Centro Hospitalar São João, Porto, Portugal
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27
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Recurrence of Basal Cell Carcinoma After Mohs Micrographic Surgery: A 4-Year Retrospective Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.105799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Among non-melanoma skin cancers (NMSC), Basal cell carcinoma (BCC) is one of the most common. Objectives: We endeavored to assess the recurrence rate of BCC after surgery and compare tumors recurrence based on different aspects. Methods: This was a retrospective and observational study which was analyzed medical records of 154 patients who had Mohs micrographic surgery (MMS) from March 2013 to February 2017 in two clinical centers. For finding if the clinical characteristics of the patients have related to tumoral recurrence, we gathered them, including gender and age of the patient, tumor size, site, and its histological type plus the existence of ulcer in malignancy. Data were analyzed using SPSS 22 statistical software. Statistical difference between proportions was determined by χ2 analysis. Results: The majority of patients (74%) were female (57%) older than 60 years old. Most tumors, based on the histopathological diagnosis, were Infiltrating (43.5%) and nodular and infiltrating (40.3%), respectively. The mean tumor size was 1.81 cm and most of them (74%) were larger than 1 cm. The tumor site was mostly in the nasal (56.5%) followed by the cheek (11%). Most patients (96.8%) had one lesion. The recurrence rate was 1.9%. The mean interval between surgeries to recurrence was 13 months. There was no significant difference between recurrence rate and age, sex, tumor type in terms of clinical diagnosis, tumor location, tumor size, number of lesions, and type of tumor (P < 0.05). Conclusions: the rate of recurrence of BCC in patients treated with MMS is low (1.9%). We recommend the utilization of the MMS technique for the treatment of BCC.
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28
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Elias ML, Skula SR, Behbahani S, Lambert WC, Schwartz RA. Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery. Dermatol Ther 2020; 33:e13991. [PMID: 32645237 DOI: 10.1111/dth.13991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 01/28/2023]
Abstract
The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi-squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan-Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non-acad; OR = 2.273; CI95% [1.448-3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203-0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182-0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan-Meier survival showed no significant difference in outcomes (P = .611), with WLE and MMS demonstrating 5-year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996-3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.
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Affiliation(s)
| | | | | | | | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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29
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Bilden T, Benedict KC, Lamb PW, Mcmullin J. Intraoperative Frozen Section Analysis for the Excision of Nonmelanoma Skin Cancer: A Single-Center Experience. Am Surg 2020. [DOI: 10.1177/000313481908501236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgical resection of nonmelanoma skin cancer (NMSC) may be performed via Mohs micrographic surgery (MMS) or standard surgical excision with complete margin analysis. Whereas MMS may necessitate delayed reconstruction surgery, intraoperative frozen section analysis (IFSA) may be used to ensure clear surgical margins before proceeding with reconstruction. To achieve curative resection while optimizing aesthetic outcomes, surgeons may use surgical excision guided by IFSA to forego extensive or delayed reconstruction. Patients undergoing wide local excision for NMSC using IFSA from October 2008 to November 2016 were evaluated. Analysis included IFSA versus permanent section outcomes, the number of required excisions, and the recurrence rate. Our analysis contained 145 patients involving 162 lesions. IFSA demonstrated that 73.4 per cent of margins were negative after one excision and 26.5 per cent were re-excised until achieving negative margins. Analysis revealed one false-positive case (0.62%) and four false-negative cases (2.47%). Nine patients had local recurrence (5.56%). Frozen section sensitivity was 88.99 per cent and specificity 99.20 per cent. The positive predictive value was 96.97 per cent, and negative predictive value was 96.90 per cent. Mean follow-up time was 39 months. Both resection and recurrence data of excised NMSC lesions at our institution suggest that surgical excision using IFSA is a safe and effective alternative to MMS.
