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1.
Chirurgia (Bucur) ; 115(1): 69-79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155401

RESUMO

Background: Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) are the most frequent skin cancers with a continuous increasing incidence and a cause of economic impact. Mohs micrographic surgery (MMS) is known as the gold-standard of treatment of non-melanoma skin cancer. Methods: The files of the patients treated with MMS were analysed during a 6 year period (2014-2019) and demographic information was extracted in addition to the information on tumor histology, localization of tumors, number of stages required for a complete removal of the tumors, and the evolution of the patients. We also analysed the information regarding the number and type of reconstructions performed. Results: Over the course of 6 years, 1,356 cutaneous tumors were treated in our clinic by means of MMS. BCC represented 80.5%, SCC 17.6%, and other tumors such as melanoma in situ, DFSP, Extramammary Paget's Disease - being 1.9% of the number of other treated tumors. During the period under review, only 4 cases of post-Mohs Micrographic Surgery recurrence have been recorded, with a cure rate of over 99.7%. Conclusions: Mohs micrographic surgery is an efficient treatment method in removing cutaneous carcinoma as well as tumors with special indications with a low recurrence rate therefore reducing the need of successive surgical interventions.


Assuntos
Cirurgia de Mohs , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Instituições de Assistência Ambulatorial , Humanos , Cirurgia de Mohs/métodos , Romênia , Resultado do Tratamento
2.
JAMA Netw Open ; 3(3): e200725, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32159810

RESUMO

Importance: Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). Objective: To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. Design, Setting, and Participants: This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. Main Outcomes and Measures: Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. Results: Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. Conclusions and Relevance: This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.


Assuntos
Cicatriz/diagnóstico , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Idoso , Cicatriz/cirurgia , Estudos Transversais , Face , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
3.
Plast Reconstr Surg ; 145(2): 533-542, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985654

RESUMO

BACKGROUND: The lips provide key functional and aesthetic features of the face. From social interactions and speech to swallowing and oral competence, a functional dynamic structure is required. This interaction with surrounding landmarks presents a challenge for reconstruction. There are a myriad of ways reported to reconstruct these defects; however, as the authors' practice has evolved, a more refined approach was developed to optimize results and minimize the complexity of each patient's surgery. METHODS: A retrospective review from 2004 to 2018 was performed of consecutive patients who underwent lip reconstruction following Mohs cancer resection performed by a single surgeon. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. In addition, the evolution of treatment types over those 14 years was evaluated. RESULTS: Six hundred fifteen patients underwent lip reconstruction. Defects most commonly involved the upper lateral lip, and 247 (40 percent) involved both the skin and vermillion. A significant majority of the patient's defects were repaired using either linear closure or V-wedge excision and closure. A complication rate of 10.2 percent (n = 63) was found, ranging from oral incompetence to cancer recurrence. There was no significant difference in complication rates in patients older than 75 years, in smokers, or in patients who were on anticoagulation. CONCLUSIONS: The authors' techniques have evolved from more invasive advancement and rotation flaps to a more reliable linear closure method over the past 14 years. This study shows that lip reconstruction is safe in elderly patients, smokers, and patients who are on anticoagulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias Labiais/cirurgia , Lábio/cirurgia , Cirurgia de Mohs/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Curativos Biológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Transplante de Pele/métodos , Resultado do Tratamento , Adulto Jovem
7.
An Bras Dermatol ; 94(6): 671-676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789269

RESUMO

BACKGROUND: Mohs micrographic surgery is a surgical technique for the treatment of nonmelanoma skin cancer. Surgery begins by removing the visible tumor before excision of the tissue specimens for evaluation of the tumor margins. OBJECTIVES: To present a new way to evaluate the material obtained from debulking, by horizontal histological analysis of the fragment. METHODS: Descriptive retrospective cross-sectional study based on the medical records and histological lamellae of patients with primary basal cell carcinomas smaller than 1.5cm submitted to Mohs micrographic surgery and who had the visible tumor analyzed by horizontal histological sections. RESULTS: The sample evaluated included 16 patients with lesions located on the face. Comparing the histopathological examinations of incisional biopsy in vertical sections and debulking in horizontal sections, there was agreement in seven cases. The histological analysis performed in horizontal sections allowed identification of the tumor site in 13 cases, and the relation between tumor and margin showed that in 11 cases, the lateral margin was compromised. STUDY LIMITATIONS: The technique was better-applied in lesions smaller than 2cm. CONCLUSION: Horizontal histological analysis of debulking has advantages for Mohs surgery, since it allows visualization of almost all tumor extension in the same view plane of the dermatoscopy, allowing better definition of the histological subtype, tumor site, and tumor/margin of lesions less than 1.5cm.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos Transversais , Dermoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral
8.
Cutis ; 104(4): E29-E31, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31774903

RESUMO

Current controversies in Mohs micrographic surgery (MMS) center on the types of tumors treated with MMS, increasing utilization, third-party payer reimbursement, the Appropriate Use Criteria (AUC), and subspecialty certification.


