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López PA, Pedraza M, Moreno A, García O, Buitrago R, Mogollon G, Fory L, Conrado H. Multidisciplinary management of giant cervicothoracic cutaneous squamous cell carcinoma. Int J Surg Case Rep 2019; 61:294-297. [PMID: 31401438 PMCID: PMC6699553 DOI: 10.1016/j.ijscr.2019.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
Non treated squamous cell carcinoma could present as an uncontrollable and substantial disaurement neoplasm. Squamous cell carcinoma that are diagnosed early and successfully treated by surgical excision, has a better forecast. When a patient present with a gigant squamous cell carcinoma always requires a multidisciplinary team.
Introduction Cutaneus squamous cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer. SCC is a malignant neoplasm of the skin characterized by aberrant proliferation of keratinocytes. Presentation case We report multidisciplinary surgical management of a 36-year-old male who presented with a huge cutaneous protruding tumor of the cervicothoracic wall. Clinically, he presented with a growing mass on the anterior cervicothoracic wall 3 years ago. Microscopic examination revealed SCC. He underwent complete excision of the lesion. The patient neglected attending our oncological department for receiving chemotherapy. Today, one year after surgery, he is alive without evidence of disease recurrence. Discussion SCC treatment depends on location of the lesion, involvement of neighboring structures, functional level of the patient, and the patient’s acceptance of the proposed management strategy. Conclusion We conclude that SCC can grow to a huge size if left untreated. Surgery by a multidisciplinary surgical team is the primary mode of treatment, followed by chemotherapy if necessary.
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Affiliation(s)
- P A López
- Department of General Surgery, Bosque University, Colombia; Bosque University, Colombia
| | - M Pedraza
- Department of General Surgery, Bosque University, Colombia; Bosque University, Colombia.
| | - A Moreno
- Department of Head and Neck Surgery, National Institute of Cancer, Bogotá, Colombia; National Institute of Cancer, Bogotá, Colombia; Bosque University, Colombia
| | - O García
- Department of Soft Tissue and Breast, National Institute of Cancer, Bogotá, Colombia; National Institute of Cancer, Bogotá, Colombia
| | - R Buitrago
- Department of Thorax Surgery, National Institute of Cancer, Bogotá, Colombia; National Institute of Cancer, Bogotá, Colombia
| | - G Mogollon
- Department of Head and Neck Surgery, National Institute of Cancer, Bogotá, Colombia
| | - L Fory
- Department of General Surgery, Universidad Militar Central, Bogotá, Colombia
| | - H Conrado
- South Colombian University, Colombia
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Wakkee M, van Egmond S, Louwman M, Bindels P, van der Lei J, Nijsten T, Hollestein L. Opportunities for improving the efficiency of keratinocyte carcinoma care in primary and specialist care: Results from population-based Dutch cohort studies. Eur J Cancer 2019; 117:32-40. [PMID: 31229947 DOI: 10.1016/j.ejca.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND High incidence rates of keratinocyte carcinoma (KC) in Western countries put pressure on healthcare systems. The aim of this study was to describe clinical practice in order to identify areas for improvement. METHODS A random selection of patients from the Integrated Primary Care Information database who consulted their general practitioner (GP) for suspicious or confirmed KC (n = 1597) was made in the analysis. For secondary care, 1569 patients with histologically confirmed KC were randomly selected from the Netherlands Cancer Registry. All patients were diagnosed between 2009 and 2013 and followed up until 2016. Details on diagnosis, treatment and care during follow-up were described. RESULTS Among 942 patients who consulted their GP, KC was included in the working or differential diagnosis, but two-thirds (629) were not KC. If the GP suspected KC, the GP directly referred to a medical specialist in most cases (548 of 942). In half (470 of 967) of all confirmed KCs, a skin malignancy was not described in the initial working or differential diagnosis of the GP. The medical specialist treated the first primary KC in 86% (1369 of 1596) by excision, 4% (69 of 1596) by Mohs surgery and 10% (158 of 1596) by another treatment. Although follow-up is not recommended for low-risk basal cell carcinoma, 83% (29 of 35) received follow-up care. In contrast, 82% (60 of 73) patients with squamous cell carcinoma received less follow-up than recommended. CONCLUSIONS Strengthening the diagnostic pathway for KC in primary care and reduction of low-value follow-up visits in secondary care seem potential areas for improving the efficiency of KC care.
