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Darsha AK, Pousti BT, Loh TY, Hau JT, Brian Jiang SI. Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor. Dermatol Surg 2024; 50:327-330. [PMID: 38261759 DOI: 10.1097/dss.0000000000004081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest. OBJECTIVE Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery. METHODS A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed. RESULTS Of 13,464 Mohs surgery cases, 4.53% ( n = 610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% ( n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% ( n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications. CONCLUSION Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness.
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Affiliation(s)
- Adrija K Darsha
- Department of Dermatology, Baylor Scott & White Medical Center, Temple, Texas
| | - Bobak T Pousti
- Department of Dermatology, University of California, San Diego, San Diego, California
| | - Tiffany Y Loh
- Department of Surgery, City of Hope Cancer Center, Duarte, California
| | - Jennifer T Hau
- Complete Dermatology and Cypress Dermatology, Houston, Texas; and
| | - Shang I Brian Jiang
- Department of Dermatology, University of California, San Diego, San Diego, California
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Ortiz AE, Ahluwalia J, Anderson RR, Franco W, Brian Jiang SI. Autofluorescence Excitation Imaging of Nonmelanoma Skin Cancer for Margin Assessment Before Mohs Micrographic Surgery: A Pilot Study. Dermatol Surg 2024:00042728-990000000-00735. [PMID: 38518178 DOI: 10.1097/dss.0000000000004171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Autofluorescence photography can detect specific light-tissue interactions and record important pathophysiological changes associated with nonmelanoma skin cancer (NMSC), which has been ascribed to the fluorescence of an aromatic amino acid, tryptophan. OBJECTIVE To assess the impact of a novel, autofluorescence imaging (AFI) device on margin control for NMSCs before Mohs micrographic surgery (MMS) in an effort to decrease overall operating time. METHODS Before the initial stage of MMS, NMSCs were measured with a 2-mm margin as standard of care (normal margin). The tumor was then imaged with the AFI device. A 2-mm margin was drawn around the fluorescent area captured by the AFI device and was referred to as the camera margin. The tumor was excised based on the normal margin and evaluated on frozen histological section. RESULTS Imaging based on the AFI device resulted in appropriate recommendations for margin control in 8 of 11 tumors. Four of these tumors did not fluoresce and demonstrated a lack of tumor residuum on stage I specimen, as anticipated. There were no side effects from the AFI device. CONCLUSION This is an initial pilot study that supports the use of a novel, noninvasive imaging device to help with margin assessment before MMS. On optimization, this device has potential to extend applicability to surgical excisions for tumors that do not fulfill criteria for MMS.
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Affiliation(s)
- Arisa E Ortiz
- Department of Dermatology, University of California, San Diego School of Medicine, La Jolla, California
| | - Jusleen Ahluwalia
- Department of Dermatology, University of California, San Diego School of Medicine, La Jolla, California
| | - R Rox Anderson
- Wellman Center of Photomedicine, Department of Dermatology Cosmetic and Laser Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Walfre Franco
- Wellman Center of Photomedicine, Department of Dermatology Cosmetic and Laser Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biomedical Engineering, University of Massachusetts Lowell, Massachusetts
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Shang I Brian Jiang
- Department of Dermatology, University of California, San Diego School of Medicine, La Jolla, California
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Victor MT, Zheng W, Park SJ, Jiang SIB, Guo TW. Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2024; 170:132-140. [PMID: 37622529 DOI: 10.1002/ohn.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To identify socioeconomic factors influencing the presentation and outcomes of cutaneous head and neck squamous cell carcinoma (cHNSCC). STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic medical center with comprehensive cancer center. METHODS Patients treated for cHNSCC at a single institution between 2008 and 2022 were included. Demographic, socioeconomic data and disease characteristics were obtained from medical record abstraction. Outcome measures included tumor stage, number of distinct primaries, recurrence, and disease-related death. χ2 and Mann-Whitney tests were implemented to evaluate clinicopathologic distributions across disease stages. Survival analyses were performed using Cox regression and Kaplan-Meier analysis. RESULTS A total of 346 patients met the inclusion criteria. The median age at presentation and length of follow-up was 70.8 and 3.1 years, respectively. The majority of the cohort was white, male, and English-speaking. 13.3% of patients were underinsured and 27.5% were immunosuppressed. Patients who presented with advanced disease were more likely to be underinsured (21.7% vs 9.6%, P = .006) and have a history of homelessness (8.5% vs 2.1%, P = .014). Immunosuppressed patients were more likely to be underinsured (P = .009). Insurance status (1.97 [1.06-3.66], P = .032) and immune status (2.35 [1.30-4.26], P = .005) were independently associated with worse recurrence-free survival. CONCLUSION Socioeconomic factors that influence access to care, such as insurance status, are associated with cHNSCC disease stage and disease recurrence. These factors may impose barriers that delay diagnosis and treatment. This may result in worse disease-related outcomes and greater treatment-associated morbidity for certain patients.
