RESUMO
BACKGROUND: Dermatologists perform most interpolated flaps after skin cancer resection. Prospective, multicenter data on complications after interpolated flap repair in this setting are limited. OBJECTIVE: To determine the rate of physician-reported complications after interpolated flap repair of the nose. METHODS: Multicenter, prospective cohort study of 169 patients undergoing 2-stage interpolated flap repair of post-Mohs nasal defects. Frequency of bleeding, infection, dehiscence, necrosis, hospitalization, and death in the 30 days after flap placement and flap takedown are reported. RESULTS: Patients experienced 23 complications after flap placement (13.61%) and 6 complications after flap takedown (3.55%) that were related to the surgical procedure. The most frequent complication after flap placement was bleeding (9, 5.33%, 95% confidence interval [CI]: 2.83%-9.82%). The most frequent complication after flap takedown was infection (5, 2.96%, 95% CI: 1.27%-6.74%). There was one hospitalization related to an adverse reaction to antibiotics. There were no deaths. CONCLUSION: Most complications after interpolated flap repair for post-Mohs defects of the nose are minor and are associated with flap placement. Interpolated flap repair for post-Mohs defects can be performed safely in the outpatient setting under local anesthesia.
Assuntos
Cirurgia de Mohs , Neoplasias Nasais , Humanos , Estudos Prospectivos , Cirurgia de Mohs/efeitos adversos , Retalhos Cirúrgicos/cirurgia , Nariz/cirurgia , Neoplasias Nasais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Local recurrence rates (LRRs) after Mohs micrographic surgery (MMS) for male genital cancers have been reported in only a few small case series, and patient-reported outcomes (PROs) have not been studied. OBJECTIVE: To determine the LRR and PROs after MMS for male genital skin cancers. METHODS: Retrospective review of all male genital skin cancers removed with MMS between 2008 and 2019 at an academic center. LRR was determined by chart review and phone calls. PROs were assessed by survey. RESULTS: A total of 119 skin cancers in 108 patients were removed with MMS. Tumors were located on the penis (90/119) and scrotum (29/119). Diagnoses included squamous cell carcinoma in situ (n = 71), invasive squamous cell carcinoma (n = 32), extramammary Paget disease (n = 13), melanoma (n = 2), and basal cell carcinoma (n = 1). The LRR was 0.84% (1/119), with a mean follow-up time of 3.25 years (median, 2.36 years). The majority of survey respondents reported no changes in urinary (66%) or sexual functioning (57.5%) after surgery. LIMITATIONS: Retrospective single-center experience; short follow-up time; low survey response rate; no baseline functional data. CONCLUSION: MMS for male genital skin cancer has a low LRR and high patient-reported satisfaction with urinary and sexual function.
Assuntos
Neoplasias dos Genitais Masculinos/cirurgia , Cirurgia de Mohs , Medidas de Resultados Relatados pelo Paciente , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias dos Genitais Masculinos/epidemiologia , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Doença de Paget Extramamária/cirurgia , Satisfação do Paciente , Neoplasias Penianas/epidemiologia , Neoplasias Penianas/cirurgia , Pennsylvania/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escroto/cirurgia , Disfunções Sexuais Fisiológicas/etiologia , Neoplasias Cutâneas/epidemiologia , Transtornos Urinários/etiologiaRESUMO
BACKGROUND: Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood. OBJECTIVE: To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions. MATERIALS AND METHODS: Multi-center, prospective discrete choice experiment (DCE). RESULTS: Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics. CONCLUSION: Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.
Assuntos
Antibioticoprofilaxia , Procedimentos Cirúrgicos Dermatológicos , Preferência do Paciente , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Antibiotic prescriptions associated with dermatologic surgical visits are increasing and prescribing practices vary among surgeons. OBJECTIVE: To describe dermatologic surgeons' attitudes and practices regarding prophylactic antibiotic use for surgical site infection (SSI), to compare current prescribing practices to those of a 2012 survey, and to determine surgeons' interest in clinical trial data on the utility of prophylactic antibiotics. MATERIALS AND METHODS: This was a cross-sectional online survey of the American College of Mohs Surgery (ACMS) members. Survey items were adapted from a 2012 survey of ACMS members. RESULTS: The survey was initiated by 101 ACMS members. 75.25% (76/101) of surgeons reported routinely prescribing prophylactic antibiotics to reduce SSI risk. The use of prophylactic antibiotics varied with clinical scenario. Most providers (84.21%, 64/76) prescribe postoperative antibiotics, with an average course of 6.56 days. 40.21% (39/97) of respondents were uncertain if prophylaxis prevents SSI, and up to 90.63% (87/96) indicated interest in clinical trial data evaluating the efficacy of oral antibiotics for SSI prevention. CONCLUSION: Dermatologic surgeons continue to report varied attitudes and practices for SSI prophylaxis. Evidence from clinical trials is desired by surgeons to guide clinical practice.
