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Rauchenwald T, Augustin A, Steinbichler TB, Zelger BW, Pierer G, Schmuth M, Wolfram D, Morandi EM. Resection of Skin Cancer Resulting in Free Vascularized Tissue Reconstruction: Always a Therapeutic Failure? Cancers (Basel) 2023; 15:cancers15092464. [PMID: 37173928 PMCID: PMC10177333 DOI: 10.3390/cancers15092464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
The globally increasing incidence of cutaneous malignancies leads, in parallel, to increasing numbers of locally advanced skin cancer resulting in reconstructive surgery. Reasons for locally advanced skin cancer may be a patient's neglect or aggressive tumor growth, such as desmoplastic growth or perineural invasion. This study investigates characteristics of cutaneous malignancies requiring microsurgical reconstruction with the aim of identifying possible pitfalls and improving diagnostic and therapeutic processes. A retrospective data analysis from 2015 to 2020 was conducted. Seventeen patients (n = 17) were included. The mean age at reconstructive surgery was 68.5 (±13) years. The majority of patients (14/17, 82%) presented with recurrent skin cancer. The most common histological entity was squamous cell carcinoma (10/17, 59%). All neoplasms showed at least one of the following histopathological characteristics: desmoplastic growth (12/17, 71%), perineural invasion (6/17, 35%), or tumor thickness of at least 6 mm (9/17, 53%). The mean number of surgical resections until cancer-free resection margins (R0) were achieved was 2.4 (±0.7). The local recurrence rate and the rate of distant metastases were 36%. Identified high-risk neoplastic characteristics, such as desmoplastic growth, perineural invasion, and a tumor depth of at least 6 mm, require a more extensive surgical treatment without concerns about defect size.
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Affiliation(s)
- Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Angela Augustin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Theresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Bernhard W Zelger
- Private Praxis for Dermatopathology Innsbruck & Zams, 6020 Innsbruck, Tyrol, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Matthias Schmuth
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
| | - Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria
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Coffey M, Edwards D, Anstey S, Gill P, Mann M, Meudell A, Hannigan B. End-of-life care for people with severe mental illness: mixed methods systematic review and thematic synthesis of published case studies (the MENLOC study). BMJ Open 2022; 12:e053223. [PMID: 35193909 PMCID: PMC8867317 DOI: 10.1136/bmjopen-2021-053223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES People with severe mental illness (SMI) have significant comorbidities and reduced life expectancy. The objective of the review reported in this paper was to synthesise material from case studies relating to the organisation, provision and receipt of care for people with SMI who have an end-of-life (EoL) diagnosis. DESIGN Systematic review and thematic synthesis. DATA SOURCES MEDLINE, PsycINFO, EMBASE, HMIC, AMED, CINAHL, CENTRAL, ASSIA, DARE and Web of Science from inception to December 2019. Supplementary searching for additional material including grey literature along with 62 organisational websites. RESULTS Of the 11 904 citations retrieved, 42 papers reporting 51 case studies were identified and are reported here. Twenty-five of the forty-two case study papers met seven, or more quality criteria, with eight meeting half or less. Attributes of case study subjects included that just over half were men, had a mean age of 55 years, psychotic illnesses dominated and the EoL condition was in most cases a cancer. Analysis generated themes as follows diagnostic delay and overshadowing, decision capacity and dilemmas, medical futility, individuals and their networks, care provision. CONCLUSIONS In the absence of high-quality intervention studies, this evidence synthesis indicates that cross disciplinary care is supported within the context of established therapeutic relationships. Attention to potential delay and diagnostic overshadowing is required in care provision. The values and preferences of individuals with severe mental illness experiencing an end-of-life condition should be recognised. PROSPERO REGISTRATION NUMBER CRD42018108988.
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Affiliation(s)
- Michael Coffey
- School of Health and Social Care, Swansea University, Swansea, West Glamorgan, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Anstey
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Mala Mann
- University Library Services, Cardiff University, Cardiff, UK
| | | | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Legrand A, Quintard B, Garrouteigt C, Beylot-Barry M, Broc G. From neglect to earlier diagnosis: a qualitative meta-synthesis of psycho-social factors associated with consultation delay in advanced basal cell carcinoma. PSYCHOL HEALTH MED 2021; 27:1793-1804. [PMID: 34251919 DOI: 10.1080/13548506.2021.1952281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Local malignant potential of basal cell carcinoma (BCC) can lead at advanced stages to the destruction of underlying tissues and significant morbidity. The primary risk factor for progression of advanced basal cell carcinoma (aBCC) is the long duration of the tumour, which results from delay in seeking medical care. To assess the implication of psycho-social factors in the delay before the first medical consultation among patients with aBCC, in order to identify potentially targetable factors enabling earlier diagnosis. Three-step qualitative meta-synthesis: (1) systematic review of the literature; (2) structured qualitative analysis of these documents; (3) construction of a logical model. After screening, 81 articles were included. Self-neglect and denial in patients are roundly put forward as the main obstacles to consultation. We found that avoidance behaviour, mistaken interpretation and banalisation of symptoms, and fear of treatment all played a role. The strongest motivation to seek help comes from the realisation that new symptoms may be dangerous; the role of interpersonal surroundings is highlighted as helpful. Patient delay has multifactorial origins in aBCC, especially self-neglect ranging from denial of tumours to conscious refusal of treatment.