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Affiliation(s)
- Mitchell T Victor
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego Health, La Jolla, California, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Wynne Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego Health, La Jolla, California, USA
| | - Soo J Park
- Moores Cancer Center, University of California, San Diego Health, La Jolla, California, USA
- Division of Hematology and Oncology, Department of Medicine, University of California, San Diego Health, La Jolla, California, USA
| | - Shang I Brian Jiang
- Department of Dermatology, University of California, San Diego Health, La Jolla, California, USA
| | - Theresa W Guo
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego Health, La Jolla, California, USA
- Moores Cancer Center, University of California, San Diego Health, La Jolla, California, USA
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Nowsheen S, Pousti B, Miller A, Eichstadt S, Brian Jiang SI. Mohs micrographic surgery for treatment of non-melanoma skin cancer involving the nipple-areola complex: A case series of 8 patients. JAAD Case Rep 2023; 42:122-125. [PMID: 38125030 PMCID: PMC10730335 DOI: 10.1016/j.jdcr.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Somaira Nowsheen
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Bobak Pousti
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Adam Miller
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Shaundra Eichstadt
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Shang I. Brian Jiang
- Department of Dermatology, University of California San Diego, San Diego, California
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Panian J, Hirotsu KE, Loh TY, Jiang SIB. Post-Operative Complications in Patients on Immune Checkpoint Inhibitors Undergoing Mohs Micrographic Surgery. J Cutan Med Surg 2023; 27:71-73. [PMID: 36411993 DOI: 10.1177/12034754221139275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Justine Panian
- 8784 School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kelsey E Hirotsu
- 8784 Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | - Tiffany Y Loh
- 8784 Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | - Shang I Brian Jiang
- 8784 Department of Dermatology, University of California San Diego, San Diego, CA, USA
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Kibbi N, Owen JL, Worley B, Wang JX, Harikumar V, Downing MB, Aasi SZ, Aung PP, Barker CA, Bolotin D, Bordeaux JS, Cartee TV, Chandra S, Cho NL, Choi JN, Chung KY, Cliby WA, Dorigo O, Eisen DB, Fujisawa Y, Golda N, Halfdanarson TR, Iavazzo C, Jiang SIB, Kanitakis J, Khan A, Kim JYS, Kuzel TM, Lawrence N, Leitao MM, MacLean AB, Maher IA, Mittal BB, Nehal KS, Ozog DM, Pettaway CA, Ross JS, Rossi AM, Servaes S, Solomon MJ, Thomas VD, Tolia M, Voelzke BB, Waldman A, Wong MK, Zhou Y, Arai N, Brackett A, Ibrahim SA, Kang BY, Poon E, Alam M. Evidence-Based Clinical Practice Guidelines for Extramammary Paget Disease. JAMA Oncol 2022; 8:618-628. [PMID: 35050310 DOI: 10.1001/jamaoncol.2021.7148] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Extramammary Paget disease (EMPD) is a frequently recurring malignant neoplasm with metastatic potential that presents in older adults on the genital, perianal, and axillary skin. Extramammary Paget disease can precede or occur along with internal malignant neoplasms. OBJECTIVE To develop recommendations for the care of adults with EMPD. EVIDENCE REVIEW A systematic review of the literature on EMPD from January 1990 to September 18, 2019, was conducted using MEDLINE, Embase, Web of Science Core Collection, and Cochrane Libraries. Analysis included 483 studies. A multidisciplinary expert panel evaluation of the findings led to the development of clinical care recommendations for EMPD. FINDINGS The key findings were as follows: (1) Multiple skin biopsies, including those of any nodular areas, are critical for diagnosis. (2) Malignant neoplasm screening appropriate for age and anatomical site should be performed at baseline to distinguish between primary and secondary EMPD. (3) Routine use of sentinel lymph node biopsy or lymph node dissection is not recommended. (4) For intraepidermal EMPD, surgical and nonsurgical treatments may be used depending on patient and tumor characteristics, although cure rates may be superior with surgical approaches. For invasive EMPD, surgical resection with curative intent is preferred. (5) Patients with unresectable intraepidermal EMPD or patients who are medically unable to undergo surgery may receive nonsurgical treatments, including radiotherapy, imiquimod, photodynamic therapy, carbon dioxide laser therapy, or other modalities. (6) Distant metastatic disease may be treated with chemotherapy or individualized targeted approaches. (7) Close follow-up to monitor for recurrence is recommended for at least the first 5 years. CONCLUSIONS AND RELEVANCE Clinical practice guidelines for EMPD provide guidance regarding recommended diagnostic approaches, differentiation between invasive and noninvasive disease, and use of surgical vs nonsurgical treatments. Prospective registries may further improve our understanding of the natural history of the disease in primary vs secondary EMPD, clarify features of high-risk tumors, and identify superior management approaches.
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Affiliation(s)
- Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Joshua L Owen
- Dermatology Service, South Texas Veterans Health Care System, San Antonio
| | | | - Jake X Wang
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Sumaira Z Aasi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Phyu P Aung
- Department of Pathology (Dermatopathology), The University of Texas MD Anderson Cancer Center, Houston
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Diana Bolotin
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jeremy S Bordeaux
- University Hospitals Cleveland Medical Center, Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Todd V Cartee
- Division of Dermatology, Pennsylvania State College of Medicine, Hershey
| | - Sunandana Chandra
- Division of Oncology, Department of Medicine, Northwestern University Medical Center, Chicago, Illinois
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Jennifer N Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kee Yang Chung
- Department of Dermatology, Yonsei University College of Medicine, Seoul, South Korea
| | - William A Cliby
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Oliver Dorigo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Women's Cancer Center, Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis, Sacramento
| | | | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia
| | | | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Jean Kanitakis
- Department of Dermatology, Ed. Herriot Hospital Group (Pav. R), Lyon, France
| | - Ashraf Khan
- Department of Pathology, University of Massachusetts Medical School-Baystate, Baystate Health, Springfield
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy M Kuzel
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Naomi Lawrence
- Division of Dermatology, Cooper Hospital, Rowan University, Camden, New Jersey
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Allan B MacLean
- Department of Gynaecology, University College, London, United Kingdom
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Curtis A Pettaway
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Ross
- Department of Pathology, Upstate Medical University, Syracuse, New York
- Department of Urology, Upstate Medical University, Syracuse, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Valencia D Thomas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael K Wong
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nobuo Arai
- Electrical Engineering, Kanagawa University, Kanagawa-ku, Yokohama, Japan
| | - Alexandria Brackett
- Cushing/Whitney Medical Library, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Otolaryngology-Head and Neck Surgery and Surgery (Organ Transplantation), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ahn GS, Pousti B, Singh G, Elsensohn A, Jiang SIB. No Recurrence in Primary Invasive Stage 1a and 1b Melanoma and Melanoma in Situ Treated With Serial Disk Staged Excision. Dermatol Surg 2022; 48:276-282. [PMID: 34935746 DOI: 10.1097/dss.0000000000003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal surgical treatment modality for invasive melanoma (IM) and melanoma in situ (MIS) has been debated with proponents for standard wide local excision (WLE), serial disk staged excision, and Mohs micrographic surgery. OBJECTIVE The purpose of this study is to identify the recurrence rates and surgical margins of invasive stage 1 melanoma and MIS lesions using serial disk staged excision technique with rush permanent processing and "bread loafing" microscopic analysis. MATERIALS AND METHODS Recurrence rates and surgical margins of 63 IM and 207 MIS at the University of California Dermatology Surgery Unit were retrospectively reviewed. RESULTS No recurrences were observed with average follow-up of 34 and 36 months for IM and MIS, respectively (range, 10-92 months). Average surgical margins were 19.8 mm (SD 9.7) for IM and 12.1 mm (SD 12.2) for MIS. CONCLUSION This SSE technique for the treatment of IM and MIS is comparable in efficacy to other SSE techniques, and it offers physicians a simple and accessible alternative to WLE and MMS.
