Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.100
Filtrar
1.
Dermatol Surg ; 47(2): 194-199, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565773

RESUMO

BACKGROUND: Treatment of nonmelanoma skin cancer (NMSC) by Mohs surgery has traditionally relied on previous pathologic evaluation of paraffin-embedded tissue. Tissue processing by frozen sections allows for expedited diagnosis and treatment; however, data on its accuracy are limited. OBJECTIVE: To measure the accuracy and outcomes of biopsy via frozen sections for clinical NMSC. METHODS: Biopsies of clinical NMSCs processed via frozen sections with in-office diagnosis rendered by one Mohs surgeon were retrospectively reviewed by one board-certified dermatopathologist. Discordant diagnoses were re-read in blinded fashion by both physicians. If still discordant, final diagnosis was determined by consensus discussion. Inter-rater reliability was calculated using Cohen's kappa statistic. RESULTS: Two hundred ninety-seven lesions from 208 patients were included. Correlation between in-office and final diagnosis was 0.876 indicating "almost perfect" concordance. Sensitivity and specificity of in-office diagnosis for detecting malignancy were 98.1% and 94.4%. Seven cases (2.0%) had a clinically relevant change in final diagnosis, but appropriate treatment had been rendered. Two benign lesions (0.7%) initially diagnosed as malignant underwent excision. CONCLUSION: In-office biopsy via frozen sections is highly accurate in confirming NMSC. This practice may speed diagnosis and treatment thus improving outcomes and patient satisfaction.


Assuntos
Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Ceratose Actínica/diagnóstico , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Idoso , Biópsia/estatística & dados numéricos , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Secções Congeladas/estatística & dados numéricos , Humanos , Ceratose Actínica/patologia , Ceratose Actínica/cirurgia , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
2.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500305

RESUMO

Nasal reconstruction following a total or subtotal resection presents a challenging clinical scenario. Ample external skin coverage is readily available using the paramedian forehead flap (PMFF), but restoring adequate internal lining of sufficient size and pliability is a major limitation. Intranasal mucosal flaps or free tissue transfer is often employed for this purpose, each with their own sets of limitations. Prelamination of the PMFF with a skin graft prior to transfer is a method to create a composite flap with both internal and external lining. Another challenge in subtotal nasal reconstruction centres around restoring adequate dimensions to the nose without an existing template to work from. Three-dimensional (3D) printing has become an increasingly popular tool in reconstructive surgery as it captures precise patient-specific dimensions to guide reconstruction. Herein, we describe a case of subtotal nasal reconstruction using a prelaminated PMFF using a patient-specific 3D printed model as a template for reconstruction.


Assuntos
Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Idoso , Carcinoma Basocelular/cirurgia , Testa , Humanos , Masculino , Neoplasias Nasais/cirurgia , Impressão Tridimensional , Neoplasias Cutâneas/cirurgia
3.
Cir. plást. ibero-latinoam ; 46(4): 449-454, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198729

RESUMO

La utilidad del colgajo condrocutáneo del hélix para cubrir defectos menores de 2 cm es ampliamente aceptada. Con esta publicación queremos mostrar el resultado de esta técnica para el manejo de un defecto extenso que incluía el tercio medio del hélix y antihelix. Realizamos la técnica de Antia-Buch con doble colgajo condrocutáneo para reconstruir, en un solo tiempo quirúrgico, un defecto de 40 mm en el tercio medio del pabellón auricular de una paciente de avanzada edad, que había rechazado opciones reconstructivas que requirieran varios tiempos de cirugía, obteniendo un resultado funcional y cosmético adecuado


Usefulness of chondrocutaneous helix flap for defects smaller than 2 cm is widely accepted. This paper attempts to show the outcome of this technique for the management of a large helix and antihelix defect. We performed the Antia-Buch technique, with two chondrocutaneous flaps, to reconstruct in a single surgical stage a 40 mm defect in the middle third of the auricle of an elderly patient who refused more than one surgical time, achieving an appropriate functional and cosmetical outcome


