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Mirza FN, Haq Z, Abdi P, Diaz MJ, Libby TJ. Artificial Intelligence for Mohs and Dermatologic Surgery: A Systematic Review and Meta-Analysis. Dermatol Surg 2024:00042728-990000000-00881. [PMID: 38991503 DOI: 10.1097/dss.0000000000004297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Over the past decade, several studies have shown that potential of artificial intelligence (AI) in dermatology. However, there has yet to be a systematic review evaluating the usage of AI specifically within the field of Mohs micrographic surgery (MMS). OBJECTIVE In this review, we aimed to comprehensively evaluate the current state, efficacy, and future implications of AI when applied to MMS for the treatment of nonmelanoma skin cancers (NMSC). MATERIALS AND METHODS A systematic review and meta-analysis was conducted following PRISMA guidelines across several databases, including PubMed/MEDLINE, Embase, and Cochrane libraries. A predefined protocol was registered in PROSPERO, with literature search involving specific keywords related to AI and Mohs surgery for NMSC. RESULTS From 23 studies evaluated, our results find that AI shows promise as a prediction tool for precisely identifying NMSC in tissue sections during MMS. Furthermore, high AUC and concordance values were also found across the various usages of AI in MMS, including margin control, surgical recommendations, similarity metrics, and in the prediction of stage and construction complexity. CONCLUSION The findings of this review suggest promising potential for AI to enhance the accuracy and efficiency of Mohs surgery, particularly for NMSC.
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Affiliation(s)
- Fatima N Mirza
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Zaim Haq
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Parsa Abdi
- Memorial University of Newfoundland, Faculty of Medicine, St. Johns, Newfoundland & Labrador, Canada; and
| | - Michael J Diaz
- University of Florida, College of Medicine, Gainesville, Florida
| | - Tiffany J Libby
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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2
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Abril-Pérez C, Mansilla-Polo M, Escutia-Muñoz B, Sanmartín O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-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, Serra-Guillén C, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Flórez-Menéndez Á, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Botella-Estrada R. Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery). J Eur Acad Dermatol Venereol 2024. [PMID: 38733285 DOI: 10.1111/jdv.20103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. OBJECTIVES This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. METHODS The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. RESULTS IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. CONCLUSIONS This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.
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Affiliation(s)
- Carlos Abril-Pérez
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Miguel Mansilla-Polo
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Begoña Escutia-Muñoz
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Beatriz González-Sixto
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Ángeles Flórez-Menéndez
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | | | - Rafael Botella-Estrada
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
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Akella SS, Lee J, May JR, Puyana C, Kravets S, Dimitropolous V, Tsoukas M, Manwar R, Avanaki K. Using optical coherence tomography to optimize Mohs micrographic surgery. Sci Rep 2024; 14:8900. [PMID: 38632358 PMCID: PMC11024158 DOI: 10.1038/s41598-024-53457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
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Affiliation(s)
- Sruti S Akella
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jenna Lee
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Julia Roma May
- School of Medicine, University of Illinois-Chicago, Chicago, IL, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sasha Kravets
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA
| | | | - Maria Tsoukas
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Rayyan Manwar
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA.
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Lee SH, Chung KY, Choi S, Techapichetvanich T. Rare Cutaneous Soft Tissue Sarcomas Treated With Slow Mohs Micrographic Surgery: Ten Years' Experience at a Single Institution. Ann Dermatol 2024; 36:120-122. [PMID: 38576250 PMCID: PMC10995616 DOI: 10.5021/ad.21.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 04/06/2024] Open
Affiliation(s)
- Sul Hee Lee
- Department of Dermatology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kee Yang Chung
- Department of Dermatology, Cutaneous Biology Research Institute, Seoul, Korea
| | - Sooyie Choi
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
- Yonsei BB Skin Clinic, Seoul, Korea
| | - Thanya Techapichetvanich
- Department of Dermatology, Cutaneous Biology Research Institute, Seoul, Korea
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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5
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Ezaldein HH. Rapidly Growing and Aggressive Squamous Cell Carcinoma of the Forearm: A Report of Successful Treatment With Mohs Surgery and Complex Reconstruction With Rhombic Triple Z-Plasty. Cureus 2024; 16:e55182. [PMID: 38558613 PMCID: PMC10980786 DOI: 10.7759/cureus.55182] [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: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Reconstruction of complex post-surgical wounds requires functional and aesthetic considerations. We present a case of a complex radial-dorsal forearm defect in a patient who underwent Mohs surgery for an aggressive and rapidly growing squamous cell carcinoma. Following complete tumor excision, we utilized a modified rhombic flap for complete wound coverage with long-term conservation of extensor function. The rhombic flap modification included three Z-plasties at the flap base to add rotational components to the flap transposition. Long-term follow-up showed acceptable cosmesis, preserved extensor tendon function, and no evidence of tumor recurrence.
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Affiliation(s)
- Harib H Ezaldein
- Mohs Micrographic Surgery, Bennett Surgery Center, Santa Monica, USA
- Dermatology, Miami Dermatology and Mohs Surgery, Miami, USA
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Levy JJ, Davis MJ, Chacko RS, Davis MJ, Fu LJ, Goel T, Pamal A, Nafi I, Angirekula A, Suvarna A, Vempati R, Christensen BC, Hayden MS, Vaickus LJ, LeBoeuf MR. Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site. NPJ Precis Oncol 2024; 8:2. [PMID: 38172524 PMCID: PMC10764333 DOI: 10.1038/s41698-023-00477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.