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Affiliation(s)
- Grace Sora Ahn
- All authors are affiliated with the Department of Dermatology, University of California San Diego, La Jolla, California
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8
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Chao K, Singh G, Elsensohn AN, Brian Jiang SI. Online learning tool for the acquisition of frozen-section histopathology knowledge. J Am Acad Dermatol 2021; 87:184-186. [PMID: 34311043 DOI: 10.1016/j.jaad.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Kevin Chao
- Department of Dermatology, University of California, San Diego, California.
| | - Gaurav Singh
- Department of Dermatology, University of California, San Diego, California
| | - Ashley N Elsensohn
- Department of Dermatology, University of California, San Diego, California
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Sohn GK, Keniston K, Kannan S, Hinds B, Jiang SIB. Characteristics of Superficial Basal Cell Carcinomas Containing More Aggressive Subtypes on Final Histopathologic Diagnosis. J Drugs Dermatol 2021; 20:283-288. [PMID: 33683071 DOI: 10.36849/jdd.5383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognosis and treatment of basal cell carcinoma (BCC) are largely dependent on tumor subtype, which is typically determined by punch or shave biopsy. Data regarding concordance between BCC subtype on initial biopsy and final histopathology for Mohs micrographic surgery (MMS) or excision with frozen sections (EFS) are limited. OBJECTIVES To determine the concordance between initial biopsy and final MMS or EFS subtyping of BCC. We aim to investigate the incidence and clinical characteristics of lesions initially diagnosed as superficial BCC (sBCC) that are later found to have a nodular, micronodular, or infiltrative component. METHODS We conducted a retrospective review of all MMS or EFS cases performed at a single academic center from August 1, 2015 to August 31, 2017. Inclusion criteria were a biopsy-proven diagnosis of sBCC and presence of residual tumor following stage I of MMS or EFS. Fisher’s exact test was used to evaluate significance of clinical characteristics and outcomes associated with the presence of a nodular, micronodular, or infiltrative BCC component. RESULTS A total of 164 MMS or EFS cases had an initial biopsy showing sBCC. Of these, 117 had residual BCC on stage I, and 43 (37%) were found to have a nodular, micronodular, or infiltrative component. Significant predictors of reclassified BCC subtype included age over 60 years (P=0.006) and location on the head or neck (P=0.043). Reclassified lesions required significantly more stages of MMS to clear (P=0.036). Shave biopsy was used to diagnose 114 (98%) of the included cases. CONCLUSIONS Over one third of shave biopsies that initially diagnosed sBCC failed to detect a nodular, micronodular, or infiltrative component. Management of biopsy-proven sBCC should take into account the possible presence of an undiagnosed deeper tumor component with appropriate margin-assessment treatment modalities when clinically indicated. J Drugs Dermatol. 2021;20(3):283-288. doi:10.36849/JDD.5383.
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10
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Chao K, Elsensohn AN, Singh G, Jiang SIB. Suture materials and techniques for optimal cutaneous wound cosmesis: A systematic review. J Am Acad Dermatol 2021; 86:1136-1137. [PMID: 33892012 DOI: 10.1016/j.jaad.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Kevin Chao
- Department of Dermatology, University of California, San Diego, California.
| | - Ashley N Elsensohn
- Department of Dermatology, University of California, San Diego, California
| | - Gaurav Singh
- Department of Dermatology, University of California, San Diego, California
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Chow ML, Sennett R, Hinds B, Brian Jiang SI. Large Atrophic Plaque on the Chest: Challenge. Am J Dermatopathol 2021; 43:e43. [PMID: 33743003 DOI: 10.1097/dad.0000000000001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maggie L Chow
- Department of Dermatology, University of California San Diego, San Diego, CA; and.,Skin and Beauty Center, Glendale CA
| | - Rachel Sennett
- Department of Dermatology, University of California San Diego, San Diego, CA; and
| | - Brian Hinds
- Department of Dermatology, University of California San Diego, San Diego, CA; and
| | - Shang I Brian Jiang
- Department of Dermatology, University of California San Diego, San Diego, CA; and
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Chow M, Brian Jiang SI. Lack of knowledge about surgical smoke, masks, and respirators among US dermatology residents and fellows in the era of COVID-19. Cutis 2020; 106:190;212. [PMID: 33186428 DOI: 10.12788/cutis.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maggie Chow
- Department of Dermatology, University of California, San Diego, USA
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Yuan JT, Jiang SIB. Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic. Dermatol Online J 2020; 26:13030/qt2qr3w771. [PMID: 32941709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023] Open
Abstract
Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.
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Affiliation(s)
- Joyce T Yuan
- Department of Dermatology, University of California San Diego, San Diego, CA.
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Sohn GK, Sohn JH, Yeh J, Chen Y, Brian Jiang SI. A deep learning algorithm to detect the presence of basal cell carcinoma on Mohs micrographic surgery frozen sections. J Am Acad Dermatol 2020; 84:1437-1438. [PMID: 32590033 DOI: 10.1016/j.jaad.2020.06.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Grace K Sohn
- Department of Dermatology, University of California-San Diego.
