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1.
J Am Acad Dermatol ; 82(5): 1158-1165, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31931085

RESUMO

OBJECTIVE: To provide a formal statistical comparison of the efficacy of melanoma detection among different clinical settings. METHODS: A systematic review and meta-analysis of all relevant observational studies on number needed to treat (NNT) in relation to melanoma was performed in MEDLINE. We performed a random-effects model meta-analysis and reported NNTs with 95% confidence intervals (CIs). The subgroup analysis was related to clinical setting. RESULTS: In all, 29 articles including a total of 398,549 biopsies/excisions were analyzed. The overall NNT was 9.71 (95% CI, 7.72-12.29): 22.62 (95% CI, 12.95-40.10) for primary care, 9.60 (95% CI, 6.97-13.41) for dermatology, and 5.85 (95% CI, 4.24-8.27) for pigmented lesion specialists. LIMITATIONS: There is heterogeneity in data reporting and the possibility of missing studies. In addition, the incidence of melanoma varies among clinical settings, which could affect NNT calculations. CONCLUSION: Pigmented lesion specialists have the lowest NNT, followed by dermatologists, suggesting that involving specialists in the diagnosis and treatment of pigmented skin lesions can likely improve patient outcomes.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Centros Médicos Acadêmicos , Biópsia por Agulha , Procedimentos Cirúrgicos Dermatológicos/métodos , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Melanoma/diagnóstico , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/diagnóstico , Resultado do Tratamento , Estados Unidos
2.
Int J Dermatol ; 59(3): 321-325, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31777957

RESUMO

BACKGROUND: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. METHODS: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. RESULTS: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). CONCLUSION: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.


Assuntos
Cirurgia de Mohs/estatística & dados numéricos , Cirurgia de Mohs/normas , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Humanos , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/cirurgia , Sistema de Registros/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Espanha/epidemiologia
3.
Dermatol Surg ; 46(4): 521-524, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31490309

RESUMO

BACKGROUND: Repair of periocular defects poses unique functional and aesthetic challenges. Data on the safety of periocular repairs by Mohs surgeons are limited. OBJECTIVE: Analyze the frequency and types of postreconstruction complications encountered with periocular repairs performed by Mohs surgeons, identify risk factors associated with complications, and enumerate interventions for complications encountered. MATERIALS AND METHODS: An institutional review board-approved retrospective study on periocular repairs performed by Mohs surgeons at 2 academic institutions between 07 2013 and 06 2016. Patients undergoing periocular Mohs surgery were identified via billing codes. Patient demographics and surgery details were recorded. Follow-up visit notes were reviewed for postoperative complications and interventions performed. RESULTS: Two hundred ten cases were included in the analysis. The most common locations for postreconstruction complications were the medial canthus (57%) and lower eyelid (37%). The complications identified included medial canthal webbing (4.3%), hypertrophic scarring (4.3%), ectropion (1.9%), infection (1.4%), pincushioning (1.4%), and epiphora (1.0%). The most common postoperative intervention was intralesional triamcinolone. Scar revision was performed in 2.4% of all cases. CONCLUSION: Periocular repairs performed by Mohs surgeons have a similar safety profile as repairs performed by oculoplastic surgeons.


Assuntos
Neoplasias Palpebrais/cirurgia , Cirurgia de Mohs/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Palpebrais/patologia , Pálpebras/patologia , Pálpebras/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Resultado do Tratamento
4.
Dermatol Surg ; 46(4): 508-513, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31403533

RESUMO

BACKGROUND: Telemedicine is improving access to subspecialty care within the Veterans Health Administration (VHA). Mohs micrographic surgery (MMS) is a surgical modality used to treat nonmelanoma skin cancers. OBJECTIVE: This study evaluates the use of teledermatology for preoperative consultation for MMS. METHODS AND MATERIALS: A retrospective analysis of interfacility MMS referrals to the Bronx Veterans Affairs Medical Center (VAMC) was conducted. The consult failure rates (CFRs), treatment follow-through rates, time to treatment, and travel savings for "face-to-face" preoperative consults were compared with store-and-forward "teledermatology" preoperative consults. RESULTS: Although both "teledermatology" and "face-to-face" preoperative consults resulted in an equivalent percentage of treated lesions, teledermatology had a significantly decreased CFR. In addition, teledermatology decreased the time to treatment by 2 weeks, increased the percentage of lesions treated within 60 days, and resulted in average travel savings of 162.7 minutes, 144.5 miles, and $60.00 per person. CONCLUSION: This study demonstrates that teleconsultation is effective for preoperative consults for MMS within the VHA system. Teledermatology improved access measures such as time to treatment and travel burden. This program may serve as a model not only for other VAMCs that accept interfacility MMS consults, but also for VAMCs that provide other types of access-limited subspecialty care.