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Affiliation(s)
- Joshua J Levy
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
| | - Matthew J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | | | - Michael J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Lucy J Fu
- Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Tarushii Goel
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Akash Pamal
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Virginia, Charlottesville, VA, 22903, USA
| | - Irfan Nafi
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Stanford University, Palo Alto, CA, 94305, USA
| | - Abhinav Angirekula
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
| | - Anish Suvarna
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Ram Vempati
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Brock C Christensen
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Matthew S Hayden
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Matthew R LeBoeuf
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
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7
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Govas P, Ha MV, Wessel CB, Hurst A, Gordon BR, Carroll BT. Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review. Dermatol Surg 2023; 49:1116-1121. [PMID: 37962132 DOI: 10.1097/dss.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional surgical excision. Competing performance measures have fostered numerous histologic techniques for MMS. OBJECTIVE To analyze differences in primary outcomes in the published literature regarding the technique of tissue processing and embedding during the MMS process. METHODS A systematic review was performed of the published literature in MEDLINE, PubMed, Embase, and Cochrane library that included a description of the manipulation of tissue during the grossing and embedding steps of MMS. RESULTS Inclusion criteria were met by 61 articles. Of these studies, the cure/recurrence rate was assessed in 1 article (1.6%), tissue conservation was assessed in 47 (77%), time-saving was assessed in 35 (57%), cost-saving was assessed in 6 (10%), and decreased artifact were assessed in 20 (33%). CONCLUSION There is a lack of standardization for assessing clinical outcomes in the published literature regarding MMS process techniques. Cure is a critical outcome in studies comparing MMS processing methodologies.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles B Wessel
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania
| | - Anne Hurst
- Atlantic Skin Cancer Surgery, Virginia Beach, Virginia
| | - Beth R Gordon
- Department of Internal Medicine, NYU Langone Health, New York, New York
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Cho MY, Kim SC, Choi YS, Jang DS, Heo SJ, Choi YJ, Chung KY, Roh MR, Kim J. Mohs Micrographic Surgery With Digital Pathology Improves Surgical Quality and Efficiency: A Retrospective Cohort Study. Dermatol Surg 2023; 49:635-640. [PMID: 37235875 DOI: 10.1097/dss.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Mohs micrographic surgery, involving pathology of the surgical margin, has the lowest recurrence rate for skin cancer. Moreover, because of technological advances, digital pathology systems are gradually being adopted in hospitals. Yongin Severance Hospital was the first hospital to construct a fully digitalized pathology system in Korea. OBJECTIVE To evaluate the efficiency and characteristics of the digital pathology system for Mohs micrographic surgery. METHODS The medical records of 80 patients with skin cancer who underwent Mohs micrographic surgery from March 2020 to August 2022 were analyzed for the number of frozen margins, number of stages, operation time, and recurrence rate to compare cases based on the pathology system. RESULTS Overall, 23 and 57 patients were examined using the conventional and digital pathology systems, respectively. The mean number of final stages was 0.494 lower ( p -value = .008), the time from the previous to the next stage was 0.687-fold shorter ( p = .002), and the rate of switching from positive to negative margins was 1.990 times higher ( p = .044) in the digital than the conventional group. LIMITATIONS Retrospective single-center experience; short follow-up time. CONCLUSION Digital pathology reduces operative time and increases accuracy in Mohs micrographic surgery.
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Affiliation(s)
- Mi Yeon Cho
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Soo Chan Kim
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Ye Seul Choi
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Dong Su Jang
- Research Affairs, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Yoon Jung Choi
- Department of Pathology, Yongin Severance Hospital, Yongin-si, Republic of Korea
| | - Kee-Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Jihee Kim
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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9
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One-class machine learning classification of skin tissue based on manually scanned optical coherence tomography imaging. Sci Rep 2023; 13:867. [PMID: 36650283 PMCID: PMC9845382 DOI: 10.1038/s41598-023-28155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
We investigated a method for automatic skin tissue characterization based on optical coherence tomography (OCT) imaging. We developed a manually scanned single fiber OCT instrument to perform in vivo skin imaging and tumor boundary assessment. The goal is to achieve more accurate tissue excision in Mohs micrographic surgery (MMS) and reduce the time required for MMS. The focus of this study was to develop a novel machine learning classification method to automatically identify abnormal skin tissues through one-class classification. We trained a deep convolutional neural network (CNN) with a U-Net architecture for automatic skin segmentation, used the pre-trained U-Net as a feature extractor, and trained one-class support vector machine (SVM) classifiers to detect abnormal tissues. The novelty of this study is the use of a neural network as a feature extractor and the use of a one-class SVM for abnormal tissue detection. Our approach eliminated the need to engineer the features for classification and eliminated the need to train the classifier with data obtained from abnormal tissues. To validate the effectiveness of the one-class classification method, we assessed the performance of our algorithm using computer synthesized data, and experimental data. We also performed a pilot study on a patient with skin cancer.
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10
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Alcalá NE, Reines KL, Merritt B, Figler BD, Bjurlin MA. Mohs microsurgery for localized penile carcinoma: 10 year retrospective review of local recurrence rates and surgical complications. Urol Oncol 2022; 40:457.e1-457.e7. [DOI: 10.1016/j.urolonc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/26/2022]
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11
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Kechrid N, Tonellotto L, Monnier S, Rossi SA, Ulrich F, Kuonen F. Ex vivo confocal microscopy for the intraoperative assessment of deep margins in giant basal cell carcinoma. JAAD Case Rep 2022; 27:41-45. [PMID: 35996442 PMCID: PMC9391502 DOI: 10.1016/j.jdcr.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Nebiha Kechrid
- Department of Dermatology and Venereology, Hôpital de Beaumont, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Luca Tonellotto
- Department of Dermatology and Venereology, Hôpital de Beaumont, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sandra Monnier
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Severin A Rossi
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Franzisca Ulrich
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François Kuonen
- Department of Dermatology and Venereology, Hôpital de Beaumont, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Hristu R, Eftimie LG, Stanciu SG, Glogojeanu RR, Gheorghita P, Stanciu GA. Assessment of Extramammary Paget Disease by Two-Photon Microscopy. Front Med (Lausanne) 2022; 9:839786. [PMID: 35280872 PMCID: PMC8913931 DOI: 10.3389/fmed.2022.839786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Two-photon microscopy techniques are non-linear optical imaging methods which are gaining momentum in the investigation of fixed tissue sections, fresh tissue or even for in vivo experiments. Two-photon excited fluorescence and second harmonic generation are two non-linear optical contrast mechanisms which can be simultaneously used for offering complementary information on the tissue architecture. While the former can originate from endogenous autofluorescence sources (e.g., NADH, FAD, elastin, keratin, lipofuscins, or melanin), or exogenous eosin, the latter is generated in fibrillar structures within living organisms (e.g., collagen and myosin). Here we test the ability of both these contrast mechanisms to highlight features of the extramammary Paget disease on fixed tissue sections prepared for standard histological examination using immunohistochemical markers and hematoxylin and eosin staining. We also demonstrate the label-free abilities of both imaging techniques to highlight histological features on unstained fixed tissue sections. The study demonstrated that two-photon microscopy can detect specific cellular features of the extramammary Paget disease in good correlation with histopathological results.