Assuntos
Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Certificação , Humanos , Reembolso de Seguro de Saúde , Neoplasias Cutâneas/patologia , Especialização
9.
Pan Afr Med J ; 33: 245, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692779

RESUMO

Mohs micrographic surgery (MMS) is a technique allowing for intraoperative histologic assessment of surgical margin of malignant tumors. This study aims to highlight the role of MMS in the achievement of radical healing of basal cell carcinoma (BCC) in our patients. We conducted a study of 29 patients with basal cell carcinoma of the face over a period of 5 years. The median age of patients was 45.8 years (12-80). The sex-ratio M/F was 1.23. One-stage surgical procedure was sufficient to obtain complete resection in 51% of cases. Three-stage surgical procedure was needed in 14% of the cases. The mean duration of one-stage surgical procedure was 1 hour. No complications were reported in the postoperative period and sequelae were simple. The aesthetic and functional result was satisfactory. No recurrence was noted. BCC accounts for approximately 80% of all skin cancers. The decision to use MMS to treat BCC is based on three variables: the seat and the size of the tumor, its histological appearance with the identification of resection margin and its recurrent nature. MMS is currently the most effective method in the treatment of BCC and allows maximum healthy tissue preservation. It is a safe and repeatable surgical procedure based on team work and adapted to the treatment of patients with BCC who are at high risk of recidivism. The aesthetic and functional results are satisfactory. Recurrence rate at 5 years is 10 times lower than with the other methods.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Criança , Neoplasias Faciais/patologia , Feminino , Hospitais Universitários , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Marrocos , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Adulto Jovem
10.
Pan Afr Med J ; 33: 297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692830

RESUMO

Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.


Assuntos
Dermatofibrossarcoma/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Dermatofibrossarcoma/patologia , Procedimentos Cirúrgicos Dermatológicos/métodos , Humanos , Recidiva Local de Neoplasia , Neoplasias Cutâneas/fisiopatologia , Resultado do Tratamento
11.
Dermatol Surg ; 45 Suppl 2: S57-S69, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764292

RESUMO

BACKGROUND: Mohs micrographic surgery (MMS) is the most reliable tissue-sparing technique in the management of cutaneous malignancies. Although the concept is simple, there is considerable variability in the mapping and processing techniques used by Mohs surgeons and histotechnicians. OBJECTIVE: This review article aims to examine the frozen-section tissue processing techniques. Existing variations will be discussed and pearls offered to optimize the frozen processing technique. METHODS: A PubMed search was performed for publications on methods of tissue processing in MMS. RESULTS: Our review highlights variations in debulking, embedding, processing adipose tissue, cartilage, and wedge resections. We offer pearls on how to avoid false-positive and false-negative margins and discuss advances in immunohistochemistry. CONCLUSION: Our article provides a how-to format on the different stages of tissue processing with pearls and techniques to optimize practice and improve accuracy.


Assuntos
Secções Congeladas/métodos , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Anticorpos/análise , Corantes , Procedimentos Cirúrgicos de Citorredução , Secções Congeladas/normas , Humanos , Imuno-Histoquímica/métodos , Queratinas/imunologia , Margens de Excisão , Cirurgia de Mohs/normas , Controle de Qualidade , Cloreto de Tolônio
12.
Dermatol Surg ; 45 Suppl 2: S70-S78, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764293

RESUMO

BACKGROUND: Skin cancers of the periorbital area present unique challenges to Mohs surgeons. OBJECTIVE: The need for precise and high-quality Mohs micrographic surgery (MMS) is paramount because of the complex anatomy, vital structures, and potential threat to vision. METHODS: A thorough comprehension of anatomy is essential to help predict tumor behavior and ensure successful outcomes for patients. RESULTS: Tumors occurring at the medial and lateral canthi are of greatest concern for deeper orbital penetration. CONCLUSION: In this study, we present our experience with MMS of periorbital tumors, including clinical pearls and techniques to aid the Mohs surgeon.


