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BACKGROUND: Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. OBJECTIVES: This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. METHODS: The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. RESULTS: IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. CONCLUSIONS: This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.
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COVID-19 , Nevo Pigmentado , Nevo , Neoplasias Cutâneas , Humanos , COVID-19/complicações , Neoplasias Cutâneas/complicaçõesRESUMO
INTRODUCTION: There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs micrographic surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure. MATERIALS AND METHODS: A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to three or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale. RESULTS: A total of 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. A total of 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required three or more stages. A model to predict the need for three or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non-complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location. CONCLUSION: We present a model to predict MMS needing ≥3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration.
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BACKGROUND: Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. OBJECTIVES: To describe the risk of MMS complications and the risk factors for them. METHODS: A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. RESULTS: 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. CONCLUSIONS: MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.
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Cirurgia de Mohs , Neoplasias Cutâneas , Estudos de Coortes , Humanos , Cirurgia de Mohs/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/cirurgiaRESUMO
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the "real-life" results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1-1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3-6.1), being constant over time (0-5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.
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Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Cirurgia de Mohs , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgiaRESUMO
Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person-years (95% IC = 0.36-2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow-up time was 28.6 months with 414 patient-years of follow-up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence.
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Dermatofibrossarcoma/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Cirurgia de Mohs/métodos , Sistema de Registros , Neoplasias Cutâneas/cirurgia , Dermatofibrossarcoma/patologia , Humanos , Invasividade Neoplásica , Estudos Prospectivos , Fatores de Risco , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. METHODS: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. RESULTS: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). CONCLUSION: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.
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Cirurgia de Mohs/estatística & dados numéricos , Cirurgia de Mohs/normas , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Humanos , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/cirurgia , Sistema de Registros/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Espanha/epidemiologiaAssuntos
Ictiose/etiologia , Micose Fungoide/diagnóstico , Neoplasias Cutâneas/diagnóstico , Administração Cutânea , Idoso , Biomarcadores Tumorais/análise , Biópsia , Clobetasol/administração & dosagem , Humanos , Ictiose/tratamento farmacológico , Ictiose/patologia , Imuno-Histoquímica , Masculino , Micose Fungoide/complicações , Micose Fungoide/tratamento farmacológico , Micose Fungoide/patologia , Pomadas/administração & dosagem , Pele/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Resultado do TratamentoAssuntos
Leiomiomatose/diagnóstico , Síndromes Neoplásicas Hereditárias/diagnóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias Uterinas/diagnóstico , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico , Feminino , Hematúria/complicações , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Leiomiomatose/complicações , Leiomiomatose/patologia , Pessoa de Meia-Idade , Síndromes Neoplásicas Hereditárias/complicações , Síndromes Neoplásicas Hereditárias/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologiaRESUMO
BACKGROUND: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma of mature cytotoxic T cells. Initially, patients with SPTCL were treated with doxorubicin-based polychemotherapy. OBJECTIVE: To analyze clinical, biologic, immunophenotypical, molecular, imaging, treatment, and outcome data reflecting the current state of knowledge. METHODS: A retrospective multicenter study of 16 patients with SPTCL that was diagnosed between 1996 and 2016. RESULTS: The female-to-male ratio was 1.7. The median age at diagnosis was 46.5 years. Patients presented with multiple nodular or plaque-like lesions preferentially affecting the legs and/or trunk. Histopathology typically showed a lobular panniculitis with individual adipocytes surrounded by atypical lymphocytes, usually with a CD3+, CD4-, CD8+, CD56-, TIA1 cytotoxic granule associated RNA binding protein 1-positive phenotype and high proliferation rate. SPTCL was associated with autoimmune diseases in 25% of patients, and with the development of hemophagocytic syndrome in 18% of patients. Oral steroids alone or in combination with low-dose methotrexate or cyclosporine A were the most common initial treatment, achieving a complete response in 85% of the treated patients. The median follow-up time was 14 months. The 5-year disease-specific survival rate was 85.7%. LIMITATIONS: This was a retrospective study. CONCLUSIONS: SPTCL has an excellent prognosis. Immunosuppressive agents can be considered for first-line treatment.
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Linfoma Cutâneo de Células T/patologia , Linfoma Cutâneo de Células T/terapia , Linfoma de Células T/patologia , Linfoma de Células T/terapia , Paniculite/patologia , Paniculite/terapia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Adulto , Idoso , Quimiorradioterapia/métodos , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Linfoma de Células T/diagnóstico por imagem , Linfoma de Células T/mortalidade , Linfoma Cutâneo de Células T/diagnóstico por imagem , Linfoma Cutâneo de Células T/mortalidade , Masculino , Pessoa de Meia-Idade , Paniculite/diagnóstico por imagem , Paniculite/mortalidade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/mortalidade , Espanha , Análise de Sobrevida , Adulto JovemAssuntos
Dermatite Alérgica de Contato/diagnóstico , Papulose Linfomatoide/diagnóstico , Pseudolinfoma/diagnóstico , Acrilatos/efeitos adversos , Adulto , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pseudolinfoma/induzido quimicamente , Pseudolinfoma/patologia , Pele/patologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/patologiaAssuntos
Alopecia/etiologia , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Radiodermite/etiologia , Radiografia Intervencionista/efeitos adversos , Alopecia/diagnóstico , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Radiodermite/diagnósticoRESUMO
Leukemia cutis refers to cutaneous infiltration by malignant hematopoietic cells. Its clinical manifestations are highly variable and biopsy is required for confirmation. We present three cases of patients with persistent monocytosis and skin lesions whose diagnosis was chronic myelomonocytic leukemia. The biopsy of skin lesions showed a dermal infiltration by atypical myelocytes and monocytes. Immunohistochemical study was positive for CD68. These findings were compatible with cutaneous infiltration by chronic myelomonocytic leukemic cells.