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Dermatol Surg ; 46(4): 508-513, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31403533


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.

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
Dermatol Surg ; 46(2): 165-168, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31274529


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.

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
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 759-762, nov. 2019. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-185568


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

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
Dermatol Surg ; 45(3): 329-339, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30608296


BACKGROUND: Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms. OBJECTIVE: To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions. METHODS: A literature search was conducted using PubMed to identify articles pertaining to MMS. RESULTS: The fresh frozen technique led to widespread use of MMS in the 1970s. One randomized controlled trial and several large prospective studies have demonstrated low recurrence rates for treatment of nonmelanoma skin cancer (NMSC). MMS, when compared with surgical excision, also achieved a statistically significant higher cure rate for treatment of recurrent NMSC. Studies have demonstrated low recurrence for the treatment of melanoma and melanoma in situ with MMS. MMS has also been shown to effectively treat several rare cutaneous neoplasms. The future of MMS is likely to include the adoption of noninvasive imaging, immunostaining, and digital technology. CONCLUSION: Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.

Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Adenocarcinoma Sebáceo/cirurgia , Carcinoma de Célula de Merkel/cirurgia , Dermatofibrossarcoma/cirurgia , Previsões , Humanos , Margens de Excisão , Melanoma/cirurgia , Doença de Paget Extramamária/cirurgia , Neoplasias Cutâneas/diagnóstico por imagem
Dermatol Surg ; 44(6): 778-784, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29642110


BACKGROUND: Studies show that patients recall less than half of the information given by their physicians. Use of video in medicine increases patient comprehension and satisfaction and decreases anxiety. However, studies have not elaborated on video content. OBJECTIVE: To use principles of learning with multimedia to improve the Mohs surgery consultation. MATERIALS AND METHODS: The authors developed 2 informational videos on Mohs surgery: traditional versus narrative. The focus of the traditional video was purely didactic. The narrative video included patient testimonials, patient-physician interaction, and animations. New Mohs surgery patients viewed either the traditional (n = 40) or the narrative video (n = 40). Existing Mohs surgery patients (n = 40) viewed both videos. Both groups answered questionnaires about their satisfaction. RESULTS: For new Mohs surgery patients, no significant difference was found between the traditional and the narrative video groups because respondent satisfaction was high for both video formats. For existing Mohs surgery patients, all respondents (100%) reported that videos were helpful for understanding Mohs surgery; however, the majority would recommend the narrative over the traditional format (72.5% vs 27.5%, p = .01). CONCLUSION: Technology is useful for patient education because all patients preferred seeing a video to no video. Further research is needed to optimize effective multimedia use in patient education.

Carcinoma Basoescamoso/cirurgia , Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs , Satisfação do Paciente , Encaminhamento e Consulta , Neoplasias Cutâneas/cirurgia , Gravação em Vídeo , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Cirurgia de Mohs/tendências , Educação de Pacientes como Assunto/métodos , Relações Médico-Paciente , Encaminhamento e Consulta/tendências , Inquéritos e Questionários , Gravação em Vídeo/métodos
J Drugs Dermatol ; 17(3): 368-369, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29537457


The following is a response to the Letter to the Editor by Konda, Francis, and Patel regarding the article "Mohs and Close" Technique (MCT) for selected cases to increase the efficiency of Mohs micrographic surgery.1,2 The letter raises questions about our utilization of MCT that require clarification.

Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Humanos , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/diagnóstico , Resultado do Tratamento
Dermatol Surg ; 44(2): 186-192, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28930787


BACKGROUND: Mohs micrographic surgery (MMS) is the gold standard for treatment of high-risk skin cancers. There has been an upward trend in the use of this procedure as demonstrated by data from Medicare and the National Ambulatory Medical Care Survey. OBJECTIVE: To assess interest in MMS among members of the general public as measured by number of online searches, and how that interest has changed over time. MATERIALS AND METHODS: Google Trends was used to plot interest in search terms including "Mohs surgery," "basal cell carcinoma," "squamous cell carcinoma," "melanoma," and "skin cancer" from January 1, 2004, to November 30, 2016. RESULTS: Search interest for the term "Mohs surgery" has steadily increased since 2004 and correlates closely with increased interest for "basal cell carcinoma" (r = 0.82) and "squamous cell carcinoma" (r = 0.85). Search interest in MMS did not correlate well with searches for melanoma (r = -0.15) or skin cancer (r = -0.29). CONCLUSION: Public interest in MMS has continued to steadily increase in the United States, which may be a reflection of the increasing volume of MMS that is performed.