| | - Jae Ho Sohn
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California-San Francisco
| | - Jessica Yeh
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California-San Francisco
| | - Yixin Chen
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California-San Francisco
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Crow LD, Jambusaria‐Pahlajani A, Chung CL, Baran DA, Lowenstein SE, Abdelmalek M, Ahmed RL, Anadkat MJ, Arcasoy SM, Berg D, Bibee KP, Billingsley E, Black WH, Blalock TW, Bleicher M, Brennan DC, Brodland DG, Brown MR, Carroll BT, Carucci JA, Chang TW, Chaux G, Cusack CA, Dilling DF, Doyle A, Emtiazjoo AM, Ferguson NH, Fosko SW, Fox MC, Goral S, Gray AL, Griffin JR, Hachem RR, Hall SA, Hanlon AM, Hayes D, Hickey GW, Holtz J, Hopkins RS, Hu J, Huang CC, Brian Jiang SI, Kapnadak SG, Kraus ES, Lease ED, Leca N, Lee JC, Leitenberger JJ, Lim MA, Longo MI, Malik SM, Mallea JM, Menter A, Myers SA, Neuburg M, Nijhawan RI, Norman DJ, Otley CC, Paek SY, Parulekar AD, Patel MJ, Patel VA, Patton TJ, Pugliano‐Mauro M, Ranganna K, Ravichandran AK, Redenius R, Roll GR, Samie FH, Shin T, Singer JP, Singh P, Soon SL, Soriano T, Squires R, Stasko T, Stein JA, Taler SJ, Terrault NA, Thomas CP, Tokman S, Tomic R, Twigg AR, Wigger MA, Zeitouni NC, Arron ST. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 2019; 32:1268-1276. [DOI: 10.1111/tri.13520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/25/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
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Basu P, Goldenberg A, Cowan N, Eilers R, Hau J, Jiang SIB. A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery. J Am Acad Dermatol 2018; 80:1594-1601. [PMID: 30502411 DOI: 10.1016/j.jaad.2018.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet postoperative complications associated with different types of immunosuppression are largely unstudied. OBJECTIVE To determine the incidence and nature of postoperative complications in immunosuppressed patients undergoing Mohs micrographic surgery. METHODS A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications. RESULTS Univariable analysis showed that compared with immunocompetence, immunosuppression was associated with 9.6 times the odds of postoperative complication (P = .003), with solid organ transplant recipients having 8.824 times higher odds (P = .006) and immunosuppressive therapy use displaying 5.775 times higher odds (P = .021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in the immunosuppressed population. Multivariable analysis of the association between immunosuppression and postoperative complication closely trended toward, but did not meet, significance (P = .056). LIMITATIONS This was a single-center, retrospective study. Other limitations include lack of non-solid organ transplants, limited medication-related data on nontransplant patients, and exclusion of cases involving patients with double transplants or multiple sources of immunosuppression. CONCLUSIONS Immunosuppression overall, particularly owing to solid organ transplant and immunosuppressive therapy use, places patients at higher risk for postoperative complications, including surgical site infection and wound dehiscence following MMS.
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Affiliation(s)
- Pallavi Basu
- School of Medicine, University of California San Diego, San Diego, California
| | - Alina Goldenberg
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Natasha Cowan
- School of Medicine, University of California San Diego, San Diego, California
| | - Robert Eilers
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Jennifer Hau
- Department of Dermatology, University of California San Diego, San Diego, California
| | - Shang I Brian Jiang
- Department of Dermatology, University of California San Diego, San Diego, California.
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Bari O, Eilers RE, Rubin AG, Jiang SIB. Clinical Characteristics of Lower Extremity Surgical Site Infections in Dermatologic Surgery Based Upon 24-Month Retrospective Review. J Drugs Dermatol 2018; 17:766-771. [PMID: 30005099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dermatologic surgery performed on the lower extremities has an increased risk for surgical site infections (SSI). Our objective was to evaluate the clinical characteristics associated with SSI following Mohs micrographic surgery (MMS) and wide local excisions (WLE) performed below the knee. We performed a single-center retrospective chart review of patients (n=271) that underwent these procedures. Within 14 days of the lower extremity procedure, four of 175 MMS patients (2.3%) developed SSI compared to eight of 96 WLE patients (8.3%; P=0.029). Subcuticular sutures and vertical mattress sutures as a group were associated with reduced 30-day infection rate when compared to other suture methods (P=0.006). Comparison of patients on prophylactic antibiotics to control patients without antibiotics did not reveal a statistically significant difference in infection rate. MMS infection rates trended lower as compared to WLE in the 14-day post-operative window. Doxycycline prophylaxis did not produce a statistically significantly lower rate of SSI, though results approached significance. A prospective study may be warranted to further compare cephalexin and doxycycline for dermatologic surgery below the knee. Subcuticular or vertical mattress sutures may be preferred when closing wounds due to their association with reduced infection rate. J Drugs Dermatol. 2018;17(7):766-771.
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Cowan N, Goldenberg A, Basu P, Eilers R, Hau J, I Brian Jiang S. A Retrospective Analysis of Complication Rates in Mohs Micrographic Surgery Patients With Clinically Large Tumors and Tumors With Aggressive Subclinical Extension. J Drugs Dermatol 2018; 17:511-515. [PMID: 29742181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Clinically large cutaneous tumors and those with aggressive subclinical extension (ASE) often require wider margins and increased operative time during Mohs micrographic surgery (MMS). Our goal is to improve dermatologic surgeons' counseling information on complication risks for aggressive tumors. OBJECTIVE To examine the incidence of postoperative complications in MMS patients, with a focus on differences between aggressive and non-aggressive tumors. METHODS AND MATERIALS We performed a retrospective cross-sectional chart review of 4151 MMS cases at the University of California, San Diego. A postoperative complication was defined as an adverse event directly related to MMS reported within 6 weeks of the procedure. RESULTS Clinically, large tumors had 50 times the odds of postoperative complication as compared to all other tumors (P less than 0.001). ASE was not found to be significantly associated with higher rates of postoperative complications when controlled for other factors. CONCLUSION Clinically, large tumors may be at higher risk for complications following MMS due to their increased size and need for repair with methods other than linear closures. Tumors with ASE were not found to be at higher risk for postoperative complications. J Drugs Dermatol. 2018;17(5):511-515.