Assuntos
Dermatologia/métodos , Cirurgia de Mohs/métodos , Cuidados Pré-Operatórios/métodos , Encaminhamento e Consulta/tendências , Neoplasias Cutâneas/cirurgia , Telemedicina/tendências , Idoso , Biópsia , Dermatologia/organização & administração , Dermatologia/estatística & dados numéricos , Dermatologia/tendências , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Hospitais de Veteranos/organização & administração , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Masculino , Cirurgia de Mohs/instrumentação , Cirurgia de Mohs/estatística & dados numéricos , Cirurgia de Mohs/tendências , Fotografação , Cuidados Pré-Operatórios/estatística & dados numéricos , Cuidados Pré-Operatórios/tendências , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Tempo para o Tratamento , Viagem/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs
6.
Dermatol Surg ; 46(2): 165-168, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31274529

RESUMO

BACKGROUND: The availability of Mohs micrographic surgery (MMS) in Australia has increased dramatically since its inception in the 1980s. OBJECTIVE: This study aimed to describe the evolution of MMS practices at the Skin and Cancer Foundation Australia (SCFA) over the past 20 years (1997-2017). METHODS: Retrospective analysis of Mohs surgery cases at SCFA in 2017, 2007, and 1997, comparing data on sex, age, tumor type and site, initial tumor and final defect size, number of surgical stages and sections, and closure management. The present study is limited by being a retrospective analysis from a single institution. RESULTS: There was a 415% increase in the number of Mohs surgery cases from 1997 to 2017, and a significant increase in Mohs surgery-treated squamous cell carcinoma. The preoperative tumor and final defect size have decreased. More side-to-side closures and fewer grafts are being performed over time. LIMITATIONS: Retrospective analysis from a single institution. CONCLUSION: Over the last 20 years, MMS has remained appropriate in its application and is being increasingly used for treatment of squamous cell carcinoma suggesting improved access.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Especializados/estatística & dados numéricos , Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Idoso , Austrália , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Fundações/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Ferida Cirúrgica/etiologia , Ferida Cirúrgica/patologia , Carga Tumoral , Técnicas de Fechamento de Ferimentos/tendências
8.
Dermatol Surg ; 46(1): 1-6, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31188146

RESUMO

BACKGROUND: Dermatologists overall perform a large number of procedures billed to Medicare, though the proportion of surgical procedures attributable to general dermatologists who do not perform Mohs micrographic dermatologic surgery (MDS) is unknown. OBJECTIVE: To determine the surgical volume of dermatologists who do not perform MDS and compare it to the surgical volume of MDS-performing dermatologists and all non-dermatologists. METHODS: A cross-sectional analytical study was performed using the Medicare public use file for 2014. Data were divided by physician specialty (dermatologists vs all non-dermatologists), and dermatologists were then dichotomized by MDS performance. RESULTS: Non-MDS dermatologists performed 42.19% of the benign excisions, 57.18% of the malignant excisions, and 46.00% of the intermediate repairs billed to Medicare in 2014. Micrographic dermatologic surgery-performing dermatologists were responsible for most of the complex repairs (67.56%), flaps (52.85%), and grafts (59.65%) billed to Medicare. CONCLUSION: Dermatologists who do not perform MDS represent the single largest group billing Medicare for benign excisions, malignant excisions, and intermediate repairs. They also bill for more complex repairs than all non-dermatologists combined. Micrographic dermatologic surgery-performing dermatologists performed most of the complex repairs, flaps, and grafts billed to Medicare.


