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1.
Dermatol Surg ; 49(1): 13-16, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36533789

RESUMO

BACKGROUND: There are limited data on the etiology, clinical characteristics, and optimal treatment of vulvar basal cell carcinoma (BCC). OBJECTIVE: This retrospective review may aid in treatment decisions for vulvar BCC. MATERIALS AND METHODS: A retrospective review of our institutional CoPath database was performed, using search terms to identify cases of vulvar BCCs from 2000 to 2018. RESULTS: A total of 35 cases of vulvar BCC were included. Patient age ranged from 33 to 97 years with a mean age of 70 years. Of the 35 cases, 28 (80%) involved the cutaneous vulva, 6 (17%) involved the suprapubic area, and 1 (3%) involved the clitoris. Most vulvar BCCs were treated by wide local excision (46%) and vulvectomies (37%), with 3 cases treated with Mohs (11%) and 2 with electrodesiccation and curettage (6%). Preoperative tumor sizes were 0.86 cm2 for Mohs, 0.94 cm2 for excision, and 1.54 cm2 for vulvectomy. The mean margins were 3 mm for Mohs, 4.4 mm for wide local excision, and 6 mm for vulvectomy. Most cases (77%) were identified and treated by gynecology. CONCLUSION: Mohs micrographic surgery should be considered for the advantages of being tissue sparing, evaluating the complete peripheral and deep margin, and avoiding the costs and risks of general anesthesia.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Neoplasias Vulvares , Feminino , Humanos , Idoso , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Cirurgia de Mohs , Vulva/cirurgia , Vulva/patologia , Neoplasias Vulvares/cirurgia , Neoplasias Vulvares/patologia
2.
Dermatol Surg ; 49(1): 1-7, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36533788

RESUMO

BACKGROUND: Histologic perineural invasion (PNI) in basal cell carcinomas (BCC) lacks evidence-based treatment guidelines. OBJECTIVE: Systematically review and analyze treatment outcomes of BCC with histologic PNI (PNBCC). MATERIALS AND METHODS: PubMed, Embase, and Cochrane Reviews were searched through June 25, 2021. Thirteen eligible cohort studies were meta-analyzed. RESULTS: 502 of 713 PNBCC were treated with Mohs Surgery (MMS), wide local excision (WLE), or surgery (MMS or WLE) with adjuvant radiation (Surg + RT). Overall 5-year local control (LC) was 97.2% and cancer-specific survival (CSS) was 99.6%. Surg and Surg + RT did not differ in recurrence (2.1% vs 4.7%; p-value 0.56; RR 1.51 [0.37, 6.20]), LC (97.9% vs 96.2%; p-value 0.19; RR 0.98 [0.96, 1.01]) or CSS (100% vs 99.1%; p-value 0.40; RR 0.99 [0.95, 1.02]). LIMITATIONS: No randomized controlled trials were found. Outcome data were often lacking. CONCLUSION: Overall LC and CSS were high at median 5-year follow-up for surgery alone and Surg + RT. Surgery alone and Surg + RT demonstrated statistically equivalent outcomes. We do not recommend adjuvant radiation therapy for solely histologic PNBCC if clear margins are achieved.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Radioterapia Adjuvante , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Recidiva Local de Neoplasia/cirurgia , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Cirurgia de Mohs
6.
Cutis ; 110(3): E21-E24, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36446119

RESUMO

Mohs micrographic surgery (MMS) has shown lower recurrence rates for unique skin tumors compared with wide local excision, but there is a lack of standardization on margin size. We aimed to assess MMS practice patterns of margin sizes for unique skin tumors. A survey was distributed to members of the American College of Mohs Surgery (ACMS). Demographic information on participants was collected in addition to initial/subsequent MMS margin size for unique skin tumors, including dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), melanoma, sebaceous carcinoma, microcystic adnexal carcinoma (MAC), poorly differentiated squamous cell carcinoma (SCC), and Merkel cell carcinoma. Eighty-seven respondents completed the survey (response rate <10%). Given that no guidelines exist on MMS margins for less commonly treated skin tumors, this study helps give Mohs surgeons perspective on current practice patterns for margin sizes. Mohs surgeons are more likely to take larger initial margins for these common skin tumors compared with BCCs or SCCs.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs , Margens de Excisão , Neoplasias Cutâneas/cirurgia , Inquéritos e Questionários
8.
Dermatol Surg ; 48(11): 1135-1139, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342245

RESUMO

BACKGROUND: Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS). OBJECTIVE: Evaluate how bupivacaine affects postoperative pain and narcotic use. MATERIALS AND METHODS: In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0-10), and whether pain was controlled. RESULTS: One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08-4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91-5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28-5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73-2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred. CONCLUSION: Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.


