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
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/cirurgiaRESUMO
There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.
Assuntos
Assistência Ambulatorial , Anestesia Local/normas , Anestésicos Locais/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos , Dor/prevenção & controle , Administração Tópica , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Anestésicos Locais/efeitos adversos , Epinefrina/administração & dosagem , Medicina Baseada em Evidências , Humanos , Hialuronoglucosaminidase/administração & dosagem , Bloqueio Nervoso , Preferência do Paciente , Bicarbonato de Sódio/administração & dosagem , Vasoconstritores/administração & dosagemRESUMO
BACKGROUND: Many variations in the surgical treatment of upper eyelid blepharoplasty have been described, including orbicularis oculi muscle stripping. There is no evidence in the literature to support the efficacy of this technique in improving the aesthetic results of the procedure. OBJECTIVES: To conduct a single-blind, randomized, controlled, split-face pilot study to evaluate the effects of orbicularis oculi muscle stripping on upper lid blepharoplasty. METHODS: Ten subjects were randomized to receive upper lid blepharoplasty with orbicularis oculi muscle stripping on one side and skin-only blepharoplasty on the other. Patients and two blinded physicians evaluated the aesthetics of the eyelids at 1-, 3-, and 17-month follow-up visits. RESULTS: Blinded physician evaluation failed to show a difference in the overall cosmetic appearance of the eyelids between the control and treatment sides at any time point. Analysis of the composite of all patient scores showed a trend favoring the control side at 3 months (p = .28) and the treatment side at 17 months (p = .50), but neither difference was significant. CONCLUSION: Based on the data from this pilot study, orbicularis oculi muscle stripping appears to have no affect on the aesthetic outcome of upper lid blepharoplasty.
Assuntos
Blefaroplastia/métodos , Músculos Oculomotores/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoAssuntos
Angioceratoma/congênito , Angioceratoma/radioterapia , Lasers de Corante/uso terapêutico , Neoplasias Penianas/congênito , Neoplasias Penianas/radioterapia , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/radioterapia , Criança , Humanos , Terapia com Luz de Baixa Intensidade , Masculino , Recidiva Local de NeoplasiaAssuntos
Aminoquinolinas/efeitos adversos , Antineoplásicos/efeitos adversos , Hipopigmentação/induzido quimicamente , Idoso , Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Basocelular/tratamento farmacológico , Feminino , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Vitiligo/induzido quimicamenteRESUMO
PURPOSE: A survey-based study was conducted to gather expert experience on safety procedures used when performing Mohs micrographic surgery (MMS) on patients with known infectious hepatitis or human immunodeficiency virus (HIV). METHODS: Six hundred eighty-four fellowship-trained Mohs surgeons were surveyed to examine the types of safety protocols used when treating patients with known infectious hepatitis or HIV and the frequency of exposure injuries to laboratory and surgical personnel from these patients. RESULTS: One hundred eighty-eight (27.5%) surveys were collected; 64.7% of respondents reported at least one exposure injury to surgical or laboratory personnel in the past year, and 4.8% reported exposure from a patient with known hepatitis or HIV infection. Risk of reporting at least one injury from a patient with known infection within the past year was significantly less when also reporting disposal of the ink applicator after each use (relative risk [RR] = 0.109) and greater when employing laboratory personnel with no medical education or background (RR = 3.857). No exposures were reported from respondents using blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply, or 24-hour formalin fixation. CONCLUSION: Although firm associations cannot be made from this study, the data suggest that certain measures may help to reduce the rate of exposure injuries in MMS.
Assuntos
Infecções por HIV/transmissão , Pessoal de Saúde , Hepatite B/transmissão , Hepatite C/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cirurgia de Mohs/efeitos adversos , Exposição Ocupacional/prevenção & controle , Agendamento de Consultas , Desinfecção , Luvas Cirúrgicas , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Segurança , Manejo de Espécimes , Inquéritos e Questionários , VentilaçãoRESUMO
Mutations in the sonic hedgehog signaling pathway play a key role in the development of basal cell carcinomas. Specifically, mutations in the PTCH1 (also known as PTCH or PTC1) and SMO genes cause tumor formation through constitutive activation of the pathway. Misregulation of the pathway has also been implicated in the nevoid basal cell carcinoma syndrome and other tumors. Understanding the function of the sonic hedgehog pathway has led to novel strategies for treatment. In this review we highlight the role of the pathway in the pathogenesis of basal cell carcinoma and review potential targeted therapies.