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Ortiz AE, Anderson RR, DiGiorgio C, Jiang SIB, Shafiq F, Avram MM. An expanded study of long-pulsed 1064 nm Nd:YAG laser treatment of basal cell carcinoma. Lasers Surg Med 2018; 50:727-731. [PMID: 29436720 DOI: 10.1002/lsm.22803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is an indolent form of skin cancer that is rarely life threatening, but can cause significant cosmetic and functional morbidity. Surgical treatments often result in disfiguring scars, while topical therapies frequently result in recurrence. The need for a more effective nonsurgical alternative has led to the investigation of laser treatment of BCC. We have previously conducted a pilot study which showed 100% histologic clearance at high fluences. Treatments were well tolerated with no significant adverse events. The objective of this larger study was to confirm preliminary results that the 1064 nm Nd:YAG laser is a safe and effective method for treating non-facial BCC. DESIGN This is an IRB-approved, prospective, multi-center study evaluating the safety and efficacy of the 1064 nm Nd:YAG laser for the treatment of BCC on the trunk and extremities. Thirty-three subjects seeking treatment for biopsy-proven BCC that did not meet the criteria for Mohs surgery were recruited. Subjects on current anticoagulation therapy, or with a history of immunosuppression were excluded. Subjects received one treatment with the 1064 nm Nd:YAG laser as follows: 5-6 mm spot, fluence of 125-140 J/cm2 and a pulse duration of 7-10 ms. Standard excision with 5 mm clinical margins was performed at 30 days after laser treatment to evaluate clinical and histologic clearance of BCC. Standardized photographs and adverse assessments were taken at the baseline visit, immediately after laser treatment and on the day of excision. RESULTS Thirty-one subjects completed the study. BCC tumors had a 90% (28 of 31 BCC tumors) histologic clearance rate after one treatment with the long-pulsed 1064 nm Nd:YAG laser. Treatments were generally well tolerated without any anesthesia. Immediate side effects included edema and erythema. At 1-month follow-up, some patients had residual crusting. No significant adverse events occurred. CONCLUSION The 1064 nm long-pulsed Nd:YAG laser is an alternative for treating non-facial BCC for those that are poor surgical candidates. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
| | - R Rox Anderson
- Dermatology Cosmetic and Laser Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Wellman Center for Photomedicine, Boston, Massachusetts, 02114
| | - Catherine DiGiorgio
- Wellman Center for Photomedicine, Boston, Massachusetts, 02114
- Krauss Dermatology, Wellesley Hills, Massachusetts
| | | | | | - Mathew M Avram
- Dermatology Cosmetic and Laser Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Wellman Center for Photomedicine, Boston, Massachusetts, 02114
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Song SS, Goldenberg A, Ortiz A, Eimpunth S, Oganesyan G, Jiang SIB. Nonmelanoma Skin Cancer With Aggressive Subclinical Extension in Immunosuppressed Patients. JAMA Dermatol 2017; 152:683-90. [PMID: 26981734 DOI: 10.1001/jamadermatol.2016.0192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Immunosuppression (IS), such as in solid-organ transplant recipients (SOTRs) and patients with human immunodeficiency virus (HIV) or hematologic malignant neoplasms, increases the risk of developing nonmelanoma skin cancers (NMSCs). However, it is unknown whether IS patients are at increased risk of developing NMSCs with aggressive subclinical extensions (NMSC-ASE), which may extend aggressively far beyond conventional surgical margins. OBJECTIVE To study clinical characteristics of NMSC-ASE among immunocompetent (IC) and various subgroups of IS patients and to suggest a predictive model for NMSC-ASE lesions. DESIGN, SETTING, AND PARTICIPANTS A 6-year retrospective review of 2998 NMSC cases between February 26, 2007, and February 17, 2012, at the Dermatologic and Mohs Micrographic Surgery Unit of the University of California, San Diego, Medical Center. Nonmelanoma skin cancers that required at least 3 Mohs micrographic surgery stages with final surgical margins of at least 10 mm were defined as ASE lesions. All cases were categorized into 1 of 2 groups, IS or IC. Immunosuppressed cases were further subcategorized into 3 subgroups: SOTRs and patients with HIV or hematologic malignant neoplasm. The data were analyzed in December 2012. MAIN OUTCOMES AND MEASURES We evaluated the odds ratio of having NMSC-ASE lesions in IS patients (SOTRs, HIV, hematologic malignant neoplasm) compared with IC patients. Other clinical characteristics and preoperative risks were analyzed and compared. RESULTS Of all 2998 cases, we identified 805 NMSC-ASE cases: 137 IS and 668 IC. Immunosuppressed patients had an odds ratio of 1.94 of having ASE lesions compared with IC patients (95% CI, 1.54-2.44; P < .001). Additionally, the SOTR subgroup was associated with a 2.74 odds of having NSMC-ASE compared with non-SOTRs (95% CI, 2.00-3.76; P < .001), and the presence of hematologic malignant neoplasm was associated with 1.74 times the odds compared with IC patients (95% CI, 1.04-2.90; P = .04). Multivariate analysis found older age (P < .001), lesion locations such as zone 1 (OR, 1.39 [95% CI, 1.04-1.85]; P = .02) or zone 2 (OR, 1.45 [95% CI, 1.08-1.94]; P = .01), and IS status (OR, 1.94 [95% CI, 1.54-2.44]; P < .001) to be significant predictors of ASE. CONCLUSIONS AND RELEVANCE The findings of this study suggest an increased risk for NMSC-ASE lesions in IS patients, especially in SOTRs and those with hematologic malignant neoplasm, but not patients with HIV. Statistically significant predictors of NMSC-ASE lesions such as age, location, and IS status can help physicians choose the most appropriate treatment modalities and optimize surgical planning.
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Affiliation(s)
- Silvia Soohyun Song
- Department of Dermatology, University of California, San Diego2Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Arisa Ortiz
- Department of Dermatology, University of California, San Diego
| | - Sasima Eimpunth
- Department of Dermatology, Siriraj Hospital, Bangkok, Thailand
| | - Gagik Oganesyan
- Department of Dermatology, Kaiser Permanente Fontana Medical Center, Fontana, California
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Garrett GL, Blanc PD, Boscardin J, Lloyd AA, Ahmed RL, Anthony T, Bibee K, Breithaupt A, Cannon J, Chen A, Cheng JY, Chiesa-Fuxench Z, Colegio OR, Curiel-Lewandrowski C, Del Guzzo CA, Disse M, Dowd M, Eilers R, Ortiz AE, Morris C, Golden SK, Graves MS, Griffin JR, Hopkins RS, Huang CC, Bae GH, Jambusaria A, Jennings TA, Jiang SIB, Karia PS, Khetarpal S, Kim C, Klintmalm G, Konicke K, Koyfman SA, Lam C, Lee P, Leitenberger JJ, Loh T, Lowenstein S, Madankumar R, Moreau JF, Nijhawan RI, Ochoa S, Olasz EB, Otchere E, Otley C, Oulton J, Patel PH, Patel VA, Prabhu AV, Pugliano-Mauro M, Schmults CD, Schram S, Shih AF, Shin T, Soon S, Soriano T, Srivastava D, Stein JA, Sternhell-Blackwell K, Taylor S, Vidimos A, Wu P, Zajdel N, Zelac D, Arron ST. Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States. JAMA Dermatol 2017; 153:296-303. [PMID: 28097368 DOI: 10.1001/jamadermatol.2016.4920] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States. Objective To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. Design, Setting, and Participants This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. Main Outcomes and Measures Incident skin cancer was determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). Results Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95% CI, 3.26-6.73), male sex (HR, 1.56; 95% CI, 1.34-1.81), white race (HR, 9.04; 95% CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95% CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95% CI, 1.22-1.94). Conclusions and Relevance Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.