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Affiliation(s)
- Tylert Bilden
- University of North Dakota School of Medicine, Grand Forks, North Dakota
| | | | - Patrick W. Lamb
- University of North Dakota School of Medicine, Grand Forks, North Dakota
- General Surgery Department, Altru Health System, Grand Forks, North Dakota; and
| | - Jaron Mcmullin
- University of North Dakota School of Medicine, Grand Forks, North Dakota
- Plastic Surgery Department, Altru Health System, Grand Forks, North Dakota
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30
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Johnson TM, Smith NR. Mohs Surgery versus Standard Local Excision for Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Skin Cancer. Facial Plast Surg 2020; 36:133-140. [PMID: 32413920 DOI: 10.1055/s-0040-1709142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Basal cell carcinoma, squamous cell carcinoma, and melanoma represent the three most common skin cancers that occur on the face. The most common surgical treatments for facial skin cancers are Mohs' surgery and standard local excision. The effective utilization of either of these techniques is based on tumor and patient risk stratification incorporating known risk factors for occult invasion and local recurrence, combined with patient comorbidities, expectations, and desires. Best available evidence highlights multiple and consistent risk factors for each specific skin cancer type, and dictate local control rates reported in the literature. Recognizing gaps in the literature, we compare and review surgical treatment guidelines and data for standard local excision versus Mohs' surgery for cutaneous nonmelanoma and melanoma skin cancer. This article serves as a resource for optimal therapeutic decision making for surgical management of skin cancer on the face.
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Affiliation(s)
- Timothy M Johnson
- Department of Dermatology, Otolaryngology, and Surgery, University of Michigan, Ann Arbor, Michigan
| | - Noah R Smith
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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31
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego M, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, Descalzo-Gallego MA, García-Doval I, Ríos-Buceta L, Redondo-Bellón P. Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:291-299. [PMID: 32241529 DOI: 10.1016/j.ad.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists. MATERIAL AND METHODS Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREEII (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review. RESULTS The highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered. CONCLUSIONS This new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences.
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Affiliation(s)
- F Vílchez-Márquez
- Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, España.
| | | | - L Barchino-Ortiz
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Ruíz-de-Casas
- Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Palacios-Álvarez
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
| | - A Soria-Rivas
- Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - L Ríos-Buceta
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, España
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33
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Castanheira A, Boaventura P, Pais Clemente M, Soares P, Mota A, Lopes JM. Head and neck cutaneous basal cell carcinoma: what should the otorhinolaryngology head and neck surgeon care about? ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2020; 40:5-18. [PMID: 31388193 PMCID: PMC7147542 DOI: 10.14639/0392-100x-2245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/10/2018] [Indexed: 11/23/2022]
Abstract
Cutaneous basal cell carcinoma (cBCC) is the most common malignancy diagnosed in the human population. cBCC presents an increasing incidence which, in the near future, will be higher than all other cancers combined. The majority of cBCC are located in the head and the neck. A diversity of management modalities is currently available; nonetheless, surgical excision remains the main modality of treatment. cBCC rarely metastasises and presents a low mortality rate. cBCC morbidity is influenced by local invasion and destruction, especially in the face, where function and aesthetics are major issues. Easy accessibility to the face and skin on the neck makes cBCC an important issue for otorhinolaryngology head and neck surgeons who must be aware and committed in its management, as the main modality of treatment continues to be surgical. The aim of this review is to present a brief and practical overview of head and neck cBCC management for ear, nose and throat (ENT) surgeons, discussing key issues about its epidemiology, risk factors, diagnosis and pathogenesis.