Assuntos
Bupivacaína , Transtornos Relacionados ao Uso de Opioides , Humanos , Anestésicos Locais , Manejo da Dor , Cirurgia de Mohs/efeitos adversos , Estudos Prospectivos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Entorpecentes/uso terapêutico , Método Duplo-Cego
9.
Dermatol Surg ; 48(11): 1155-1158, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342247

RESUMO

BACKGROUND: There are multiple modalities for patient education ranging from written to audiovisual formats. However, little is known regarding which modality is optimal. OBJECTIVE: To assess patient preference for educational materials about scar care following surgery for facial skin cancer using the FACE-Q Skin Cancer patient reported outcome measure. MATERIALS AND METHODS: On the day of Mohs surgery, patients were given a written handout or viewed a 3-minute animation video regarding best practices in scar improvement. Afterward, patients received the FACE-Q Skin Cancer-Satisfaction with Information: Appearance scale. Three months later, patients were called and given the same scale and additional questions regarding scar care. RESULTS: A total of 75 patients were enrolled. There was no difference between the 2 groups' preoperative information scores (p = .85) and the three-month postoperative scores (p = .37). The change in preoperative and postoperative score showed no significant difference between the 2 groups (p = .21); but there was a trend of higher satisfaction in the video group on the day of Mohs surgery. After the 3-month timepoint, there was a higher satisfaction trend observed with the written handout group. CONCLUSION: Patient preferences in information delivery and accessibility will contribute to greater information retention and satisfaction.


Assuntos
Neoplasias Faciais , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs/efeitos adversos , Cicatriz/etiologia , Cicatriz/prevenção & controle , Cicatriz/cirurgia , Preferência do Paciente , Satisfação do Paciente , Educação de Pacientes como Assunto , Neoplasias Cutâneas/cirurgia , Neoplasias Faciais/cirurgia
14.
Dermatol Surg ; 48(12): 1283-1288, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36449868

RESUMO

BACKGROUND: As Mohs micrographic surgery becomes more widely used in immunosuppressed patients, it is important to understand the risks in this unique population. OBJECTIVE: To determine whether immunosuppressed patients are at an increased risk for surgical site infection and evaluate the utility of postoperative antibiotics for the prevention of surgical site infection. MATERIALS AND METHODS: A single-center retrospective review of patients who underwent Mohs micrographic surgery between October 9, 2014, and August 20, 2021, was performed. RESULTS: Five thousand eight hundred eighty-six independent cases were identified. Factors associated with an increased incidence of antibiotic use included preoperative lesion size >40 mm (86.7%, n = 13; p < .01) and high-risk lesion location (46.4%, n = 1,268; p < .01). Patients were not more likely to be prescribed antibiotics if immunosuppressed (37.0%, n = 269 vs 34.2%, n = 1765; p = .14), and immunosuppression was not independently associated with antibiotic use on multivariate analysis (odds ratio 1.2, 95% confidence interval 1.0-1.5). Infection rates were similar between immunocompromised patients and immunocompetent patients (2.1%, n = 15 vs 1.6%, n = 80, respectively; p = .30). In immunosuppressed patients, antibiotic use did not decrease the likelihood of infection (3.0%, n = 8 vs 1.5%, n = 7; p = .19). CONCLUSION: There was no association between immunosuppression and surgical infection rate. Furthermore, postoperative antibiotics should not be indicated in these patients unless other high-risk criteria exist.


