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Pakhchanian H, Aizman L, Raiker R, Ng E. Top 100 Most Cited Articles in Mohs Micrographic Surgery: A Bibliometric Analysis. Dermatol Surg 2024; 50:137-143. [PMID: 37994504 DOI: 10.1097/dss.0000000000004023] [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: 11/24/2023]
Abstract
BACKGROUND Bibliometric analysis is a scientific method that can derive insights into major publications' trends within a field. Currently, no bibliometric study has been conducted for Mohs micrographic surgery (MMS). OBJECTIVE To characterize the most frequently cited articles in MMS. METHODS Web of Science was used to identify the 100 most cited publications on MMS between 1970 and 2022. Articles were analyzed by title, authorship, institution, journal, year, citation frequency, originating country, funding, citation index, Altmetric score, impact factor, Eigenfactor score, and article influence score. RESULTS Since January 2023, the top 100 articles had 9,096 total citations, ranging from 47 to 304. The top cited publication was "Mohs surgery is the treatment of choice for recurrent (previously treated) basal-cell carcinoma" in 1989. The top contributing organization was Harvard University (17%) and top contributing authors were Brodland, DJ (12%) and Zitelli, JA (11%). The year 2005 accounted for most of the articles (12%). Most articles were from the Journal of the American Academy of Dermatology (32%) and Dermatologic Surgery (27%). The United States contributed to 76% of the top articles. CONCLUSION This bibliometric analysis offers researchers a detailed overview of important MMS publications and provides useful data into current findings steering MMS research and practice.
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Affiliation(s)
- Haig Pakhchanian
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Leora Aizman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rahul Raiker
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Elise Ng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chen R, Krueger S, Flahive J, Mahmoud BH. Wound Care Adherence in Mohs Micrographic Surgery: A Prospective Cohort Study. Dermatol Surg 2023; 49:921-925. [PMID: 37506091 DOI: 10.1097/dss.0000000000003889] [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: 07/30/2023]
Abstract
BACKGROUND Patients undergoing Mohs micrographic surgery (MMS) are given detailed wound care instructions to prevent postoperative complications. Previous studies have revealed low treatment adherence in general dermatology, but adherence to postoperative wound care and its potential association with poor surgical outcomes remain largely unstudied. OBJECTIVE To determine the frequency and causes of wound care nonadherence in patients who underwent MMS. MATERIALS AND METHODS A questionnaire containing a modified Eight-Item Morisky Medication Adherence Measure Scale was administered to Mohs patients at their 1 to 2 weeks postoperative visit. RESULTS Sixty-three patients were solicited and consented to completing the questionnaire. The average modified Eight-Item Morisky Medication Adherence Measure Scale score was 7.4 of 8, indicating high adherence. Old age and wound care assistance were associated with increased adherence. Factors contributing to nonadherence included feeling well, being too busy, wound care causing discomfort, and being with friends or family. One patient (1.6%) with high adherence developed an epidermal inclusion cyst within the scar. No other complications were observed. CONCLUSION Most MMS patients demonstrated high adherence to wound care instructions, and nonadherence was not associated with postoperative complications.
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Affiliation(s)
- Ryan Chen
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Steven Krueger
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Julie Flahive
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bassel H Mahmoud
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Pashazadeh A, Boese A, Castro NJ, Hutmacher DW, Friebe M. A new 3D printed applicator with radioactive gel for conformal brachytherapy of superficial skin tumors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6979-6982. [PMID: 31947444 DOI: 10.1109/embc.2019.8856407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Surface brachytherapy is an effective method in the treatment of skin cancer. Current skin brachytherapy techniques are based on the placement of a source of gamma or X-ray photons in a close distance from the skin to irradiate the lesion. Due to the nature of photons, radiation dose in these methods may affect healthy tissue as well as sensitive structures around the target. In order to minimize unwarranted and incidental exposure, we propose a new skin brachytherapy applicator based upon beta particles which have penetration ranges of a few millimeters in tissue. The proposed concept is radioactive gel housed within a pre-designed tumor-specific applicator matching the topology of the skin lesion. The particles mixed with the gel showed a uniform distribution pattern, which is an essential prerequisite in having a uniform dose profile on the skin surface. Based on the dose calculation data from the proposed concept, the dose delivered to the depth of 4500 μm in skin tissue is 10% of the dose delivered to the surface of the tumor, making it suitable is treating thin skin tumors especially when located on top of the bone. Through the innovative combination of radioactive gel and tumor-specific applicator, the radiation entering the skin surface can be personalized while minimizing the adverse effects of undesired exposure to the surrounding healthy tissue.