Comportamento de Busca de Informação , Internet , Cirurgia de Mohs/tendências , Preferência do Paciente , Neoplasias Cutâneas/cirurgia , Humanos , Cirurgia de Mohs/estatística & dados numéricos , Educação de Pacientes como Assunto , Estados Unidos
Actas dermo-sifiliogr. (Ed. impr.) ; 108(9): 836-843, nov. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-168141


Introducción: El Registro Español de Cirugía de Mohs recoge los datos de aplicación y resultados de esta técnica en España. Se describen los datos de las intervenciones realizadas desde el inicio del Registro en julio de 2013 a enero de 2016. Se analizan los datos de las cirugías tanto perioperatorios como intraoperatorios. Material y métodos: Estudio de cohortes prospectivo en el que participan 18 centros. Se recogen los datos de las intervenciones quirúrgicas como tipo de anestesia, técnica quirúrgica, ingreso hospitalario, número de estadios, manejo de factores de riesgo preoperatorios, tratamientos complementarios, tratamientos previos, tipo de tumor, tiempo empleado en la cirugía y complicaciones. Resultados: Se analizan 1.796 intervenciones quirúrgicas. El tumor intervenido con más frecuencia es el carcinoma basocelular (85,96%), seguido del carcinoma epidermoide (6,18%), lentigo maligno (2,81%) y dermatofibrosarcoma protuberans (1,97%). El 66,9% de los tumores eran primarios, el 19,2% recurrentes y el 13,9% persistentes. El tratamiento previo más frecuente fue quirúrgico. La cirugía de Mohs se realizó con más frecuencia bajo anestesia local (86,7%) y de forma ambulatoria (71,8%). En el 89,5% de los casos se utilizó la técnica de Mohs en congelación. El número de etapas requerido para alcanzar márgenes libres de tumor fue una en 56,45% de los pacientes, 2 en 32,1%, 3 en 7,1%, 4 en 2,7% y 5 o más en 1,8%. El propio dermatólogo reconstruyó el defecto en el 98% de los pacientes y la técnica reconstructiva más utilizada fue el colgajo (47,2%). Solo el 1,62% de los pacientes presentó alguna complicación intraoperatoria y la mediana de la duración de la cirugía fue 75 (p25:60-p75:100). Conclusión: Las características de los pacientes y tumores tratados son similares a las descritas en estudios de las mismas características en otras áreas geográficas. Existe un porcentaje mayor de lentigo maligno y dermatofibrosarcoma protuberans. La reconstrucción la realiza el dermatólogo con más frecuencia que en otras series. El tiempo de utilización de quirófano no es mucho mayor que para otras técnicas y la tasa de complicaciones intraoperatorias es muy reducida (AU)

Introduction: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. Material and methods: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. Results: Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. Conclusion: The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low (AU)

Humanos , Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Sarda Melanótica de Hutchinson/epidemiologia , Dermatofibrossarcoma/epidemiologia
J Biomed Opt ; 22(2): 24002, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28199474


Confocal mosaicking microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed in fluorescence mode using acridine orange (nuclear specific dye), it enhances nuclei-to-dermis contrast that enables detection of all types of basal cell carcinomas (BCCs), including micronodular and thin strands of infiltrative types. So far, this technique has been mostly validated in research settings for the detection of residual BCC tumor margins with high sensitivity of 89% to 96% and specificity of 99% to 89%. Recently, CMM has advanced to implementation and testing in clinical settings by "early adopter" Mohs surgeons, as an adjunct to frozen section during Mohs surgery. We summarize the development of CMM guided imaging of ex vivo skin tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of residual BCC margins in the Mohs surgical setting but also for some melanocytic lesions and other skin conditions in clinical dermatology settings. Last, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.