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Affiliation(s)
- M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - S van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Louwman
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - P Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - J van der Lei
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - L Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
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Lobeck A, Weiss C, Orouji A, Koch PS, Heck M, Utikal J, Koenen W, Faulhaber J, Klemke CD, Felcht M. [Single center analysis of the dermatosurgical patient cohort of a tumor center in Germany]. Hautarzt 2018; 68:377-384. [PMID: 28361252 DOI: 10.1007/s00105-017-3951-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of skin cancer continues to increase. However, little is known about the dermatosurgical characteristics of the patients. PATIENTS AND METHODS In this single center, retrospective study, dermatosurgical reports of all patients treated because of basal cell carcinomas (BCC), squamous cell carcinomas (SCC), and malignant melanoma (MM) between 2004 and 2013 were analyzed. RESULTS During the observed period, the number of operated BCC rose by a factor of 1.86 and the number of MM by a factor of 2.3. In comparison to BCC/MM, there was a disproportionately high increase of SCC by a factor of 4.02. The average age was 71.5 ± 13.4 years (minimum: 14 years; maximum: 104 years), whereupon a significant increase of male age and a significant decrease of female age occurred. Almost 70% of all tumors were located in the head and neck area. The nose was most commonly treated. CONCLUSIONS During the last 10 years, the cohort of dermatosurgical patients changed in the tumor center. This should be verified in multicenter studies.
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Affiliation(s)
- A Lobeck
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - C Weiss
- Medizinische Statistik, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - A Orouji
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - P-S Koch
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Heck
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologische Praxis Dr. Heck und Kollegen, Griesheim, Deutschland
| | - J Utikal
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Klinische Kooperationseinheit Dermatoonkologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - W Koenen
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologie im Fronhof, Bad Dürkheim, Deutschland
| | - J Faulhaber
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologische Gemeinschaftspraxis: Dr. Weller, Prof. Dr. Faulhaber & Kollegen, Schwäbisch Gmünd, Deutschland
| | - C-D Klemke
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Hautklinik, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe, Deutschland
| | - M Felcht
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Kreuter A, van Eijk T, Lehmann P, Fischer M, Horn T, Assaf C, Schley G, Herbst R, Kellner I, Weisbrich C, Hyun J, Wieland U, Schlaak M, Rübben A, Lommel K. Elektrochemotherapie bei fortgeschrittenen Hauttumoren und Hautmetastasen - eine retrospektive multizentrische Auswertung. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12583_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen
| | - Tina van Eijk
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Kompetenzzentrum Hautkrebs, HELIOS Klinikum Wuppertal
| | | | - Thomas Horn
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld
| | - Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld
| | | | - Rudolf Herbst
- Klinik für Dermatologie und Allergologie, HELIOS Klinikum Erfurt
| | - Ivonne Kellner
- Klinik für Dermatologie und Allergologie, HELIOS Klinikum Erfurt
| | | | - Julia Hyun
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen
| | | | - Max Schlaak
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln
| | - Albert Rübben
- Klinik für Dermatologie und Allergologie, Universitätsklinik RWTH Aachen
| | - Kerstin Lommel
- Klinik für Dermatologie und Allergologie, HELIOS Klinikum Berlin-Buch
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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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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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[Tumors of the scalp: special aspects of selected examples]. Hautarzt 2014; 65:1030-6. [PMID: 25315428 DOI: 10.1007/s00105-014-3531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tumors of the scalp display some clinical, histological and prognostic characteristics. Early recognition of tumors is hampered by dense hair growth which can result in delayed diagnosis. MATERIAL AND METHODS Taking current literature into consideration atypical fibroxanthoma, cutaneous angiosarcoma, melanoma of the scalp, some adnexal tumors including the proliferating trichilemmal tumor as well as cutaneous metastases from visceral malignancies will be discussed. RESULTS Based on the fact that early scalp tumors are clinically difficult to recognize, they are often diagnosed at a late stage. Angiosarcomas belong to the most aggressive skin tumors and show a rapid growth with unfavorable prognosis. Malignant melanoma on the head has a more serious prognosis in comparison to other locations of the body. Cutaneous metastases are mostly a sign of an advanced tumor stage with a fatal prognosis. The various types of adnexal tumors are mostly benign. In exceptional cases rapid growth and ulceration may be an indicator for the development of an adnexal carcinoma. On the scalp tumors with sweat gland differentiation are more frequent than tumors with follicular differentiation. This shows that the general view that adnexal tumors develop from local adnexal structures is wrong. CONCLUSION Scalp lesions in which the diagnosis is unclear should be biopsied or excised early. Based on the result of the histological examination further therapy can be determined.
