Smart Mohs: técnica inovadora em cirurgia de Mohs / Smart Mohs: Innovative technique in Mohs surgery

O processamento tecidual em cirurgia de Mohs visa à confecção de lâminas histológicas que permitam a análise de 100% das margens cirúrgicas. É uma etapa crítica e passível de erros. Como não há padronização na montagem dos blocos, há desnivelamento das superfícies de corte das diferentes amostras, levando à necessidade de contínuos ajustes no eixo X-Y no interior do criostato, lentificando o processo. Visando à resolução desse problema, desenvolveu-se um dispositivo que minimiza quaisquer inclinações dos blocos, mantendo-se as margens cirúrgicas paralelas em todas as amostras, acelerando-se o processo e mantendo-se a alta qualidade das lâminas histológicas.

The tissue processing in Mohs surgery aims at histological slides that allow the analysis of 100% of the surgical margins. The embedding tissue is a critical step and prone to errors. As there is no standardization when mounting the blocks, there may be unevenness in the different samples cutting surfaces, leading to the need for continuous adjustments on the X-Y axis inside the cryostat, slowing down the process. A device was developed to solve this problem, minimizing any blocks inclination, keeping the surgical margins parallel in all samples, accelerating the process, and maintaining the histological slides high quality

Carcinoma basoescamoso na pálpebra inferior: reconstrução com enxerto de cartilagem auricular associado ao retalho de Tripier após cirurgia de Mohs / Basosquamous carcinoma in lower eyelid: reconstruction with auricular cartilage graft associated with the Tripier flap after Mohs surgery

O carcinoma basoescamoso tem alto potencial de recorrência local e metástase, especialmente quando recidivado e na localização periocular. Um paciente masculino de 49 anos foi submetido a cirurgia micrográfica de Mohs e reconstrução subtotal da pálpebra inferior com enxerto de cartilagem da hélice da orelha associado ao retalho de Tripier, evoluindo com ótimo resultado funcional e estético

Basosquamous carcinoma has a high potential for local recurrence and metastasis, especially when it recurs and at the periocular area. A 49-year-old man underwent Mohs micrographic surgery and subtotal reconstruction of the lower eyelid with cartilage graft from the helix of the ear associated with the Tripier flap, evolving with excellent functional and aesthetic results

Técnica inovadora para tratamento de flacidez cervical com fio mononylon para sustentação transmastoide / Innovative technique for the treatment of cervical laxity with mononylon thread for trans-mastoid support

Existem muitos procedimentos para o rejuvenescimento da região cervical; os mais invasivos, porém, como a ritidectomia, podem gerar cicatrizes inestéticas relativamente grandes. Em contrapartida, procedimentos pouco invasivos, como os clássicos fios de sustentação absorvíveis, não têm efeito significativo no tratamento das bandas platismais mais evidentes. Visando solucionar o problema da pouca durabilidade relacionada aos fios de sustentação e eliminar a cicatriz submentoniana indesejável causada pela ritidoplastia, descreve-se uma técnica pouco invasiva para tratamento da flacidez cervical, que pode ser usada isoladamente em pacientes com pouca redundância de pele, ou associada ao minilifting nos pacientes com muita flacidez.

There are many procedures for the rejuvenation of the cervical region. Nevertheless, the most invasive ones ­ such as the rhytidectomy ­ can lead to relatively large unaesthetic scars. In contrast, noninvasive procedures ­ such as the classic absorbable lifting threads ­ have no significant effect on the treatment of the most evident platysmal bands. Aiming at solving the problem of short durability linked to the lifting threads and eliminating the undesirable submental scar caused by rhytidoplasty, a less invasive technique is described for the treatment of cervical laxity. This technique can be used isolatedly in patients with small amounts of skin redundancy, or associated to mini face lifts in patients with considerable sagginess.

Validation of a new technique to freezing and embedding tissue in Mohs surgery, using an animal model.

PURPOSE: To validate the innovative Dry Ice method, comparing it with two standard methods currently used for tissue processing in Mohs surgery, the Heat Sink method and the Miami Special. METHODS: Forty eight samples of pigs kin with the standard beveled Mohs technique were used, and randomly allocated into six groups. Each group was processed with one of the 3 methods and evaluated for: The freezing time, the depth required to cut into the block to obtain a complete section, and the quality of histological slides analyzed with a image software. The statistical analysis was performed with the software SAS(r) System. The inferential analysis was made by one-way ANOVA. RESULTS: The Miami Special showed a processing time significantly shorter than Dry Ice method and Heat Sink method. There was no significant difference in the depth required to cut into the blocks, and area of surgical margins visualized. CONCLUSION: The Dry Ice method was as efficient as the other two methods currently used in Mohs surgery, considering the individual advantages and disadvantages of each method.

