Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.338
Filtrar
1.
Med Clin North Am ; 105(4): 643-661, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059243

RESUMO

Melanoma accounts for approximately 1% of all skin cancers but contributes to almost all skin cancer deaths. The developing picture suggests that melanoma phenotypes are driven by epigenetic mechanisms that reflect a complex interplay between genotype and environment. Furthermore, the growing consensus is that current classification standards, notwithstanding pertinent clinical history and appropriate biopsy, fall short of capturing the vast complexity of the disease. This article summarizes the current understanding of the clinical picture of melanoma, with a focus on the tremendous breakthroughs in molecular classification and therapeutics.


Assuntos
Melanoma/diagnóstico , Melanoma/genética , Estadiamento de Neoplasias/métodos , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Idoso , Biópsia , Tratamento Farmacológico/métodos , Epigênese Genética/genética , Feminino , GTP Fosfo-Hidrolases/antagonistas & inibidores , Genótipo , Humanos , Imunoterapia/métodos , Incidência , Masculino , Melanoma/epidemiologia , Melanoma/terapia , Proteínas de Membrana/antagonistas & inibidores , Cirurgia de Mohs/métodos , Terapia de Alvo Molecular/métodos , Mutação/genética , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
2.
Rev Med Suisse ; 17(732): 630-634, 2021 Mar 31.
Artigo em Francês | MEDLINE | ID: mdl-33793100

RESUMO

Cutaneous tumours can be ill-delineated and subclinical tumour can be missed when using the usual methods of pathology processing because only less than 1 % of the margin is examined. Micrographic surgery was developed to allow for examination of 100 % of the margin. It reduces the recurrence rate and spares healthy tissue thus reducing lesion size and facilitating reconstruction. This method is particularly suitable for peri-orificial cutaneous tumours of the face with high rates of local recurrence. Mohs micrographic surgery is the main technique for frozen tissue and there are other often under-recognized variations using permanent paraffin sections known as the «â€…collerette ¼ ( spaghetti), «â€…muffin ¼ or the «â€…Tübinger Torte ¼ method.


Assuntos
Recidiva Local de Neoplasia , Neoplasias Cutâneas , Face , Humanos , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia
4.
An Bras Dermatol ; 96(3): 263-277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33849752

RESUMO

Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or "roots" that may be missed if an excised tumor is serially cross-sectioned in a "bread-loaf" fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs's initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.


Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Melanoma , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Humanos , Melanoma/cirurgia , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia
5.
Br J Dermatol ; 184(4): e126-e147, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33835484

RESUMO

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing skin cancer that is primarily treated with surgery. Because this cancer can spread deep into the skin and surrounding tissue in an irregular way, it is notoriously difficult to ensure that it has been completely removed after conventional surgery and histological examination. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). In WLE, the tumour and a predetermined margin of skin around it is removed. The margin is usually in the range of 1-5 cm. MMS involves removing the tumour and a much smaller margin around it, followed by immediate microscopic examination of the edges of the removed skin. Areas still containing tumour cells are then removed. This is repeated until all the edges are clear of tumour cells. This method allows the surgeon to track the tumour and only remove tissue where is it present. This study was carried out at several centres in the UK. Clinical records were examined of cases of DFSP between 1 January 2004 and 31 December 2013. This study includes the largest number of cases of DFSP reported in the UK: 483 new and 64 recurring cases of DFSP, in 11 plastic surgery and 15 dermatology departments. The methods used to perform these 547 surgeries were analysed. Almost 75% of cases of new DFSP were treated with WLE and 20% were treated with MMS. For recurring DFSP, 69% of patients had WLE and 23% had MMS. After a median follow-up period of just over 2 years for new DFSP and 1.6 years for recurring DFSP, the tumour returned in six patients after WLE and none after MMS. Although no DFSP were found to have returned after MMS, the study could not detect any significant difference in recurrences between the two surgical methods. Until data from more detailed studies are available, the choice of treatment for DFSP should be based on the patient's preference, treatment availability and cost. Linked Article: Durack et al. Br J Dermatol 2021; 184:731-739.


