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Kromer CM, Jefferson J, Crowe D, Knackstedt T. Outcomes of Upper Lip Mohs Surgery Repairs Using Standardized Scar Scales With Particular Emphasis on Vermillion Border Involvement. Dermatol Surg 2023; 49:1085-1090. [PMID: 37712745 DOI: 10.1097/dss.0000000000003918] [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: 09/16/2023]
Abstract
BACKGROUND The lips are a common location for skin cancer, and thus, a common site for Mohs micrographic surgery (MMS). As an important cosmetic and functional facial unit, MMS defects and reconstruction can affect patient perception on functional and aesthetic outcomes. OBJECTIVE The objective of this study was to compare aesthetic and functional outcomes after upper lip MMS between patients with vermillion sparing repairs (VSR) versus vermillion crossing repairs (VCR). MATERIALS AND METHODS Patients from a single institution from 2018 to 2022 undergoing MMS of the upper lip with linear or select flap repairs were included. Patients were assessed at a minimum of 6-week follow-up for self-assessment of functional and cosmetic outcomes, as well as physician assessment of scar cosmesis using validated Patient and Observed Scar Assessment Scale and Scar Cosmesis Assessment and Rating scale. The results were compared between VSR and VCR groups. RESULTS Forty-five patients were included in this study. No significant difference between patient assessment of functional and cosmetic outcome was identified between VSR and VCR. CONCLUSION Patient satisfaction with lip reconstruction can be high. Crossing the vermillion border does not affect patient assessment of aesthetic and functional results and should be considered if needed to optimize reconstructive outcomes.
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Affiliation(s)
| | | | | | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology and Mohs Surgery Center, Pinehurst, North Carolina
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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2
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Miller AC, Ratushny V, Schaffer A, Cognetta AB. Large squamous cell carcinoma of the lip in a Black woman with a history of hydrochlorothiazide use treated with Mohs micrographic surgery. JAAD Case Rep 2023; 38:1-3. [PMID: 37456514 PMCID: PMC10338230 DOI: 10.1016/j.jdcr.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Austinn C. Miller
- Dermatology Associates of Tallahassee, Tallahassee, Florida
- University of Central Florida/HCA Consortium, Tallahassee, Florida
| | - Vladimir Ratushny
- Dermatology Associates of Tallahassee, Tallahassee, Florida
- Division of Dermatology, Mohs Micrographic Surgery Unit, Florida State University College of Medicine, Tallahassee, Florida
| | - Andras Schaffer
- Dermatology Associates of Tallahassee, Tallahassee, Florida
- University of Central Florida/HCA Consortium, Tallahassee, Florida
| | - Armand B. Cognetta
- Dermatology Associates of Tallahassee, Tallahassee, Florida
- University of Central Florida/HCA Consortium, Tallahassee, Florida
- Division of Dermatology, Mohs Micrographic Surgery Unit, Florida State University College of Medicine, Tallahassee, Florida
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3
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Hwang JR, Khachemoune A. Lower lip basal cell and squamous cell carcinomas: a reappraisal of the similarities and differences in clinical presentation and management. Arch Dermatol Res 2023; 315:117-125. [PMID: 35312855 DOI: 10.1007/s00403-022-02345-z] [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: 09/09/2021] [Revised: 12/26/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Basal cell carcinoma and squamous cell carcinoma are the two most common types of carcinomas, affecting a total of 5.4 million people each year in the United States. Sun-exposed areas, especially the face and nose, are most affected given the strong association between these carcinomas and ultraviolet radiation. Less research has been done surrounding carcinomas of the lip, despite the significant aesthetic and functional importance of this area. Although lip carcinomas tend to follow a classic, unique distribution pattern that favors basal cell carcinoma on the upper lip and squamous cell carcinoma on the lower lip, more cases of lower lip basal cell carcinoma are being reported, warranting further educational awareness to differentiate carcinomas of the lower lip. In this article, we provide an updated overview of the risk factors, presentations, differential diagnoses, metastatic risks, evaluation, management guidelines, and outcomes of lower lip carcinoma. Of note, recent advances in imaging modalities are beginning to show promise as a non-invasive, affordable, and rapid way to detect and stage tumors. We conclude that increased clinical awareness and investigation of lower lip carcinoma is needed to improve early intervention, as a delayed diagnosis can rapidly alter the management and outcomes of lip carcinomas.
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Affiliation(s)
| | - Amor Khachemoune
- Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA. .,SUNY Downstate, Brooklyn, NY, USA.
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Brown AC, Brindley L, Hunt WTN, Earp EM, Veitch D, Mortimer NJ, Salmon PJM, Wernham A. A review of the evidence for Mohs micrographic surgery in the treatment of basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794-1804. [PMID: 35596540 DOI: 10.1111/ced.15266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
MMS is considered the gold standard treatment for basal cell carcinoma (BCC) particularly for sites with a high-risk of incomplete excision such as the central face, tumours with an aggressive growth pattern and consequent unpredictable sub-clinical extension and recurrent tumours. However, the process is more time consuming and the magnitude of benefit is uncertain. This article aims to provide a more complete picture of current evidence, including a review of cosmetic outcomes, tissue sparing ability and cost-effectiveness of MMS. Whilst robust evidence is lacking, there is a large volume of observational data supporting a low recurrence rate after MMS. The risk of incomplete excision and higher recurrence rate of standard excision favours the use of MMS at high-risk sites. There is some low certainty evidence that MMS results in a smaller defect size than SE and that incomplete excision with SE results in larger defects. Larger defects may affect cosmetic outcome but there is no direct evidence that MMS improves cosmetic outcome compared to SE. There is conflicting evidence regarding the cost of MMS in comparison to SE with some studies recognising MMS as less expensive than SE and others more which may reflect the healthcare setting. A multi-centre 10 year RCT comparing MMS and SE in the treatment of high-risk BCC would be desirable, but is unlikely to be feasible or ethical. Collection of robust registry data capturing both MMS and SE outcomes would provide additional long-term outcomes.
