Assuntos
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 MorteAssuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Estudos Prospectivos , Masculino , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Feminino , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Cirurgia de Mohs , Pigmentação da Pele , Idoso de 80 Anos ou maisRESUMO
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
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
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.