Assuntos
Dermatofibrossarcoma , Neoplasias Cutâneas , Dermatofibrossarcoma/cirurgia , Humanos , Cirurgia de Mohs , Recidiva Local de Neoplasia/cirurgia , Pele , Neoplasias Cutâneas/cirurgia
6.
Dermatol Surg ; 47(2): 162-166, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565771

RESUMO

BACKGROUND: Although many repair methods for postsurgical lip defects have been described, the literature lacks a comprehensive review of these methods. OBJECTIVE: To perform a systematic review of lip defect repair methods after Mohs surgery or excisions. MATERIALS AND METHODS: Terms related to perioral anatomy, Mohs surgery and excision, and reconstruction were used to search 8 databases. Articles were included if they reported postsurgical lip repair data for 4 or more patients, were in English, and were published from 2004 onward. Two reviewers screened all titles and abstracts, followed by the full texts of the remaining articles. Data were then extracted including author specialties, study design, demographic, tumor, and defect information, surgical procedures, outcomes, and complications. RESULTS: Forty-two studies were eligible, including a randomized trial, 25 case series, and 16 cohort studies. Most were written by dermatologic or plastic surgeons, and most studies were small, with an average subject number of 61. Very few studies used structured outcome measures. Many repair methods were described, the most common of which were linear closures and various flaps. CONCLUSION: Many repair methods for lip defects have been published, but overall, the quality of the available evidence is low.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Labiais/cirurgia , Cirurgia de Mohs/efeitos adversos , Retalhos Cirúrgicos/transplante , Ferida Cirúrgica/cirurgia , Humanos , Lábio/cirurgia , Ferida Cirúrgica/etiologia , Técnicas de Fechamento de Ferimentos
7.
Dermatol Surg ; 47(2): 170-173, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565772

RESUMO

BACKGROUND: Little is known about dermatologists' perceptions of postoperative pain and how those perceptions correlate with patient-reported pain and opioid prescribing. OBJECTIVE: To determine dermatologists' accuracy in predicting postoperative pain compared with patient-reported pain and how physicians' perceptions affect opioid prescribing practices. METHODS AND MATERIALS: A prospective observational study in which patients undergoing Mohs surgery rated pain on the Numerical Rating Scale (0-10). Using the same scale, the physician predicted how much pain the patient would experience postoperatively on the evening of surgery. All analgesic medications taken in postoperative period were recorded. RESULTS: A total of 316 patients completed the study (70% completion rate). Physician predictions were correlated with patient-reported pain (p < .001; r = 0.29) and were within 2 points of patient-reported pain in 70% of cases. When physicians overestimated patient-reported by ≥3 points, they were not more likely to prescribe opioids (p = .8094). Physicians predicted higher pain for patients who were prescribed opioids (p = .0002). CONCLUSION: Dermatologists were fairly accurate at predicting postoperative pain. Dermatologists were not more likely to prescribe opioids when pain was overpredicted.


Assuntos
Analgésicos Opioides/uso terapêutico , Dermatologistas/estatística & dados numéricos , Cirurgia de Mohs/efeitos adversos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Percepção , Padrões de Prática Médica/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
8.
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
10.
Dermatol Surg ; 47(2): e31-e36, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565775

RESUMO

BACKGROUND: The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found. OBJECTIVE: The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification. PATIENTS AND METHODS: We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed. RESULTS: Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease. CONCLUSION: Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.