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Affiliation(s)
- António Castanheira
- Department of Otorhinolaryngology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
- FMUP-Faculty of Medicine
| | - Paula Boaventura
- FMUP-Faculty of Medicine
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
| | | | - Paula Soares
- FMUP-Faculty of Medicine
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
| | - Alberto Mota
- FMUP-Faculty of Medicine
- Department of Dermatology of Centro Hospitalar São João, Porto, Portugal
| | - José Manuel Lopes
- FMUP-Faculty of Medicine
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
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Factors Affecting Recurrence and Costs of Basal Cell Carcinoma Undergoing Mohs Micrographic Surgery: A Hospital-Based Retrospective Cohort Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.84695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Giacomelli MG, Faulkner-Jones BE, Cahill LC, Yoshitake T, Do D, Fujimoto JG. Comparison of nonlinear microscopy and frozen section histology for imaging of Mohs surgical margins. BIOMEDICAL OPTICS EXPRESS 2019; 10:4249-4260. [PMID: 31453008 PMCID: PMC6701533 DOI: 10.1364/boe.10.004249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 05/07/2023]
Abstract
Mohs surgery uses en face frozen section analysis (FSA) with complete margin examination for the excision of select basal cell carcinomas (BCC), obtaining excellent cosmetic outcomes and extremely low recurrence rates. However, Mohs with FSA is time-consuming because of the need to iteratively perform cryosectioning on sequential excisions. Fluorescent microscopies can image tissue specimens without requiring physical sectioning, potentially reducing the time to perform Mohs surgery. We demonstrate a protocol for nonlinear microscopy (NLM) imaging of surgical specimens that combines dual agent staining, virtual H&E rendering, and video rate imaging. We also introduce a novel protocol that enables micron-level co-registration of NLM images with FSA histology, and demonstrate that NLM can reproduce similar features similar to FSA in BCC specimens with both negative and positive surgical margins. We show that the fluorescent labels can be extracted with conventional vacuum infiltration processing, enabling subsequent immunohistochemistry on fluorescently labeled tissue. This protocol can also be applied to evaluate the performance of NLM compared with FSA in a wide range of pathologies for intraoperative consultation.
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Affiliation(s)
- Michael G. Giacomelli
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139, USA
| | - Beverly E. Faulkner-Jones
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Lucas C. Cahill
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139, USA
| | - Tadayuki Yoshitake
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139, USA
| | - Daihung Do
- Harvard Medical School, Department of Dermatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - James G. Fujimoto
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139, USA
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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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Immunocryosurgery for non-superficial basal cell carcinomas ≤ 20 mm in maximal diameter: Five-year follow-up. J Geriatr Oncol 2019; 10:475-478. [DOI: 10.1016/j.jgo.2018.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/25/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
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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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40
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Cecchi R. Fresh/frozen Tübingen technique (margin strip method) for head and neck basal cell carcinoma: A retrospective study of 298 cases. Dermatol Ther 2018; 32:e12799. [PMID: 30521148 DOI: 10.1111/dth.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Roberto Cecchi
- Department of Dermatology, San Jacopo Hospital, Pistoia, Italy
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41
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Rajabi-Estarabadi A, Zheng C, Vazquez T, Akhtar S, Williams N, Nouri K. Cells to Surgery Quiz: December 2018. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Abstract
Head and neck cancers comprise 4% of the cancer burden in the United States each year. Many types of head and neck cancers present as an asymptomatic, nontender neck mass or nonspecific symptoms, such as hoarseness, sore throat, and pain. Head and neck cancers are frequently diagnosed incidentally by the primary care physician or dentist. This review summarizes the epidemiology, clinical manifestations, diagnosis, and treatment of several common head and neck cancers in order to provide an increased awareness for the internist to facilitate early detection of these diseases.
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Affiliation(s)
- Kenneth Yan
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Nishant Agrawal
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Zhen Gooi
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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43
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Delgado Jiménez Y, Camarero-Mulas C, Sanmartín-Jiménez O, Garcés JR, Rodríguez-Prieto MÃ, Alonso-Alonso T, Miñano Medrano R, López-Estebaranz JL, de Eusebio Murillo E, Redondo P, Ciudad-Blanco C, Toll A, Artola Igarza JL, Allende Markixana I, Suarez Fernández R, Alfaro Rubio A, Alonso Pacheco ML, Vázquez-Veiga H, de la Cueva Dobao P, Ruiz-Salas V, Vilarrasa E, Barchino L, Morales-Gordillo V, Ocerin-Guerra I, Navarro Tejedor R, Hueso L, Mayor Arenal M, Seoane-Pose MJ, Cano-Martinez N, Garcia-Doval I, Descalzo MA. Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma. Int J Dermatol 2018; 57:1375-1381. [DOI: 10.1111/ijd.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Joan R. Garcés
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | - Ignacio Garcia-Doval