Assuntos
Dermatologia , Medicare , Cirurgia de Mohs/estatística & dados numéricos , Padrões de Prática Médica , Neoplasias Cutâneas/cirurgia , Estudos Transversais , Humanos , Neoplasias Cutâneas/patologia , Retalhos Cirúrgicos , Estados Unidos
9.
Cutis ; 103(5): 284-287, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31233572

RESUMO

One benefit of Mohs micrographic surgery (MMS) is maximal tissue sparing compared to standard excisional surgery techniques. It also has the highest statistical cure rate for appropriately selected nonmelanoma skin cancers (NMSCs) in cosmetically sensitive areas, making it a preferred choice for many self-referred patients or their referring physicians. Patients and nondermatologist physicians may be unaware of how frequently Mohs surgeons perform complex surgical repairs compared to other specialists. Our objective was to compare the quantity and characteristics of flap or graft repairs on the nose or ears following skin cancer extirpation performed by either a fellowship-trained Mohs surgeon or plastic surgeons at 1 academic institution. A retrospective chart review of all skin cancer surgeries was performed to collect data on all flap or graft repairs on the nose or ears at Baylor Scott and White Health (Temple, Texas) from October 1, 2016, to October 1, 2017. We collected secondary data on final defect size prior to the repair, skin tumor type, referring specialty for the procedure, and patient demographics. We found that Mohs surgeons performed a larger number of complex repairs on cosmetically sensitive areas compared to plastic surgeons following skin cancer removal, which may be unrecognized in several specialties that refer patients for management of skin cancers, creating a possible practice gap. More data may aid referring providers in optimally advising and managing patients with cutaneous malignancies.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias da Orelha/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Nasais/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Plástica/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos
10.
Dermatol Surg ; 45(11): 1345-1352, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30893175

RESUMO

BACKGROUND: The rate of occult invasive disease within biopsy-proven squamous cell carcinoma in situ (SCCIS) is not well defined. OBJECTIVE: To examine the rate of occult invasion in SCCIS. METHODS: An institutional-wide pathology database was retrospectively searched for "squamous cell carcinoma in situ" over a 6-year period, and the treatment modality and final pathology results were analyzed for evidence of invasion. In addition, consecutive tumor blocks from Mohs micrographic surgery (MMS) cases of SCCIS were prospectively analyzed for invasion. RESULTS: The rate of occult invasion for biopsy-proven SCCIS treated with excision was 4.0% (N = 49) and for the MMS margins was 3.5% (N = 310). For the prospective MMS tumor block analysis, the rate of occult invasion was 10.1% (N = 69). No clinical factors (age, sex, location, or size) correlated with increased risk of invasion. All invasive SCCs detected were superficial and well differentiated. CONCLUSION: The rate of occult invasion for biopsy-proven SCCIS ranged from 3.5% to 10.1%. The detected rate of invasion varies based on the method of excision and pathology processing of specimens. The rate of invasion should be considered when managing SSCIS.


Assuntos
Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Idoso , Biópsia , Carcinoma in Situ/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Margens de Excisão , Invasividade Neoplásica/patologia , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Pele/patologia , Neoplasias Cutâneas/cirurgia , Centros de Atenção Terciária/estatística & dados numéricos
11.
Dermatol Surg ; 45(6): 782-790, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30829776

RESUMO

BACKGROUND: The management of skin cancers has evolved with the development of Mohs micrographic surgery and a greater emphasis on surgical training within dermatology. It is unclear whether these changes have translated into innovations and contributions to the reconstructive literature. OBJECTIVE: To assess contributions from each medical specialty to the cutaneous head and neck oncologic reconstructive literature. METHODS: The authors conducted a systematic review of the head and neck reconstructive literature from 2000 through 2015 based on a priori search terms relating to suture technique, linear closure, advancement, rotation, transposition and interpolation flaps, and identified the specialty of the senior authors. RESULTS: The authors identified 74,871 articles, of which 1,319 were relevant. Under suture technique articles, the senior authors were primarily dermatologists (58.2%) and plastic surgeons (20.3%). Under linear closure, the authors were dermatologists (48.1%), plastic surgeons (22.2%), and otolaryngologists (20.4%). Under advancement and rotation flaps, the senior authors were plastic surgeons (40.5%, 38.9%), dermatologists (38.1%, 34.2%), and otolaryngologists (14.4%, 21.6%). Under transposition and interpolation flaps, the senior authors were plastic surgeons (47.3%, 39.4%), dermatologists (32.3%, 27.0%), and otolaryngologists (15.3%, 23.4%). CONCLUSION: The primary specialties contributing to the cutaneous head and neck reconstructive literature are plastic surgery, dermatology, and otolaryngology.