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Affiliation(s)
- Radu Hristu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
| | - Lucian G. Eftimie
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
- Pathology Department, Central University Emergency Military Hospital, Bucharest, Romania
| | - Stefan G. Stanciu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
| | - Remus R. Glogojeanu
- Department of Special Motricity and Medical Recovery, The National University of Physical Education and Sports, Bucharest, Romania
| | - Pavel Gheorghita
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
- Faculty of Energetics, University Politehnica of Bucharest, Bucharest, Romania
| | - George A. Stanciu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
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13
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Kappelin J, Green AC, Ingvar Å, Ahnlide I, Nielsen K. Incidence and trends of basal cell carcinoma in Sweden: A population-based registry study. Br J Dermatol 2021; 186:963-969. [PMID: 34939666 DOI: 10.1111/bjd.20964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer. Incidence is largely unknown because of incomplete, or lack of, registration in most countries. OBJECTIVES To assess current incidence rates and recent trends for BCC in the Swedish population. METHODS Patient- and tumour-related features of all histologically confirmed BCC tumours diagnosed in Sweden from 2004 to 2017 were extracted from the population-based Swedish BCC Registry. Incidence rates were standardized to the 2013 European Standard Population and trends were analysed using Poisson regression models. RESULTS Age-standardized person-based incidence rate of BCC in Sweden in 2017 was 405/100 000, rising from 308/100 000 in 2004, corresponding to an annual relative increase of 1.8% (women, 2.1%; men, 1.4%). Incidence was highest in the elderly and the most common tumour site was the head and neck. In 2017, the most common BCC subtypes were nodular and micronodular/infiltrative BCC (each 31%). Incidence of aggressive BCC subtypes increased faster than other subtypes. CONCLUSIONS BCC incidence rates in Sweden are relatively high and increasing. The increasing trends were more pronounced in women and for aggressive BCC subtypes.
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Affiliation(s)
- Johan Kappelin
- Department of Clinical Sciences Helsingborg, Dermatology, Lund University.,Department of Clinical Sciences Lund, Dermatology, Lund University Skin Cancer Research group, Lund University.,Helsingborg Hospital, Sweden
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Åsa Ingvar
- Department of Clinical Sciences Lund, Dermatology, Lund University Skin Cancer Research group, Lund University.,Skåne University Hospital, Lund, Sweden
| | - Ingela Ahnlide
- Department of Clinical Sciences Lund, Dermatology, Lund University Skin Cancer Research group, Lund University.,Landskrona Hospital, Sweden
| | - Kari Nielsen
- Department of Clinical Sciences Helsingborg, Dermatology, Lund University.,Department of Clinical Sciences Lund, Dermatology, Lund University Skin Cancer Research group, Lund University.,Helsingborg Hospital, Sweden.,Skåne University Hospital, Lund, Sweden
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14
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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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15
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Zhou AE, Hoegler KM, Khachemoune A. Review of Perineural Invasion in Keratinocyte Carcinomas. Am J Clin Dermatol 2021; 22:653-666. [PMID: 34105084 DOI: 10.1007/s40257-021-00615-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
Perineural invasion is an infiltrative process of peripheral nerves by the primary neoplasm within the immediate vicinity. Aggressive forms of keratinocyte carcinomas, such as basal cell and squamous cell carcinomas, may feature perineural invasion, which is often associated with tumor recurrence and poorer prognosis. Diagnosis requires a high clinical suspicion. Imaging and histopathology are used to assess for extent of disease while surgical excision with complete circumferential peripheral and margin assessment is the treatment goal. However, there is still significant uncertainty about adjuvant chemotherapy and definitive management guidelines. Here, we summarize the current understanding of this complex pathogenic process, the clinical presentation, and the significance of perineural inflammation. We also discuss the recommendations about staging, prognosis, adjuvant radiotherapy, and general guidelines for managing keratinocyte carcinomas with perineural invasion. A better understanding of perineural invasion is essential to improve diagnosis, tailor interventions, and mitigate patient morbidity and mortality.
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16
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Lizio MG, Boitor R, Notingher I. Selective-sampling Raman imaging techniques for ex vivo assessment of surgical margins in cancer surgery. Analyst 2021; 146:3799-3809. [PMID: 34042924 DOI: 10.1039/d1an00296a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
One of the main challenges in cancer surgery is to ensure the complete excision of the tumour while sparing as much healthy tissue as possible. Histopathology, the gold-standard technique used to assess the surgical margins on the excised tissue, is often impractical for intra-operative use because of the time-consuming tissue cryo-sectioning and staining, and availability of histopathologists to assess stained tissue sections. Raman micro-spectroscopy is a powerful technique that can detect microscopic residual tumours on ex vivo tissue samples with accuracy, based entirely on intrinsic chemical differences. However, raster-scanning Raman micro-spectroscopy is a slow imaging technique that typically requires long data acquisition times wich are impractical for intra-operative use. Selective-sampling Raman imaging overcomes these limitations by using information regarding the spatial properties of the tissue to reduce the number of Raman spectra. This paper reviews the latest advances in selective-sampling Raman techniques and applications, mainly based on multimodal optical imaging. We also highlight the latest results of clinical integration of a prototype device for non-melanoma skin cancer. These promising results indicate the potential impact of Raman spectroscopy for providing fast and objective assessment of surgical margins, helping surgeons ensure the complete removal of tumour cells while sparing as much healthy tissue as possible.
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Affiliation(s)
- Maria Giovanna Lizio
- School of Physics and Astonomy, University of Nottingham, Nottingham, Nottinghamshire, UK.
| | - Radu Boitor
- School of Physics and Astonomy, University of Nottingham, Nottingham, Nottinghamshire, UK.
| | - Ioan Notingher
- School of Physics and Astonomy, University of Nottingham, Nottingham, Nottinghamshire, UK.