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Affiliation(s)
- Giorgia L Garrett
- University of California-San Francisco Medical Center, San Francisco
| | - Paul D Blanc
- University of California-San Francisco Medical Center, San Francisco
| | - John Boscardin
- University of California-San Francisco Medical Center, San Francisco
| | | | | | - Tiffany Anthony
- Baylor All Saints and Baylor University Medical Center, Dallas, Texas
| | | | | | | | - Amy Chen
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | | | - Max Disse
- University of Minnesota Medical Center, Minneapolis
| | - Margaret Dowd
- New York Presbyterian/Columbia University Medical Center, New York
| | - Robert Eilers
- University of California-San Diego Medical Center, San Diego
| | | | | | | | | | - John R Griffin
- Baylor All Saints and Baylor University Medical Center, Dallas, Texas
| | | | | | | | | | | | | | | | | | | | - Goran Klintmalm
- Baylor All Saints and Baylor University Medical Center, Dallas, Texas
| | | | | | | | - Peter Lee
- University of Minnesota Medical Center, Minneapolis
| | | | - Tiffany Loh
- University of California-San Diego Medical Center, San Diego
| | - Stefan Lowenstein
- University of California-San Francisco Medical Center, San Francisco
| | | | | | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas
| | | | | | | | | | | | | | | | | | | | | | - Sarah Schram
- University of Minnesota Medical Center, Minneapolis
| | | | | | - Seaver Soon
- Scripps Green Hospital, La Jolla, California
| | - Teresa Soriano
- University of California-Los Angeles Medical Center, Los Angeles
| | | | | | | | - Stan Taylor
- University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas
| | | | - Peggy Wu
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Sarah T Arron
- University of California-San Francisco Medical Center, San Francisco
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Vajdi T, Eilers R, Jiang SIB. Clinical Characteristics of Non-Melanoma Skin Cancers Recurring within 5 years after Mohs Micrographic Surgery: Single Institution Retrospective Chart Review. ACTA ACUST UNITED AC 2017; 5. [PMID: 28936477 PMCID: PMC5603292 DOI: 10.13188/2373-1044.1000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Mohs micrographic surgery (MMS) is used to treat certain high-risk non-melanoma skin cancers (NMSC) due to its high cure rate. However, clinical recurrences do occur in a small number of cases. Objective We examined specific clinical characteristics associated with NMSC recurrences following MMS. Methods We employed a retrospective chart review of the 1467 cases of NMSC that underwent MMS at UC San Diego from January 1, 2008 through December 31, 2009. A total of 356 cases were excluded due to lack of follow-up. Results Five (0.45%) of 1111 cases developed recurrences of NMSC at the site of MMS. There were 741 cases of basal cell carcinomas (BCC); 3 were recurrences (0.40%). There were 366 cases of squamous cell carcinomas (SCC); 2 were recurrences (0.55%). Review of MMS histopathology of these recurrent tumors showed that there were no errors or difficulty with the processing or interpretation of the slides. Conclusion Five-year recurrence rate of NMSC following MMS at our institution is below the reported average. Our retrospective chart review identified specific clinical characteristics associated with NMSC recurrence including a history of smoking, anatomical location on the cheeks, ears or nose, and a history of immunosuppression for SCCs.
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Affiliation(s)
- Tina Vajdi
- Department of Dermatology, School of Medicine, University of California , San Diego, CA, USA
| | - Robert Eilers
- Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, School of Medicine, University of California San Diego, CA, USA
| | - Shang I Brian Jiang
- Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, School of Medicine, University of California San Diego, CA, USA
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Affiliation(s)
- Tanya Greywal
- Department of Dermatology, University of California San Diego Health System, San Diego, California; Division of Adolescent and Pediatric Dermatology, Rady Children's Hospital, San Diego, California
| | - Audrey S Wang
- Department of Dermatology, University of California San Diego Health System, San Diego, California; Division of Adolescent and Pediatric Dermatology, Rady Children's Hospital, San Diego, California
| | - Shang I Brian Jiang
- Department of Dermatology, University of California San Diego Health System, San Diego, California
| | - Andrew C Krakowski
- Department of Dermatology, University of California San Diego Health System, San Diego, California; Division of Adolescent and Pediatric Dermatology, Rady Children's Hospital, San Diego, California
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Abstract
BACKGROUND Trichilemmal carcinoma (TC) is a rare malignant adnexal neoplasm with outer root sheath differentiation. Most cases have been treated by surgical excision with a few recurrences. There have been 6 case reports of TC treated with Mohs micrographic surgery (MMS). OBJECTIVE To perform an updated review of the literature regarding management of this uncommon tumor. METHODS A comprehensive literature review was conducted by searching the PubMed database using the keywords trichilemmal carcinoma, tricholemmal carcinoma, and tricholemmocarcinoma. RESULTS There have been 103 reported cases of TC, and most of these were treated with surgical excisions. Of the 35 cases with follow-up data, 3 reported local recurrences and 1 had subsequent metastatic disease. There are 6 cases of TC successfully treated with MMS without any recurrence. In addition, we report the seventh case of TC successfully treated with MMS. Other reported treatment modalities include imiquimod and excision with frozen sections. Histopathologically, the distinction between TC and squamous cell carcinoma with clear cell differentiation has been debated in the literature. CONCLUSION Trichilemmal carcinoma is a rare neoplasm that may behave aggressively. The recommended treatment should be a complete surgical excision with histologic confirmation of clear margins. In cases where tissue sparing or cosmesis is important, MMS may be considered.