Assuntos
Cirurgia de Mohs/normas , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos/normas , Competência Clínica , Dermatologia/normas , Dermatologia/estatística & dados numéricos , Humanos , Cirurgia de Mohs/métodos , Cirurgia de Mohs/estatística & dados numéricos , Otolaringologia/normas , Otolaringologia/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia Plástica/normas , Cirurgia Plástica/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Técnicas de Sutura/normas , Técnicas de Sutura/estatística & dados numéricos , Estados Unidos/epidemiologia , Técnicas de Fechamento de Ferimentos/normas , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
12.
JAMA Dermatol ; 155(4): 465-470, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30825412

RESUMO

Importance: Although overall antibiotic use among dermatologists is decreasing, there has been an increase in use associated with dermatologic procedures during the past decade. This higher antibiotic use may increase antibiotic-associated adverse events and promote the development of antibiotic resistance. Objective: To characterize antibiotic use associated with dermatologic procedures, including geographic variation. Design, Setting, and Participants: Using Optum Clinformatics DataMart deidentified commercial claims data, we performed a repeated cross-sectional analysis of antibiotic prescribing by dermatologists from 2008 to 2016. Dermatology clinicians were identified by their National Uniform Claim Committee taxonomy codes, encounters for surgical procedures were identified by Common Procedure Terminology codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes. Exposures: Claims for oral antibiotic prescriptions associated with encounters with dermatologists associated with dermatologic procedures. Main Outcomes and Measures: Frequency of antibiotic prescribing and associated procedures. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time. Results: Between 2008 and 2016, among 1 934 633 encounters (1 128 244 unique patients, 854 072 [44.1%] were women and the median [interquartile range] age was 66 [52-76] years) for dermatologic procedures, oral antibiotic prescribing associated with benign excisions increased from 2.9% to 4.4% of visits (52.5% relative change; incidence rate ratio [IRR], 1.04; 95% CI, 1.03-1.04), antibiotic prescribing associated with malignant excisions increased from 4.2% to 6.3% of visits (49.5% relative change; IRR, 1.06; 95% CI, 1.05-1.06), and antibiotic prescribing associated with Mohs surgery increased from 9.9% to 13.8% of visits (39.7% relative change; IRR, 1.04; 95% CI, 1.03-1.04). There was greater than 2-fold variation in antibiotic prescribing rates across geographic census divisions. If higher prescribing divisions were to develop antibiotic prescribing rates similar to lower prescribing divisions, antibiotic use could be decreased by over 50%. Conclusions and Relevance: Oral antibiotic prescribing by dermatologists associated with benign excisions, malignant excisions, and Mohs surgery is increasing over the past decade and there is substantial geographic variation. These findings highlight that there may be opportunities to optimize antibiotic use associated with dermatologic procedures.


Assuntos
Antibacterianos/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos/métodos , Resistência Microbiana a Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Adulto , Idoso , Antibacterianos/efeitos adversos , Estudos Transversais , Bases de Dados Factuais , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Cirurgia de Mohs/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco
15.
Dermatol Surg ; 45(2): 268-273, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30199438

RESUMO

BACKGROUND: It is important to understand variability in practice patterns of Mohs surgeons. OBJECTIVE: To examine the practice patterns of physicians performing Mohs micrographic surgery (MMS) in the United States. METHODS AND MATERIALS: This retrospective cohort study of the 2012 Medicare Physician and Other Supplier Public Use Files includes all physicians who billed Medicare for MMS. RESULTS: The authors found 2,067 physicians who billed Medicare for MMS in 2012. American College of Mohs Surgery (ACMS) members took a significantly higher average number of head and neck (H&N) and trunk layers compared with American Society for Mohs Surgery (ASMS) members and those with no membership (p < .001). Male surgeons, surgeons with more experience (21+ years out), surgeons in private practice, and those practicing in rural populations closed a significantly greater proportion of cases with flaps or grafts, as compared to females (p < .001), those with less experience (<21 years out) (p < .001), surgeons in academic practice (p = .004), and those practicing in urban or cluster populations (p < .001), respectively. CONCLUSION: There is significant variability in practices of Mohs surgeons in the United States.