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Pashazadeh A, Robatjazi M, Castro NJ, Friebe M. A multiwell applicator for conformal brachytherapy of superficial skin tumors: A simulation study. Skin Res Technol 2019; 26:537-541. [DOI: 10.1111/srt.12826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/15/2019] [Accepted: 12/08/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Ali Pashazadeh
- Chair for intelligent catheter and image guided procedures Otto von Guericke University Magdeburg Magdeburg Germany
| | - Mostafa Robatjazi
- Department of Medical Physics and Radiological Sciences Sabzevar University of Medical Sciences Sabzevar Iran
| | - Nathan J. Castro
- Joint Quantum Institute and Physical Measurements Laboratory NIST/University of Maryland Gaithersburg MD USA
| | - Michael Friebe
- Chair for intelligent catheter and image guided procedures Otto von Guericke University Magdeburg Magdeburg Germany
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Cocks MM. A challenging and rewarding time: The early days of graduate medical education in dermatology. JOURNAL OF MEDICAL BIOGRAPHY 2019; 27:173-178. [PMID: 28972437 DOI: 10.1177/0967772017732863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Specialized residency training was still in its infancy in mid-20th century America. While specialty boards in various fields such as ophthalmology and otolaryngology had been established in the 1920s and 1930s, the details of training programs were still being fine-tuned and formal curricula were lacking. In dermatology, three prominent physicians including Harry L. Arnold Jr., J. Lamar Callaway and Walter B. Shelley trained during these experimental days of medical education. Each of them captured personal reflections of their own training experiences in brief memoirs published in scientific journals. A closer examination of these texts provides unique insights into how dermatology subspecialty training in particular and medical education more broadly evolved during this period.
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Papac N, Collins L. The female pioneers in Mohs micrographic surgery. Int J Womens Dermatol 2018; 5:18-20. [PMID: 30809574 PMCID: PMC6374705 DOI: 10.1016/j.ijwd.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- N. Papac
- The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - L. Collins
- Department of Dermatology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Corresponding author. The University of Oklahoma Health Sciences Center, 619 NE 13 Street, Oklahoma City, OK 73104.
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8
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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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Zinc as a possible preventive and therapeutic agent in pancreatic, prostate, and breast cancer. Eur J Cancer Prev 2016; 25:457-61. [DOI: 10.1097/cej.0000000000000194] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bobotsis R, Guenther L. How Mohs Surgery Transformed Into a First-Line Treatment of Skin Cancer. J Cutan Med Surg 2016; 21:40-41. [PMID: 27381921 DOI: 10.1177/1203475416658289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mohs surgery is considered ideal treatment for many types of skin cancers. Developed by Dr Frederic Edward Mohs (1910-2002), Mohs surgery allows all surgical margins to be viewed microscopically, ensuring no cancer cells go unremoved, yet it failed to achieve immediate acceptance when first introduced in the 1940s. A catalyst to the widespread acceptance of Mohs surgery occurred with the work of dermatologic colleagues who reported excellent results without using the paste. It suggested the real innovation of Mohs surgery lay in its microscopic control and not the paste, the discontinuation of which removed all the problems associated with its use.