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Affiliation(s)
- Michael Shane Hamman
- *Both authors are affiliated with the Division of Dermatology, San Diego Medical Center, University of California, San Diego, CA
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Gladsjo JA, Kim SS, Jiang SIB. Review of the use of a semisynthetic bilaminar skin substitute in dermatology and a case series report of its utility in Mohs surgery. J Drugs Dermatol 2014; 13:537-541. [PMID: 24809876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Biobrane is a biosynthetic wound dressing that has been widely used in burn treatment and as a skin graft donor site dressing. Our aim for this review was to establish whether Biobrane serves as a useful tool for the field of Dermatology and Dermatologic surgery. It has been frequently used in the field of Dermatology for the management of burns, erosive skin diseases, laser procedures, and surgical procedures. From the past experiences evident in the literature and in our cases series, it has been shown to improve patient's quality of life by reducing pain, healing time, and length of hospital stay. Our case series further demonstrate its use in temporary closures, delayed reconstructions, and secondary intention healing in Mohs surgery. Reports of successful use of Biobrane in the literature and in our case series support the fact that it is an effective therapeutic option to facilitate the healing process in the field of Dermatology and Dermatologic surgery.
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Alam M, Ibrahim O, Nodzenski M, Strasswimmer JM, Jiang SIB, Cohen JL, Albano BJ, Batra P, Behshad R, Benedetto AV, Chan CS, Chilukuri S, Crocker C, Crystal HW, Dhir A, Faulconer VA, Goldberg LH, Goodman C, Greenbaum SS, Hale EK, Hanke CW, Hruza GJ, Jacobson L, Jones J, Kimyai-Asadi A, Kouba D, Lahti J, Macias K, Miller SJ, Monk E, Nguyen TH, Oganesyan G, Pennie M, Pontius K, Posten W, Reichel JL, Rohrer TE, Rooney JA, Tran HT, Poon E, Bolotin D, Dubina M, Pace N, Kim N, Disphanurat W, Kathawalla U, Kakar R, West DP, Veledar E, Yoo S. Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers. JAMA Dermatol 2014; 149:1378-85. [PMID: 24080866 DOI: 10.1001/jamadermatol.2013.6255] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Omer Ibrahim
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael Nodzenski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Shang I Brian Jiang
- Division of Dermatology, Department of Medicine, University of California, San Diego
| | - Joel L Cohen
- AboutSkin Dermatology and Dermsurgery, Englewood, Colorado
| | - Brian J Albano
- Dermatology Associates, PA, of the Palm Beaches, Delray Beach, Florida
| | - Priya Batra
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts
| | - Ramona Behshad
- Laser and Dermatologic Surgery Center, Chesterfield, Missouri
| | - Anthony V Benedetto
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania12Dermatologic SurgiCenter, Philadelphia, Pennsylvania
| | - C Stanley Chan
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts
| | - Suneel Chilukuri
- Bellaire Dermatology Associates, Houston, Texas14Department of Dermatology, Baylor University College of Medicine, Houston, Texas15Memorial Hermann Family Practice Residency Program, Columbia University College of Surgeons and Physicians, Manhattan, New York
| | | | | | - Anir Dhir
- Dermatology Associates of Kentucky, PSC, Lexington
| | | | | | | | - Steven S Greenbaum
- Skin and Laser Surgery Center of Pennsylvania, Philadelphia21Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania22Department of Dermatology, Division of Dermatologic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth K Hale
- New York University School of Medicine, New York, New York24Laser and Skin Surgery Center of New York, New York, New York
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Carmel26Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - George J Hruza
- Laser and Dermatologic Surgery Center, Chesterfield, Missouri27Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri
| | - Laurie Jacobson
- Pacific Dermatology and Cosmetic Center, Seattle, Washington
| | - Jason Jones
- AboutSkin Dermatology and Dermsurgery, Englewood, Colorado
| | | | - David Kouba
- The Toledo Clinic Dermasurgery and Laser Center, Toledo, Ohio
| | - James Lahti
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois30DPNS Surgical Center, Northbrook, Illinois
| | | | | | - Edward Monk
- Wesmed Medical Group, New Rochelle, New York
| | - Tri H Nguyen
- Northwest Diagnostic Clinic, Houston, Texas32Department of Dermatology, MD Anderson Cancer Center, The University of Texas, Houston
| | - Gagik Oganesyan
- Division of Dermatology, Department of Medicine, University of California, San Diego
| | - Michelle Pennie
- Department of Dermatology, University of Florida College of Medicine, Gainesville34Pennie Dermatology & Skin Surgery Center, Englewood, Florida
| | | | | | | | - Thomas E Rohrer
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts36Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island
| | | | - Hien T Tran
- Seaside Dermatology and Skin Cancer Center, Irvine, California
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Diana Bolotin
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Meghan Dubina
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Natalie Pace
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Natalie Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wareeporn Disphanurat
- Dermatology Unit, Department of Medicine, Thammasat University, Patumthani, Thailand
| | - Ummul Kathawalla
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rohit Kakar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Emir Veledar
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Gladsjo JA, Jiang SIB. Treatment of surgical scars using a 595-nm pulsed dye laser using purpuric and nonpurpuric parameters: a comparative study. Dermatol Surg 2013; 40:118-26. [PMID: 24373006 DOI: 10.1111/dsu.12406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies have examined laser treatment of scars, but cosmetic results have been variable. Although no studies have examined the effect of purpura on scar improvement using the pulsed dye laser (PDL), many clinicians believe inducing purpura results in better and quicker improvement. OBJECTIVE To determine whether PDL treatment of fresh surgical scars with purpura-inducing settings improves clinical appearance more than non-purpura-inducing settings or no treatment. METHODS Twenty-six subjects with surgical scars enrolled in this prospective study. Scars were divided into three equal segments; treatment was randomized: 595-nm PDL with purpuric (1.5 ms) or nonpurpuric (10 ms) settings or no treatment. Fluences were adjusted to Fitzpatrick skin type. Scars were treated three times, 1 month apart, beginning at suture removal. Outcome measures included Vancouver Scar Scale (VSS) and blind clinical ratings. RESULTS The nonpurpuric condition showed significant improvement on the VSS total score, vascularity, and pliability ratings. The purpuric condition demonstrated a trend for improvement on the VSS total. According to blind observer ratings, all conditions improved, without differences between groups. CONCLUSION Nonpurpuric settings on the PDL resulted in significant improvements in the appearance of fresh surgical scars for vascularity, pliability, and VSS total scores, although all scar segments improved over time.
