ABSTRACT
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.
Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Melanoma , Neoplasms, Basal Cell , Skin Neoplasms , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Cohort Studies , Female , Humans , Male , Melanoma/complications , Mohs Surgery , Prospective Studies , Risk Factors , Skin Neoplasms/epidemiology , Skin Neoplasms/etiology , Skin Neoplasms/surgerySubject(s)
Antiprotozoal Agents , Leishmaniasis, Cutaneous , Organometallic Compounds , Antiprotozoal Agents/therapeutic use , Electrocardiography , Humans , Injections, Intralesional , Leishmaniasis, Cutaneous/drug therapy , Meglumine/therapeutic use , Meglumine Antimoniate/therapeutic use , Organometallic Compounds/therapeutic useABSTRACT
The electrosurgical unit is a very useful tool widely used in dermatology to treat benign and malignant skin lesions and to achieve hemostasis during surgery. However, precautions are required when this technique is used in patients with implantable electronic cardiac devices (IECD), such as pacemakers and defibrillators, because electromagnetic interference produced by the tool may cause such devices to malfunction. Before using electrosurgery in patients with IECDs, it is essential to ascertain the type of implanted device and the patient's level of dependence on it. The location of the skin lesion to be treated with respect to the device should also be assessed. Bipolar pacemakers are more resistant to interference. Appropriate monitoring and the use of bipolar forceps are recommended.