Carcinoma Basocelular/diagnóstico por imagem , Dermatologistas/tendências , Dermatologia/tendências , Microscopia Confocal , Microscopia de Fluorescência , Cirurgia de Mohs/tendências , Cirurgiões/tendências , Dermatologia/instrumentação , Humanos , Microscopia Confocal/estatística & dados numéricos , Microscopia de Fluorescência/estatística & dados numéricos , Cirurgia de Mohs/instrumentação
Clin. transl. oncol. (Print) ; 17(7): 497-503, jul. 2015. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-138445


Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA (AU)

No disponible

Feminino , Humanos , Masculino , Neoplasia de Células Basais/diagnóstico , Neoplasia de Células Basais/cirurgia , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/patologia , Microcirurgia/métodos , Cirurgia de Mohs/métodos , Proteínas Hedgehog/isolamento & purificação , Neoplasia de Células Basais/complicações , Neoplasia de Células Basais/fisiopatologia , Cirurgia de Mohs/instrumentação , Cirurgia de Mohs/tendências , Cirurgia de Mohs
Dermatol Surg ; 41(3): 397-403, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25705954


BACKGROUND: In Mohs surgery, the histologic verification of tumor removal results in a lower rate of cancer recurrence compared with simple excision. Factors associated with the increased use of Mohs surgery are not well characterized. OBJECTIVE: To investigate trends in the utilization of Mohs surgery. METHODS AND MATERIALS: The authors performed a retrospective analysis of the National Ambulatory Medical Care Survey for patient visits associated with Mohs surgery from 1995 to 2010. The authors assessed percentage of skin cancers managed with Mohs surgery, the most common locations of skin cancer managed with Mohs surgery, and patient demographics associated with Mohs surgery. RESULTS: Although there was an upward trend in the use of Mohs surgery (p = .004), a low percentage of skin cancers (average of 10.0%) were managed with this technique. When the surgical location was specified, Mohs surgery was most commonly used for the head and neck region. Demographic groups receiving Mohs surgery at higher rates included African Americans (44.2%) and patients aged 75 to 84 years (12.4%). CONCLUSION: There has been an upward trend in the use of Mohs surgery, particularly in the head and neck region where tissue preservation is essential.

Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/tendências , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Estados Unidos/epidemiologia , Adulto Jovem
Actas dermo-sifiliogr. (Ed. impr.) ; 104(4): 299-303, mayo 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-111900


La cera para huesos es un material inerte y maleable que se utiliza como hemostático en los defectos óseos. La curación por segunda intención es una opción terapéutica en determinados casos después de la cirugía dermatológica. En las heridas quirúrgicas profundas, con exposición de distintos tejidos como hueso o cartílago, ciertos apósitos pueden adherirse al tejido de granulación. Esto dificulta y hace muy dolorosa la curación posterior. En estos casos la aplicación de un molde con cera para huesos proporciona un microambiente oclusivo hemostático ideal que favorece la cicatrización por segunda intención (AU)

Bone wax is an inert, malleable material used as a hemostatic agent in treating surgical defects. Healing by secondary intention is an appropriate approach for certain situations in dermatologic surgery. When surgical wounds are deep enough for such tissues as bone or cartilage to be exposed, dressings may adhere to granulation tissue, making removal and subsequent wound care difficult and painful. In such cases bone wax can be molded around deep tissues to create an ideal occlusive, hemostatic microenvironment that facilitates second-intention wound healing (AU)

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ligas Metalo-Cerâmicas/uso terapêutico , Osso e Ossos/anormalidades , Osso e Ossos/cirurgia , Cimentos para Ossos/uso terapêutico , Ossos Faciais/anormalidades , Ossos Faciais/cirurgia , Adenocarcinoma/cirurgia , Adenoma/cirurgia , Cirurgia de Mohs/instrumentação , Cirurgia de Mohs/métodos , Bandagens/tendências , Cicatrização , Cirurgia de Mohs/tendências , Cirurgia de Mohs
Dermatol Surg ; 39(1 Pt 1): 35-42, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23199014


