RESUMO
OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.
Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Melanoma , Neoplasia de Células Basais , Neoplasias Cutâneas , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Melanoma/complicações , Cirurgia de Mohs , Estudos Prospectivos , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: Regesmohs registry is a nationwide registry including patients evaluated for Mohs surgery in 17 Spanish centres since July 2013. Given that Mohs surgery is the therapy with best results for high risk basal cell carcinoma (BCC) and other skin tumours, we wanted to describe the reasons that lead to some patients being excluded from this therapy and the alternative treatments that they received. These data may be useful to avoid excluding patients for Mohs surgery use, to estimate the healthcare demand of these patients and the demand for Hedgehog inhibitors therapy in this group. OBJECTIVE: To describe patients excluded for Mohs surgery after pre-surgical assessment, and the treatments that they received. METHODS: Regesmohs includes all consecutive patients assessed for Mohs surgery in the participating centres, collecting data on patient characteristics, intervention, and short and long-term results. Patients excluded for Mohs surgery after pre-surgical evaluation were described. RESULTS: 3011 patients were included in Regesmohs from July 2013 to October 2016. In 85, Mohs surgery was not performed as they were considered inadequate candidates. 67 had BCC. Reasons for exclusion were: medical contraindication (27.1%, n=23) low-risk tumour in (18.8%, n=16) and giant tumour and bone invasion (15.3%, n=13). Only 1 patient (1.2%) showed lymph node involvement and no patients had visceral metastases. Of the 85 excluded patients, 29 (34.1%) were treated with conventional surgery, 24 (28.3%) with radiotherapy, 4 (4.7%) with inhibitors of the Hedgehog pathway (only indicated for BCC), and 2 (2.4%) received palliative care. We had no follow-up data on 14 patients (16.5%). CONCLUSION: Medical comorbidities were the most common reason for withholding Mohs surgery. Withholding therapy on the basis of distant extension is uncommon. Most excluded patients received simpler therapies: conventional surgery or radiotherapy, with hedgehog inhibitors being a new option.
Assuntos
Cirurgia de Mohs , Seleção de Pacientes , Neoplasias Cutâneas/cirurgia , Suspensão de Tratamento , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Comorbidade , Contraindicações de Procedimentos , Feminino , Proteínas Hedgehog/antagonistas & inibidores , Humanos , Masculino , Proteínas de Neoplasias/antagonistas & inibidores , Cuidados Paliativos , Estudos Prospectivos , Sistema de Registros , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/radioterapia , EspanhaRESUMO
BACKGROUND: The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery (MMS). The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single-centre studies without a comparison group. OBJECTIVE: To compare the characteristics of patients, tumours, MMS and 1-year follow-up in patients younger than 80 years, with patients older than 80 years at the time of surgery. METHODS: Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour and surgery were recorded. Follow-up data were collected from two visits; the first within 1 month postsurgery and the second within the first year. RESULTS: From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75.4%) were aged <80 years and 633 (24.6%) were ≥80 years old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma. Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects and requiring more time in the operating room. Despite this, the incidence of postoperative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first-year follow-up. CONCLUSION: The risk of short-term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly.
Assuntos
Cirurgia de Mohs , Recidiva Local de Neoplasia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/efeitos adversos , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Sistema de Registros , Carga TumoralRESUMO
INTRODUCTION: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS: Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION: The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.
Assuntos
Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anestesia/métodos , Anestesia/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Sistema de Registros , Gestão de Riscos , Neoplasias Cutâneas/terapia , Espanha , Retalhos CirúrgicosAssuntos
Pioderma Gangrenoso/diagnóstico por imagem , Ultrassonografia , Idoso , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Transtornos Mieloproliferativos/complicações , Prednisona/uso terapêutico , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Ultrassonografia Doppler em CoresAssuntos
Neoplasias Penianas/tratamento farmacológico , Sarcoma de Kaposi/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Timolol/administração & dosagem , Administração Cutânea , Antagonistas Adrenérgicos beta/administração & dosagem , Idoso , Humanos , Masculino , Neoplasias Penianas/patologia , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS: This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS: Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION: The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.
