Low recurrence rate of head and neck basal cell carcinoma treated with Mohs micrographic surgery: A retrospective study of 1021 cases.

OBJECTIVE: Mohs micrographic surgery (MMS) is the treatment of choice for high-risk primary basal cell carcinoma (BCC) and recurrent BCC of the head and neck, showing fewer recurrences compared with surgical excision (SE). The objectives of this study were to determine the recurrence rate of head and neck BCC after MMS and to develop a prediction model with significant risk factors for recurrence. DESIGN: A retrospective study of patient records. METHODS: All BCCs treated with MMS between 1 January 1995 and 1 July 2013 at the University Medical Center Groningen (UMCG) were selected retrospectively. Recorded parameters were patient characteristics, tumour size, tumour location, histopathological subtype, previous treatment, the number of stages until microscopic clearance, defect size, adverse events, follow-up time and recurrence after MMS. RESULTS: The study covered 1021 MMS operations conducted on primary BCCs (57.4%), residual BCCs (25.6%) and recurrent BCCs (17.0%). The median follow-up time was 54.0 months (ranging from 1 to 221 months). The 5-year cumulative probability of recurrence was 3.3%: 2.6% for primary BCCs, 5.4% for residual BCCs and 2.9% for recurrent BCCs. An aggressive histopathological subtype, residual BCCs and recurrent BCCs were significant risk factors for predicting a higher risk of recurrence after MMS. CONCLUSION: This large-scale retrospective study showed low recurrence rates after MMS for primary and recurrent BCCs. Residual BCCs treated with MMS had relatively higher recurrence rates. The risk of recurrence for MMS-treated residual aggressive BCCs was more than four times higher than that for primary non-aggressive BCCs.

The tandem repeated irritation test: a new method to assess prevention of irritant combination damage to the skin.

The effect of a protective cream was tested in a new tandem repeated irritation test with tandem application of 0.5% sodium lauryl sulphate (SLS) and undiluted toluene. The irritants were applied twice daily for 30 min to the ventral forearms of 20 volunteers. Irritant cutaneous reactions were quantified by a visual score, transepidermal water loss, chromametry and skin capacitance. Concurrent application of SLS/toluene induced stronger reactions than those caused by twice daily application of each irritant on its own. A protective effect of the protective cream was obtained against all treatment combinations and was significant for SLS/SLS (p < or = 0.01) and SLS/ toluene (p < or = 0.05). Our results indicate that the tandem repetitive irritation test has great potential in the evaluation of skin care products to prevent irritant contact dermatitis.

Skin cleansers: three test protocols for the assessment of irritancy ranking.

In this article, the results of 3 studies on 2 hand cleansers (products A and B) are analysed. Three different test models (the patch test, the forearm wash test and the use test) are used to obtain information on the skin irritancy of these 2 products. Test reactivity was assessed by clinical scores and bioengineering methods such as corneometry for skin moisture, transepidermal water loss measurements for barrier function and chromametry for erythema. A correlating trend of product A being more aggressive than product B could be confirmed in all 3 studies and was statistically significant in the patch-testing series. Distinction of the results was dependent on the test protocol employed. Models for testing cleansing preparations should be chosen carefully, depending on the hypothesis to be evaluated.