Assuntos
Neoplasias Oculares/cirurgia , Neoplasias Palpebrais/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias da Túnica Conjuntiva/cirurgia , Pálpebras/anatomia & histologia , Feminino , Humanos , Aparelho Lacrimal/anatomia & histologia , Masculino , Cirurgia de Mohs/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/prevenção & controle
13.
Dermatol Surg ; 45 Suppl 2: S79-S98, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764294

RESUMO

BACKGROUND: Mohs surgery was developed for the treatment of advanced skin cancers. Advanced centrofacial tumors are among the most challenging lesions. OBJECTIVE: The objective of the study was to review the most complex midface cases from our practice and to delineate how to plan the approach to these lesions, how to remove them in a step-by-step fashion, and how the patients were managed in a multidisciplinary manner when indicated. METHODS: We reviewed 15 years of the most complex tumors to present to our practice for which Mohs micrographic surgery was performed. Follow-up for patients ranged from 3 to 13 years and is ongoing. RESULTS: Twenty cases were identified in which tumors of the central face extended to bone and created extensive operative wounds. Eleven lesions were recurrent at presentation, and 9 had perineural disease. These cases are reviewed sequentially and demonstrate the challenges, successes, and pitfalls of Mohs micrographic surgery in the treatment of the most difficult tumors. Two patients died from disease. CONCLUSION: Mohs surgery is an excellent technique for the removal of extensive midfacial lesions and allows for the surgical removal of lesions that might otherwise be considered inoperable. Approach to these lesions requires careful planning, meticulous surgical technique, excellence in histology, and an experienced reconstructive surgeon. Such tumors often require a multidisciplinary approach, imaging, and adjuvant therapy. All such cases require diligent follow-up. Although many such lesions will be cured, regional recurrence and metastasis may result, even when clear margins are achieved.


Assuntos
Neoplasias Faciais/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/patologia , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Neoplasias Cutâneas/patologia
14.
Dermatol Surg ; 45 Suppl 2: S99-S109, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764295

RESUMO

BACKGROUND: Failure to perform Mohs micrographic surgery (MMS) meticulously on the nose and lips can lead to larger defects and tumor recurrence, which can have aesthetic and functional repercussions for patients. OBJECTIVE: To review pre-, intra-, and postoperative techniques and pearls for performing MMS on the nose and lips to optimize outcomes. MATERIALS AND METHODS: Technical nuances and pearls cultured from the authors' own practice, those acquired from mentors and colleagues, and information identified from the literature are discussed to provide a logical approach to performing effective MMS on the nose and lips. RESULTS: When performing MMS on the nose and lips, sound preoperative preparation, precise surgical technique, and particular attention to reducing false-positives and false-negatives while harvesting Mohs layers enhances the fidelity of the MMS procedure, minimizing defect sizes and reducing tumor recurrence. CONCLUSION: Refining Mohs technique on the nose and lips allows more effective performance of tumor extirpation, improved microscopic evaluation, and more conservative reconstruction, leading to better patient outcomes.


Assuntos
Neoplasias Labiais/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Nasais/cirurgia , Neoplasias Cutâneas/cirurgia , Procedimentos Cirúrgicos de Citorredução , Humanos , Margens de Excisão , Cirurgia de Mohs/efeitos adversos , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Resultado do Tratamento
15.
Dermatol Surg ; 45 Suppl 2: S110-S117, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764296

RESUMO

BACKGROUND: The scalp presents unique surgical challenges, and specialized techniques are sometimes required to achieve optimal results. Tumors arising on the scalp may also be at increased risk of complications such as in-transit metastasis and perineural invasion. OBJECTIVE: To review challenges to Mohs micrographic surgery on the scalp and techniques for successful tumor extirpation and reconstruction. METHODS AND MATERIALS: This article reviews our experience with tumors of the scalp including techniques that we have found helpful both for tumor removal and for reconstruction. CONCLUSION: Familiarity with the anatomy of the scalp as well as common challenges encountered during Mohs surgery may help improve outcomes and impart increase confidence to the practicing surgeon.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Cirurgia de Mohs/efeitos adversos , Invasividade Neoplásica , Metástase Neoplásica , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento
16.
Dermatol Surg ; 45 Suppl 2: S142-S154, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764299

RESUMO

BACKGROUND: Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon. OBJECTIVE: To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites. METHODS: A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms. CONCLUSION: These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.


