RESUMEN
BACKGROUND: Pinch grafting has experienced a resurgence in interest in recent years, stemming from its simplicity, safety, and potential in restoring tissue integrity. While historically employed for chronic nonhealing wounds, pinch grafts have shown promise following surgical procedures, particularly those involving the lower extremities. OBJECTIVE: To systematically review the literature and present an updated overview of the current applications of pinch grafting. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In collaboration with a medical reference librarian, the PubMed, Embase, Scopus, and Web of Science databases were searched for studies reporting on the use of pinch grafting from 2000 onward. The references of each included article were also screened. RESULTS: Ten articles met final inclusion criteria. In total, 300 patients underwent pinch grafting for treatment of skin ulceration, while an additional 35 cases were performed as an alternative to primary closure following skin cancer resection. Overall, pinch grafting was safe and well tolerated, with minimal adverse outcomes reported. CONCLUSION: Pinch grafting is a safe, straightforward, and effective technique to promote the healing of chronic wounds. While the procedure shows early promise in emerging applications within dermatologic surgery, only about 10% of the reported cases involved this indication, reflecting a need for further research in this area.
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BACKGROUND: Hidradenocarcinoma (HAC) is a rare adnexal carcinoma. To the best of the authors' knowledge, there are no published systematic reviews on HAC. OBJECTIVE: To incorporate a case series from the authors' institution and systematically integrate reported information to provide a reference tool for optimization of diagnosis and management. METHODS: A comprehensive MEDLINE search was conducted from database inception to 2021 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This yielded 225 studies with 165 cases of HAC. References of included articles were also searched. In addition, 9 patients with HAC were identified from the authors' institution over the past 10 years. RESULTS: The mean age of HAC presentation is 60 years with a slight male predilection (60%). The head and neck is the most commonly affected region. Over 36% of cases either presented with metastatic disease or went on to metastasize. The most common treatment type was wide local excision, followed by Mohs micrographic surgery. CONCLUSION: Early detection with accurate histologic interpretation is prudent in all cases of HAC. Wide local excision is the current first-line treatment. However, Mohs micrographic surgery offers complete marginal analysis with evidence of reduced risk of metastasis and better outcomes compared with wide local excision. Currently, there are no National Comprehensive Cancer Network guidelines for the treatment of HAC, and consensus guidelines are limited to tumor and nodal metastasis staging provided by the American Joint Committee on Cancer, eighth edition. Thus, this case series and systematic review integrates important aspects of diagnosis, workup, and management of HAC.
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Cirugía de Mohs , Neoplasias de las Glándulas Sudoríparas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Acrospiroma/patología , Acrospiroma/diagnóstico , Acrospiroma/cirugía , Neoplasias de las Glándulas Sudoríparas/patología , Neoplasias de las Glándulas Sudoríparas/cirugía , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/terapiaRESUMEN
BACKGROUND: Lidocaine is the most commonly used local anesthetic for Mohs micrographic surgery (MMS), but given its limited half-life, postoperative pain remains a significant concern for patients. Bupivacaine is used in various surgical subspecialty procedures and has demonstrated improved pain control compared with lidocaine. However, its role in MMS is insufficiently explored. OBJECTIVE: To systematically review the current literature for reports on use of bupivacaine, traditional nonliposomal and newer liposomal formulations, for MMS. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE, PubMed, and EMBASE databases were queried for articles presenting original data on the use of bupivacaine for MMS. RESULTS: Of 483 potentially relevant articles, 3 studies met final inclusion criteria, capturing a total of 253 patients involved in primary investigations comparing bupivacaine to traditional local anesthesia for MMS. Bupivacaine was well-tolerated and associated with comparable or modestly reduced intraoperative and postoperative pain and opioid use. CONCLUSION: Bupivacaine may have a role in prolonging intraoperative anesthesia, reducing acute postoperative pain, and reducing postoperative opioid use after MMS. However, large, prospective studies are needed to solidify the generalizability and clinical utility of these findings.
