Subject(s)
Carcinoma, Basal Cell/surgery , Mohs Surgery , Nose Neoplasms/surgery , Nose/surgery , Skin Neoplasms/surgery , Aged , Humans , MaleSubject(s)
Mohs Surgery/adverse effects , Rhinoplasty/methods , Skin Transplantation/methods , Surgical Wound/surgery , Adult , Aged , Aged, 80 and over , Bandages , Esthetics , Female , Humans , Male , Middle Aged , Nose/pathology , Nose/surgery , Nose Neoplasms/pathology , Nose Neoplasms/surgery , Prospective Studies , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Time Factors , Treatment OutcomeSubject(s)
Mohs Surgery/adverse effects , Skin Neoplasms/surgery , Surgical Wound Infection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Australia , Databases, Factual , Female , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors , Skin Neoplasms/complications , Skin Neoplasms/pathology , Young AdultSubject(s)
Antibiotic Prophylaxis , Surgical Wound Infection , Anti-Bacterial Agents , Germany , HumansABSTRACT
The tangential excision technique for removal of skin tumours has been previously described for truncal superficial BCCs but never before as an option for debulking prior to Mohs micrographic surgery (MMS). Tangential excision debulking with vertical sections represents an alternative to traditional curettage debulking and offers many advantages, most notably a far better tissue specimen for histopathological analysis.
Subject(s)
Cytoreduction Surgical Procedures/methods , Mohs Surgery , Skin Neoplasms/surgery , Humans , Skin Neoplasms/pathologySubject(s)
Carcinoma, Squamous Cell/surgery , Mohs Surgery/methods , Neoplasm Recurrence, Local/pathology , Patient Safety , Skin Neoplasms/surgery , Carcinoma, Squamous Cell/pathology , Cohort Studies , Disease Management , Female , Humans , Incidence , Interdisciplinary Communication , Male , Mohs Surgery/adverse effects , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Skin Neoplasms/mortality , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE: The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS: The authors performed a randomized controlled trial of S. aureus nasal swab-negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS: In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION: Topical decolonization reduces SSI in nasal swab-negative Mohs surgery patients.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Infective Agents/administration & dosage , Antibiotic Prophylaxis , Chlorhexidine/administration & dosage , Decontamination/methods , Mohs Surgery , Mupirocin/administration & dosage , Nose/microbiology , Skin Neoplasms/surgery , Surgical Wound Infection/prevention & control , Administration, Intranasal , Administration, Topical , Aged , Carrier State/drug therapy , Carrier State/microbiology , Female , Humans , Male , Middle Aged , Preoperative Care , Staphylococcus aureus/isolation & purification , Surgical Wound Infection/microbiology , Treatment OutcomeSubject(s)
Carcinoma, Basal Cell/surgery , Lip Neoplasms/surgery , Mohs Surgery , Neoplasm Recurrence, Local/surgery , Surgical Flaps , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Female , Humans , Lip Neoplasms/pathology , Mohs Surgery/adverse effects , Mohs Surgery/methods , Neoplasm Recurrence, Local/pathology , Plastic Surgery Procedures/methods , Treatment OutcomeSubject(s)
HIV Infections/drug therapy , Immune Reconstitution Inflammatory Syndrome/diagnosis , Syphilis, Cutaneous/diagnosis , Vision Disorders/microbiology , Aged , Anti-HIV Agents/therapeutic use , Diagnosis, Differential , HIV Infections/complications , Humans , Male , Syphilis, Cutaneous/complicationsABSTRACT
BACKGROUND: In Mohs micrographic surgery (MMS), the standard local anesthetic agent used is lignocaine with adrenaline. However, MMS can be prolonged; thus reinjections of local anesthetics are often required. OBJECTIVE: Is 0.5% bupivacaine with 1:200,000 epinephrine a useful adjunctive treatment when compared with the use of 1% lidocaine with 1:100,000 epinephrine in MMS for the nose? METHODS: Participants undergoing MMS received 2.5 mL of 1% lidocaine with 1:100,000 epinephrine before commencement of Stage 1. At the end of Stage 1, participants were randomized sequentially to either 2.5 mL 0.5% bupivacaine with 1:200,000 epinephrine (Group A) or 2.5 mL of 1% lidocaine with 1:100,000 epinephrine (Group B). Effectiveness of anesthesia was assessed using 30 G needle to 5 points of the wound before further stage or repair. RESULTS: Fifty-one patients were randomized, 26 to Group A, and 25 to Group B. No differences between the 2 groups in size of defect and time lapse between time of injection and time of testing were observed. Seven of 25 were tested positive in Group B. Zero of 26 tested positive in Group A (p = .003, 95% confidence interval: 10%-46%). CONCLUSION: Adjunctive use of 0.5% bupivacaine with 1:200,000 epinephrine is effective in prolonging anesthesia in MMS.