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Retalhos Cirúrgicos/cirurgia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirurgia , Técnicas de Sutura/métodos , Patologia/métodos , Cartilagem da Orelha/cirurgia , Cartilagem da Orelha/transplante
4.
Cir. plást. ibero-latinoam ; 46(4): 455-464, oct.-dic. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198730

RESUMO

INTRODUCCIÓN Y OBJETIVO: Para la reconstrucción del maxilar se han descrito múltiples clasificaciones y algoritmos de manejo. Actualmente, el más aceptado es el planteado por Cordeiro y Santamaría. Presentamos nuestra experiencia en reconstrucción microquirúrgica del maxilar con colgajos libres de peroné y ánterolateral de muslo, con el objetivo de que se consideren herramientas de primera elección en la reconstrucción de defectos clasificados como tipo II y III. MATERIAL Y MÉTODO: Estudio retrospectivo descriptivo, serie de casos, en el que presentamos 7 casos clínicos de reconstrucción de maxilar con colgajo libre de peroné y ánterolateral de muslo realizados en el Hospital Universitario de La Samaritana (HUS) en Bogotá, Colombia, entre enero de 2018 y febrero de 2019. RESULTADOS: Para la reconstrucción de los defectos IIa, IIb y IIIa utilizamos el colgajo libre de peroné. En maxilectomías clasificadas como IIIb implementamos el colgajo ánterolateral de muslo quimérico con vasto lateral. La supervivencia de los colgajos fue del 100%. CONCLUSIONES: El colgajo libre de peroné es nuestra principal opción reconstructiva en los defectos por maxilectomías IIa, IIb y IIIa, mientras que el colgajo ánterolateral de muslo quimérico con vasto lateral es nuestro colgajo de elección en defectos tipo IIIb


BACKGROUND AND OBJECTIVE: Multiple classifications and management algorithms have been described for maxillary reconstruction, at the present time, the most widely accepted is described by Cordeiro and Santamaría. We present our experience in microsurgical reconstruction of the maxillary with free flaps retrieved from fibula and anterolateral thigh with the intent to consider it as a first-choice option in the reconstruction of defects classified as type II and III. METHODS: A retrospective, descriptive, case series study of 7 maxillary reconstruction cases with free flap from fibula and anterolateral thigh is described. Database was recollected between January 2018 and February 2019 from Hospital Universitario de La Samaritana (HUS) in Bogotá, Colombia. RESULTS: For the reconstruction of IIa, IIb and IIIa defects, a fibular free flap was used. For maxillectomies classified as IIIb, an anterolateral thigh and vast lateral chimeric free flap was implemented. Survival rate of the free flaps was observed at 100%. CONCLUSIONS: The fibular free flap is our primary reconstructive option in defects by maxillectomy classified as IIa, IIb and IIIa. In defects constituted as IIIb, our choice is an anterolateral thigh and vast lateral chimeric flap


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Microcirurgia/métodos , Maxila/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos de Tecido Biológico/cirurgia , Maxila/lesões , Maxila/patologia , Estudos Retrospectivos , Neoplasias Maxilares/cirurgia , Neurofibroma/cirurgia , Carcinoma Basocelular/cirurgia
6.
Medicine (Baltimore) ; 99(50): e23545, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327304

RESUMO

It is difficult to repair large skull and dural defects. We observed the therapeutic effects of anterolateral thigh flaps with vascular fascia lata for repairing large skull and dural defects.From December 2008 to June 2019, we repaired large skull and dural defects for 28 cases including 12 cases with scalp malignant tumor and 16 cases requiring removal of titanium mesh which had been once placed due to craniocerebral trauma. The scalp malignant tumor invaded full-thickness skull in 12 cases; and invaded cervical lymph nodes, dura mater or brain tissue in 3 cases. In the 12 cases with scalp malignant tumor, the scalp defects of 12 cm × 9 cm to 22 cm × 18 cm and skull defects of 9 cm × 7 cm to 15 cm × 12 cm after radical tumor resection were repaired using anterolateral thigh flaps of 14 cm × 11 cm to 23 cm × 19 cm with fascia lata of 10 cm × 8 cm to 16 cm × 12 cm. Postoperative radiotherapy and chemotherapy were also performed in the 3 cases with tumor metastasis. In the 16 cases requiring removal of titanium mesh, the skull and dural defects of 8 cm × 7 cm to 15 cm × 11 cm after removal of titanium mesh were repaired using anterolateral thigh flaps of 10 cm × 8 cm to 16 cm × 12 cm.In all cases, the transplanted anterolateral thigh flap with fascia lata survived after surgery and no vascular crisis occurred. During the followup of 8 months to 9 years, the flap appearance in the head-repaired area was fine, no external hernia of brain tissue occurred, the appearance of the femoral donor site was acceptable, and femoral muscle strength and movements were normal in all cases. The 12 cases with scalp malignant tumor had no local recurrence or distant metastasis.Repairing the skull and dural defects caused by radical surgery for scalp malignant tumor or removal of titanium mesh using anterolateral thigh flaps with vascular fascia lata, is effective. The appearance in the head-repaired area is fine without external hernia of brain tissue.