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Affiliation(s)
- Alistair C Brown
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Luke Brindley
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - William T N Hunt
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - David Veitch
- Department of Dermatology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Neil J Mortimer
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Paul J M Salmon
- Department of Dermatologic Surgery and Cutaneous Oncology, The Skin Centre, Tauranga, New Zealand
| | - Aaron Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK.,Department of Dermatology, University Hospitals Leicester NHS Trust, Leicester, UK
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5
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O’Connell KA, Conran RM. Educational Case: Basal Cell Carcinoma. Acad Pathol 2021; 8:2374289521998030. [PMID: 33763533 PMCID: PMC7944528 DOI: 10.1177/2374289521998030] [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: 12/04/2020] [Revised: 12/04/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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6
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Colon A, Saikaly SK, Ramos-Caro FA. A man with an enlarging lower lip lesion. JAAPA 2021; 34:55-57. [PMID: 33332837 DOI: 10.1097/01.jaa.0000723968.13786.c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alysha Colon
- Alysha Colon is a student at the University of Florida College of Medicine in Gainesville, Fla. Sami K. Saikaly is a dermatology resident physician and Francisco A. Ramos-Caro is on the dermatology faculty at the University of Florida. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Prud'homme R, Lacombe M, Delauménie S, Pittoni J, Douard PA, Bourgaux M, Marcaillou M, Prugnit M, Bédane C. [An original reconstruction technique for double upper white lip defect]. Ann Dermatol Venereol 2020; 147:658-661. [PMID: 32482384 DOI: 10.1016/j.annder.2020.04.009] [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: 05/16/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Herein we report a case of a surgical repair of double substance loss along the nasolabial groove by means of a double superior advancement flap from the cheek to the upper lip that we have here called the "double jigsaw puzzle" flap. OBSERVATION A 58-year-old man underwent surgery for 2 basal cell carcinomas located in the right white upper lip. The two lesions were first removed and the two defects were then carried over to the cheek symmetrically along the nasolabial groove. Two triangular "lugs" were excised on both sides to allow horizontal advancement of the cheek to the upper lip to fill the 2 gaps from the upper lip excisions like 2 pieces of a puzzle. The nasolabial groove was then recreated by deep anchoring stitches, with suturing comprising superficial stitches. DISCUSSION This surgical flap can be created quickly and easily and yields good aesthetic results in the immediate postoperative period and in the longer term, and the scar is totally masked within the nasolabial fold. The only limitation to a good aesthetic outcome is the presence of a small area of hairless skin within what constitutes an area of hair growth in male subjects.
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Affiliation(s)
- R Prud'homme
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - M Lacombe
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - S Delauménie
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Pittoni
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P A Douard
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Bourgaux
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Marcaillou
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Prugnit
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - C Bédane
- Service de dermatologie du CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Gade VKV, Mony A, Munisamy M, Chandrashekar L, Rajappa M. An investigation of vitamin D status in alopecia areata. Clin Exp Med 2018; 18:577-584. [PMID: 29869122 DOI: 10.1007/s10238-018-0511-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
Alopecia areata (AA) is a type of non-scarring, recurrent patchy loss of hair in hair-bearing areas and is mostly of autoimmune origin. Previous studies have suggested that some autoimmune diseases were found to be associated with vitamin D deficiency. The current study was designed to assess the levels of serum 25-hydroxy vitamin D and C-reactive protein in AA, as compared with controls and to further identify the association between vitamin D levels and disease severity in patients with AA. This cross-sectional study included 45 patients with AA and 45 healthy volunteers. Clinical and anthropometric parameters were recorded, according to a pre-designed proforma. Serum 25-hydroxy vitamin D and high-sensitivity C-reactive protein were estimated using ELISA kits. The severity of AA was determined using Severity of Alopecia Tool (SALT) score. We observed a significant rise in systemic inflammation as seen by elevated high-sensitive C-reactive protein levels and lowered 25-hydroxy vitamin D levels in patients with alopecia areata, compared to controls (p = 0.001). The levels of 25-hydroxy vitamin D showed a significant negative correlation with disease severity, while hs-CRP levels showed a significant positive correlation with disease severity (ρ = - 0.714, p = 0.001 and ρ = 0.818, p = 0.001). Our results suggest significant systemic inflammation and vitamin D deficiency in alopecia areata, more so with increasing disease severity. This gains particular importance in the treatment of alopecia areata in future, as supplementing vitamin D to AA patients would result in reducing the disease severity and inducing remission.
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Affiliation(s)
| | - Archana Mony
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
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