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17
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Combalia M, Garcia S, Malvehy J, Puig S, Mülberger AG, Browning J, Garcet S, Krueger JG, Lish SR, Lax R, Ren J, Stevenson M, Doudican N, Carucci JA, Jain M, White K, Rakos J, Gareau DS. Deep learning automated pathology in ex vivo microscopy. BIOMEDICAL OPTICS EXPRESS 2021; 12:3103-3116. [PMID: 34221648 PMCID: PMC8221965 DOI: 10.1364/boe.422168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 05/09/2023]
Abstract
Standard histopathology is currently the gold standard for assessment of margin status in Mohs surgical removal of skin cancer. Ex vivo confocal microscopy (XVM) is potentially faster, less costly and inherently 3D/digital compared to standard histopathology. Despite these advantages, XVM use is not widespread due, in part, to the need for pathologists to retrain to interpret XVM images. We developed artificial intelligence (AI)-driven XVM pathology by implementing algorithms that render intuitive XVM pathology images identical to standard histopathology and produce automated tumor positivity maps. XVM images have fluorescence labeling of cellular and nuclear biology on the background of endogenous (unstained) reflectance contrast as a grounding counter-contrast. XVM images of 26 surgical excision specimens discarded after Mohs micrographic surgery were used to develop an XVM data pipeline with 4 stages: flattening, colorizing, enhancement and automated diagnosis. The first two stages were novel, deterministic image processing algorithms, and the second two were AI algorithms. Diagnostic sensitivity and specificity were calculated for basal cell carcinoma detection as proof of principal for the XVM image processing pipeline. The resulting diagnostic readouts mimicked the appearance of histopathology and found tumor positivity that required first collapsing the confocal stack to a 2D image optimized for cellular fluorescence contrast, then a dark field-to-bright field colorizing transformation, then either an AI image transformation for visual inspection or an AI diagnostic binary image segmentation of tumor obtaining a diagnostic sensitivity and specificity of 88% and 91% respectively. These results show that video-assisted micrographic XVM pathology could feasibly aid margin status determination in micrographic surgery of skin cancer.
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Affiliation(s)
- Marc Combalia
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sergio Garcia
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - James Browning
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Sandra Garcet
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - James G. Krueger
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Samantha R. Lish
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Rivka Lax
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Jeannie Ren
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Mary Stevenson
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Nicole Doudican
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - John A. Carucci
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Manu Jain
- Ronald O. Pearlman Department of Dermatology, New York University, 550 First Avenue, New York, NY 10016, USA
| | - Kevin White
- Department of Dermatology, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR 97239, USA
| | - Jaroslav Rakos
- SurgiVance Inc., 310 East 67th Street, New York, NY 10065, USA
| | - Daniel S. Gareau
- The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
- SurgiVance Inc., 310 East 67th Street, New York, NY 10065, USA
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18
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Dermoscopic Findings in the Presurgical Evaluation of Basal Cell Carcinoma. A Prospective Study. Dermatol Surg 2021; 47:e37-e41. [PMID: 32804889 DOI: 10.1097/dss.0000000000002471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgery is the best treatment for basal cell carcinoma (BCC); however, incomplete excisions are possible. OBJECTIVE Assessment of the accurateness of dermoscopy and clinical evaluation in the detection of borders of BCC and description of dermoscopic findings in clinically healthy tissue surrounding BCC. MATERIALS AND METHODS Eighty-eight lesions with clinical dermoscopic diagnosis of BCC were examined clinically and dermoscopically, to delineate the correct site of surgical incision, demarcating the respective margins with colred dermographic pencils. Specific dermoscopic features were searched in the skin adjacent to the demarcated clinical margin. RESULTS In 29 of 88 lesions, clinical and dermoscopic margins of the tumor coincided. In the remaining 59 (67%), 10 (16.9%) presented, in the lesion area identified under dermoscopy, classical criteria for BCC and 57 (96.6%) nonclassical criteria. Differences between clinical and dermoscopic margins were significantly more frequent in superficial BCCs (p = .006). The frequency was not significantly different (p = .85) in relation to body sites. CONCLUSION Dermoscopy improves the identification of margins for surgical excision in BCC. The observation of nontraditional dermoscopic criteria of BCC, mainly pink-white areas and short telangiectasias in the area between clinically and dermoscopically detected margins, helps to define the actual tumoral margins and to achieve a really radical excision.
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19
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Boitor R, de Wolf C, Weesie F, Shipp DW, Varma S, Veitch D, Wernham A, Koloydenko A, Puppels G, Nijsten T, Williams HC, Caspers P, Notingher I. Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma. BIOMEDICAL OPTICS EXPRESS 2021; 12:2015-2026. [PMID: 33996213 PMCID: PMC8086475 DOI: 10.1364/boe.417896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 05/31/2023]
Abstract
We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis "tumour clear yes/no" during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting.
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Affiliation(s)
- Radu Boitor
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Coen de Wolf
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Frank Weesie
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Dustin W. Shipp
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Sandeep Varma
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - David Veitch
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - Aaron Wernham
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - Alexey Koloydenko
- Mathematics Department, Royal Holloway University of London, Egham, TW20 OEX, United Kingdom
| | - Gerwin Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
- RiverD International B.V., Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Hywel C. Williams
- Centre for Evidence Based Dermatology, Nottingham University Hospital NHS Trust, QMC Campus, Derby Road, Nottingham NG7 2UH, United Kingdom
| | - Peter Caspers
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
- RiverD International B.V., Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Ioan Notingher
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
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20
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van Egmond S, Wakkee M, Hoogenraad M, Korfage IJ, Mureau MAM, Lugtenberg M. Complex skin cancer treatment requiring reconstructive plastic surgery: an interview study on the experiences and needs of patients. Arch Dermatol Res 2021; 314:25-36. [PMID: 33611719 PMCID: PMC8741685 DOI: 10.1007/s00403-021-02204-3] [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: 09/26/2020] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
To provide patient-centered care, it is essential to explore what patients consider important and to adjust care accordingly. This may specifically be relevant for patients with complex skin cancer, for whom the care process is often more complicated and psychological and social problems may play a larger role. The objective was to explore the experiences and needs of patients who had undergone surgical treatment by a dermatologist for a complex skin cancer with a subsequent reconstruction by a plastic surgeon. An interview study was conducted among 16 patients who had undergone surgical treatment by a dermatologist and reconstruction by a plastic surgeon for basal cell carcinoma, cutaneous squamous cell carcinoma, or lentigo maligna. The interviews focused on patients’ experiences and needs regarding care using a predefined topic list. All interviews were audio-taped, transcribed verbatim and inductively analyzed using Atlas.ti. Patients reported a need for a skilled and friendly physician who tailors information and communication to their individual situation. A need for continuity of care and improved collaboration between healthcare providers was also emphasized. Furthermore, patients experienced complications and unmet expectations and expressed a need for shared decision-making at various steps throughout the treatment process (depending on age). Patients also considered completeness of tumor removal, follow-up visits with multiple specialists to be planned the same day and recognition of the psychological impact of the disease on the partner important. To improve patient-centered care for complex skin cancer patients, more efforts should be directed towards improving continuity of care and collaboration. Furthermore, it is advocated for physicians to be sensitive to the individual needs of patients and their partner and adjust information, communication and (supportive) care accordingly.
