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1.
J Natl Compr Canc Netw ; : 1-6, 2024 Jul 30.
Article in English | MEDLINE | ID: mdl-39079545

ABSTRACT

BACKGROUND: Mohs micrographic surgery (MMS) is a promising treatment modality for melanoma in situ (MIS). However, variations in surgical technique limit the generalizability of existing data and may impede future study of MMS in clinical trials. METHODS: A modified Delphi method was selected to establish consensus on optimal MMS techniques for treating MIS in future clinical trials. The Delphi method was selected due to the limited current data, the wide range of techniques used in the field, and the intention to establish a standardized technique for future clinical trials. A literature review and interviews with experienced MMS surgeons were performed to identify dimensions of the MMS technique for MIS that (1) likely impacted costs or outcomes of the procedure, and (2) showed significant variability between surgeons. A total of 8 dimensions of technical variation were selected. The Delphi process consisted of 2 rounds of voting and commentary, during which 44 expert Mohs surgeons across the United States rated their agreement with specific recommendations using a Likert scale. RESULTS: Five of eight recommendations achieved consensus in Round 1. All 3 of the remaining recommendations achieved consensus in Round 2. Techniques achieving consensus in Round 1 included the use of a starting peripheral margin of ≤5 mm, application of immunohistochemistry, frozen tissue processing, and resecting to the depth of subcutaneous fat. Consensus on the use of Wood's lamp, dermatoscope, and negative tissue controls was established in Round 2. CONCLUSIONS: This study generated 8 consensus recommendations intended to offer guidance for Mohs surgeons treating MIS. The adoption of these recommendations will promote standardization to facilitate comparisons of aggregate data in multicenter clinical trials.

2.
J Am Acad Dermatol ; 90(6): 1226-1231, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38253130

ABSTRACT

BACKGROUND: Although current guidelines recommend a 5 mm surgical margin for the excision of melanoma in situ (MIS), increasing evidence has shown this may be suboptimal to achieve tumor clearance. OBJECTIVE: To evaluate margins required for optimal cure rates with excision of MIS on the head and neck and investigate tumor and/or patient factors in those requiring >5 mm margins to achieve tumor clearance. METHODS: A retrospective chart review was performed on 846 (807 primary and 39 recurrent) MIS cases on the head and neck treated in the authors' dermatologic surgery department over a 126-month (10.5 year) period. RESULTS: Sixty-two percent were cleared with 5 mm margins. A total of 15 mm margins were required to achieve a 97% clearance rate. Difference in clearance rate between margin thresholds was significant (P < .001). Tumor location on the cheek and larger preoperative size correlated with requiring >5 mm margins to achieve tumor clearance (P = .006 and P = .001, respectively). LIMITATIONS: This is a single-center retrospective study which relies on accurate documentation of clinical data. CONCLUSION: This study demonstrates that MIS on the head and neck often requires margins >5 mm margins to achieve tumor clearance. When Mohs micrographic surgery is not possible, excision margins of ≥10 mm are likely necessary for head and neck tumors.


Subject(s)
Head and Neck Neoplasms , Margins of Excision , Melanoma , Mohs Surgery , Skin Neoplasms , Humans , Mohs Surgery/methods , Retrospective Studies , Melanoma/surgery , Melanoma/pathology , Skin Neoplasms/surgery , Skin Neoplasms/pathology , Female , Male , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/pathology , Middle Aged , Aged , Adult , Aged, 80 and over , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/prevention & control , Treatment Outcome
3.
Dermatol Surg ; 2024 Sep 16.
Article in English | MEDLINE | ID: mdl-39282963

ABSTRACT

BACKGROUND: Treatment of basal cell carcinoma (BCC) is recommended. However, patients often note that the biopsy site appears resolved and inquire about the need for additional treatment. OBJECTIVE: This study aims to determine the rate of residual BCC on excision specimens after initial shave biopsy to aid in decision-making on the necessity of further treatment. METHODS AND MATERIALS: A retrospective chart review was conducted that reviewed excision specimen pathology reports of previously biopsy-proven basal cell carcinomas for the presence of residual tumor between 2012 and 2022 at a single institution. RESULTS: Two thousand one hundred seventeen cases met inclusion criteria. Overall, 39.4% of patients had residual BCC after an initial shave biopsy. Using an odds ratio and 95% confidence interval, a significant relationship was found between larger lesions, longer time between biopsy and excision, and lesions on high-risk body sites with increased odds of residual BCC. A significant relationship was found between negative or not specified margins on shave biopsy with decreased odds of residual BCC. CONCLUSION: The results show that a large percentage of patients have residual BCC following initial biopsies. These results should be included in physician-patient discussions about treatment options for BCC.

4.
Dermatol Surg ; 50(3): 241-246, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38170669

ABSTRACT

BACKGROUND: Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs micrographic surgery. Given variable training and experience, dermatologic surgeons may seek additional references to help reconstruct certain advanced defects. We sought to synthesize literature from dermatologic surgery, plastic surgery, and otolaryngology to review repair options and considerations for repair of nasal lining defects. OBJECTIVE: To present a comprehensive literature review of repair options for nasal lining reconstruction and discuss advantages, disadvantages, specific anatomic considerations, and techniques to execute such options. MATERIALS AND METHODS: Articles from several different reconstructive specialties including dermatologic/Mohs surgery, otolaryngology, and plastic and reconstructive surgery were reviewed. Instructive images were compiled to illustrate several techniques, with additional medical illustration recreations included to help showcase important reconstructive approaches. RESULTS: A comprehensive descriptive review of nasal lining repair options for the reconstructive surgeon. CONCLUSION: Advanced tumors can result in full-thickness nasal defects, and this review describes various reconstructive options for reconstruction based on the extent of the defect.


Subject(s)
Otolaryngology , Plastic Surgery Procedures , Surgeons , Humans , Mohs Surgery/adverse effects , Nose/surgery
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