Assuntos
Carcinoma Basocelular/genética , Predisposição Genética para Doença , Proteínas Hedgehog/genética , Transdução de Sinais/efeitos dos fármacos , Neoplasias Cutâneas/genética , Animais , Carcinoma Basocelular/tratamento farmacológico , Estudos de Coortes , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos/métodos , Feminino , Humanos , Masculino , Camundongos , Biologia Molecular , Mutação , Sensibilidade e Especificidade , Transdução de Sinais/genética , Neoplasias Cutâneas/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Tumescent liposuction (TL) allows the removal of large volumes of fat with minimal blood loss or postoperative morbidity, excellent cosmesis, and a remarkable safety profile. OBJECTIVE: To review the literature on the safety of tumescent liposuction, liposuction under general anesthesia and laser-assisted liposuction. RESULTS: Aggregate safety data on liposuction under tumescent anesthesia reveals over 100,000 body areas treated with liposuction. There were no serious complications of death, emboli, hypovolemic shock, perforation of thorax or peritoneum, thrombophlebitis, seizures, or toxic reactions to drugs. In contrast, in the plastic surgery literature, liposuction under general anesthesia was associated with complications of deep venous thrombosis or pulmonary embolus, abdominal or other organ perforation, infection, and bleeding. Most recently, survey data in the European literature analyzed data showed 72 cases of severe complications from liposuction, including 23 deaths in a 5-year period from 1998 to 2002. The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism. CONCLUSION: Tumescent local anesthesia utilizing lidocaine with epinephrine allows the removal of large volumes of fat with minimal associated blood loss and postoperative morbidity.
Assuntos
Terapia a Laser/efeitos adversos , Lipectomia/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Local/efeitos adversos , Humanos , Lipectomia/métodosRESUMO
Cutaneous lymphadenoma (CL) is a benign neoplasm commonly presenting on the head and neck of young and middle-aged adults. Complete surgical excision of CL is the treatment of choice and appears to be curative. As compared to local excision without margin control, Mohs micrographic surgery (MMS) may allow for more definitive tumor extirpation for large cases of CL and allow for greater tissue preservation at functionally and aesthetically sensitive sites. We present a case of cutaneous lymphadenoma presenting on the right cheek of a middle-aged male who was successfully treated with MMS.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Resultado do TratamentoAssuntos
Ácido Aminolevulínico/uso terapêutico , Aminoquinolinas/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Fotoquimioterapia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Antineoplásicos/uso terapêutico , Carcinoma Adenoide Cístico/tratamento farmacológico , Carcinoma Adenoide Cístico/cirurgia , Carcinoma de Apêndice Cutâneo/tratamento farmacológico , Carcinoma de Apêndice Cutâneo/cirurgia , Terapia Combinada , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Síndromes Neoplásicas Hereditárias/tratamento farmacológico , Síndromes Neoplásicas Hereditárias/cirurgia , Fármacos Fotossensibilizantes/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Subcuticular incision is performed to release fibrotic bands beneath acne scars and to stimulate neocollagenesis. Naturally sourced porcine collagen has been approved for filling moderate to deep facial wrinkles and nasolabial folds. To our knowledge, naturally sourced porcine collagen filler has not yet been tried as a treatment for correcting atrophic acne scars. OBJECTIVE: To objectively assess and directly compare the efficacy and safety of subcuticular incision versus naturally sourced porcine collagen dermal filler in correcting atrophic and rolling acne scars. MATERIALS AND METHODS: We performed a prospective, randomized, split-face, single-blind study to evaluate intermediate long-term efficacy of subcision and collagen dermal filler on 20 unilateral faces. Patients and blinded physicians evaluated results. RESULTS: Patients rated subcision as superior to collagen dermal filler at 3 months (p=.03). At 6 months, subcision had a slightly higher rating than collagen dermal filler (p=.12). Blinded evaluators leaned toward subcision at 3 months (p=.12) and at 6 months showed no preference (p=.69). CONCLUSION: Subcuticular incision and naturally sourced porcine collagen dermal filler appear to be efficacious for improving atrophic and rolling acne scars. Patients may prefer subcuticular incision over collagen dermal filler. Blinded evaluators found no significant difference between the treatments.
Assuntos
Acne Vulgar/complicações , Cicatriz/cirurgia , Colágeno/administração & dosagem , Ritidoplastia/métodos , Adulto , Idoso , Cicatriz/etiologia , Seguimentos , Humanos , Injeções , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Fatores de TempoRESUMO
BACKGROUND: Although upper eyelid blepharoplasty is a common procedure, subtleties in surgical technique can affect cosmetic outcomes. Suture materials commonly used include polypropylene, monofilament nylon, fast-absorbing gut, and ethylcyanoacrylate (ECA) tissue adhesive. OBJECTIVE: To assess upper lid blepharoplasty scars in participants whose incision had been closed with 6-0 polypropylene sutures, 6-0 fast-absorbing gut sutures, or ECA. MATERIALS AND METHODS: A randomized, split-eyelid, single-blind, prospective study of the short- (1 month) and intermediate-term (3 months) efficacy of polypropylene, fast-absorbing gut, and ECA on 36 consecutive upper lid blepharoplasties. Participants and a blinded physician evaluator evaluated cosmetic outcome 1 and 3 months after the procedure. RESULTS: Three subgroups tested were ECA versus fast-absorbing gut, ECA versus polypropylene, and fast-absorbing gut versus polypropylene. At 1 month, ECA was superior to fast-absorbing gut (p=.03) and had a marginally better outcome than polypropylene (p=.25), and polypropylene had an equivalent outcome to fast-absorbing gut (p=.46). At 3-month follow-up, ECA remained superior to fast-absorbing gut (p=.03). CONCLUSION: Although sutured epidermal closure and tissue adhesive are highly efficacious for upper eyelid blepharoplasty, physicians and participants felt that cosmesis with ECA was superior to that with fast-absorbing gut.