Assuntos
Neoplasias da Orelha/cirurgia , Neoplasias Palpebrais/cirurgia , Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Masculinos/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Nasais/cirurgia , Neoplasias Cutâneas/cirurgia , Orelha Externa/anatomia & histologia , Pálpebras/anatomia & histologia , Feminino , Genitália Feminina/anatomia & histologia , Genitália Masculina/anatomia & histologia , Humanos , Masculino , Nariz/anatomia & histologia
17.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 759-762, nov. 2019. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-185568

RESUMO

La reparación de los defectos nasales distales producidos durante la cirugía micrográfica de Mohs representa un desafío para el cirujano. Existen múltiples técnicas por las cuales se puede optar para el cierre del defecto. Presentamos 3 casos en los que se realizó el colgajo este-oeste, un colgajo de avance, de fácil diseño, que consiste en un triángulo que cubre el defecto y un segundo triángulo de descarga con sus bases en la línea de desplazamiento. Con este colgajo se obtiene un óptimo resultado estético con un movimiento mínimo de los tejidos, preservando la arquitectura nasal y con líneas de sutura bien disimuladas


Repair of distal nasal defects resulting from Mohs micrographic surgery is a challenge, but surgeons can choose from a number of techniques. We present 3 cases in which an east-west flap was used to close the defect. The east-west flap is an easily conceived advancement flap that consists of a superior triangle used to cover the defect and an inferior triangle whose base is located along the advancement line. The flap results in an optimal cosmetic outcome and involves minimum movement of tissue (preserving the nasal architecture) and well-camouflaged suture lines


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Retalhos Cirúrgicos , Cirurgia de Mohs/métodos , Neoplasias Nasais/cirurgia , Cirurgia de Mohs/tendências , Procedimentos Cirúrgicos Dermatológicos/métodos , Nariz/patologia , Nariz/cirurgia
18.
An. bras. dermatol ; 94(6): 671-676, Nov.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1054890

RESUMO

Abstract Background: Mohs micrographic surgery is a surgical technique for the treatment of nonmelanoma skin cancer. Surgery begins by removing the visible tumor before excision of the tissue specimens for evaluation of the tumor margins. Objectives: To present a new way to evaluate the material obtained from debulking, by horizontal histological analysis of the fragment. Methods: Descriptive retrospective cross-sectional study based on the medical records and histological lamellae of patients with primary basal cell carcinomas smaller than 1.5 cm submitted to Mohs micrographic surgery and who had the visible tumor analyzed by horizontal histological sections. Results: The sample evaluated included 16 patients with lesions located on the face. Comparing the histopathological examinations of incisional biopsy in vertical sections and debulking in horizontal sections, there was agreement in seven cases. The histological analysis performed in horizontal sections allowed identification of the tumor site in 13 cases, and the relation between tumor and margin showed that in 11 cases, the lateral margin was compromised.Study limitations: The technique was better-applied in lesions smaller than 2 cm. Conclusion: Horizontal histological analysis of debulking has advantages for Mohs surgery, since it allows visualization of almost all tumor extension in the same view plane of the dermatoscopy, allowing better definition of the histological subtype, tumor site, and tumor/margin of lesions less than 1.5 cm.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Cirurgia de Mohs/métodos , Biópsia , Estudos Transversais , Estudos Retrospectivos , Resultado do Tratamento , Dermoscopia , Carga Tumoral
19.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471358

RESUMO

Cutaneous squamous cell carcinoma (cSCC) is a form of non-melanoma skin cancer responsible for more deaths in the USA than all other skin cancers combined. Some features, including anatomic site, are considered high risk in nature and pose a challenge for complete tumour removal. We present a case of a 62-year-old male surgeon with a multiply recurrent cSCC of the right conchal bowl. The tumour described herein was doubly recurrent to excision with a standard margin and could ultimately not be cleared with Mohs micrographic surgery. Ultimately, it necessitated auriculectomy and parotidectomy. This case exemplifies the pitfalls of traditional wide local excision with standard pathologic processing for high-risk cSCC.


Assuntos
Carcinoma de Células Escamosas/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/cirurgia , Pavilhão Auricular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/cirurgia , Neoplasias Cutâneas/cirurgia
20.
Dermatol Clin ; 37(4): 425-433, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466583

RESUMO

Nonmelanoma skin cancer (NMSC) is the most commonly diagnosed malignancy in the United States. Surgery is considered the gold standard treatment. Techniques include curettage and electrodesiccation, surgical excision, and Mohs micrographic surgery. While each is effective, there are relative advantages and disadvantages with respect to cost, time, quality of life, and role in patients with limited life expectancy. Preventing local tumor recurrence is the primary objective; however, recurrence rates are based on retrospective data, and high-quality comparator studies assessing effectiveness are scarce. Prospective and randomized controlled trials are imperative to create comprehensive, evidence-based recommendations for the surgical management of NMSC.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Análise Custo-Benefício , Curetagem/métodos , Tomada de Decisão Compartilhada , Procedimentos Cirúrgicos Dermatológicos/métodos , Dessecação/métodos , Medicina Baseada em Evidências , Humanos , Expectativa de Vida , Margens de Excisão , Participação do Paciente , Preferência do Paciente , Seleção de Pacientes , Guias de Prática Clínica como Assunto
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