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Affiliation(s)
- Rob Bobotsis
- 1 Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Lyn Guenther
- 2 The Guenther Dermatology Research Centre, London, ON, Canada
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11
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Eberle FC, Kanyildiz M, Schnabl SM, Schulz C, Häfner HM, Adam P, Breuninger H. Dreidimensionale (3D) Histologie im Routineverfahren: praktische Durchführung und deren Evaluation. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12466_suppl] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Franziska Carola Eberle
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
| | - Mukaddes Kanyildiz
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
| | - Saskia Maria Schnabl
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
| | - Claudia Schulz
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
| | - Hans-Martin Häfner
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
| | | | - Helmut Breuninger
- Universitäts-Hautklinik; Eberhard Karls Universität Tübingen; Universitätsklinikum; Tübingen
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12
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Eberle FC, Kanyildiz M, Schnabl SM, Schulz C, Häfner HM, Adam P, Breuninger H. Three dimensional (3D) histology in daily routine: practical implementation and its evaluation. J Dtsch Dermatol Ges 2014; 12:1028-35. [PMID: 25354011 DOI: 10.1111/ddg.12466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/04/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The continuous evaluation of the edges of a tumor by means of three-dimensional (3D) histology often appears complicated and require the surgeon and dermatopathologist to work together closely. We present clear rules that allow communication between all parties involved and then verify their application in daily routine. METHODS Tissue processing, interpretation of results, as well as communication between the surgeon and the dermatopathologist are based on an algorithm with the aid of exact times and embedding cassettes, which allow precise topographic orientation. We evaluated the use of this method in daily clinic practice, taking into account 947 operated basal cell carcinomas in regard to the development of recurrent tumors. RESULTS At a median follow-up of 47 months, 10 of the 947 operated basal cell carcinomas (1.1 %) recurred. Sclerodermiform basal cell carcinomas and basal cell carcinomas which could not be curatively resected (R0 resection) during the initial surgery showed a significantly higher recurrence rate (p < 0.05 and p < 0.001). CONCLUSIONS Standardized rules for dealing with excised tissue allow an effective application of 3D histology in daily clinical practice. 3D histology results in low recurrence rates. Sclerodermiform basal cell carcinomas which could not be curatively resected (R0 resection) were identified as a risk group for the development of recurrent tumors.
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13
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Bernstein JA, Storey ES, Bauer RW. Moh’s micrographic surgery for the management of a periocular mast cell tumor in a dog. Vet Ophthalmol 2012; 16:234-9. [DOI: 10.1111/j.1463-5224.2012.01059.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Aoyagi S, Hata H, Homma E, Shimizu H. Controlling the histological margin for non-melanoma skin cancer conveniently using a double-bladed scalpel. J Surg Oncol 2010; 101:175-9. [DOI: 10.1002/jso.21456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Nehal KS, Tudisco M, Busam KJ. Introduction. Dermatopathology (Basel) 2010. [DOI: 10.1016/b978-0-443-06654-2.00019-6] [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] Open
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16
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Affiliation(s)
- Ellie Rush
- Dental Illustration Unit, Cardiff University, Cardiff, UK.
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17
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Cumberland L, Dana A, Liegeois N. Mohs micrographic surgery for the management of nonmelanoma skin cancers. Facial Plast Surg Clin North Am 2009; 17:325-35. [PMID: 19698914 DOI: 10.1016/j.fsc.2009.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many treatment modalities have been described to address the growing epidemic of nonmelanoma skin cancer (NMSC). Mohs micrographic surgery (MMS) is a surgical technique that allows complete and precise microscopic margin analysis by using horizontal frozen sections. The purpose of MMS is twofold: to ensure definitive excision and to minimize loss of normal surrounding tissue. MMS offers the advantages of superior cure rates and, because tissue removal is minimized, excellent cosmetic outcomes. Therefore, MMS has become the treatment of choice for many high-risk tumors. Because this technique is labor intensive, MMS is not indicated in certain situations. Understanding the indications, advantages, and disadvantages of MMS remains paramount for facial plastic surgeons managing NMSC.