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Bupivacaína , Cirugía de Mohs , Humanos , Cirugía de Mohs/efectos adversos , Analgésicos Opioides , Anestésicos Locales , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , LidocaínaRESUMEN
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) and primary cutaneous mucinous carcinoma (PCMC) are rare low-grade neoplasms thought to arise from apocrine glands that share many histological features and are proposed to be on a single histopathologic continuum, with EMPSGC as the in situ form that may progress to the invasive PCMC. Management involves a metastatic workup and either wide local excision (WLE) with greater than 5 mm margins or Mohs micrographic surgery (MMS) in anatomically sensitive areas. We present 2 cases of EMPSGC and 3 cases of PCMC and review their clinical and histopathologic features, differential diagnoses, and treatment.
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Adenocarcinoma Mucinoso , Carcinoma de Apéndice Cutáneo , Neoplasias Cutáneas , Neoplasias de las Glándulas Sudoríparas , Humanos , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/patología , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/cirugía , Neoplasias de las Glándulas Sudoríparas/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Glándulas Sudoríparas/patología , MucinasRESUMEN
Neurotropic melanoma is a rare type of malignant melanoma with nerve invasion or neural differentiation. Neurocristic cutaneous hamartoma is a rare, benign tumor of the skin and superficial soft tissue that arises from aberrant migration of neural crest cells. We report a rare case of a 74-year-old man with a clinically diagnosed giant congenital nevus of the right mid-back, histopathologically confirmed to be a neurocristic cutaneous hamartoma, who developed neurotropic spindle cell melanoma within the lesion. The patient was treated with serial re-excisions until clear margins were achieved.
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Hamartoma , Melanoma , Nevo Pigmentado , Enfermedades de la Piel , Neoplasias Cutáneas , Masculino , Humanos , Anciano , Neoplasias Cutáneas/patología , Melanoma/patología , Nevo Pigmentado/patología , Hamartoma/patología , Enfermedades de la Piel/patología , Melanoma Cutáneo MalignoAsunto(s)
Citas y Horarios , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Cirugía de Mohs/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma Basocelular/patología , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Derivación y Consulta , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/radioterapia , Centros de Atención Terciaria , Tiempo de TratamientoRESUMEN
BACKGROUND: Extraocular sebaceous carcinoma (SC) is rare, with distinct features from its ocular counterpart. These neoplasms have been associated with Muir-Torre syndrome (MTS). Associated internal malignancies include gastrointestinal and genitourinary. OBJECTIVE: Assess for local recurrence, metastasis, disease-specific death, and additional malignancies in patients with extraocular SC treated with Mohs micrographic surgery (MMS) at a single referral center. METHODS: Review of patients with extraocular SC treated with MMS between 1995 and 2019. Follow-up was obtained by chart review. RESULTS: Thirty-eight patients with 41 tumors were identified (25, 66% male). During a mean follow-up of 5.9 ± 5 years, one case of metastasis was identified in an incompletely treated case. No recurrence was identified in the remaining 40 tumors. Five of 41 (12%) tumors had aggressive histologic features. Seven of 38 (18%) patients had a diagnosis of MTS or associated risk factors. There was no association between MTS or its risk factors and high-risk tumors. CONCLUSION: There were no incidences of local recurrence, metastasis, or disease-specific death in cases treated completely with MMS. Metastasis and disease-specific death occurred in an incompletely treated case, highlighting the risk associated with aggressive tumors.