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Affiliation(s)
- Sven van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marit Hoogenraad
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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21
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Surmanowicz P, Sivanand A, Du AX, Mahmood MN, Gniadecki R. Muffin Technique Micrographic Surgery for Non-melanoma Skin Cancer. Front Med (Lausanne) 2021; 7:637223. [PMID: 33553223 PMCID: PMC7859636 DOI: 10.3389/fmed.2020.637223] [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: 12/03/2020] [Accepted: 12/29/2020] [Indexed: 01/31/2023] Open
Abstract
Background: Mohs micrographic surgery (MMS) is the gold standard treatment for high-risk facial non-melanoma skin cancer. However, patients' access to MMS is limited by cost. The muffin technique micrographic surgery (MTMS) is an alternative micrographic technique wherein the entire excised margin is evaluated post-operatively by a pathologist using paraffin-embedded material. Herein, we describe the implementation and the preliminary results of MTMS in an academic dermatology center. Objective: To describe the MTMS and outline its efficacy and safety in a real-world clinical academic setting. Methods: A retrospective chart review was conducted of all patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) who underwent MTMS at the University of Alberta Dermatology Center from June 2016 until July 2019. Results: A total of 69 patients were included (64 BCCs and 5 SCCs). 68.1% of surgeries had clear margins following the first incision, 100% after second round re-excisions. There were no observed cases of tumor recurrence after a median 40 months of follow-up. There were no major adverse events or complications. Conclusions: MTMS is a superior alternative to simple excision of skin cancer by providing full margin control and residual tumor mapping.
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Affiliation(s)
- Philip Surmanowicz
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Arunima Sivanand
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amy X Du
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Muhammad N Mahmood
- Department of Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Gniadecki
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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22
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How We Do It: Optimizing the Histological Mapping of Thin Delicate Tissue in Mohs Micrographic Surgery-The "Paper Cut Technique". Dermatol Surg 2021; 47:133-135. [PMID: 31574027 DOI: 10.1097/dss.0000000000002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Manier KK, Maibach HI. Skin Cancer Knowledge, Awareness, and Perception. ETHNIC SKIN AND HAIR AND OTHER CULTURAL CONSIDERATIONS 2021. [DOI: 10.1007/978-3-030-64830-5_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Indications and Outcomes of Mohs Micrographic Surgery Using a Multidisciplinary Approach: A Decade of Experience. Dermatol Surg 2020; 47:10-15. [DOI: 10.1097/dss.0000000000002467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Kappelin J, Nielsen K, Nilsson F, Bjellerup M, Ahnlide I. Surgical treatment of basal cell carcinoma: a case series on factors influencing the risk of an incomplete primary excision. J Eur Acad Dermatol Venereol 2020; 34:2518-2525. [PMID: 32124503 DOI: 10.1111/jdv.16327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer form, and one first-line treatment is surgical excision. Complete excision is vital to minimize risk of recurrence. Studies on occurrence of incomplete excisions have given diverse results and seldom include large populations from a dermatological setting. OBJECTIVES The rate of positive surgical margins in primary surgery of BCC at a tertiary dermatology clinic is studied. Factors associated with an incomplete primary excision are analysed. METHODS Patients scheduled for standard excision, without perioperative margin control, of BCC during the years 2008-2015 were prospectively enrolled in the study. Tumour-specific factors, including histopathologic subtype, as well as postoperative outcome were registered. Incomplete excisions were analysed in relation to patient- and tumour-related factors. RESULTS In total, 4.6% of 3911 BCC tumours were incompletely excised. The rate of incomplete excisions was higher for facial tumours and among tumours with an aggressive histological subtype. Morpheiform BCC on the nose or ear had the highest rate of an incomplete excision, 61.5% and 50%, respectively. CONCLUSIONS Most BCCs, irrespective of subtype, were completely excised during the primary excision. Tumour sites nose and ears were associated with the highest rate of positive primary surgical margins, especially for infiltrative or morpheiform BCCs. Surgery with perioperative examination of margins is strongly recommended for these tumours.
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Affiliation(s)
- J Kappelin
- Department of Clinical Sciences Helsingborg and Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden.,Helsingborg Hospital, Helsingborg, Sweden
| | - K Nielsen
- Department of Clinical Sciences Helsingborg and Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden.,Helsingborg Hospital, Helsingborg, Sweden.,Skåne University Hospital, Lund, Sweden
| | - F Nilsson
- Clinical Pharmacology, Lund University, Lund, Sweden
| | - M Bjellerup
- Department of Clinical Sciences Helsingborg and Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden
| | - I Ahnlide
- Department of Clinical Sciences Helsingborg and Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden.,Helsingborg Hospital, Helsingborg, Sweden
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Somé OR, Diallo M, Konkobo D, Belemlilga GLH, Yabré N, Konségré V, Zaré C. Darier and Ferrand's dermatofibrosarcoma: A carcinologic and cosmetologic challenge in a low-income country. Bull Cancer 2020; 107:328-332. [PMID: 32059813 DOI: 10.1016/j.bulcan.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.
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Affiliation(s)
- Ollo Roland Somé
- CHU de Sourô-Sanou, service de chirurgie générale et digestive, Bobo-Dioulasso, Burkina-Faso.