Assuntos
Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Pele/patologia , Seguimentos , Humanos , Margens de Excisão , Recidiva Local de Neoplasia/prevenção & controle , Medição de Risco/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia
13.
J Eur Acad Dermatol Venereol ; 35(6): 1323-1330, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33539573

RESUMO

BACKGROUND: For basal cell carcinoma (BCC), only few controlled data have been published so far, which directly compare micrographically controlled surgery with conventional serial section histology. In addition to Mohs surgery, which uses cryostat sections, also three-dimensional histology (3D-histology), based on paraffin sections, is available to ensure complete control of the margins and basic sections. OBJECTIVES: To investigate the rate of local recurrence (LR) as well as the number of required re-excisions for basal cell carcinomas with serial section histology vs. 3D-histology. METHODS: We compared serial sections histology with 3D-histology in a prospective, randomized, controlled blinded trial and analysed 569 BCC of all subtypes up to 30 mm diameter, 287 BCC in the 3D group and 282 BCC in the serial section group. Excisions were performed with adapted primary resection margin according to location and size of the tumour. Surgeons were blinded at the time of surgery as they did not know which histological method will be used. Both methods used paraffin sections. RESULTS: Both groups did not differ regarding patients age, tumour location, tumour diameter, tumour subtypes or primary resection margins. In the serial section group, re-excisions were required in 21%; 24 tumours (8.4%) recurred after a median of 2.2 years. In the 3D-histology group, re-excisions were required in 39%; 10 tumours recurred (3.5%) after a median of 2.8 years. The recurrence rates differed significantly between both groups. Mean follow-up was 4.5 years. CONCLUSIONS: 3D-histology is a useful technique to detect tumour outgrowths at the excision margins, but required a high rate of re-excisions. 3D-histology was associated with a significantly lower LR rate than serial section histology.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Humanos , Cirurgia de Mohs , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Neoplasias Cutâneas/cirurgia
14.
Medicine (Baltimore) ; 100(7): e24767, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607825

RESUMO

ABSTRACT: Cutaneous squamous cell carcinoma usually extends beyond the visible margin. Little is known about the predictors for cutaneous squamous cell carcinoma with subclinical extension in Chinese individuals. This study aimed to construct a nomogram for predicting the probability of subclinical extension of cutaneous squamous cell carcinoma in Chinese patients.A retrospective analysis was conducted using data from Mohs micrographic surgery-treated cutaneous squamous cell carcinoma patients at a single institution between December 1, 2009 and October 31, 2019. Subclinical extension was defined as a lesion requiring ≥ 2 Mohs stages or with final safe margins of ≥ 5 mm. A nomogram predicting the probability of subclinical extension was constructed using the predictors identified in multivariable analysis.Of 274 patients included, 119 (43.4%) had subclinical extension. In multivariable analysis, male sex (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.40-4.29; P = .002), lesions on mucocutaneous areas (OR, 3.71; 95% CI, 1.34-10.32; P = .012) and extremities (OR, 2.40; 95% CI, 1.20-4.78; P = .013), maximum diameter of 10 to 19 mm (OR, 14.15; 95% CI, 4.24-47.28; P < .001), and 20 to 29 mm (OR, 9.21; 95% CI, 2.80-30.29; P < .001) were associated with subclinical extension. A nomogram incorporating these 3 variables demonstrated promising predictive ability (C statistics = 0.78; 95% CI, 0.67-0.89).The nomogram incorporating sex, tumor location, and maximum diameter can provide individualized prediction for subclinical extension in Chinese patients with cutaneous squamous cell carcinoma. This information may help surgeons determine appropriate margins at the first Mohs stage.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Margens de Excisão , Cirurgia de Mohs/métodos , Nomogramas , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Estudos de Casos e Controles , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/patologia
15.
Actas dermo-sifiliogr. (Ed. impr.) ; 112(2): 171-175, feb. 2021. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-200871

