RESUMO
BACKGROUND: The availability of Mohs micrographic surgery (MMS) in Australia has increased dramatically since its inception in the 1980s. OBJECTIVE: This study aimed to describe the evolution of MMS practices at the Skin and Cancer Foundation Australia (SCFA) over the past 20 years (1997-2017). METHODS: Retrospective analysis of Mohs surgery cases at SCFA in 2017, 2007, and 1997, comparing data on sex, age, tumor type and site, initial tumor and final defect size, number of surgical stages and sections, and closure management. The present study is limited by being a retrospective analysis from a single institution. RESULTS: There was a 415% increase in the number of Mohs surgery cases from 1997 to 2017, and a significant increase in Mohs surgery-treated squamous cell carcinoma. The preoperative tumor and final defect size have decreased. More side-to-side closures and fewer grafts are being performed over time. LIMITATIONS: Retrospective analysis from a single institution. CONCLUSION: Over the last 20 years, MMS has remained appropriate in its application and is being increasingly used for treatment of squamous cell carcinoma suggesting improved access.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Especializados/estatística & dados numéricos , Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Idoso , Austrália , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Fundações/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Ferida Cirúrgica/etiologia , Ferida Cirúrgica/patologia , Carga Tumoral , Técnicas de Fechamento de Ferimentos/tendênciasRESUMO
Cutaneous T-cell lymphoma is an uncommon group of non-Hodgkin's lymphoma primarily affecting the skin. It is comprised of a variety of entities with different clinical behaviours and prognosis. Mycosis fungoides is the commonest subtype, and Sézary syndrome is a much rarer form of cutaneous T-cell lymphoma. At this stage, control rather than cure is the goal of therapy, with particular emphasis placed on preserving quality of life. Our review of the efficacy, safety profile and accessibility of treatment modalities for mycosis fungoides/Sézary syndrome is a tailored guide for the clinician treating these rare conditions.
Assuntos
Linfoma Cutâneo de Células T/terapia , Neoplasias Cutâneas/terapia , Antineoplásicos/uso terapêutico , Antagonistas do Ácido Fólico/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Fatores Imunológicos/uso terapêutico , Interferons/uso terapêutico , Linfoma Cutâneo de Células T/patologia , Estadiamento de Neoplasias , Fotoferese , Fototerapia , Radioterapia/métodos , Neoplasias Cutâneas/patologia , Transplante de Células-TroncoRESUMO
BACKGROUND/OBJECTIVES: Keratinocyte cancer impacts health-related quality of life (HRQL). Disease progression and treatment can lead to adverse physical and psychosocial consequences. The skin cancer index (SCI) is a validated tool with higher scores reflecting greater HRQL. Our objectives were to assess and compare the impact of keratinocyte cancer using the SCI in two diverse populations. METHODS: A total of 120 patients were prospectively recruited from dermatology clinics in Sydney, Australia, and Santander, Spain, providing demographics and completing the SCI. RESULTS: About 61.1% of Australians reported ≥2 skin cancers (vs 20% P = <0.001), 44.4% resulting visible scars (vs 14.8% P = <0.001). Visible scars were associated with poorer HRQL, across total SCI (68.3 vs 81.5 P = <0.001), social (76.0 vs 86.7 P = 0.003) and emotional (54.2 vs 69.7 P = 0.003) domains. Interestingly, perceived visible scars were not associated with appearance scores. The Spanish population reported greater appearance (88.0 vs 75.6 P = 0.008) and emotional (70.7 vs 60.5 P = 0.034) HRQL. Surprisingly, incidence of cancer, recent disease, gender and education were not associated with HRQL impairment. CONCLUSIONS: Australians with keratinocyte cancer experience poorer HRQL compared to a Spanish population. Offering non-surgical means when amenable and consideration of psychosocial needs during clinical course is emphasised. While our study highlights the importance of HRQL tools, our results question the sensitivity of the SCI across populations. Further research is required to substantiate its ongoing use.
Assuntos
Carcinoma Basocelular/psicologia , Carcinoma de Células Escamosas/psicologia , Cicatriz/psicologia , Qualidade de Vida , Neoplasias Cutâneas/psicologia , Fatores Etários , Idoso , Austrália/epidemiologia , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia , Espanha/epidemiologiaAssuntos
Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Cirurgia Plástica/tendências , Retalhos Cirúrgicos/tendências , Procedimentos Cirúrgicos Ambulatórios/tendências , Austrália , Dermatologia/tendências , Feminino , Humanos , Masculino , Procedimentos de Cirurgia Plástica/tendênciasRESUMO
BACKGROUND: There is a need for improvement in informed medical consent to address the lack of standardization and to increase patient engagement. OBJECTIVE: To investigate the use of a video to aid informed consent for Mohs micrographic surgery and evaluate patient understanding, satisfaction, anxiety, and time savings relative to verbal consent. METHODS: A 2-armed randomized controlled trial involving 102 patients compared video-assisted consent with a control group who underwent consent in the standard verbal manner. All participants underwent questionnaire-based testing of knowledge, satisfaction, and anxiety, and the time of each consultation was measured. RESULTS: Patients who watched the video performed significantly better in the knowledge questionnaire compared with the control group (P = .02), were more satisfied with their understanding of the risks of Mohs micrographic surgery (P = .013), and spent less time with their physician (P = .008). Additionally, 78.4% of video group patients reported that they preferred seeing the video before speaking with their physician. LIMITATIONS: The study design may not replicate day-to-day clinical practice. CONCLUSION: Video-assisted consent for Mohs micrographic surgery improves patient knowledge, leads to a better understanding of the risks, and saves physicians time without compromising patient satisfaction and anxiety levels in this study setting.
RESUMO
Squamous Cell Carcinoma (SCC) with Osteoclast-like giant cell (OLGC) is a rare SCC variant; only 10 cases have been reported. Our case suggests OLGC are resultant of a reactive process, driven by the fusion of adjacent macrophages. Knowledge regarding SCC with OLGC is of great importance as this entity has greater prometastatic potential compared to conventional SCC.