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Affiliation(s)
- Julie Akiko Gladsjo
- Division of Dermatology, Department of Medicine, University of California at San Diego, San Diego, California
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29
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Goldenberg A, Nguyen BT, Jiang SIB. Knowledge, understanding, and use of preventive strategies against nonmelanoma skin cancer in healthy and immunosuppressed individuals undergoing Mohs surgery. Dermatol Surg 2013; 40:93-100. [PMID: 24354730 DOI: 10.1111/dsu.12399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite various national recommendations advising individuals to reduce their exposure to ultraviolet radiation, many people still do not use these skin cancer prevention strategies. OBJECTIVES To assess patient sources of medical information, knowledge of sun protection strategies, and barriers to implementing these strategies and to compare the overall rate of use of skin cancer prevention strategies of healthy and immunocompromised patients. MATERIALS AND METHODS Survey-based study conducted on 140 individuals undergoing Mohs surgery. RESULTS Seventy-three percent of healthy and 74% of immunosuppressed participants identified sunscreen use as a form of protective strategy, whereas 36% and 27%, respectively, used sunscreen daily. Participants cited physicians and the internet as equal sources of medical information. Knowing two or more strategies correlated to a higher self-rating of daily use of any protective strategy. CONCLUSION General knowledge regarding sun protection strategies is limited, but awareness of multiple strategies correlated with greater sun protective behavior. Despite having a much higher incidence of skin cancers, the immunosuppressed group did not show more awareness of prevention strategies or higher use than healthy participants.
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Affiliation(s)
- Alina Goldenberg
- School of Medicine, University of California at San Diego, San Diego, California
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30
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Oganesyan G, Jarell AD, Srivastava M, Jiang SIB. Efficacy and complication rates of full-thickness skin graft repair of lower extremity wounds after Mohs micrographic surgery. Dermatol Surg 2013; 39:1334-9. [PMID: 23789591 DOI: 10.1111/dsu.12254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repair of below-the-knee lower extremity defects after Mohs micrographic surgery (MMS) that are not amenable to primary closure can be challenging given the high propensity for complications. No criterion standard exists for management of these wounds, but secondary-intention healing, partial- and full-thickness skin grafts (FTSGs), and various flaps are possible options to manage these wounds. Few data exist on the efficacy of FTSG repairs for lower extremity wounds. OBJECTIVES Assess the efficacy and complications rates of FTSG repairs for lower extremity wounds after MMS. METHODS This was a retrospective review of 80 FTSG repairs performed after MMS. Data were derived from 45 cases at Beth Israel Deaconess Medical Center and 35 cases at University of California, San Diego (UCSD) Medical Center. RESULTS Seventy-two of 80 cases (90%) had full graft survival, six (7.5%) had partial failure, and two (2.5%) had complete failure. In the cases where grafts had failed, wounds healed by secondary intention without further complications. Other complications included infections in nine (11%) cases and hematoma formation in two (2.5%). CONCLUSION FTSG is a consistent and safe reconstructive option for the management of lower extremity wounds after MMS.
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Affiliation(s)
- Gagik Oganesyan
- Division of Dermatology, Department of Medicine, University of California at San Diego, San Diego, California; Sutter Medical Group of the Redwoods, Sutter Pacific Medical Foundation, Santa Rosa, California
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31
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Afshar M, Lee RA, Jiang SIB. Desmoplastic trichilemmoma--a report of successful treatment with Mohs micrographic surgery and a review and update of the literature. Dermatol Surg 2012; 38:1867-71. [PMID: 22805188 DOI: 10.1111/j.1524-4725.2012.02514.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maryam Afshar
- Division of Dermatology, Department of Medicine, University of California at San Diego, CA, USA
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32
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Melancon JM, Tom WL, Lee RA, Jackson M, Brian Jiang SI. Management of Pilomatrix Carcinoma: A Case Report of Successful Treatment with Mohs Micrographic Surgery and Review of the Literature. Dermatol Surg 2011; 37:1798-805. [DOI: 10.1111/j.1524-4725.2011.02170.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alam M, Berg D, Bhatia A, Cohen JL, Hale EK, Herman AR, Huang CC, Jiang SIB, Kimyai-Asadi A, Lee KK, Levy R, Rademaker AW, White LE, Yoo SS. Association between number of stages in Mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study of practice patterns of 20 early- and mid-career Mohs surgeons. Dermatol Surg 2010; 36:1915-20. [PMID: 21040123 DOI: 10.1111/j.1524-4725.2010.01758.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the number of Mohs micrographic surgery (MMS) stages per tumor taken by early- to mid-career Mohs surgeons and to assess other factors affecting number of stages. METHODS Statistical analysis of MMS logs of 20 representative early- to mid-career surgeons. RESULTS There was no difference in stages when surgeons were divided into two categories based on whether they had more than 500 cases per year or more than 5 years of experience. Similarly, when surgeons were categorized according to geographic location, there was no difference in number of stages. Anatomic location was associated with the number of stages (analysis of variance, p<.001), with the greatest number of stages for nose (2.01) and ear (2.06) lesions and the fewest for neck (1.47), back and shoulder (1.47), and lower extremity (1.33) lesions. Basal cell carcinomas required 1.92 stages (median 2.00), compared with 1.66 (median 1.00) for squamous cell carcinoma (p<.001). CONCLUSIONS Early- and mid-career Mohs surgeons appear to remove tumors with similar numbers of stages regardless of their experience, case volume, or geographic location. Number of stages varies with anatomic location and tumor type. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, Otolaryngology, and Surgery, Northwestern University, Chicago, IL, USA.
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