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Cirugía de Mohs , Neoplasias de las Glándulas Sebáceas/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Neoplasias de las Glándulas Sebáceas/patología , Resultado del TratamientoAsunto(s)
Carcinoma Ductal/terapia , Carcinoma de Apéndice Cutáneo/terapia , Cirugía de Mohs/estadística & datos numéricos , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de las Glándulas Sudoríparas/terapia , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma Ductal/diagnóstico , Carcinoma Ductal/patología , Carcinoma de Apéndice Cutáneo/diagnóstico , Carcinoma de Apéndice Cutáneo/patología , Glándulas Ecrinas/patología , Glándulas Ecrinas/efectos de la radiación , Glándulas Ecrinas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Radioterapia Adyuvante/estadística & datos numéricos , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/patología , Resultado del Tratamiento , Carga TumoralRESUMEN
BACKGROUND: Venous ulcers are very common with few curative treatment options. OBJECTIVE: To report the closure rate and clinical characteristics of active venous ulcers in a vein clinic using endovenous laser ablation (EVLA) with a 1,320-nm laser. METHODS AND MATERIALS: A prospective database was kept consisting of patients with an active venous ulcer at the time of consultation in a single-practitioner academic vein clinic from March 2007 to May 2014. A database was maintained and charts were reviewed with attention to the length of time the patient reported having the ulcer, procedures performed, and time to ulcer healing. RESULTS: Thirty-one patients were identified at consultation with venous ulceration. One patient's ulcer was healed with conservative medical management before receiving treatment. The remaining 30 patients were treated with a combination of EVLA of the great and/or short saphenous veins, foam sclerotherapy of insufficient varicose and reticular veins, and phlebectomy as appropriate. Two patients were lost to follow up after partial treatment. Ulcer healing occurred in more than 93% (27/29) of patients with a median healing time of 55 days from the time of first treatment. The median follow-up time after treatment was 448 days. CONCLUSION: Endovenous laser ablation with a 1,320-nm laser in combination with foam sclerotherapy and phlebectomy as appropriate is effective treatment of chronic venous ulcers and should be considered as a treatment option for patients with C6 venous insufficiency. To the authors' knowledge, this is the largest, prospective series of chronic venous ulcers treated with EVLA. Further randomized controlled studies are needed to confirm these findings.
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Procedimientos Endovasculares/métodos , Láseres de Estado Sólido/uso terapéutico , Vena Safena/cirugía , Escleroterapia , Úlcera Varicosa/terapia , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Terapia Combinada , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Úlcera Varicosa/etiología , Insuficiencia Venosa/complicacionesAsunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Cirugía de Mohs , Osteorradionecrosis/terapia , Cuero Cabelludo , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/cirugía , Cráneo , Terapia Combinada , Humanos , Osteorradionecrosis/etiología , Periodo PosoperatorioRESUMEN
Acral calcified angioleiomyoma is an uncommon tumor that presents as a non-descript papule or subcutaneous nodule, classically on the foot. Biopsy or excision is typically the diagnostic method of choice as well as the treatment for these sometimes painful tumors. We report an uncommon clinical presentation of acral calcified angioleiomyoma with considerable extrusion of calcium perforating through the skin.
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Angiomioma/patología , Calcinosis/patología , Úlcera del Pie/patología , Neoplasias Cutáneas/patología , Anciano , Angiomioma/cirugía , Calcinosis/cirugía , Femenino , Úlcera del Pie/cirugía , Humanos , Neoplasias Cutáneas/cirugíaRESUMEN
BACKGROUND: Mohs micrographic surgery (MMS) is a multistep outpatient procedure that has become the treatment of choice for the removal of many cutaneous malignancies. The surgeon initially removes the tumor with nonsterile gloves in MMS. Sterile or nonsterile gloves are then used during the final repairs. OBJECTIVE: This prospective patient-blinded single-institution pilot study was performed to evaluate whether there is a difference in infection rate when using clean, nonsterile gloves versus sterile gloves during tumor removal and the wound repair phases of MMS. MATERIALS AND METHODS: This study randomized 60 patients undergoing MMS. Data on age, sex, anatomic location, number of Mohs stages, closure type, size of final defect, operative time, number of pairs of gloves used, and type of glove used were recorded and evaluated. RESULTS: Three infections were identified. Two infections occurred in the sterile glove arm and one in the clean glove arm. Overall, there was no greater infection rate when using clean, nonsterile gloves than sterile gloves (p=.99). CONCLUSIONS: Our study supports the use of clean, nonsterile gloves as a safe alternative to sterile gloves during all steps of MMS, at a significant cost savings. A larger confirmatory study comparing the equivalence in infection rates between clean and sterile gloves is warranted.
