Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Dermatomiosite/etiologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Síndromes Paraneoplásicas , Idoso , Carcinoma de Células Pequenas/tratamento farmacológico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , MasculinoRESUMO
Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Labiais/cirurgia , Lábio/cirurgia , Melanoma/cirurgia , Cirurgia de Mohs , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/cirurgia , Adulto , Idoso , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Autoanticorpos/imunologia , Doenças Autoimunes/etiologia , Linfoma Folicular/complicações , Linfoma não Hodgkin/complicações , Pênfigo/etiologia , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Autoantígenos/imunologia , Doenças Autoimunes/imunologia , Linfócitos T CD8-Positivos/química , Linfócitos T CD8-Positivos/imunologia , Desmogleína 1/imunologia , Evolução Fatal , Feminino , Humanos , Linfoma Folicular/diagnóstico , Linfoma Folicular/imunologia , Linfoma Folicular/patologia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/imunologia , Linfoma não Hodgkin/patologia , Pênfigo/imunologia , PlaquinasRESUMO
Actinic keratosis is a precursor lesion to the most common nonmelanoma skin cancer. Conventional photodynamic therapy (PDT) has been shown to be effective, but the procedure is time-consuming, can be very painful, and requires infrastructure. These shortcomings led to the emergence of daylight PDT. To obtain a global estimate of efficacy, we undertook a systematic literature review and performed a meta-analysis of the available evidence on the efficacy and safety of daylight PDT as compared to conventional PDT in the treatment of actinic keratosis and/or field cancerization. The conclusion is that the difference in efficacy is clinically negligible (global estimate of the mean response rate difference, -3.69%; 95% CI, -6.54% to -0.84%). The adverse effects of daylight PDT are mild and localized (79% of patients report no discomfort), and patients report less pain (P<.001). Daylight PDT gives good to excellent cosmetic results in more than 90% of patients, and patient satisfaction is greater (P<.001).