Assuntos
Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Sistema de Registros , Neoplasias Cutâneas/cirurgia , Carcinoma/epidemiologia , Carcinoma/cirurgia , Carcinoma Basocelular/epidemiologia , Terapia Combinada , Bases de Dados Factuais , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/cirurgia , Neoplasias Faciais/epidemiologia , Neoplasias Faciais/cirurgia , Humanos , Hospedeiro Imunocomprometido , Melanoma/epidemiologia , Melanoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Fatores de Risco , Terapia de Salvação , Neoplasias Cutâneas/epidemiologia , Espanha/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: Involvement of the female genital tract by Darier's disease, an unusual genodermatosis, is uncommon, and the manifestation of the disease in a cervicovaginal smear is exceptionally rare. CASE: A 39-year-old woman had an abnormal Pap smear caused by involvement of the female genital tract by Darier's disease. Cytologic examination showed features consistent with a low grade squamous intraepithelial lesion, but during a biopsy it was found to be vaginal involvement by Darier's disease. CONCLUSION: The correct interpretation of cytologic findings is not possible when the diagnosis of Darier's disease is not known since a low grade squamous intraepithelial lesion cannot be ruled out. This case underlines the importance of knowing the patient's medical histoiy in any moment of medical attention.
Assuntos
Doença de Darier/complicações , Doença de Darier/patologia , Pele/patologia , Neoplasias do Colo do Útero/patologia , Vagina/patologia , Doenças Vaginais/patologia , Acitretina/uso terapêutico , Adulto , Colo do Útero/patologia , Doença de Darier/genética , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Células Epiteliais/patologia , Feminino , Humanos , Queratinas/metabolismo , Ceratolíticos/uso terapêutico , Teste de Papanicolaou , Recidiva , Doenças Vaginais/etiologia , Doenças Vaginais/genética , Esfregaço Vaginal , Displasia do Colo do Útero/patologiaRESUMO
Blue nevus rarely develops a malignant melanoma. The loss of the regular border and the development of satellite lesions are ominous clinical indicators of the malignant change. A case is presented in which both of these clinical features--irregular border and satellite lesions--were present, but no malignant change was observed histopathologically. To our knowledge, such a single nodule with satellite lesions mimicking malignant melanoma has not been described previously.
Assuntos
Melanoma/patologia , Nevo Azul/patologia , Neoplasias Cutâneas/patologia , Idoso , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Two unrelated patients, a woman aged 44 and a man aged 56, with a type I neurofibromatosis, showed comedo-like formations at the top of some neurofibromas. One of them was excised in each case and they were studied histopathologically. The comedo-like formation of the first case mimicked the epithelial component of a fibrofolliculoma, and that of the second case had the structure of a primary late microcomedo and showed also anagen hair differentiation in the form of a follicular bulb and papilla. Both events are considered to be the result of a stimulation phenomenon and to reflect the essential role of the stroma in many cutaneous epithelial hyperplasias, hamartomas and possibly in some neoplasms.
Assuntos
Folículo Piloso/patologia , Neurofibromatose 1/patologia , Glândulas Sebáceas/patologia , Neoplasias Cutâneas/patologia , Adulto , Divisão Celular , Diagnóstico Diferencial , Feminino , Fibroma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibromatose 1/metabolismo , Proteínas S100/metabolismo , Pele/patologia , Neoplasias Cutâneas/metabolismoRESUMO
Although 2% to 10% of lymphomas present first in the oral cavity and lymphomas are the third most common oral malignancy, pseudolymphoma is a very infrequent problem within oral pathology. Two cases of oral pseudolymphoma are presented. Both were old persons with an infiltrative lesion on the oral mucosa that histologically showed a dense polymorphous infiltrate with some nuclear atypia that raised the problem of lymphoma versus pseudolymphoma. Both lesions disappeared with no relapse after 2-years' follow-up. Histologically, case 1 was mainly a lymphohistiocytic infiltrate whose histiocytic component showed nuclear features that mimicked Hodgkin's cells. In case 2, the infiltrate was mainly composed of histiocytes and eosinophils. The suspicion of malignancy here was a consequence of a high mitotic rate of histiocytes and of the large hyperchromatic nuclei of the intraepithelial lymphocytes. Similarities and differences with other pseudomalignant (lymphomatoid papulosis and atypical histiocytic granuloma) and inflammatory (traumatic ulcerative granuloma with stromal eosinophilia) disorders, as well as with some histiocytoses, are discussed. In the absence of a wider experience on this subject, an objective description of new cases seems appropriate.
Assuntos
Doenças da Boca/patologia , Pseudolinfoma/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Five patients in the same family showed small keratotic plugs of the palmar creases. Transmission in lineage was consistent with an autosomal dominant pattern of inheritance. The syndrome was highly associated with ichthyosis vulgaris in several members of the family. The histopathology in two patients revealed a close relation between the plugs and the acrosyringium.