Assuntos
Dura-Máter/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Retalhos Cirúrgicos/transplante , Coxa da Perna/cirurgia , Adulto , Idoso , Lesões Encefálicas/cirurgia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Dura-Máter/lesões , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Crânio/lesões , Telas Cirúrgicas , Titânio , Adulto Jovem
7.
An Bras Dermatol ; 95(6): 714-720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33250112

RESUMO

BACKGROUND: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging. OBJECTIVES: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour. METHODS: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used. RESULTS: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05). STUDY LIMITATIONS: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice. CONCLUSIONS: Primary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.


Assuntos
Carcinoma Basocelular , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Humanos , Cirurgia de Mohs , Nariz , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia
8.
Hautarzt ; 71(12): 960-968, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-32930855

RESUMO

BACKGROUND: Basal cell carcinomas are the most frequent epithelial skin tumors and a frequent indication for dermatological interventions. Despite the establishment of drug treatment options, surgery is still the treatment of choice. Various options are available ranging from curettage to complex dermatosurgical procedures. In addition to the main aspect of low local recurrence rates, esthetic factors and the number of procedures are also important for the choice of treatment. METHODS: In this study 347 patients with 398 basal cell carcinomas (nodular type, diameter up to 10 mm) were prospectively examined. The patients were randomized into two treatment arms: in one group the tumor was treated by ring curettage and in the other group the tumor was excised. Patients who underwent 3D histologically controlled surgery due to basal cell carcinoma during the same investigation period served as controls. RESULTS: The highest local recurrence rate was observed after curettage (14.0%), whereas the group with 3D histology had the lowest recurrence rate (0.9%, p < 0.001). In the 3D group, more re-excisions were required to achieve complete tumor clearance compared to the group who underwent excisions with serial section histology. Patients rated the esthetic outcome best after curettage. The median follow-up was 3.9 years. CONCLUSION: The choice of surgical treatment for small nodular basal cell carcinomas depends on individual circumstances. Excisions controlled by 3D histology with wound closure after complete tumor clearance showed the lowest recurrence rate in our study; however, curettage is also a possible surgical treatment option with minimal effort and an acceptable recurrence rate, which can lead to good esthetic results.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento
10.
An Bras Dermatol ; 95(5): 583-588, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32711927

RESUMO

BACKGROUND: High-risk basal cell carcinoma involves a significant rate of basal cell carcinoma that requires Mohs micrographic surgery for definitive treatment. Staged excision with pathologic margin control is a simple, accessible, and curative procedure suggested for the treatment of high-risk basal cell carcinoma. OBJECTIVE: To evaluate the results of staged excision of high-risk basal cell carcinoma in the head region. METHODS: This interventional study was performed on patients with high-risk basal cell carcinoma, who underwent staged excision until the margins were free of tumor. RESULTS: A total of 122 patients (47 females and 75 males) with mean age of 57.66 ±â€¯9.13 years were recruited in this study. Nasal and nodular types were the most common of both clinical and pathologic forms, respectively. Further, 89.3 % of cases were cured by staged excision after four years of follow-up. There was a significant relationship between treatment outcomes and recurrent lesions, multiplicity of risk factors, long-standing disease, and pathologic type. There was also a significant association between the number of surgical excisions and multiplicity of risk factors, as well as recurrence, location, and size of basal cell carcinoma. STUDY LIMITATIONS: Lack of magnetic resonance imaging assessment in cases of suspected perineural invasion. CONCLUSIONS: High-risk basal cell carcinoma had a high cure rate by staged excision. Patients with more risk factors and those with nasal and recurrent basal cell carcinoma required more staged excisions. Failure of treatment is more probable in patients with more risk factors, long-standing lesions, and high-risk pathologic and recurrent basal cell carcinomas.