| | - Malick Diallo
- CHU de Sourô-Sanou, service d'orthopédie traumatologie, Bobo-Dioulasso, Burkina-Faso
| | - Damien Konkobo
- Institut du cancer, Hôpital Aristide le Dantec, Dakar, Senegal
| | | | - Nassirou Yabré
- CHU de Sourô-Sanou, service de chirurgie générale et digestive, Bobo-Dioulasso, Burkina-Faso
| | - Valentin Konségré
- CHU de Sourô-Sanou, service d'anatomopathologie, Bobo-Dioulasso, Burkina-Faso
| | - Cryprien Zaré
- CHU de Sourô-Sanou, service de chirurgie générale et digestive, Bobo-Dioulasso, Burkina-Faso
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Predictive Value of Preoperative Periocular Skin Cancer Measurements for Final Mohs Defect Size. Ophthalmic Plast Reconstr Surg 2020; 35:604-608. [PMID: 31206459 DOI: 10.1097/iop.0000000000001421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relationship between pre-Mohs skin cancer lesion measurements with the post-Mohs defect size in order to most accurately estimate post-Mohs defect size. METHODS This is a retrospective analysis of patients who underwent Mohs excision by one of 3 Mohs surgeons followed by reconstruction for basal cell carcinoma or squamous cell carcinoma of the eyelid. The study included all patients from January 2011 to May 2018 operated on by a single oculoplastic surgeon (R.M.) at the University of Texas Southwestern Medical Center. Maximum horizontal and vertical (H/V) dimensions were determined clinically by Mohs surgeons at the time of excision and photographs of the lesion and defect size were analyzed in order to determine the total area of the lesion preoperatively and the defect postoperatively with Image J using H/V dimensions and the area tracing function. RESULTS Forty-two patients with periocular skin cancers underwent Mohs resection followed by reconstruction. The Mohs defect was overall 4.88 times the size of the preoperative skin cancer measurement using maximum H/V dimensions by Mohs surgeons (p < 0.0001). When using Image J, the area of the Mohs defect was 6.5 times the size of the preoperative lesion (p < 0.0001) using both the maximum H/V dimensions and the area tracing function. There was a statistically significant difference between the Image J area tracing and area determined with H/V dimensions by both the Mohs surgeon and Image J. CONCLUSIONS Postoperative Mohs defect size can be estimated based on maximum H/V dimensions clinically or with Image J technology. Image J digital photograph analysis using the area tracing function more accurately determines the pre-Mohs lesion size and the post-Mohs defect area when compared with standard maximum H/V measurements and digital photographic analysis of maximum H/V measurements with Image J.The preoperative periocular skin cancer measurements can assist in determining the post-Mohs defect size.
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Mohs Micrographic Surgery for the Treatment of External Ear Melanoma: an Outcome Study. Dermatol Surg 2019; 46:995-1003. [DOI: 10.1097/dss.0000000000002229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bailey A, Vasicek B, Tao J, Janeczek M, Mitri A, Tung R. Management of keratinocyte carcinoma - Special considerations in the elderly. Int J Womens Dermatol 2019; 5:235-245. [PMID: 31700979 PMCID: PMC6831749 DOI: 10.1016/j.ijwd.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 02/06/2023] Open
Abstract
Keratinocyte carcinomas (KCs) are now an epidemic in The United States of America, especially in elderly patients. KCs, including basal cell carcinoma and squamous cell carcinoma, can lead to disfigurement and occasionally death. However, the lower mortality rate associated with KC compared with melanoma allows for increased flexibility in the selection of treatment. Flexibility in treatment is particularly important in the elderly given that this patient population often has medical comorbidities that should be considered. These patients may have multiple KCs, higher risk tolerance to recurrence, and different concerns about cosmetic outcomes compared with their younger counterparts. We review treatment options for KCs and how the selection of each option may affect the elderly patient.
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Affiliation(s)
- Alison Bailey
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Brooke Vasicek
- Loyola University Chicago, Division of Dermatology, Chicago, Illinois
| | - Joy Tao
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Monica Janeczek
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Andia Mitri
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Rebecca Tung
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
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Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review. Dermatol Surg 2019; 46:299-304. [PMID: 31453905 DOI: 10.1097/dss.0000000000002062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery (MMS). Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in MMS. OBJECTIVE To systematically evaluate the efficacy of therapies aimed at reducing perioperative anxiety in MMS. METHODS AND MATERIALS Eligible articles were identified using PubMed MEDLINE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. All available studies investigating interventions to reduce perioperative anxiety during MMS were considered. RESULTS Of the 183 abstracts identified and screened, 5 studies met inclusion criteria. Three studies reported a postintervention reduction in patient anxiety (midazolam, educational video, and personalized music). Two studies reporting on similar interventions did not find an effect. CONCLUSION There is currently limited evidence to support either pharmacologic or nonpharmacologic therapy for alleviation of perioperative patient anxiety in MMS. Midazolam may provide patients a short-term benefit, though any estimate of the effect is very uncertain. Personalized music may be a promising nonpharmacologic intervention for future research.
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Cabrera S, Smith S, Ryman W. Synoptic reporting in Mohs micrographic surgery. Australas J Dermatol 2019; 61:43-45. [PMID: 31429917 DOI: 10.1111/ajd.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
There is currently no standardised reporting format for Mohs surgery with its operation reports mostly written in a narrative form making them prone to unintentional errors and omission of necessary data. Synoptic histology reporting is used to describe excised skin cancers such as melanomas and, more recently, squamous cell and basal cell carcinomas. Since Mohs surgery is utilised as the gold standard treatment for locally invasive squamous and basal cell carcinomas, we propose the use of our model of synoptic reporting to ensure the completeness and consistency of Mohs surgery operation reports.
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Affiliation(s)
- Samantha Cabrera
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Saxon Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - William Ryman
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Sharp Debulking and Nonbeveled Layers in Mohs Micrographic Surgery, A Video Walkthrough: How We Do It. Dermatol Surg 2019; 46:1338-1339. [PMID: 31343444 DOI: 10.1097/dss.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bai Y, Wang G, Fu W, Lu Y, Wei W, Chen W, Wu X, Meng H, Feng Y, Liu Y, Li G, Wang S, Wang K, Dai J, Li H, Li M, Huang J, Li Y, Wei S, Yuan J, Yao P, Miao X, He M, Zhang X, Yang H, Wu T, Guo H. Circulating essential metals and lung cancer: Risk assessment and potential molecular effects. ENVIRONMENT INTERNATIONAL 2019; 127:685-693. [PMID: 30991224 DOI: 10.1016/j.envint.2019.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Essential metals play important roles in the carcinogenic process. However, seldom longitudinal investigations have evaluated their roles in lung cancer development. We aimed to investigate the associations between multiple essential metals and lung cancer incidence and to explore the potential mechanisms. METHODS A nested case-control study of 440 incident lung cancer cases and 1:3 frequency matched 1320 healthy controls from the Dongfeng-Tongji Cohort was conducted. The baseline plasma concentrations of 11 essential metals (cobalt, copper, iron, manganese, molybdenum, rubidium, selenium, strontium, stannum, vanadium, and zinc) were measured, and their associations with lung cancer incidence were estimated. Effect of positive metal (zinc) on 4-year telomere attrition was then evaluated among an occupational cohort of 724 workers. We also assessed the transcriptional regulation effects of plasma zinc on mRNA expression profiles, and the expressions of zinc-related genes were further compared in pair-wised lung tumor and normal tissues. RESULTS Elevated plasma level of zinc was associated with lower incident risk of lung cancer [OR (95% CI) = 0.89 (0.79, 0.99)] and decreased 4-year telomere attrition [β (95% CI) = -0.73 (-1.27, -0.19)]. These effects were pronounced among males. In particularly, zinc could regulate the expressions of 8 cancer-related genes, including SOD1, APE, TP53BP1, WDR33, LAPTM4B, TRIT1, HUWE1, and ZNF813, which were over-expressed in lung tumor tissues. CONCLUSIONS We propose that high plasma zinc could prevent incident lung cancer, probably by slowing down telomere attrition and regulating the expressions of cancer-related genes. These results provided a new insight into lung cancer prevention.
