RESUMEN
BACKGROUND: Mohs micrographic surgery (MMS) is a promising treatment modality for melanoma in situ (MIS). However, variations in surgical technique limit the generalizability of existing data and may impede future study of MMS in clinical trials. METHODS: A modified Delphi method was selected to establish consensus on optimal MMS techniques for treating MIS in future clinical trials. The Delphi method was selected due to the limited current data, the wide range of techniques used in the field, and the intention to establish a standardized technique for future clinical trials. A literature review and interviews with experienced MMS surgeons were performed to identify dimensions of the MMS technique for MIS that (1) likely impacted costs or outcomes of the procedure, and (2) showed significant variability between surgeons. A total of 8 dimensions of technical variation were selected. The Delphi process consisted of 2 rounds of voting and commentary, during which 44 expert Mohs surgeons across the United States rated their agreement with specific recommendations using a Likert scale. RESULTS: Five of eight recommendations achieved consensus in Round 1. All 3 of the remaining recommendations achieved consensus in Round 2. Techniques achieving consensus in Round 1 included the use of a starting peripheral margin of ≤5 mm, application of immunohistochemistry, frozen tissue processing, and resecting to the depth of subcutaneous fat. Consensus on the use of Wood's lamp, dermatoscope, and negative tissue controls was established in Round 2. CONCLUSIONS: This study generated 8 consensus recommendations intended to offer guidance for Mohs surgeons treating MIS. The adoption of these recommendations will promote standardization to facilitate comparisons of aggregate data in multicenter clinical trials.
RESUMEN
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.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias Cutáneas , Humanos , Masculino , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas/patología , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/patología , Estadificación de Neoplasias , Recurrencia Local de Neoplasia/patología , Cobertura del SeguroRESUMEN
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.
Asunto(s)
Enfermedad de Paget Extramamaria , Neoplasias Cutáneas , Anciano , Humanos , Imiquimod/uso terapéutico , Enfermedad de Paget Extramamaria/diagnóstico , Enfermedad de Paget Extramamaria/patología , Enfermedad de Paget Extramamaria/terapia , Estudios Prospectivos , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapiaRESUMEN
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.
Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Márgenes de Escisión , Melanoma/patología , Melanoma/cirugía , Cirugía de Mohs/métodos , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Melanoma Cutáneo MalignoRESUMEN
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.
Asunto(s)
Carcinoma Basocelular/diagnóstico , Cirugía de Mohs/estadística & datos numéricos , Neoplasias Cutáneas/diagnóstico , Piel/patología , Anciano , Biopsia/estadística & datos numéricos , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Femenino , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Estadificación de Neoplasias/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaAsunto(s)
Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Infecciones por VIH/inmunología , Márgenes de Escisión , Neoplasias Cutáneas/cirugía , Recuento de Linfocito CD4 , Carcinoma Basocelular/complicaciones , Carcinoma de Células Escamosas/complicaciones , Estudios de Casos y Controles , Infecciones por VIH/complicaciones , Humanos , Cirugía de Mohs , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/complicacionesRESUMEN
BACKGROUND: Surgical and nonsurgical methods are used for treating basal cell carcinoma (BCC). Few randomized controlled trials exist on the effectiveness of the pulsed dye laser (PDL) on BCC treatment. OBJECTIVE: We investigated the effectiveness of PDL treatment in a single session for the management of nodular and superficial BCCs on the trunk and extremities of adults using a randomized, double-blind, controlled technique. METHODS: We used settings of fluence 7.5 J/cm2, 3-ms pulse duration, no dynamic cooling, 10-mm spot size, 10% overlap between pulses, and 2 stacked pulses on a 595-nm wavelength laser. Histopathologic clearance on excision of tumor with 4-mm margins was the primary outcome measure. RESULTS: Twenty-four patients were included in the study, with 14 in the laser treatment group and 10 patients in the sham/control group. In total, 10/14 (71.4%) of the tumors in the treatment group were successfully treated with no residual tumor on excisional specimen histology, compared with 3/10 (30.0%) of the control group (p = .045). CONCLUSION: Our study shows that PDL may be an effective treatment for low-risk BCCs of the trunk and extremities, but the cure rate is lower than those of other treatments for BCC. Thus, PDL under the current settings cannot be recommended.
Asunto(s)
Carcinoma Basocelular/cirugía , Láseres de Colorantes/uso terapéutico , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Relación CD4-CD8 , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Infecciones por VIH/complicaciones , Neoplasias Cutáneas/inmunología , Carcinoma Basocelular/sangre , Carcinoma Basocelular/inmunología , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/sangre , Carcinoma de Células Escamosas/inmunología , Carcinoma de Células Escamosas/patología , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/inmunología , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Cirugía de Mohs/estadística & datos numéricos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/sangre , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Carga Tumoral/inmunologíaRESUMEN
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.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Dermatólogos , Enfermedades Profesionales/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Administración de la Seguridad/métodos , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Procedimientos Quirúrgicos Electivos , Humanos , Cirugía de Mohs/efectos adversos , Cirugía de Mohs/métodos , Enfermedades Profesionales/epidemiología , Procedimientos Quirúrgicos Oftalmológicos/métodos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Cuidados Preoperatorios , Procedimientos de Cirugía Plástica/métodos , SARS-CoV-2 , Humo/prevención & controlAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Manejo de la Enfermedad , Oncología Médica/métodos , Neumonía Viral/complicaciones , Neoplasias Cutáneas/complicaciones , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2 , Neoplasias Cutáneas/terapiaRESUMEN
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.