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Affiliation(s)
- Lara Cumberland
- St. Matthew's University School of Medicine, Grand Cayman, Cayman Islands
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Abstract
Since the inception of Mohs micrographic surgery in the 1930s, this technique has proved its utility in the treatment of cutaneous tumors. This review describes the technique of Mohs micrographic surgery and the various indications for which it is used. We discuss the use of Mohs micrographic surgery for the following cutaneous tumors: basal cell carcinoma, squamous cell carcinoma, melanoma in situ, dermatofibrosarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma, atypical fibroxanthoma, and sebaceous carcinoma. Mohs micrographic surgery is cost effective in the U.S. health care system because billing for the surgeon-pathologist and laboratory processing is bundled together. However, Mohs micrographic surgery may be more expensive in European systems because the Mohs technique surgeon, pathologist, and laboratory fees may be billed separately.
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Affiliation(s)
- Krisinda C. Dim-Jamora
- Department of Dermatology, Division of Dermatologic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Jennifer B. Perone
- Department of Dermatology, Division of Dermatologic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Cuevas J, de Eusebio E, Díez E, Castiñeira I. [Mohs micrographic surgery: aplication of this technique to penile neoplasms]. Actas Urol Esp 2008; 31:1076-81. [PMID: 18257374 DOI: 10.1016/s0210-4806(07)73768-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mohs micrographic surgery is a surgical technique that allows the excision in successive layers of cutaneous malignancies with the higher cure rates. At the same time, this surgical technique offers the maximal preservation of normal tissue. That is possible because Mohs surgery provides the advantage of microscopically controlled tumor-free borders in each stage guiding the surgeon in the tumor persistence until the complete surgical excision. Mohs micrographic surgery is a precise treatment for penile neoplasms and its utility is justified because the removal of a substantial surgical margin of normal tissue is obviated. MoHs micrographic surgery is indicated in the treatment of penile verrucous carcinoma due to the significant risk of loco-regional recurrence after conventional surgery. Although infrequent, other penile neoplasms that can benefit from Mohs micrographic surgery are: basal cell carcinoma, extrammamary Paget's disease, in situ melanoma and granular cell tumor.
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Moehrle M, Breuninger H, Röcken M. A confusing world: what to call histology of three-dimensional tumour margins? J Eur Acad Dermatol Venereol 2007; 21:591-5. [PMID: 17447971 DOI: 10.1111/j.1468-3083.2007.02187.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Complete three-dimensional histology of excised skin tumour margins has a long tradition and, unfortunately, a multitude of names as well. Mohs, who introduced it, called it 'microscopically controlled surgery'. Others have described it as 'micrographic surgery', 'Mohs' micrographic surgery', or simply 'Mohs' surgery'. Semantic confusion became truly rampant when variant forms, each useful in its own way for detecting subclinical outgrowths of malignant skin tumours, were later introduced under such names as histographic surgery, systematic histologic control of the tumour bed, histological control of excised tissue margins, the square procedure, the perimeter technique, etc. All of these methods are basically identical in concept. All involve complete, three-dimensional histological visualization and evaluation of excision margins. Their common goal is to detect unseen tumour outgrowths. For greater clarity, the authors of this paper recommend general adoption of '3D histology' as a collective designation for all the above methods. As an added advantage, 3D histology can also be used in other medical disciplines to confirm true R0 resection of, for example, breast cancer or intestinal cancer.
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Affiliation(s)
- M Moehrle
- Department of Dermatology, University Hospital, Eberhard-Karls-University, Tübingen, Germany.