Assuntos
Antibioticoprofilaxia , Atitude do Pessoal de Saúde , Procedimentos Cirúrgicos Dermatológicos , Dermatologistas/psicologia , Padrões de Prática Médica , Infecção da Ferida Cirúrgica/prevenção & controle , Estudos Transversais , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Pesquisas sobre Atenção à Saúde , Humanos , Cirurgia de Mohs , Sociedades Médicas , Estados UnidosAssuntos
Melanoma/diagnóstico , Melanoma/cirurgia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amarelo de Eosina-(YS) , Feminino , Corantes Fluorescentes , Secções Congeladas , Hematoxilina , Humanos , Antígeno MART-1/análise , Masculino , Margens de Excisão , Melanoma/química , Pessoa de Meia-Idade , Cirurgia de Mohs , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/química , Fixação de TecidosAssuntos
Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Imuno-Histoquímica , Queratinas/análise , Queratinas/metabolismo , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/prevenção & controle , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologiaAssuntos
Mãos/cirurgia , Cirurgia de Mohs/efeitos adversos , Retalho Perfurante/transplante , Neoplasias Cutâneas/cirurgia , Ferida Cirúrgica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artérias/transplante , Feminino , Seguimentos , Humanos , Masculino , Ossos Metacarpais/irrigação sanguínea , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective: Among patients undergoing two-stage interpolated flap repair of nasal defects, nasal function, and appearance before surgery and at 16 weeks after flap takedown were compared using the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ). Design: Multicenter prospective cohort study. Methods: Adult patients with a nasal skin cancer anticipated to require two-stage interpolation flap repair completed the NAFEQ before surgery, at 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Results: One hundred sixty-nine patients were enrolled, with 138 patients completing both presurgical and 16-week post-takedown NAFEQs. Overall NAFEQ score increased by 1.09 points (1.91% improvement, confidence interval [95% CI -0.34 to 2.53]). NAFEQ functional subscale increased by 0.72 points (2.58% increase; 95% CI [0.10-1.35]) and appearance subscale increased by 0.37 points (1.28% improvement, 95% CI [-0.65 to 1.39]). Conclusion: At 16 weeks after flap takedown, patients' perceptions of their nasal function and appearance are similar to or slightly improved when compared with their presurgical assessments.
Assuntos
Neoplasias Nasais , Rinoplastia , Neoplasias Cutâneas , Adulto , Humanos , Estudos Prospectivos , Nariz/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Nasais/cirurgia , Medidas de Resultados Relatados pelo PacienteRESUMO
A 42-year-old Latino man with a medical history of vitiligo presented to our outpatient clinic with a 25-year history of a recurrent, itchy eruption on his face and hands. Physical examination revealed pink, scaly, erythematous, lichenified papules and plaques with overlying crusts, photodistributed on the nose, chin, cheeks, hands, and ears (Figures 1a and 2a). The lips were edematous with hemorrhagic crusting, and conjunctival injection and partial corneal opacities were noted (Figures 1b-1c). Histologic evaluation demonstrated psoriasiform hyperplasia with hyper-granulosis and a superficial perivascular infiltrate composed of lymphocytes, histiocytes, and eosinophils. Human leukocyte antigen (HLA) class II typing was positive for HLA-DRB1*0407, thus confirming the diagnosis of actinic prurigo (AP).
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Transtornos de Fotossensibilidade , Dermatopatias Genéticas , Adulto , Humanos , Masculino , Transtornos de Fotossensibilidade/tratamento farmacológico , Dermatopatias Genéticas/tratamento farmacológicoRESUMO
IMPORTANCE: Single-center studies have shown that patients report better skin cancer-specific quality of life (QOL) after Mohs micrographic surgery (MMS), but it is unclear whether this improved QOL applies to patients after MMS and complex reconstruction in cosmetically sensitive areas. OBJECTIVE: To evaluate patient QOL after MMS and interpolation flap reconstruction for patients with nasal skin cancers. DESIGN, SETTING AND PARTICIPANTS: This multicenter prospective survey study used the Skin Cancer Index (SCI), a validated, 15-question QOL questionnaire administered at 4 time points: before MMS, 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Patients age 18 years or older with a nasal skin cancer who presented for MMS and were anticipated to undergo 2-stage interpolated flap repair by a Mohs surgeon were recruited from August 9, 2018, to February 2, 2020, at 8 outpatient MMS locations across the United States, including both academic centers and private practices. MAIN OUTCOMES AND MEASURES: Mean difference in overall SCI score before MMS vs 16 weeks after flap takedown. RESULTS: A total of 169 patients (92 men [54.4%]; mean [SD] age, 67.7 [11.4] years) were enrolled, with 147 patients (75 men [51.0%]; mean [SD] age, 67.8 [11.7] years) completing SCI surveys both before MMS and 16 weeks after flap takedown. Total SCI scores improved significantly 16 weeks after flap takedown compared with pre-MMS scores, increasing by a mean of 13% (increase of 7.11 points; 95% CI, 5.48-8.76; P < .001). All 3 SCI subscale scores (emotion, appearance, and social) improved significantly (emotion subscale, increase of 3.27 points; 95% CI, 2.35-4.18; P < .001; appearance subscale, increase of 1.65 points; 95% CI, 1.12-2.18; P < .001; and social subscale, increase of 2.10 points; 95% CI, 1.55-2.84; P < .001) 16 weeks after flap takedown compared with pre-MMS. CONCLUSIONS AND RELEVANCE: Removal of a nasal skin cancer and repair of the resulting defect can be distressing for patients. However, this cohort study suggests that physicians referring patients for MMS can be reassured that their patient's QOL will improve on average after surgery, even when a complex reconstruction is required.