Assuntos
Medicare/estatística & dados numéricos , Cirurgia de Mohs/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
16.
Br J Dermatol ; 181(2): 338-343, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30199574

RESUMO

BACKGROUND: Recurrent cutaneous squamous cell carcinoma (cSCC) has been associated with an increased risk of local functional and aesthetic comorbidity, metastasis and mortality. OBJECTIVES: To compare the risk of recurrence between Mohs micrographic surgery (MMS) and standard excision for cSCC of the head and neck. METHODS: This was a retrospective cohort study of all patients with a cSCC treated with MMS or standard excision at the departments of dermatology of a secondary or tertiary care hospital in the Netherlands between 2003 and 2012. To detect all recurrences, patients were linked to the Dutch pathology registry. To compare the risk of recurrence between MMS and standard excision, hazard ratios (HRs) were used adjusted for clinical tumour size > 2 cm and deep tumour invasion. RESULTS: A total of 579 patients with 672 cSCCs were included: 380 cSCCs were treated with MMS and 292 with standard excision. The risk of recurrence was 8% (22 of 292) after standard excision during a median follow-up of 5·7 years [interquartile range (IQR) 3·5-7·8], which was higher than the 3% (12 of 380) after MMS during a median follow-up of 4·9 years (IQR 2·3-6·0). The cumulative incidence of recurrence was higher for standard excision than for MMS during the entire follow-up period of 8·6 years. Carcinomas treated with MMS were at a three times lower risk of recurrence than those treated with standard excision when adjusted for tumour size and deep tumour invasion (adjusted HR 0·31, 95% confidence interval 0·12-0·66). CONCLUSIONS: MMS might be superior to standard excision for cSCCs of the head and neck because of a lower rate of recurrence.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Países Baixos/epidemiologia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento
17.
Australas J Dermatol ; 60(2): 137-139, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30353549

RESUMO

Peer-derived Australian Mohs data were used to define volume outliers and a benchmark for quality improvement. Higher volume practice was linked to less complex anatomical locations for surgery. Reflection on individual practice compared to peers may reduce the number of volume outliers in Mohs surgery.


Assuntos
Benchmarking , Cirurgia de Mohs/estatística & dados numéricos , Austrália , Humanos , Modelos Lineares , Indicadores de Qualidade em Assistência à Saúde
20.
Br J Dermatol ; 180(5): 1176-1182, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30536656

RESUMO

BACKGROUND: Despite the widespread use of Mohs micrographic surgery (MMS) for periocular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) - together called keratinocyte carcinoma (KC) - follow-up data regarding recurrences are limited. OBJECTIVES: To investigate the recurrence rate for periocular KCs after MMS and to describe our experience with interdisciplinary collaborations. METHODS: Patients with periocular KCs treated with MMS between 2006 and 2016 in a tertiary MMS referral hospital were included in this retrospective cohort study. Descriptive statistics were used to describe the MMS procedure-related characteristics. Using follow-up data from the electronic patient records and linkage with the Dutch nationwide network and registry of histopathology and cytopathology on 30 June 2017, the recurrence rate was evaluated and calculated using a cumulative incidence curve. RESULTS: In total, 683 (93·7%) periocular BCCs and 46 (6·3%) SCCs were treated with MMS. Three-quarters (n = 549) were primary tumours and the majority were located at the medial canthus or lower eyelid (n = 649, 89·0%). In 505 MMS procedures (69·3%) an oculoplastic surgeon participated, and in 63 patients (8·6%) a plastic surgeon performed the reconstruction. After a median follow-up of 46 months the recurrence rate was 3·0%, based on 22 recurrences (20 BCCs and two SCCs). CONCLUSIONS: MMS is an excellent treatment option for periocular KCs, with a low recurrence rate. Due to this specific anatomical location an interdisciplinary approach should pre-eminently be considered.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Palpebrais/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Neoplasias Palpebrais/epidemiologia , Neoplasias Palpebrais/patologia , Pálpebras/patologia , Pálpebras/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Aparelho Lacrimal/patologia , Aparelho Lacrimal/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Países Baixos/epidemiologia , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia
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