Asunto(s)
Terapia de Inmunosupresión/efectos adversos , Cirugía de Mohs/efectos adversos , Complicaciones Posoperatorias/epidemiología , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/inmunología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Trasplante de Órganos , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Prevalencia , Estudios Retrospectivos , Neoplasias Cutáneas/cirugía , Dehiscencia de la Herida Operatoria/epidemiología , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiologíaRESUMEN
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.
Asunto(s)
Profilaxis Antibiótica/métodos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Emolientes/uso terapéutico , Crema para la Piel/uso terapéutico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Cefalexina/uso terapéutico , Procedimientos Quirúrgicos Dermatologicos/métodos , Doxiciclina/uso terapéutico , Emolientes/farmacología , Epidermis/efectos de los fármacos , Epidermis/fisiopatología , Femenino , Pie , Humanos , Incidencia , Pierna , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Crema para la Piel/farmacología , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Técnicas de Sutura/efectos adversos , Resultado del Tratamiento , Pérdida Insensible de Agua/efectos de los fármacos , Pérdida Insensible de Agua/fisiologíaRESUMEN
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.
RESUMEN
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.
RESUMEN
BACKGROUND: Shave biopsy may not be able to accurately distinguish squamous cell carcinoma in situ (SCCIS) from invasive squamous cell carcinoma (SCC). Information on the incidence of biopsy-proven SCCIS upstaged to SCC after a more complete histologic examination is limited. OBJECTIVE: To determine the incidence and clinical risk factors associated with upstaging the biopsy diagnosis of SCCIS into invasive SCC based on findings during Mohs micrographic surgery (MMS). METHODS: All MMS cases of SCCIS performed between March 2007 and February 2012 were identified, MMS operative notes were examined, and invasive dermal components were confirmed by the MMS slide review. Upstaged SCCIS was defined as biopsy-diagnosed SCCIS subsequently found to be an invasive SCC during MMS. RESULTS: From 566 cases with the preoperative diagnosis of SCCIS, 92 (16.3%) cases were SCCIS upstaged to SCC. Location of ears, nose, lips, and eyelids, preoperative diameter >10 mm, and biopsy report mentioning a transected base were significant predictors of upstaged SCCIS. CONCLUSION: Considering the possibility that over 16% of SCCIS may be truly invasive SCC, biopsy-proven SCCIS should be treated adequately with margin-assessed treatment modalities such as surgical excision or Mohs surgery when indicated.
Asunto(s)
Carcinoma in Situ/patología , Carcinoma de Células Escamosas/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Humanos , Persona de Mediana Edad , Cirugía de Mohs , Invasividad Neoplásica , Estadificación de Neoplasias , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/cirugíaRESUMEN
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 10â¯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 100â¯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, 10â¯649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59â¯923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100â¯000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100â¯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.
Asunto(s)
Carcinoma de Células de Merkel/epidemiología , Carcinoma de Células Escamosas/epidemiología , Melanoma/epidemiología , Trasplante de Órganos/estadística & datos numéricos , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Carcinoma de Células de Merkel/etnología , Carcinoma de Células Escamosas/etnología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Melanoma/etnología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Neoplasias Cutáneas/etnología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Ultraviolet radiation is a well-known risk factor for basal cell carcinoma (BCC). Therefore, the high incidence of BCCs in sun-exposed areas such as the head and neck is unsurprising. However, unexpectedly, BCCs on the sun-protected dorsal foot have also been reported, and tumor occurrence here suggests that other factors besides ultraviolet radiation may play a role in BCC pathogenesis. Because only few dorsal foot BCCs have been reported, data on their clinical features and management are limited. OBJECTIVE: To perform an updated review of the literature on clinical characteristics and treatment of dorsal foot BCCs. METHODS: We conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal foot," "basal cell carcinoma foot," and "basal cell carcinoma toe." RESULTS: We identified 20 cases of dorsal foot BCCs in the literature, 17 of which had sufficient data for analysis. Only 1 case was treated with Mohs micrographic surgery. We present 8 additional cases of dorsal foot BCCs treated with Mohs micrographic surgery. CONCLUSION: Basal cell carcinomas on the dorsal foot are rare, and potential risk factors include Caucasian descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment option.
Asunto(s)
Carcinoma Basocelular/cirugía , Enfermedades del Pie/cirugía , Neoplasias Cutáneas/cirugía , Carcinoma Basocelular/epidemiología , Enfermedades del Pie/epidemiología , Humanos , Cirugía de Mohs , Pronóstico , Factores de Riesgo , Neoplasias Cutáneas/epidemiologíaRESUMEN
BACKGROUND: Randomized controlled trials are the gold standard for comparing safety and effectiveness of surgical interventions. Reporting guidelines are available for conveying the results of such trials. OBJECTIVE: To assess adherence to standard reporting guidelines among randomized controlled trials in dermatologic surgery. MATERIALS AND METHODS: Systematic review. Data source was randomized controlled trials in the journal Dermatologic Surgery, per PubMed search, 1995 to 2014. Studies were appraised for the number of the 37 CONSORT 2010 Checklist criteria reported in each. Analysis included comparison of reporting across 4 consecutive periods. RESULTS: Three hundred sixty-three studies were eligible. The mean number of items reported per study increased monotonically from 14.5 in 1995 to 1999 to 16.2 in 2002 to 2004, 17.7 in 2005 to 2009, and 18.0 in 2010 to 2014 (p < .0001). A limitation was that study procedures may have been performed without being reported. CONCLUSION: Completeness of reporting in randomized controlled trials in dermatologic surgery has improved significantly during the preceding 2 decades. Some elements are still reported at lower rates.