Validation of a new technique to freezing and embedding tissue in Mohs surgery, using an animal model

ABSTRACT PURPOSE: To validate the innovative Dry Ice method, comparing it with two standard methods currently used for tissue processing in Mohs surgery, the Heat Sink method and the Miami Special. METHODS: Forty eight samples of pigs kin with the standard beveled Mohs technique were used, and randomly allocated into six groups. Each group was processed with one of the 3 methods and evaluated for: The freezing time, the depth required to cut into the block to obtain a complete section, and the quality of histological slides analyzed with a image software. The statistical analysis was performed with the software SAS(r) System. The inferential analysis was made by one-way ANOVA. RESULTS: The Miami Special showed a processing time significantly shorter than Dry Ice method and Heat Sink method. There was no significant difference in the depth required to cut into the blocks, and area of surgical margins visualized. CONCLUSION: The Dry Ice method was as efficient as the other two methods currently used in Mohs surgery, considering the individual advantages and disadvantages of each method.

Reconstrução palpebral com enxerto condro-pericondral de hélice de orelha. Experiência de um centro de referência em cirurgia micrográfica de Mohs / Palpebral reconstruction of the ear helix with chondroperichondrial graft: experience of a Mohs micrographic surgery specialist center

Introdução: A pálpebra inferior frequentemente é sede de carcinomas basocelulares, sendo ideal para seu tratamento a cirurgia micrográfica de Mohs, que permite controle histológico preciso, com máxima preservação tecidual. Os tumores que invadem a lamela posterior, causam defeitos de espessura total da pálpebra inferior, para cuja reconstrução têm sido descritas várias técnicas com enxertos compostos; poucos autores, porém, utilizam a hélice da orelha como área doadora. Objetivo: Descrever a aplicabilidade do enxerto composto de hélice da orelha nas reconstruções de pálpebra inferior. Métodos: Estudo retrospectivo de série de seis casos de carcinoma basocelular em pálpebra inferior, com invasão tarsal, operados pela cirurgia micrográfica de Mohs, em serviço privado de referência nessa técnica no município do Rio de Janeiro, Brasil. Todos os pacientes apresentavam defeitos de espessura total e tiveram reconstrução da lamela posterior através de enxerto condro-pericondral de hélice da orelha. A lamela anterior foi reconstituída com mobilização do tecido palpebral remanescente ou com retalho de avanço. Os pacientes foram avaliados em relação à capacidade funcional e estética. Resultados: Houve completa adaptação do pericôndrio à conjuntiva, após contato com o globo ocular durante oito semanas. Todos os pacientes evoluíram com discreto escleroshow, sem ectrópio. Conclusões: Apesar da amostragem pequena, todos os pacientes tiveram excelentes resultados cosméticos e funcionais.

Introduction: The lower eyelid is often the site of basal cell carcinomas, with Mohs micrographic surgery (which allows precise histological control with maximum tissue preservation) being the ideal method for their treatment. Tumors that invade the posterior lamella cause full-thickness defects of the lower eyelid, for which several reconstruction techniques have been described with composite grafts. However, few authors use the helix of the ear as a donor area. Objective: To describe the applicability of ear helix composite grafts in the reconstruction of the lower eyelid. Methods: Retrospective study of a series of 6 cases of basal cell carcinoma in the lower eyelid, with tarsal invasion, operated through Mohs micrographic surgery in a private specialist service in the city of Rio de Janeiro, Brazil. All patients had full-thickness defects, and had undergone reconstruction of the posterior lamella through chondroperichondrial graft of the ear helix. The anterior lamella was reconstructed with the remaining eyelid tissue mobilization or with an advancement flap. Patients were assessed for functional capacity and aesthetics. Results: There was complete adaptation of the perichondrium to the conjunctiva, after contact with the eyeball for 8 weeks. All patients with mild escleral show without ectropion. Conclusions: Despite the small sample, all patients had excellent cosmetic and functional results.

Reconstrução completa de asa nasal com retalho de Spear após cirurgia micrográfica de Mohs no tratamento de carcinoma basocelular / Complete reconstruction of the nasal ala with a Spear's flap, following Mohs micrographic surgery in the treatment of basal cell carcinoma

O carcinoma basocelular é tumor maligno localmente invasivo, com maior incidência em caucasianos. A asa nasal é localização frequente dessa neoplasia. O tratamento de eleição é cirúrgico, sendo a cirurgia micrográfica de Mohs uma das técnicas indicadas, por apresentar grande acurácia no controle histológico das margens e alto índice de cura com baixas taxas de recidiva. Nessa localização se faz necessária não apenas a cura, mas também a tentativa da manutenção da estética facial. Descrevem-se cinco casos de amputação completa da asa nasal após cirurgia micrográfica de Mohs, seguida de reconstrução com retalho de Spear.