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Guantes Quirúrgicos , Cirugía de Mohs , Infección de la Herida Quirúrgica/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Contaminación de Equipos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Método Simple Ciego , Neoplasias Cutáneas/cirugía , Esterilización , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
BACKGROUND: Excision of invasive melanoma and melanoma in situ (MIS) using variations of the Mohs micrographic surgery (MMS) technique is becoming increasingly common in difficult areas, such as the periocular area, where standard surgical margins may not be feasible, and clinical margins are poorly defined. However, little long-term data evaluating the treatment of periocular melanoma are available in the literature. OBJECTIVE: To present our long-term experience in the treatment of periocular melanoma using a staged, modified Mohs excision technique with rush permanent, paraffin-embedded tissue sections. MATERIALS AND METHODS: A total of 35 patients with periocular melanoma and MIS were treated using modified MMS during a 15-year period. Twenty-nine patients were available with adequate follow-up of greater than 5 years duration. The mean follow-up duration was 94 months. RESULTS: There were a total of five recurrences (17.2%) detected an average of 85 months after excision. Four of the five recurrent tumors had been previously excised. The recurrence rate for primary tumors was 5% (1/20). The recurrence rate for previously excised tumors was 44.4% (4/9). CONCLUSION: Margin-control surgery is favored in the treatment of periocular melanoma to maximize the cure rate and minimize postoperative morbidity by sparing normal tissue. Ample follow-up intervals are required to adequately assess recurrence rates. The best opportunity for cure is associated with the first tumor excision.
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Neoplasias Faciales/cirugía , Melanoma/cirugía , Cirugía de Mohs/métodos , Neoplasias Cutáneas/cirugía , Ojo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios RetrospectivosRESUMEN
BACKGROUND: Injectable calcium hydroxylapatite is becoming increasingly popular as a facial soft tissue filler, due in part to its purported longevity of esthetic correction compared with other materials, but little is known about its long-term histologic appearance and persistence in facial skin. We recently encountered calcium hydroxylapatite microspheres incidentally during Mohs surgery of the nasolabial fold 6 years after implantation. OBJECTIVE: To describe the long-term histologic appearance of calcium hydroxylapatite microspheres in human facial skin and review the relevant literature with a consideration of clinical implications. METHOD: Routine hematoxylin and eosin staining was performed on frozen and fixed excised tissue containing calcium hydroxylapatite microspheres. Additional fixed sections were stained using Movat's pentachrome method. RESULTS: Numerous 4- to 20-mum round vacuoles were present throughout the reticular dermis associated with focal fibrosis, interstitial mucin, and little surrounding inflammation. CONCLUSION: Calcium hydroxylapatite microspheres and associated fibrosis may persist in facial dermis at least 6 years after implantation, long after its clinical effects are thought to subside. Dermatologists and dermatopathologists must be mindful of dermal implants because it is likely that incidental encounters will be an increasingly common occurrence.
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Materiales Biocompatibles/administración & dosificación , Técnicas Cosméticas , Dermis/patología , Durapatita/administración & dosificación , Reacción a Cuerpo Extraño/patología , Prótesis e Implantes , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Femenino , Fibrosis , Humanos , Inyecciones Intradérmicas , Microesferas , Persona de Mediana Edad , Cirugía de Mohs , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Factores de TiempoRESUMEN
OBJECTIVES: The purpose of this study was to evaluate the use of modified Mohs micrographic surgery (MMS) for dermatofibroma sarcoma protuberans (DFSP) in a single institution by a single surgeon. METHODS: The authors conducted a retrospective analysis of 25 patients with DFSP who were treated with modified MMS over the past 19 years at Scripps Clinic. RESULTS: Of the 25 patients treated with modified MMS for DFSP, there were no identifiable recurrences. The mean follow-up time was 101 months. The defect sizes of DFSP lesions treated by modified MMS are smaller than if the lesions had been treated with the standard wide local excision (WLE) margins of 3 cm. LIMITATIONS: This is a retrospective analysis using the data of one surgeon. Five of the 25 patients were not examined in our office. Not all patients had 5-year follow-up. There were no cases of the fibrosarcomatous variant. CONCLUSION: Our data support the growing literature that modified MMS achieves excellent local control for DFSP with a possible benefit of smaller defects when compared with treatment with WLE. The authors have indicated no significant interest with commercial supporters.