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Bernstein JA, Hodgin EC, Holloway HW, Hedlund CS, Storey ES, Hubert JD. Mohs micrographic surgery: a technique for total margin assessment in veterinary cutaneous oncologic surgery. Vet Comp Oncol 2006; 4:151-60. [DOI: 10.1111/j.1476-5829.2006.00104.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Tilleman TR, Tilleman MM, Neumann MHA. Minimal bevelling angle in Mohs micrographic surgery cut: a 10 degrees angle is sufficient. Br J Dermatol 2005; 152:1081-3. [PMID: 15888185 DOI: 10.1111/j.1365-2133.2005.06569.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fein H, Maytin EV, Mutasim DF, Bailin PL. Topical protease therapy as a novel method of epidermal ablation: preliminary report. Dermatol Surg 2005; 31:139-47; discussion 147-8. [PMID: 15762204 DOI: 10.1111/j.1524-4725.2005.31034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND For more than 50 years, proteolytic enzymes have been extensively used in laboratory settings for the purposes of in vitro epidermal separation and keratinocyte isolation. However, the topical, in vivo pharmacologic properties of these enzymes are virtually unknown. Previous therapeutic applications for topically applied proteases have been limited to wound debridement. OBJECTIVE To characterize the clinical and histologic effects of topically applied proteases as a method of therapeutic epidermal ablation. MATERIALS AND METHODS SKH-1 hairless mouse and human skin samples were exposed both in vitro and in vivo to varying concentrations of the proteases subtilisin, trypsin, and dispase for different exposure durations. The effects of protease exposure were then assessed by both clinical and histologic examination. RESULTS Exposure of both human and mouse skin samples to topical protease solutions resulted in reproducible, differential patterns of epidermal ablation: subcorneal, intraepidermal, and subepidermal. In a limited study, topical application of trypsin solution resulted in the scar-free ablation of lesions of seborrheic keratosis located on the lower extremity. CONCLUSION Topically applied proteases represent an alternative method of epidermal ablation with several potential advantages over existing techniques. Further studies are needed to delineate ideal enzyme formulations, vehicles, and applications.
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Affiliation(s)
- Howard Fein
- Palos Verdes Dermatology Associates, Rolling Hills Estates, California, and Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California 90274, USA.
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Tilleman TR, Tilleman MM, Neumann MHA. Optimizing the cut in Mohs' micrographic surgery in regard to skin sparing and microscopic view: is a round incision cut necessary? Clin Exp Dermatol 2005; 30:116-9. [PMID: 15725233 DOI: 10.1111/j.1365-2230.2005.01723.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Saucer incision is the common cut in Mohs' micrographic surgery. To date no proof as to the superiority of this cut over other patterns has been presented. In this work we examine the round pattern aspect of the saucer incision and answer two questions: does the round cut provide the best skin-sparing pattern? And, does it provide the best microscopic view? A two-dimensional geometric analysis is used to determine whether a round incision is optimal from the standpoint of skin sparing and microscopic view. Mohs' micrographic surgery views are used to back up the geometric hypothesis. The result is that the round incision pattern is skin-wasteful compared to an incision that follows the cancerous lesion. In the lesion presented here the two cuts have a ratio of 1.5 between the two excised skin areas, indicating a waste of healthy skin of 50%. It is also shown that specimens with a pointed edge provide better layer projection. The conclusion is that a tailored cut following the lesion pattern is the optimal Mohs' incision. Therefore in the first stage of Mohs' micrographic surgery the skin cut should replicate the lesion pattern instead of a round saucer cut. Though many Mohs' surgeons already implement this philosophy, in the literature the saucer incision recommended by Dr. Frederic Mohs' remains the norm.
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Affiliation(s)
- T R Tilleman
- Dermatology Department, Mohs' Unit, Academisch Ziekenhuis Maastricht, The Netherlands.
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Abstract
Mohs micrographic surgery is a highly effective technique for the removal of some skin cancers. The technique is founded on the idea of excision with minimal margins (sparing normal tissue) and immediate histologic examination of horizontal frozen sections of the specimen while the patient waits. By doing this, a Mohs surgeon is able to examine the margins. If residual tumor is present, subsequent excisions are performed until it is completely removed. In cases of aggressive tumors, recurrent tumors, or in which the lesions are present in high-risk anatomic locations (H-zone of the face) or functionally important areas (e.g., digits, genitals), the preferred treatment is Mohs micrographic surgery.
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Affiliation(s)
- Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, School of Medicine, University of Miami, Miami, FL 33136, USA.
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Ratner D. Commentary: New developments in cutaneous oncology. Clin Dermatol 2004; 22:175-7. [PMID: 15262301 DOI: 10.1016/j.clindermatol.2003.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Désirée Ratner
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA.