RESUMO

La reconstrucción del labio superior tras la cirugía de Mohs supone, en ocasiones, un reto para el cirujano dermatológico. Presentamos una serie de 15 pacientes (7 hombres y 8 mujeres; edad media de 65,6 años) con cáncer cutáneo (10 carcinomas basocelulares, 2 melanomas y 3 carcinomas escamosos) localizados en el labio superior intervenidos mediante cirugía de Mohs con defectos resultantes de 3-7,6 cm. Para la reconstrucción se empleó un colgajo en isla del labio superior diseñado escondiendo las incisiones en el pliegue nasolabial, en la línea de unión del bermellón con la piel y en las líneas de tensión de la piel relajada. Se explican las claves del diseño y la cirugía, enfatizando en la importancia de sacrificar en ocasiones pequeñas zonas de tejido sano. Se alcanzaron resultados satisfactorios cosméticos y funcionales, sin complicaciones posquirúrgicas en todos los pacientes


Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cirurgia de Mohs/métodos , Retalhos Cirúrgicos/cirurgia , Lábio/cirurgia , Neoplasias Labiais/cirurgia , Neoplasias Cutâneas/cirurgia , Melanoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Carcinoma Basocelular/cirurgia , Resultado do Tratamento , Sulco Nasogeniano/cirurgia
16.
Ann Plast Surg ; 86(2): 171-174, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33449464

RESUMO

BACKGROUND: Nasal reconstruction after Mohs resection of skin cancer commonly uses local flaps, many of which present limitations concerning their movement and skin color/texture match. In this article, the use of a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining for the management of defects at challenging locations on the nose is described as a versatile and cosmetically appropriate flap option. In addition, a novel mathematical sizing methodology for this flap is presented. METHODS: Between March 2013 and May 2016, 57 patients having undergone Mohs resection of skin cancer underwent nasal reconstruction using a myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining at our clinic. During the postoperative follow-up, patients were monitored for complications and received proper wound care. RESULTS: The mean age was 68.4 (range, 34-94) years. The mean follow-up was 10.1 (range, 3.0-34.9) months. The mean defect size was 1.99 (range, 0.70-5.25) cm2. No complete losses of flap occurred. Incidence of minor complications (pin cushion effect, minor delayed healing, etc) was minimal (4/57; 7.0%). Two of the cases in this series involved the utilization of cartilage grafts in combination with the myocutaneus island pedicle flap. CONCLUSIONS: The myocutaneous island pedicle flap based on the nasalis muscle with bilevel undermining can be used as a versatile flap for the closure of defects of various sizes and locations on the nose because of its rich blood supply, ease and convenience of use, and highly acceptable cosmetic outcome.


Assuntos
Retalho Miocutâneo , Neoplasias Nasais , Presbytini , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Idoso , Animais , Humanos , Cirurgia de Mohs , Nariz/cirurgia , Neoplasias Nasais/cirurgia
17.
BMC Health Serv Res ; 21(1): 100, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514362

RESUMO

BACKGROUND: The Improving Wisely intervention is a peer-to-peer audit and feedback intervention to reduce overuse of Mohs Micrographic Surgery (MMS). The objective of this study was to conduct a process evaluation to evaluate Mohs surgeons' perceptions of the implementation quality and perceived impact of the Improving Wisely intervention. METHODS: Surgeons in the Improving Wisely intervention arm, comprised of members of the American College of Mohs Surgeons (ACMS) who co-led the intervention, were invited to complete surveys and key informant interviews. Participants described perceptions of implementation quality (evaluated via dose, quality of implementation, reach and participant responsiveness), perceived impact of the Improving Wisely intervention (evaluated on a 1-5 Likert and qualitatively), and barriers and facilitators to changing surgeons' clinical practice patterns to reduce Mohs overuse. RESULTS: Seven hundred thirty-seven surgeons participated in the survey. 89% were supportive of the intervention. Participants agreed that the intervention would improve patient care and reduce the annual costs of Mohs surgery. Thirty surgeons participated in key informant interviews. 93% were interested in receiving additional data reports in the future. Participants recommended the reports be disseminated annually, that the reports be expanded to include appropriateness data, and that the intervention be extended to non ACMS members. Six themes identifying factors impacting potential MMS overuse were identified. CONCLUSIONS: Participants were strongly supportive of the intervention. We present the template used to design and implement the Improving Wisely intervention and provide suggestions for specialty societies interested in leading similar quality improvement interventions among their members.