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
| | - Miguel A. Descalzo
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
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Kuiper EM, van den Berge BA, Spoo JR, Kuiper J, Terra J. Low recurrence rate of head and neck basal cell carcinoma treated with Mohs micrographic surgery: A retrospective study of 1021 cases. Clin Otolaryngol 2018; 43:1321-1327. [DOI: 10.1111/coa.13176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Elsa M. Kuiper
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Bente A. van den Berge
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Julia R. Spoo
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Dermatology; Ommelander Ziekenhuis Groningen; Groningen The Netherlands
| | - Jeroen Kuiper
- Public Health Service Groningen; Groningen The Netherlands
| | - Jorrit B. Terra
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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45
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Basosquamous Carcinoma: A Single Centre Clinicopathological Evaluation and Proposal of an Evidence-Based Protocol. J Skin Cancer 2018; 2018:6061395. [PMID: 29973992 PMCID: PMC6008864 DOI: 10.1155/2018/6061395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/08/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022] Open
Abstract
Basosquamous carcinoma (BSC) is an uncommon skin malignancy with significant invasive and metastatic potential. There are currently no clear management guidelines. This study evaluates the management and outcomes of patients diagnosed with BSC over a 7-year period. We present an evidence-based unit protocol for the management of BSC. All patients treated for BSC between 2009 and 2015 were reviewed. Data collected included patient demographics, tumour-specific information, management strategy, presence of recurrence or metastasis, and details of follow-up. 74 patients were identified, making this one of the largest cohorts of BSC patients reported. Mean age at diagnosis was 75.4 years, with a male:female ratio of 1.6:1. The most common tumour site was the head and neck (n=43, 58.1%). All tumours were graded at pT1 (n=51) or pT2 (n=23). Inadequate excision occurred in 17 patients (23%). Mean excision margins were >4mm peripherally and deep. Inadequately excised BSCs were further treated with wide local excision (n=6) or radiotherapy (n=5), or both (n=1). There were no cases of local recurrence or metastatic disease. This study demonstrates a cohort of patients with BSCs that appear less aggressive than previously reported. Current management with surgical excision appears to produce adequate results. However, an evidence-based guideline is still lacking.
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46
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Cells to Surgery Quiz: May 2018. J Invest Dermatol 2018; 138:e41. [PMID: 29681392 DOI: 10.1016/j.jid.2018.03.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Cerci FB. 'Dermohscopy' mapping: correlating dermoscopic findings with histology in Mohs micrographic surgery. J Eur Acad Dermatol Venereol 2018; 32:e343-e344. [PMID: 29512194 DOI: 10.1111/jdv.14918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F B Cerci
- Department of Dermatology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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48
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Wee E, Goh MS, Estall V, Tiong A, Webb A, Mitchell C, Murray W, Tran P, McCormack CJ, Henderson M, Hiscutt EL. Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer. Australas J Dermatol 2018; 59:302-308. [DOI: 10.1111/ajd.12779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Edmund Wee
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Michelle S Goh
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Vanessa Estall
- Department of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Albert Tiong
- Department of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Angela Webb
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Catherine Mitchell
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - William Murray
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Phillip Tran
- Department of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Christopher J McCormack
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Michael Henderson
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Emma L Hiscutt
- Department of Surgical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Abstract
Basal cell carcinoma (BCC) is the most common malignancy worldwide, arising from non-keratinizing cells within the basal layer of the epidermis. The incidence of BCC continues to rise annually, increasing the burden of management of these carcinomas and the morbidity associated with their treatment. While surgical interventions such as Mohs micrographic surgery and surgical excision are the standard of care and yield the highest cure rates, the number of non-surgical interventions approved for the treatment of BCC continues to expand. We review various surgical and non-surgical approaches to the treatment of BCC, focusing on targeted molecular therapies that are approved for locally advanced or recurrent disease.
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Affiliation(s)
- Mariam Totonchy
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208059, New Haven, CT 06520-8059, Connecticut, USA
| | - David Leffell
- Department of Dermatology, Section of Cutaneous Oncology and Dermatologic Surgery , Yale University School of Medicine, 40 Temple Street 5A, New Haven, Connecticut, USA
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50
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Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015). ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:836-843. [DOI: 10.1016/j.ad.2017.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 04/21/2017] [Accepted: 04/29/2017] [Indexed: 11/19/2022] Open
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