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Alter M, Satzger I, Schrem H, Kaltenborn A, Kapp A, Gutzmer R. Rückgang nicht-melanozytärer Hauttumoren nach Umstellung der Immunsuppression auf mTOR-Inhibitoren bei organtransplantierten Patienten. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12355_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mareike Alter
- Universitätsklinik für Dermatologie und Venerologie; Otto von Guericke Universität Magdeburg
| | - Imke Satzger
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
| | - Harald Schrem
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie; Medizinische Hochschule Hannover
| | - Alexander Kaltenborn
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie; Medizinische Hochschule Hannover
| | - Alexander Kapp
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
| | - Ralf Gutzmer
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
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Alter M, Satzger I, Schrem H, Kaltenborn A, Kapp A, Gutzmer R. Non-melanoma skin cancer is reduced after switch of immunosuppression to mTOR-inhibitors in organ transplant recipients. J Dtsch Dermatol Ges 2014; 12:480-8. [PMID: 24813579 DOI: 10.1111/ddg.12355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/20/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Organ transplant recipients are prone to the development of non-melanoma skin cancer. Organ transplant recipients often develop multiple non-melanoma skin cancers and the tumors show an aggressive growth pattern, therefore surgical therapy can be difficult. Switch of the immunosuppressive regimen to mTOR-inhibitors such as everolimus or sirolimus can have an antitumor effect. PATIENTS AND METHODS In a monocentric retrospective study we evaluated organ transplant recipients who presented with non-melanoma skin cancer in the years 2008-2010. Experience with patients who were switched to an mTOR-inhibitor due to non-melanoma skin cancer are reported in detail, and recent clinical studies are reviewed. RESULTS 60 organ transplant recipients with non-melanoma skin cancer were evaluated. Due to the development of multiple non-melanoma skin cancer within a few years, the immunosuppressive regimen was switched to everolimus in 7 patients and to sirolimus in 5 patients. Eight patients were evaluable for the effect of mTOR-inhibitors on the development of non-melanoma skin cancer; 4 patients had to discontinue the medication with mTOR-inhibitors early due to various side effects. In the year before the switch to mTOR-inhibitors, 8 patients developed 16 squamous cell carcinomas, 3 Basal cell carcinomas and 22 cases of Bowen's disease. All tumors were histologically confirmed. In the year after switch of immunosuppression, the rate of squamous cell carcinomas (n = 2) and Bowen's disease (n = 3), but not of basal cell carcinomas (n = 2) was significantly reduced. Moreover, 5 prospective randomized trials recently have demonstrated a reduced number of non-melanoma skin cancers in organ transplant recipients after switch of the immunosuppressive regimen to mTOR-inhibitors. CONCLUSION Switch of the immunosuppressive regimen to mTOR-inhibitors should be considered for organ transplant recipients suffering from multiple non-melanoma skin cancers.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology and Venerology, Otto von Guericke University, Magdeburg, Germany
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Häfner HM, Schnabl S, Breuninger H, Schulz C. [Surgical treatment of epithelial skin tumors and their precursors]. Hautarzt 2014; 64:558-66. [PMID: 23948781 DOI: 10.1007/s00105-013-2541-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Squamous cell carcinomas of the skin and their precursors, actinic keratosis as well as basal cell carcinomas are classified as non-melanocytic skin cancer and belong to the group of epithelial skin tumors. This tumor entity is one of the most common forms of malignant cancer in western countries with an incidence of approximately 100-170 per 100,000 inhabitants per year in Europe. In German-speaking countries no exact numbers are available on the early forms of squamous cell carcinoma, actinic keratosis (carcinoma in situ); however, results from Great Britain show that at ages over 70 years old the prevalence of actinic keratosis is 34 % in men and 18 % in women. Because invasive epithelial cancer is very common and most commonly occurs in the head region, a safe but skin-sparing approach to surgical treatment is desirable. The safest procedure with respect to local recurrence is surgical excision with subsequent complete 3-dimensional histological preparation (micrographic surgery). With this method it is possible to excise tissue affected by tumor tissue in small steps. This facilitates defect coverage and leads to very good results as well as good esthetic results. The local recurrence rates are extremely low compared to alternative treatment methods, such as photodynamic therapy, topical application of imiquimod or cryosurgery and for the treatment of basal cell carcinoma, for example is 0.7 %. Dermatological operations are therefore interventions with a very high guarantee of tumor-free survival and functional and esthetic results.
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Affiliation(s)
- H-M Häfner
- Universitäts-Hautklinik, Eberhard Karls Universität, Liebermeisterstr. 25, 72076 Tübingen, Deutschland.
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