Assuntos
Carcinoma Basocelular , Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs , Recidiva Local de Neoplasia/cirurgia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento
11.
Niger J Clin Pract ; 23(7): 1022-1025, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620735

RESUMO

Maxillofacial prosthetics is the branch of prosthodontics which involves rehabilitation of the defects in the maxillofacial region involving the hard and soft tissue with the prosthesis. Facial defects that occur in the midfacial regions are commonly due to trauma and neoplasms like basal cell carcinoma which involves the nose. Reconstruction of the nose is an important esthetic challenge due to its esthetic and retention problems. This article emphasis rehabilitation of the nasal defect of a patient with nasal prosthesis using donor method.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Nasais/reabilitação , Nariz/cirurgia , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Carcinoma Basocelular/patologia , Carcinoma Basocelular/reabilitação , Humanos , Masculino , Prótese Maxilofacial , Implante de Prótese Maxilofacial , Pessoa de Meia-Idade , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Implantação de Prótese , Doadores de Tecidos , Resultado do Tratamento
12.
An Bras Dermatol ; 95(5): 594-601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32693938

RESUMO

BACKGROUND: The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. OBJECTIVES: a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. METHODS: Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. RESULTS: The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. STUDY LIMITATIONS: Retrospective nature, sample size, and biopsies performed by different professionals. CONCLUSIONS: The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Biópsia , Carcinoma Basocelular/cirurgia , Humanos , Cirurgia de Mohs , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia
14.
Facial Plast Surg ; 36(2): 133-140, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32413920

RESUMO

Basal cell carcinoma, squamous cell carcinoma, and melanoma represent the three most common skin cancers that occur on the face. The most common surgical treatments for facial skin cancers are Mohs' surgery and standard local excision. The effective utilization of either of these techniques is based on tumor and patient risk stratification incorporating known risk factors for occult invasion and local recurrence, combined with patient comorbidities, expectations, and desires. Best available evidence highlights multiple and consistent risk factors for each specific skin cancer type, and dictate local control rates reported in the literature. Recognizing gaps in the literature, we compare and review surgical treatment guidelines and data for standard local excision versus Mohs' surgery for cutaneous nonmelanoma and melanoma skin cancer. This article serves as a resource for optimal therapeutic decision making for surgical management of skin cancer on the face.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Humanos , Cirurgia de Mohs , Recidiva Local de Neoplasia/cirurgia
15.
Facial Plast Surg ; 36(2): 166-175, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32413924

RESUMO

Periocular skin is highly prone to malignancies, especially basal cell and squamous cell carcinomas. Because of the complex anatomy and eye-protecting functions of the periocular tissues, treatment of these cancers requires special considerations. Mohs micrographic surgery is usually the treatment of choice, whenever possible, in order to enhance margin control while limiting collateral damage to nearby normal structures. Cancer excision, whether by Mohs or other techniques, will leave a complex defect that requires careful anatomical and functional reconstruction. This study presents some of the challenges of treating periocular skin cancer and associated reconstructive surgery and provides an intellectual framework for addressing these challenges. The key topics are adherence to anatomical landmarks and aesthetic units, proper distribution of tension, and matching the correct reconstructive approach, that is, type of flap or graft, to the defect at hand. This review is not meant to be exhaustive, but it will provide both basic and advanced considerations.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Neoplasias Cutâneas/cirurgia , Estética Dentária , Humanos , Cirurgia de Mohs
16.
Acta Chir Plast ; 61(1-4): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380839