Subject(s)
Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Carcinoma, Basal Cell/surgery , Lidocaine/administration & dosage , Mohs Surgery , Nose Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Female , Humans , Male , Middle Aged , Mohs Surgery/methods , Nose Neoplasms/pathology , Prospective Studies , Treatment OutcomeABSTRACT
A 68-year-old gentleman presented with a lesion that resembled a pyogenic granuloma in his inferior fornix. The lesion was excised and biopsy demonstrated a proliferation of malignant spindle cells. Three weeks following initial excision, the lesion recurred and was removed via wedge excision of the eyelid. Definitive clearance was achieved through Mohs micrographic surgery. The patient received adjuvant postoperative radiotherapy and remains disease-free. This case demonstrates the need to consider sinister pathology in the setting of recurrent periocular lesions.
Subject(s)
Granuloma, Pyogenic/diagnosis , Histiocytoma, Malignant Fibrous/diagnosis , Orbital Neoplasms/diagnosis , Aged , Biopsy , Combined Modality Therapy , Diagnosis, Differential , Histiocytoma, Malignant Fibrous/therapy , Humans , Male , Mohs Surgery , Ophthalmologic Surgical Procedures , Orbital Neoplasms/therapy , Radiotherapy, AdjuvantABSTRACT
BACKGROUND/OBJECTIVES: Periocular skin tumours pose management challenges with literature supporting a multidisciplinary approach. This retrospective review identifies trends in multidisciplinary management, ascertaining potential benchmarks for practice review. METHODS: A retrospective review of 720 patients with periocular tumours, treated with Mohs micrographic surgery (MMS) at a single free standing Day Surgery Facility between 2009 and 2012. RESULTS: In all, 690 patients were included, with mean age 65 and slight male preponderance. Basal cell carcinoma was the most commonly excised tumour (85.4%) and lower eyelid most common tumour site (58%). Of the cases repaired by Mohs surgeons, 2% involved more than one cosmetic subunit, compared with 23% by oculoplastic surgeons. Of the cases repaired by MMS, 1% had eyelid margin involvement, compared with 64% of the cases by oculoplastic surgeons. Mean preoperative lesion size for cases repaired by Mohs and oculoplastic surgeons was 0.5 cm2 . Mean postoperative defect size was smaller for cases repaired by Mohs surgeons compared with oculoplastic surgeons (1.5 and 1.9 cm2 ). Mean number of stages was less for Mohs surgeon repairs (n = 1.5) compared with oculoplastic surgeon repairs (n = 1.9). Cases repaired by oculoplastic surgeons were more often combination repairs. CONCLUSIONS: This study identifies potential benchmarks for Mohs surgeons when reviewing or establishing a periocular Mohs surgery practice and for doctors referring periocular tumours for surgical removal. These include the proportion of periocular cases managed jointly and the location, size of defect and number of stages involved in tumors repaired by Mohs surgeon alone compared to those repaired by oculoplastic surgeons.
Subject(s)
Benchmarking , Carcinoma, Basal Cell/surgery , Eyelid Neoplasms/surgery , Mohs Surgery/statistics & numerical data , Skin Neoplasms/surgery , Surgery, Plastic/statistics & numerical data , Adult , Aged , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Eyelid Neoplasms/pathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Skin Neoplasms/pathology , Western Australia , Young AdultABSTRACT
BACKGROUND: The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization. METHODS: A randomized, controlled trial with 693 patients was conducted over a 30-week period at a single surgical practice. Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab. Nasal carriers of S. aureus were randomized to receive topical decolonization with intranasal mupirocin twice daily plus 4% chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre- and postoperative doses of oral cephalexin. RESULTS: One hundred seventy-nine patients (25.8%) were identified as carriers of S. aureus. Ninety received topical decolonization, and 89 received oral antibiotics. These groups were compared with a swab-negative Mohs surgical cohort over the same time period. There were no significant differences between the groups in terms of demographic characteristics or comorbidities. Nine percent of patients receiving oral antibiotic prophylaxis and 0% receiving topical decolonization developed early SSI (p = .003). CONCLUSION: In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.