Basal cell carcinoma is a locally invasive malignant tumor, most frequently affecting Caucasian people. The nasal ala is a frequent site for this neoplasia. The treatment of choice is surgical, and Mohs micrographic surgery is one of the indicated techniques for presenting great accuracy in the histological control of margins and high cure rates with low recurrence rates. In this location, not only is a cure needed, but also the maintenance of facial aesthetics. The authors describe five cases of complete amputation of the nasal ala after Mohs micrographic surgery, with reconstruction using the Spear's flap.

Cirurgia micrográfica de Mohs: estudo de 93 tumores operados em um centro de referência no Rio de Janeiro / Mohs micrographic surgery: a study of 93 tumors operated on in a specialist center in Rio de Janeiro

Introdução: A cirurgia micrográfica de Mohs é opção terapêutica que aumenta a taxa de cura de vários tipos de câncer de pele, com maior preservação tecidual e menores taxas de recidiva. Objetivo: Traçar o perfil clínico e histológico dos tumores operados pela cirurgia micrográfica de Mohs, em serviço privado de referência nessa técnica no município do Rio de Janeiro, Brasil, e relacioná-lo com o número de fases e tipo de reconstrução cirúrgica realizada. Métodos: Estudo retrospectivo, observacional, transversal, com revisão de prontuários. Resultados: Foram relacionados 93 tumores em 84 pacientes operados no período entre abril/2010 e agosto/2012 e seguidos até agosto/2013 (12 a 42 meses). Dados encontrados: 47,61% homens e 52,38% mulheres; idade média de 62,89 anos; fototipos predominantes II (44%) e III (43%); seis casos (6,45%) de carcinoma espinocelular; 87 (93,54%) de carcinoma basocelular; 74,19% de tumores primários; nariz como localização mais frequente (46,24%); uma fase cirúrgica realizada na maioria dos casos, tendo sido o retalho (44%) o tipo de fechamento mais realizado. Houve recidiva em um paciente, que foi reoperado em outubro/2012 e segue sem recidiva. Conclusões: A cirurgia de Mohs mostrou-se eficaz, com altos índices de cura e mínima taxa de recidiva, especialmente nas lesões da área de risco do H da face.

ORIGINAL ARTICLE Mohs micrographic surgery: a study of 93 tumors operated on in a specialist center in Rio de Janeiro Cirurgia micrográfica de Mohs: estudo de 93 tumores operados em um centro de referência no Rio de Janeiro Frederico H. Sanchez1; Juliany Lima Estefan2; Lidiany Lima Estefan3 1. Head of the Center for Micrographic Surgery of Rio de Janeiro, Policlínica Ronaldo Gazolla-Rio de Janeiro (RJ); Preceptor at the Dermatologic Surgery Fellow Program, Hospital Federal Bonsucesso-Rio de Janeiro (RJ), Brazil 2. Dermatologist Physician, MSc in Clinical Medicine from the Universidade Federal do Rio de Janeiro (UFRJ)-Rio de Janeiro (RJ), Brazil 3. Collaborating Physician at the Center for Micrographic Surgery of Rio de Janeiro, Policlínica Ronaldo Gazolla Received on: 10 August 2013 Approved on: 9 October 2013 Financial support: None Conflict of interest: None The present study was carried out at the Center for Micrographic Surgery of Rio de Janeiro-Rio de Janeiro (RJ), Brazil. Correspondence: Centro de Cirurgia Micrográfica do Rio de Janeiro Dr. Frederico H. Sanchez Rua da Assembléia 10 / sala 2807-Centro Cep: 20011-000-Rio de Janeiro-RJ, Brazil E-mail: fredhsanchez@gmail.com Abstract Introduction: Mohs micrographic surgery is a treatment option that increases the cure rate in various types of skin cancer, offering greater tissue preservation and lower recurrence rates. Objective: To describe clinically and histologically the tumors operated on with Mohs micrographic surgery, and to draw correlations to the number of stages and the type of surgical reconstruction performed. The operations were performed at a private clinic in the municipality of Rio de Janeiro, Brazil that is a specialist center for this technique. Methods: Retrospective, observational, cross-sectional/transversal study was carried out based on the review of medical records. Results: A study was conducted of 93 tumors in 84 patients, operated on between April 2010 and August 2012, and followed up with until August 2013 (12 to 42 months). Findings: 47.61% of patients were men and 52.38% were women, the mean age was 62.89 years; predominant phototypes: II (44%) and III (43%); 6 cases (6.45%) of squamous cell carcinoma, 87 (93.54%) of basal cell carcinoma; 74.19% were primary tumors; the nose was the most frequent site (46.24%); a single surgical stage was performed in most cases, with flaps (44%) being the more frequently performed type of closure. There was recurrence in one patient, who required reoperation in October 2012 and followed without new recurrence. Conclusions: Mohs surgery has proven effective with high cure rates and a minimal recurrence rate, especially in lesions located in the face's H area of risk.