RESUMO

Basal cell carcinoma (BCC) is the most prevalent malignancy, with rising incidence worldwide. Despite its naturally slow growth and initially low metastatic potential, it can cause significant morbidity and mortality when unrecognized, inadequately treated or poorly followed up. Authors present the case of a 61-year-old male with a 7-year history of multiple incomplete excisions of a “simple” BCC on the forehead. A CT scan of the head revealed an invasive mass (5.2 cm laterolateral x 4.0 cm craniocaudal) in the frontal area. There was no evidence of metastasis. Complete resection of the lesion and reconstruction was achieved in three stages. Final reconstruction was achieved using a left frontal fasciocutaneous flap. The secondary defect was closed with an advancement flap of the scalp and donor sites were covered using a split-thickness skin graft from the upper limb. This case demonstrates the necessity for vigilance in the approach to, diagnosis, treatment and follow-up of these skin neoplasms. The development of giant BCCs should be avoided at all costs. Increased size of BCCs corresponds with increased recurrence rate, metastatic rate, morbidity, mortality, treatment difficulties and overall costs.


Assuntos
Carcinoma Basocelular/prevenção & controle , Neoplasias Faciais/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/cirurgia , Neoplasias Faciais/diagnóstico por imagem , Neoplasias Faciais/cirurgia , Testa , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
17.
Ann Vasc Surg ; 68: 185-191, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32422291

RESUMO

BACKGROUND: The main risk factor associated with basal cell carcinomas (BCCs) is believed to be exposure to ultraviolet radiation (UVR). In the case of lower limb BCC, the frequency is higher in women, possibly because of greater exposure of the leg to UVR. Chronic venous insufficiency (CVI), also more common in women, may have some association with leg BCCs. METHODS: We retrospectively evaluated the histopathological features of leg BCCs removed between 1993 and 2017 in a tertiary referral center. The patients' clinical data were obtained from medical records, considering, in particular, CVI. RESULTS: We selected 149 patients with leg BCCs, predominately occurring in elderly Caucasian women. Of those, 71 had a clinical diagnosis of CVI in whom the clinical tumor size and frequency of recurrences were significantly higher than patients without CVI. There was an association between clinical diagnosis of CVI and histological findings of (1) follicular induction in epidermis and (2) distal sweat duct hyperplasia. CONCLUSIONS: CVI, besides the already known UVR exposure, is probably associated with leg BCCs and may determine a worse BCC course.


Assuntos
Carcinoma Basocelular/etiologia , Perna (Membro)/irrigação sanguínea , Neoplasias Cutâneas/etiologia , Insuficiência Venosa/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Doença Crônica , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Insuficiência Venosa/diagnóstico
18.
Surg Clin North Am ; 100(3): 629-634, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402305

RESUMO

Anal cancer is a rare cancer, comprising less than 5% of gastrointestinal tract malignancies. Diagnosis of anal canal cancer can be difficult given that presenting symptoms are similar to those of benign anorectal diseases. General surgeons who encounter suspected anal canal cancer need to have a good understanding of the anatomy of the anal canal, high index of suspicion for malignancy, and low threshold to biopsy lesions when indicated. This article discusses the most commonly encountered anal canal tumors, the evaluation of these tumors, and their management. The foundation for successful therapy includes timely diagnosis, accurate staging, and routine surveillance.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias do Ânus/cirurgia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Melanoma/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Canal Anal/patologia , Canal Anal/cirurgia , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/patologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia , Diagnóstico Diferencial , Seguimentos , Metástase Linfática/patologia , Metástase Linfática/terapia , Melanoma/diagnóstico , Melanoma/patologia , Estadiamento de Neoplasias , Proctoscopia , Prognóstico
19.
Int J Comput Assist Radiol Surg ; 15(5): 887-896, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32323209