Assuntos
Neoplasias Cutâneas , Cirurgiões , Humanos , Cirurgia de Mohs , Padrões de Prática Médica , Inquéritos e Questionários
18.
Dermatol Surg ; 47(2): e42-e46, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33481431

RESUMO

BACKGROUND: Obtaining conventional wide surgical margins is challenging in melanomas occurring at anatomically complex sites (e.g., hands and feet). OBJECTIVE: We investigated the potential benefits of slow Mohs micrographic surgery (MMS) for acral melanomas. MATERIALS AND METHODS: This single-center retrospective study investigated 210 patients who underwent slow MMS (n = 66) or wide local excision (WLE, n = 144) for melanomas during 2005 to 2015. Slow MMS was used for melanomas in anatomically complex locations and for high-risk lesions. RESULTS: Acral melanoma (166/210) was the most common lesion observed in patients, in addition to head and neck (21/210) and trunk (23/210) melanomas. Slow MMS was more commonly performed for acral, and head and neck melanomas (32.5% and 52.4%, respectively) than for trunk melanomas (4.3%, p = .002). Local recurrence of acral melanomas occurred in 3.7% of patients after slow MMS and in 10.7% of patients after WLE. Multivariate analysis showed comparable prognostic outcomes between slow MMS and WLE used for acral melanomas. Compared with WLE, slow MMS resulted in a smaller postoperative defect after acral lesion excision (p < .001). CONCLUSION: Slow MMS is an effective alternative to WLE for acral melanomas in anatomically complex sites, as evidenced by superior outcomes and maximum tissue conservation.


Assuntos
Melanoma/cirurgia , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , , Mãos , Humanos , Masculino , Margens de Excisão , Melanoma/diagnóstico , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , República da Coreia/epidemiologia , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Tronco
20.
Facial Plast Surg ; 37(3): 390-394, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33506452

RESUMO

This article determines if patient, defect, and repair factors can be used to predict the use of additional treatments to achieve optimal aesthetic results after repair of facial Mohs defects. An electronic chart review of patients undergoing Mohs excision and reconstruction of facial neoplasms from November 2005 to April 2017 was performed, reviewing patient demographics and history, tumor size, defect size and location, method and service of reconstruction, time between resection and repair, complications, and subsequent treatments. A total of 1,500 cases with basal cell and squamous cell carcinoma were analyzed. The average defect size was 3.09 ± 8.06 cm2; 81.9% of defects were less than 4 cm2 in size. Advancement flaps were used to repair 44.3% of defects. Complications and undesired sequelae (CUS) were noted in 15.9% of cases; scar hypertrophy or keloid (10.8%) was most common. Postoperative ancillary procedures were performed in less than one-quarter (23.4%) of patients to enhance the postrepair appearance; the most common procedures were intralesional corticosteroid injections and pulse dye laser treatments. CUS were more likely in females (19.6%), defects on the lips (28.7%) and on the nose (27.3%) (p < 0.001 for each). Females (22.7% vs. 12.7%), lip repairs (40.2% vs. 18.3%), transposition flaps (39.2% vs. 14.8%), and repairs performed by a dermatologist (17.9% vs. 11.2%) (p < 0.001 for each) were more likely to be treated with postoperative corticosteroid injections. Females (14.5% vs. 7.4%), patients under the age of 60 years (13.9% vs. 8.8%), and patients whose repair was performed by a dermatologist (11.9% vs. 2.9%) (p < 0.001 for each) were more likely to receive postoperative pulsed dye laser treatments. CUS and ancillary procedures after repair of facial Mohs defects are uncommon. Awareness of individual risk factors and defect characteristics allows the surgeon to choose the most appropriate repair technique while anticipating the potential need for ancillary procedures.


Assuntos
Neoplasias Faciais , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Estética Dentária , Neoplasias Faciais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Cirurgia de Mohs/efeitos adversos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...