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Affiliation(s)
- A Legrand
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - B Quintard
- INSERM U1219, Bordeaux Population Health Research Centre, Team: Handicap, Activity, Cognition, Health, Bordeaux, France
| | - C Garrouteigt
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - M Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France.,INSERM U1053, UMR Bariton, Oncogenesis of Cutaneous Lymphoma, University of Bordeaux, Bordeaux, France
| | - G Broc
- Department of Psychology, Paul Valéry Montpellier 3, University of Montpellier, Montpellier, France
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Gillanders SL, McHugh A, Hintze J, Donnelly MJ. Erosive rodent ulcer of the ear secondary to neglect. BMJ Case Rep 2020; 13:13/8/e234456. [PMID: 32847871 DOI: 10.1136/bcr-2020-234456] [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] [Indexed: 11/04/2022] Open
Abstract
Basal cell carcinomas (BCCs) are slow-growing, locally invasive lesions that rarely metastasise, however, if left untreated can progress to extensive destruction of local structures giving rise to the alternative name 'the rodent ulcer'. Here we present a case of BCC of the ear progressing to destruction of the pinna and mastoid, involving the facial nerve and breaching dura. This case presentation shows not only the seldom-seen natural progression of the rodent ulcer with impressive imaging and clinical photographs but also highlights a broader topic of capacity and consent in patients displaying maladaptive denial or abnormal illness behaviour, how this can affect patient outcomes and what we as clinicians can do to ensure the best care for our patients.
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Affiliation(s)
- Sarah Louise Gillanders
- ENT, Royal College of Surgeons in Ireland, Dublin, Ireland .,ENT, Waterford University Hospital, Waterford, Ireland
| | - Alison McHugh
- ENT, Waterford University Hospital, Waterford, Ireland
| | - Justin Hintze
- ENT, Royal College of Surgeons in Ireland, Dublin, Ireland
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Andersen RM, Lei U. A massive neglected giant basal cell carcinoma in a schizophrenic patient treated successfully with vismodegib. J DERMATOL TREAT 2015; 26:575-6. [PMID: 25909367 DOI: 10.3109/09546634.2015.1034073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The small molecule vismodegib is a great treatment alternative to patients challenged, e.g. psychiatric disorders, suffering from severe basal cell carcinoma of the skin in which surgery or other treatment modalities is not possible because of patient's wish or condition. We present a case of a 73-year-old schizophrenic patient with a 15-year history of a neglected tumour located at the forehead and scalp, admitted to hospital in a state of inanition because of tumour expansion to the meninges and severe anaemia caused by bleeding, treated successfully with vismodegib.
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Affiliation(s)
- Rosa Marie Andersen
- a Department of Dermato-Allergology , Gentofte Hospital, University of Copenhagen , Hellerup , Denmark
| | - Ulrikke Lei
- a Department of Dermato-Allergology , Gentofte Hospital, University of Copenhagen , Hellerup , Denmark
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Advanced Basal cell carcinoma in a patient with schizoaffective disorder: constraints and management. Ophthalmic Plast Reconstr Surg 2013; 29:e49-51. [PMID: 23235512 DOI: 10.1097/iop.0b013e31826a24cb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The approach used by the authors for managing a patient with a schizoaffective disorder and advanced basal cell carcinoma involving the eyelids, orbit, and face is presented. Complexities included the advanced nature of the disease, neglect of the patient's condition due to schizoaffective disorder, the difficulty of obtaining informed consent, the required aggressive surgical intervention, reconstruction, and the necessary management during the postsurgical period. A multidisciplinary team approach with psychiatry, ophthalmology, ear, nose, and throat, plastic surgery, radiation oncology, oncology, legal, and bioethics specialties is required in patients with cognitive disabilities. Curative treatment requires complete excision, reconstruction, and proper postoperative care, which can be prohibitive in a schizophrenic patient from a surgical and ethical perspective. Staging of this condition after proper informed consent with biopsy, computed tomography, and magnetic resonance imaging is presented. The options for management are discussed, including surgical intervention and palliative care.
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Mannor GE, Chern PL, Barnette D. Eyelid and periorbital skin basal cell carcinoma: oculoplastic management and surgery. Int Ophthalmol Clin 2009; 49:1-16. [PMID: 20348854 DOI: 10.1097/iio.0b013e3181b7ebe8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Geva E Mannor
- Division of Ophthalmology, Scripps Clinic, La Jolla, CA 92037, USA
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