RESUMO

PURPOSE: Basal cell carcinoma (BCC) is the most commonly diagnosed cancer and the number of diagnosis is growing worldwide due to increased exposure to solar radiation and the aging population. Reduction of positive margin rates when removing BCC leads to fewer revision surgeries and consequently lower health care costs, improved cosmetic outcomes and better patient care. In this study, we propose the first use of a perioperative mass spectrometry technology (iKnife) along with a deep learning framework for detection of BCC signatures from tissue burns. METHODS: Resected surgical specimen were collected and inspected by a pathologist. With their guidance, data were collected by burning regions of the specimen labeled as BCC or normal, with the iKnife. Data included 190 scans of which 127 were normal and 63 were BCC. A data augmentation approach was proposed by modifying the location and intensity of the peaks of the original spectra, through noise addition in the time and frequency domains. A symmetric autoencoder was built by simultaneously optimizing the spectral reconstruction error and the classification accuracy. Using t-SNE, the latent space was visualized. RESULTS: The autoencoder achieved an accuracy (standard deviation) of 96.62 (1.35%) when classifying BCC and normal scans, a statistically significant improvement over the baseline state-of-the-art approach used in the literature. The t-SNE plot of the latent space distinctly showed the separability between BCC and normal data, not visible with the original data. Augmented data resulted in significant improvements to the classification accuracy of the baseline model. CONCLUSION: We demonstrate the utility of a deep learning framework applied to mass spectrometry data for surgical margin detection. We apply the proposed framework to an application with light surgical overhead and high incidence, the removal of BCC. The learnt models can accurately separate BCC from normal tissue.


Assuntos
Carcinoma Basocelular/cirurgia , Aprendizado Profundo , Margens de Excisão , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/patologia , Estudos de Viabilidade , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia
20.
J Craniofac Surg ; 31(5): 1367-1369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224777

RESUMO

PURPOSE: Total exenteration of the orbit with removal of the eye globe and surrounding tissues is most frequently indicated for malignant tumors. The indications for exenteration of the orbit for benign orbital lesion are rare. Not adequately treated infection of the orbit by systemic antibiotics can lead to destructive changes of soft tissues in the region of the orbit and partial exenteration with eyelid sparing technique is necessary. DESIGN: Retrospective case series. METHODS: Data of all patients between 2010 and 2018 who underwent exenteration of the orbit for periocular lesions infiltrating the region of the orbit were reviewed for patient demographics, previous treatment options, tumor localization and histopathologic type. RESULTS: In group of 14 patients with periocular lesions total orbital exenteration underwent 12 patients (86%), in 1 patient biorbital exenteration was performed and in one patient orbital exenteration with eyelid sparing technique was performed. For 2 patients (14%) orbital exenteration was the first surgical procedure performed. In the group of total exenteration in 12 cases histopathologically basal cell carcinoma from eyelids was confirmed, in one case squamous cell epibulbar carcinoma was confirmed and in 1 case subtotal exenteration with eyelid sparing technique was performed-the authors reported the case.Case report of patient with long inflammation of the lacrimal pathway leading to orbital inflammation with eye globe destruction and partial exenteration with eyelids sparing technique was indicated. A 75-year-old man presented in 2014 with blepharoconjunctivitis and lacrimal sac inflammation of the left side. Treated in outpatient tract with local antibiotics, the drainage lacrimal system was transient. Few months later developed chronic blefaroconjunctivitis in cultivation result Citrobacter koseri positive was found. Patient was treated only with local therapy at outpatient tract again. In 2017 sent to hospital with painful eye-globe, visual acuity was no light perception. Computed tomography and magnetic resonance presented soft tissue mass extending along the medial orbit region in the m.rect. medialis and m. obliquus sup. and partly also m. rect. inf. space as a lesion of size 23 × 30 mm with a slight postcontrast homogeneous saturation and this lesion tightly fitted to the eyeball. Exenteration with lid sparing technique was performed. In 2019 after healing process patient got an individual epithesis. CONCLUSIONS: Basal cell carcinoma is the most frequent indication of orbital exenteration. Rarely is indicated subtotal exenteration with eyelid sparing technique for non-cancer reason as it was in our 1 case.


Assuntos
Doenças Orbitárias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Dacriocistite/cirurgia , Dor Ocular/etiologia , Pálpebras/cirurgia , Humanos , Masculino , Neoplasia de Células Basais , Exenteração Orbitária , Doenças Orbitárias/complicações , Doenças Orbitárias/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Cicatrização
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...