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28
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Ting PT, Freiman A. MOHS micrographic surgery: a historical overview. J Am Acad Dermatol 2004. [DOI: 10.1016/j.jaad.2003.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVES To describe the clinical and histologic subtypes, pathophysiology, recognition, and treatment options for basal cell and squamous cell carcinoma, and the molecular biology of sunlight-induced carcinogenesis. DATA SOURCES Journal and review articles, research studies, textbooks, and clinical practice. CONCLUSIONS Basal cell and squamous cell carcinoma will occur in more than one million cases annually in the United States, and are highly curable when detected and treated early. During the last decade, significant progress has been made in elucidating the molecular basis of skin carcinogenesis and in identifying newer approaches for the management and treatment of these keratinocyte cancers. IMPLICATIONS FOR NURSING PRACTICE Nurses can play crucial roles in decreasing the morbidity and mortality from the skin cancer epidemic by identifying and referring patients with lesions suspicious for basal cell and squamous cell carcinomas.
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Affiliation(s)
- Nancy Vargo
- Department of Dermatology, Oregon Health & Science University, 3181 SW Sam Jackson Dr, Portland, OR 97201-3098, USA
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Woerle B, Heckmann M, Konz B. Micrographic surgery of basal cell carcinomas of the head. Recent Results Cancer Res 2002; 160:219-24. [PMID: 12079216 DOI: 10.1007/978-3-642-59410-6_25] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Basal cell carcinoma (BCC) is a locally invasive malignant cutaneous tumour with a rising incidence. This tumour can be treated successfully by a variety of techniques, including local excision, radiation, cryotherapy, curettage, electrodessication and laser obliteration. Micrographic surgery is a specialised type of minimal marginal surgery that offers higher cure rates than do other options in the treatment of contiguous skin cancers in selected settings. The horizontal frozen histological sections of the excised tumour permit complete microscopic examination of the surgical margin. Maximum sparing of tumour-free adjacent tissue is achieved with histological mapping of the tumour boundaries, and subsequent wound reconstruction is optimised. Data on topographical distribution, histopathological subtype, subclinical tumour extension, therapeutic procedures required for complete eradication, and recurrence rates were recorded in 3065 BCC of the head. Micrographic surgery is the treatment of choice for large or invasive primary BCC with uncertain clinical boundaries, especially in difficult anatomical regions, for recurrent or re-recurrent BCC, and for tumours with an aggressive histopathological pattern.
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Affiliation(s)
- Birgit Woerle
- Department of Dermatology, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
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Abstract
Merkel cell carcinoma (MCC) is a rare, highly malignant cutaneous tumor, primarily of the head and neck, that requires timely diagnosis, adequate staging, and aggressive therapy. MCC tends to be overlooked in the early stage, has a high propensity for invading local and regional nodal basins, and exhibits a high postoperative recurrence rate, with distant thoracic, abdominal, and central nervous system metastases. Conventional radiography and cross-sectional imaging show lesions similar to those originating from other small cell carcinomas. Nuclear medicine procedures such as sentinel node scintigraphy, somatostatin receptor scintigraphy, and positron emission tomography may be used to supplement judicious cross-sectional imaging evaluation, thereby adding diagnostic value in staging and providing therapeutic guidance. Ultimately, however, the diagnosis relies exclusively on pathologic findings at immunohistochemical staining and electron microscopy. The rarity of MCC and the resulting insufficient awareness of this neoplasm often delay correct identification and treatment, which essentially consists of wide-margin surgical excision of the primary tumor and local and regional radiation therapy. To date, clinical information is still insufficient to fully appreciate the role of imaging in MCC management. A better imaging algorithm is expected with increased awareness and improved clinical understanding of this uncommon skin neoplasm.
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Affiliation(s)
- Ba D Nguyen
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA
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Affiliation(s)
- S N Snow
- Division of Plastic Surgery, Section on Mohs Surgery, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin 53705, USA.
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