Assuntos
Cirurgia de Mohs , Infecção da Ferida Cirúrgica , Humanos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Cirurgia de Mohs/efeitos adversos , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Hospedeiro Imunocomprometido
17.
Skinmed ; 20(4): 338-342, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36314614

RESUMO

Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer and accounts for approximately 25% of nonmelanoma skin cancers (NMSC). Although the majority of cutaneous SCC lesions have been treated successfully by surgical excision, cryotherapy, electrodessication, or Mohs micrographic surgery, some locally advanced SCC patients are either inoperable, have been metastasized, or both. In such patients, treatment is more challenging due to limited options. We reviewed the literature to describe the mechanism of anti-PD1 agents in cancer therapy and current PD-1 blockade immunotherapy trials in cutaneous SCC. Currently, cemiplimab is the only anti-PD1 agent approved by the Food and Drug Administration for the treatment of locally advanced or metastatic SCC. This review described other anti-PD1 agents, such as pembrolizumab and nivolumab, that have depicted promising effects in advanced SCC, resulting in reduction of tumor size with minimal adverse effects. Immunotherapy targeting the PD-1-PD-L1 axis must be considered for advanced cutaneous SCC patients that are refractory to first-line of procedural treatment options. (SKINmed. 2022;20:338-342).


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Humanos , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/patologia , Receptor de Morte Celular Programada 1/uso terapêutico , Cirurgia de Mohs , Imunoterapia
18.
Skinmed ; 20(5): 338-342, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36314696

RESUMO

Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer and accounts for approximately 25% of nonmelanoma skin cancers (NMSC). Although the majority of cutaneous SCC lesions have been treated successfully by surgical excision, cryotherapy, electrodessication, or Mohs micrographic surgery, some locally advanced SCC patients are either inoperable, have been metastasized, or both. In such patients, treatment is more challenging due to limited options. We reviewed the literature to describe the mechanism of anti-PD1 agents in cancer therapy and current PD-1 blockade immunotherapy trials in cutaneous SCC. Currently, cemiplimab is the only anti-PD1 agent approved by the Food and Drug Administration for the treatment of locally advanced or metastatic SCC. This review described other anti-PD1 agents, such as pembrolizumab and nivolumab, that have depicted promising effects in advanced SCC, resulting in reduction of tumor size with minimal adverse effects. Immunotherapy targeting the PD-1-PD-L1 axis must be considered for advanced cutaneous SCC patients that are refractory to first-line of procedural treatment options.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Humanos , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/patologia , Receptor de Morte Celular Programada 1/uso terapêutico , Cirurgia de Mohs , Imunoterapia
19.
Dermatol Online J ; 28(4)2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36259853

RESUMO

Despite the lower incidence of non-melanoma skin cancers in skin of color populations, greater morbidity and mortality have been reported. Literature describing non-melanoma skin cancers in Native Americans is scarce. We designed a retrospective review study aimed to evaluate the characteristics of non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) in Native American patients treated with Mohs micrographic surgery between January 2015 and August 2020, at a single academic center. Twenty-six patients with 28 tumors were identified; 12 squamous cell carcinomas (92% well-differentiated) and 16 basal cell carcinomas (94% nodular). Most tumors were on the head and neck, with mean size of 563mm2 (squamous cell carcinomas) and 350mm2 (basal cell carcinomas). Tumor clearance was achieved in one stage for 75% of tumors. Recurrence was seen in two patients with squamous cell carcinoma. No mortality reported, although follow up was limited. Few Native Americans patients underwent Mohs micrographic surgery for non-melanoma skin cancers. Squamous cell cancers were larger, lower risk while basal cell carcinomas were predominantly nodular. Average time from biopsy to Mohs micrographic surgery was three months. Further studies are needed to better characterize non-melanoma skin cancers in Native Americans and to identify barriers to prompt care.


Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia/cirurgia
20.
Dermatol Online J ; 28(4)2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-36259866

RESUMO

Mohs micrographic surgery (MMS) is a surgical technique used to remove skin tumors with a complete evaluation of the margins. The keystone flap technique is generally used to repair large surgical defects on limbs. We present a case where a modified keystone flap technique was used to close a large defect after Mohs micrographic surgery in a patient with a basal cell carcinoma on the nose. An excellent functional and aesthetic result was obtained with no complications during or after the procedure. We offer a novel indication for this technique for surgical defects in this area.


Assuntos
Carcinoma Basocelular , Neoplasias Nasais , Humanos , Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/efeitos adversos , Neoplasias Nasais/cirurgia , Retalhos Cirúrgicos/cirurgia , /métodos
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