Enfermedad del injerto contra el huésped crónica liquenoide con patrón blaschkoide / Lichenoid Chronic Graft-vs-Host Disease Following Blaschko Lines

No disponible

Evaluación de los márgenes quirúrgicos del carcinoma basocelular según la especialidad del cirujano / Evaluation of Surgical Margins in Basal Cell Carcinoma by Surgical Specialty

Introducción: El tratamiento más utilizado para el carcinoma basocelular (CBC) es la extirpación quirúrgica completa, que en muchas ocasiones es realizada por facultativos no dermatólogos (cirujanos plásticos, cirujanos generales, cirujanos maxilofaciales, oftalmólogos y otorrinolaringólogos). Objetivos: Determinar la prevalencia de márgenes quirúrgicos afectados por el CBC en función del especialista que lo interviene e identificar parámetros clínico-patológicos que puedan justificar las potenciales diferencias en estas prevalencias. Métodos: Estudio retrospectivo de los informes histológicos con diagnóstico de CBC del Hospital Universitari Vall d’Hebron entre enero de 2009 y marzo de 2010, con análisis descriptivo de las características clínico-patológicas y análisis estadístico y multivariable mediante regresión logística. Resultados: Se incluyeron 921 tumores de 750 pacientes. Los dermatólogos extirparon 549 lesiones. Los márgenes de la pieza quirúrgica estaban invadidos por el tumor en un 12,6% de las lesiones. La extirpación fue incompleta en un porcentaje significativamente menor de tumores intervenidos por dermatólogos frente a otros especialistas (6,7 vs 21,5%). El riesgo relativo de que queden márgenes afectados es 3,8 veces mayor si el cirujano no es dermatólogo, independientemente de la edad del paciente, la localización de la lesión, el diámetro máximo de la pieza extirpada y el subtipo histológico del tumor. Conclusiones: La correcta identificación macroscópica de los márgenes tumorales, muchas veces sutiles, y el conocimiento de la historia natural del CBC son claves para un adecuado abordaje quirúrgico; probablemente son los principales factores que justifican el mayor porcentaje de tumores con márgenes libres extirpados por los dermatólogos (AU)

Background: Complete surgical excision is the most common treatment for basal cell carcinoma(BCC), and this intervention is often performed by surgeons who are not dermatologists(e.g., plastic surgeons, general surgeons, oral and maxillofacial surgeons, ophthalmologists, and otorhinolaryngologists). Objectives: To determine positive margin rates in BCCs removed by surgeons from different specialties and to identify clinical and pathologic factors that might explain potential differences between specialties. Methods: We retrospectively reviewed the pathology reports of all BCCs diagnosed at Hospital Universitari Vall d’Hebron between January 2009 and March 2001. The statistical methods included a descriptive analysis of clinical and pathologic variables, standard statistical analyses, and multivariate logistic regression. Results: We included 921 BCCs from 750 patients; 549 of the tumors had been excised by a dermatologist. The overall positive margin rate was 12.6%, but the rate for tumors removed by dermatologists was significantly lower than that for those removed by other specialists (6.7%vs 21.5%). There was a 3.8-fold increased relative risk of positive margins following excision by a surgeon who was not a dermatologist, independently of patient age, tumor site, maximum diameter of the resected specimen, and histologic subtype. Conclusions: Accurate macroscopic identification of tumor margins, which are often difficult to see, and familiarity with the natural history of BCC are key factors in the successful surgical treatment of BCCs. The higher rate of tumor-free margins achieved by dermatologists in this study is probably mainly due to their greater experience in these 2 areas (AU)

Evaluation of surgical margins in Basal cell carcinoma by surgical specialty.

BACKGROUND: Complete surgical excision is the most common treatment for basal cell carcinoma (BCC), and this intervention is often performed by surgeons who are not dermatologists (e.g., plastic surgeons, general surgeons, oral and maxillofacial surgeons, ophthalmologists, and otorhinolaryngologists). OBJECTIVES: To determine positive margin rates in BCCs removed by surgeons from different specialties and to identify clinical and pathologic factors that might explain potential differences between specialties. METHODS: We retrospectively reviewed the pathology reports of all BCCs diagnosed at Hospital Universitari Vall d'Hebron between January 2009 and March 2001. The statistical methods included a descriptive analysis of clinical and pathologic variables, standard statistical analyses, and multivariate logistic regression. RESULTS: We included 921 BCCs from 750 patients; 549 of the tumors had been excised by a dermatologist. The overall positive margin rate was 12.6%, but the rate for tumors removed by dermatologists was significantly lower than that for those removed by other specialists (6.7% vs 21.5%). There was a 3.8-fold increased relative risk of positive margins following excision by a surgeon who was not a dermatologist, independently of patient age, tumor site, maximum diameter of the resected specimen, and histologic subtype. CONCLUSIONS: Accurate macroscopic identification of tumor margins, which are often difficult to see, and familiarity with the natural history of BCC are key factors in the successful surgical treatment of BCCs. The higher rate of tumor-free margins achieved by dermatologists in this study is probably mainly due to their greater experience in these 2 areas.

Tratamiento quirúrgico del lentigo maligno: cirugía convencional vs. Mohs diferida. Estudio retrospectivo de 62 casos / Conventional Surgery Compared With Slow Mohs Micrographic Surgery in the Treatment of Lentigo Maligna: A Retrospective Study of 62 Cases

Introducción: El tratamiento estándar del lentigo maligno (LM) es la escisión quirúrgica con márgenes de 0,5 cm. Sin embargo, dada la mala delimitación de muchos tumores, es frecuente que esta exéresis sea incompleta. Objetivo: identificar parámetros clínicos que puedan predecir qué LM localizados en la cabeza, extirpados de forma primaria o tras recidivar, se extienden más allá de los límites visibles y por tanto, puedan requerir márgenes quirúrgicos más amplios. Material y métodos: se revisó retrospectivamente la información clínica de los pacientes con LM localizado en la cabeza cuyo tratamiento quirúrgico definitivo, mediante cirugía convencional o cirugía de Mohs diferida, fue realizado en el Servicio de Dermatología del Instituto Valenciano de Oncología (IVO) entre enero de 1993 y abril de 2011. Resultados: un 69,2% de los LM recidivados y un 26,5% de los tumores primarios requirieron márgenes de más de 0,5 cm. La administración previa de tratamientos que puedan interferir en la delimitación clínica, la localización centro facial y las lesiones que se presentan en pacientes con fototipos altos (III-V) fueron los factores asociados a la necesidad de márgenes quirúrgicos más amplios. Conclusiones: la utilización de márgenes de 0,5 cm para el tratamiento del LM es insuficiente para un número importante de casos localizados en la cabeza, especialmente los recidivados. La cirugía de Mohs diferida, con el estudio de todos los márgenes en parafina, parece el tratamiento de elección en particular para los casos recidivados o en los que la delimitación clínica pueda verse dificultada (AU)

Introduction: Surgical excision with margins of 0.5 cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders. Objective: To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins. Material and methods: We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April2011. Results: Surgical margins larger than 0.5 cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V. Conclusions: Surgical margins of 0.5 cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension (AU)

Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases.

INTRODUCTION: Surgical excision with margins of 0.5cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders. OBJECTIVE: To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins. MATERIAL AND METHODS: We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April 2011. RESULTS: Surgical margins larger than 0.5cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V. CONCLUSIONS: Surgical margins of 0.5cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension.