Effectiveness of a 595-nm Pulsed Dye Laser for the Treatment of Basal Cell Carcinoma Using One Double-Stacked Pulse Session: A Randomized, Double-Blinded Controlled Trial.

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.

Squamous Cell Carcinoma In Situ Upstaged to Invasive Squamous Cell Carcinoma: A 5-Year, Single Institution Retrospective Review.

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.

Mohs micrographic surgery for eccrine porocarcinoma: an update and review of the literature.

BACKGROUND: Eccrine porocarcinoma (EPC) is a rare malignancy of the eccrine sweat glands that is locally aggressive with a high propensity to metastasize. Most cases have been treated by wide local excision (WLE) with 20% local recurrence rate. There have been 20 cases of EPC treated with Mohs micrographic surgery (MMS) in the literature. OBJECTIVE: To review the literature regarding the management of this aggressive tumor using MMS. METHODS: A comprehensive literature review was conducted by searching the PubMed database using the keywords Mohs, porocarcinoma, malignant eccrine poroma, and eccrine neoplasms. RESULTS: Most of the reported cases of EPC were treated by WLE, and only 20 cases were treated with MMS. Of the 20 EPC cases treated with MMS, there was only 1 nodal recurrence and no local recurrence. Other reported treatment modalities include radiation and excision with frozen sections. The authors report the second case of EPC on the temple, and the 21st case successfully treated with MMS. CONCLUSION: Eccrine porocarcinoma is a rare neoplasm with potentially aggressive clinical behavior. In cases where tissue conservation is important, MMS should be considered.

Management of trichilemmal carcinoma: an update and comprehensive review of the literature.

BACKGROUND: Trichilemmal carcinoma (TC) is a rare malignant adnexal neoplasm with outer root sheath differentiation. Most cases have been treated by surgical excision with a few recurrences. There have been 6 case reports of TC treated with Mohs micrographic surgery (MMS). OBJECTIVE: To perform an updated review of the literature regarding management of this uncommon tumor. METHODS: A comprehensive literature review was conducted by searching the PubMed database using the keywords trichilemmal carcinoma, tricholemmal carcinoma, and tricholemmocarcinoma. RESULTS: There have been 103 reported cases of TC, and most of these were treated with surgical excisions. Of the 35 cases with follow-up data, 3 reported local recurrences and 1 had subsequent metastatic disease. There are 6 cases of TC successfully treated with MMS without any recurrence. In addition, we report the seventh case of TC successfully treated with MMS. Other reported treatment modalities include imiquimod and excision with frozen sections. Histopathologically, the distinction between TC and squamous cell carcinoma with clear cell differentiation has been debated in the literature. CONCLUSION: Trichilemmal carcinoma is a rare neoplasm that may behave aggressively. The recommended treatment should be a complete surgical excision with histologic confirmation of clear margins. In cases where tissue sparing or cosmesis is important, MMS may be considered.