RESUMO
BACKGROUND: Few studies show how dermatologic surgeons manage problems with site identification. OBJECTIVE: To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question. METHODS: Nationwide, prospective, multi-site cohort study. RESULTS: Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question (LIQ) for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80/98) of initially uncertain sites, with the remaining 18% (18/98) postponed. Most postponed surgeries were at non-facial sites. LIMITATIONS: Sites were academic centers. CONCLUSIONS: When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed.
Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Cirurgia de Mohs , Estudos Prospectivos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Pigmentação da Pele , Resultado do TratamentoRESUMO
Desmoplastic trichilemmoma, an uncommon variant of trichilemmoma, is a benign adnexal neoplasm originating from the outer root sheath of a hair follicle, which has rarely been associated with atypical basaloid proliferations, including basal cell carcinoma. In this patient case, a 67-year-old female presented to our dermatology clinic for a skin check. On physical examination, a pearly, pink papule was noted on the vertex scalp, and a biopsy was obtained to rule out malignancy. Histologic examination of the lesion favored a desmoplastic trichilemmoma; however, a basaloid neoplasm could not be ruled out. Subsequently, the patient underwent Mohs micrographic surgery, and upon examination of the Stage I Mohs slides, superficial basal cell carcinoma was identified within the lesion. This case serves to further strengthen the known association between basal cell carcinoma and desmoplastic trichilemmoma. In addition, it demonstrates that the presence of basal cell carcinoma may not be observed on the initial biopsy of these lesions, underscoring the utility of complete surgical excision.
RESUMO
This case report describes an atypically large pilar sheath acanthoma (PSA) presenting on a patient's cheek. Due to the bothersome nature of the lesion, the patient underwent surgical excision, with subsequent histopathological analysis confirming the diagnosis of an unusually large PSA. In addition to a definitive diagnosis, surgical excision provided symptomatic relief for the patient.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Neoplasias Cutâneas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
Importance: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures: Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures: Reason for treatment selection. Results: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Feminino , Humanos , Masculino , Cirurgia de Mohs , Prática Privada , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaAssuntos
Cianoacrilatos/uso terapêutico , Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Adesivos Teciduais/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Asiático , Dermatofibrossarcoma , Programa de SEER , Neoplasias Cutâneas , Humanos , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/diagnóstico , Dermatofibrossarcoma/patologia , Programa de SEER/estatística & dados numéricos , Asiático/estatística & dados numéricos , Feminino , Masculino , Neoplasias Cutâneas/epidemiologia , Adulto , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Idoso , Adulto Jovem , Adolescente , IncidênciaAssuntos
Carcinoma de Célula de Merkel , Bases de Dados Factuais , Neoplasias Cutâneas , Humanos , Carcinoma de Célula de Merkel/mortalidade , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/diagnóstico , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/epidemiologia , Masculino , Feminino , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Causas de MorteRESUMO
The development of malignancies in graft donor sites is rare and may be caused by de novo malignancies as well as metastatic and iatrogenic spread. Malignancies in graft donor sites are distinguished from Marjolin ulcers by some investigators because they occur in healed surgical wounds rather than in chronic wounds or unstable scars and tend to occur sooner after injury. We present a unique case of Merkel cell carcinoma (MCC) developing in a vein graft donor site 18 years after vein harvesting.
Assuntos
Carcinoma de Célula de Merkel , Cicatriz , Dissecação/métodos , Radioterapia/métodos , Neoplasias Cutâneas , Enxerto Vascular/efeitos adversos , Idoso , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/fisiopatologia , Carcinoma de Célula de Merkel/terapia , Cicatriz/etiologia , Cicatriz/patologia , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/fisiopatologia , Neoplasias Cutâneas/terapia , Resultado do TratamentoRESUMO
Bullous eruptions in patients with lupus erythematosus can be difficult to diagnose as bullous lesions can develop in lupus-specific lesions, and primary blistering disorders can also occur. Additionally, these patients tend to have multiple co-morbidities making them more likely to be on many medications that can lead to bullous drug reactions. A thorough history, the clinical presentation, and histopathological findings along with direct immunofluorescence can be helpful in diagnosing most cases. The authors report the case of a woman with a long history of systemic lupus erythematosus who initially presented in their clinic for diagnosis and management of erythema dyschromicum perstans and one year later developed bullae in atypical targetoid lesions on the extremities and trunk. They discuss several blistering disorders that have been reported in patients with lupus erythematosus with a focus on features that help distinguish erythema multiforme, fixed drug eruption, and lupus erythematosus from Stevens-Johnson syndrome/toxic epidermal necrolysis. In the patient described herein, the authors favor a diagnosis of Stevens-Johnson syndrome, but the classification between erythema multiforme major and Stevens-Johnson syndrome/toxic epidermal necrolysis cannot be made in some cases.