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Affiliation(s)
- Yansen Bai
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gege Wang
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshan Fu
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjun Lu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Wei
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weilin Chen
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiulong Wu
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Meng
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Feng
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuhang Liu
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guyanan Li
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suhan Wang
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juanxiu Dai
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hang Li
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengying Li
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yangkai Li
- Department of Thoracic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Yao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Miao
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meian He
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Handong Yang
- Department of Cardiovascular Disease, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Guo
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Sun CK, Kao CT, Wei ML, Chia SH, Kärtner FX, Ivanov A, Liao YH. Slide-free imaging of hematoxylin-eosin stained whole-mount tissues using combined third-harmonic generation and three-photon fluorescence microscopy. JOURNAL OF BIOPHOTONICS 2019; 12:e201800341. [PMID: 30636033 DOI: 10.1002/jbio.201800341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 01/09/2019] [Indexed: 05/24/2023]
Abstract
Intraoperative margin assessment of surgical tissues during cancer surgery is clinically important, especially in the case of tissue conserving surgery like Mohs micrographic surgery in which minimization of the surgical area is considered crucial. Frozen pathology is the gold standard of assessing excised tissues for signs of remaining cancerous lesions. The current protocol, however, is time-consuming and labor-intensive. Instead of the complex frozen sectioning, staining, and traditional white light microscopy imaging protocol, optically sectioned histopathological imaging of hematoxylin-eosin stained whole-mount skin tissues with a subfemtoliter resolution is demonstrated by using nonlinear microscopy in this study. With our proposed method, the reagents of staining and the contrast of imaging are fully consistent with the current clinical standard of frozen pathology, thus facilitating rapid intraoperative assessment of surgical tissues for future applications. Image: Slide-free nonlinear microscopy imaging of H&E stained whole-mount skin tissue showing the morphology of sweat glands.
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Affiliation(s)
- Chi-Kuang Sun
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chien-Ting Kao
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ming-Liang Wei
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Shih-Hsuan Chia
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
- Physics Department, University of Hamburg and the Hamburg Center for Ultrafast Imaging, Hamburg, Germany
| | - Franz X Kärtner
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
- Physics Department, University of Hamburg and the Hamburg Center for Ultrafast Imaging, Hamburg, Germany
| | - Anatoly Ivanov
- Federal Scientific Research Center of Crystallography and Photonics, Russian Academy of Sciences, Moscow, Russia
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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The role of EGFR overexpression on the recurrence of basal cell carcinomas with positive surgical margins. Gene 2018; 687:35-38. [PMID: 30419251 DOI: 10.1016/j.gene.2018.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) expression may have role on recurrence of basal cell carcinoma (BCC) with positive surgical margin(s). OBJECTIVE The aim was to investigate the role of genetic expression changes of EGFR on recurrence rates in patients in follow up with surgically excised BCC with positive surgical margin(s). METHODS Thirty-four surgical margin-positive BCC lesions that were closely followed up without an immediate reoperation were included in this study. Real-time polymerase chain reaction (PCR) was performed from the both healthy and tumoral tissue samples. RESULTS EGFR was expressed at a significantly higher rate in tumoral tissues compared to healthy tissues (p < 0,05). In patients with recurrence lesions, EGFR expression was 6,66 times higher compared to patients with non-recurrent. Also, there was statistically significant difference EGFR expression for infiltrative subtypes (p < 0,05). CONCLUSION Our study focuses on the role of EGFR overexpression specifically and outcomes for recurrent and infiltrative subtyped lesions are significant for both clinic and pathogenesis of BCC. Similar studies have to be performed with high numbered patient groups.
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Moon Y, Han JH, Choi JH, Shin S, Kim YC, Jeong S. Mapping of cutaneous melanoma by femtosecond laser-induced breakdown spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2018; 24:1-6. [PMID: 30315643 PMCID: PMC6975237 DOI: 10.1117/1.jbo.24.3.031011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
Surgical excision (Mohs micrographic surgery) is the standard procedure to treat a melanoma, in which an in situ histologic examination of sectioned skin is carried out repeatedly until no cancer cells are detected. The possibility to identify melanoma from the surrounding skin by femtosecond laser-induced breakdown spectroscopy (fs-LIBS) is investigated. For experiments, melanoma induced on a hairless mouse by injection of B16/F10 murine melanoma cell was sampled in the form of frozen tissue sections as in Mohs surgery and analyzed by fs-LIBS (λ = 1030 nm, τ = 550 fs). For analysis, the magnesium signal normalized by carbon intensity was utilized to construct an intensity map around the cancer, including both melanoma and surrounding dermis. The intensity map showed a close match to the optically observed morphological and histological features near the cancer region. The results showed that when incorporated into the existing micrographic surgery procedure, fs-LIBS could be a useful tool for histopathologic interpretation of skin cancer possibly with significant reduction of histologic examination time.
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Affiliation(s)
- Youngmin Moon
- Gwangju Institute of Science and Technology, School of Mechanical Engineering, Gwangju, Republic of Korea
| | - Jung Hyun Han
- Gwangju Institute of Science and Technology, School of Life sciences, Gwangju, Republic of Korea
- Saint John of God Hospital, Department of Dermatology, Gwangju, Republic of Korea
| | - Jang-hee Choi
- Gwangju Institute of Science and Technology, School of Mechanical Engineering, Gwangju, Republic of Korea
| | - Sungho Shin
- Gwangju Institute of Science and Technology, School of Mechanical Engineering, Gwangju, Republic of Korea
| | - Yong-Chul Kim
- Gwangju Institute of Science and Technology, School of Life sciences, Gwangju, Republic of Korea
| | - Sungho Jeong
- Gwangju Institute of Science and Technology, School of Mechanical Engineering, Gwangju, Republic of Korea
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Dosimetric characterization and commissioning of a superficial electronic brachytherapy device for skin cancer treatment. NUCLEAR ENGINEERING AND TECHNOLOGY 2018. [DOI: 10.1016/j.net.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tokede O, Jadotte YT, Nkemjika S, Holly C, Cohen P, Schwartz R, Watkins A, Dellavalle R. Effectiveness of Mohs micrographic surgery for nonmelanoma skin cancer: a systematic review protocol. ACTA ACUST UNITED AC 2018; 15:666-675. [PMID: 28267028 DOI: 10.11124/jbisrir-2016-002997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVES/QUESTIONS The objective of the review is to evaluate the effectiveness of Mohs micrographic surgery on the mortality, recurrence and quality of life of patients with nonmelanoma skin cancers when compared with other treatment modalities.Specifically, it aims to examine the effectiveness of Mohs micrographic surgery compared with other treatment modalities such as excisional surgery, curettage and electrodessication and radiation therapy, as well as nonsurgical/chemotherapeutic interventions such as topical 5-fluorouracil and imiquimod immunotherapy in the management of nonmelanoma skin cancers.
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Affiliation(s)
- Oluwatosin Tokede
- 1Rutgers School of Social Work, Rutgers University, New Brunswick, New Jersey, USA 2Division of Nursing Science, School of Nursing, Rutgers University, Newark, New Jersey, USA 3The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence, Rutgers University, Newark, New Jersey, USA 4Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA 5School of Public Health, Faculty of the Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 6Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA 7Division of Entry to Baccalaureate Practice, School of Nursing, Rutgers University, Newark, New Jersey, USA 8VA New Jersey Health Care System, East Orange, New Jersey, USA 9Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA 10John Cotton Dana Library, Rutgers University, Newark, New Jersey, USA 11Denver Veteran Affairs Medical Center, Denver, Colorado, USA 12Department of Dermatology, School of Medicine, University of Colorado, Denver, Colorado, USA
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Le ST, Kamal HY, Khachemoune A. Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups. Pediatr Dermatol 2018; 35:434-440. [PMID: 29575263 DOI: 10.1111/pde.13460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.
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Affiliation(s)
- Stephanie T Le
- Drexel/Hahnemann University Hospital, Philadelphia, PA, USA
| | | | - Amor Khachemoune
- State University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, NY, USA
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A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location. Dermatol Surg 2018; 45:36-43. [PMID: 29894432 DOI: 10.1097/dss.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical scar length is a common concern among patients undergoing Mohs micrographic surgery (MMS). OBJECTIVE This study evaluates 3 metrics of preoperative lesion size to determine which correlates best with primary linear closure lengths for nonmelanoma skin cancers (NMSCs) treated with MMS. This metric is then used to develop predictive models for linear closure lengths in 10 different anatomical regions. MATERIALS AND METHODS A retrospective study of 4,049 NMSCs treated with MMS and repaired with primary linear closure was conducted. Primary closure lengths were plotted against preoperative lesion circumference, area, and short axis length. Linear regression analysis was performed. RESULTS Preoperative NMSC circumference correlated best with closure length. Twenty-one of the 28 regression models had coefficients of determination (R) above 0.5. Closure lengths increased by 0.52 to 1.1 mm, depending on location, for every millimeter increase in preoperative NMSC circumference. CONCLUSION Preoperative lesion circumference is directly proportional to primary closure length and is a better indicator of closure length than preoperative area and short axis for MMS of NMSCs. Closure lengths located on the nasal tip, supratip, or periocular areas are most sensitive to differences in NMSC size. These data might aid Mohs surgeons with preoperative planning for wound reconstruction and patient counseling.
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Quintanilla-Dieck J, Bichakjian CK, Durham AB. Mohs Micrographic Surgery for Treatment of Non-melanoma Skin Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fantini BDC, Bueno Filho R, Chahud F, Souza CDS. Appropriate use criteria for basal cell carcinoma Mohs surgery at a single center in the face of high-burden skin cancer: a retrospective cohort study. J DERMATOL TREAT 2018; 30:74-80. [PMID: 29727201 DOI: 10.1080/09546634.2018.1468868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) promotes high cure rates, but accessibility to MMS is limited in distinctive realities and countries. OBJECTIVE We sought to verify applicable criteria for MMS indication and prioritization regarding basal cell carcinoma (BCC) in the face of various limitations. METHODS We analyzed MMS-excised BBC, without patient exclusion, through a retrospective cohort study at a single university center. RESULTS Mohs micrographic surgery was performed in 101 BCCs, average size = 5.44 ± 11.91 cm2, 56.44% ≥ 20 mm. Most BCCs were in the H-zone (87.13%) and on the nose (52.47%). Histology showed high-risk pattern in most of tumors (69.31%), primary (64.71%), and recurrent (74.0%) BCC. Nasal (p = .01) and recurrent BCC (p = .03) had increased risk for two or more MMS stages. Appropriate use criteria were considered for all cases of BCC removed by a single stage (60.40%), two or more stages (39.60%), and three or more MMS stages (10.89%). The latter two conditions were associated with a higher number of MMS criteria (p = .02; p = .03, respectively). CONCLUSIONS All excised BCCs fulfilled criteria for MMS indication, among them recurrent and nasal BCCs stood out. The greater number of criteria may be a predictive factor for subclinical extension and can help prioritize indications for MMS.
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Affiliation(s)
- Bruno de Carvalho Fantini
- a Division of Dermatology, Department of Internal Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Roberto Bueno Filho
- a Division of Dermatology, Department of Internal Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Fernando Chahud
- b Department of Pathology , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Cacilda da Silva Souza
- a Division of Dermatology, Department of Internal Medicine , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
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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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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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Treatment Patterns, Outcomes, and Patient Satisfaction of Primary Epidermally Limited Nonmelanoma Skin Cancer. Dermatol Surg 2017; 43:1423-1430. [DOI: 10.1097/dss.0000000000001225] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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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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49
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Characterization of Surgical Procedures in the Spanish Mohs Surgery Registry (REGESMOHS) for 2013-2015. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Peck M, Yiasemides E, Badrick T. An Australian Mohs external quality assurance program. Australas J Dermatol 2017; 59:e138-e142. [PMID: 28731506 DOI: 10.1111/ajd.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Martyn Peck
- Royal College of Pathologists of Australasia Quality Assurance Programs, Sydney, New South Wales, Australia
| | - Eleni Yiasemides
- Southderm Southern Suburbs Dermatology, Kogarah, New South Wales, Australia
| | - Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, Sydney, New South Wales, Australia
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