BACKGROUND: There is a skin cancer epidemic in the United States. OBJECTIVE: To examine skin cancer treatment modality, location, and cost and physician specialty in the Medicare population from 1996 to 2008. METHODS: Centers for Medicare and Medicaid Services databases were used to examine skin cancer treatment procedures performed for Medicare beneficiaries. RESULTS: From 1996 to 2008, the total number of skin cancer treatment procedures [malignant excision, destruction, and Mohs micrographic surgery (MMS)] increased from 1,480,645 to 2,152,615 (53% increase). The numbers of skin cancers treated by excision and destruction increased modestly (20% and 39%, respectively), but the number of MMS procedures increased more rapidly (248% increase). Dermatologists treated an increasing percentage (75-82%) of skin cancers during these years, followed by plastic and general surgery. In 2008, more than 90% of all skin cancers were treated in the office, with the remainder being treated in facility-based settings. Allowable charges paid to physicians by Medicare Part B for skin cancer treatments increased 137% from 1996 to 2008, from $266,960,673 to $633,448,103. CONCLUSIONS: The number of skin cancer treatment procedures increased substantially from 1996 to 2008, as did overall costs to Medicare. Dermatologists treated the vast majority of skin cancers in the Medicare population, using a mix of treatment modalities, almost exclusively in the office setting.

Assistência Ambulatorial/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Medicare/tendências , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/cirurgia , Assistência Ambulatorial/economia , Assistência Ambulatorial/tendências , Bases de Dados Factuais , Dermatologia/tendências , Cirurgia Geral/tendências , Humanos , Cirurgia de Mohs/economia , Cirurgia de Mohs/tendências , Cirurgia Plástica/tendências , Estados Unidos
Actas dermo-sifiliogr. (Ed. impr.) ; 103(9): 762-777, nov. 2012. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-106682


El dermatofibrosarcoma protuberans es el sarcoma de piel más frecuente aunque su incidencia es muy baja comparada con otros tumores cutáneos. Se presenta clínicamente en forma de placa indurada de crecimiento lento sobre la que aparecen nódulos a medida que el tumor progresa. Se localiza inicialmente en la dermis desde donde infiltra el tejido celular subcutáneo, la fascia, el músculo e incluso el hueso. La translocación COL1A1-PDGFB es específica del dermatofibrosarcoma protuberans y sirve de ayuda en el diagnóstico de determinados casos. Según la revisión de las series publicadas en la literatura, el porcentaje de recidivas con cirugía micrográfica de Mohs es mucho menor que el encontrado cuando se emplea cirugía convencional con márgenes amplios. Para casos metastásicos o en aquellos donde la cirugía pueda ser mutilante se dispone recientemente del imatinib, fármaco de la familia de los inhibitores de la tirosina quinasa (AU)

Dermatofibrosarcoma protuberans is the most common skin sarcoma, although its incidence is very low compared with other skin tumors. It presents as a slow-growing indurated plaque on which nodules develop over time. The lesion arises in the dermis but can invade subcutaneous tissue, fascia, muscle and even bone. COL1A1-PDGFB translocation is specific to dermatofibrosarcoma protuberans, and the presence of this fusion contributes to diagnosis in certain cases. A review of the literature provides evidence that recurrence is much lower after Mohs micorgraphic surgery than after conventional wide local excision. In the case of metastatic disease or when surgery would be mutilating, another recently approved treatment is the tyrosine kinase inhibitor imatinib (AU)

Humanos , Masculino , Feminino , Dermatofibrossarcoma/complicações , Dermatofibrossarcoma/diagnóstico , Dermatofibrossarcoma/cirurgia , Cirurgia de Mohs/métodos , Receptores Proteína Tirosina Quinases/uso terapêutico , Imuno-Histoquímica/métodos , Antígenos CD34 , Fator XIIIa , Imuno-Histoquímica/instrumentação , Imuno-Histoquímica/normas , Dermatofibrossarcoma/microbiologia , Cirurgia de Mohs/tendências , Imuno-Histoquímica , Dermatofibrossarcoma/fisiopatologia , Dermatofibrossarcoma , Proteínas Proto-Oncogênicas c-sis/isolamento & purificação , Citogenética/métodos
Actas dermo-sifiliogr. (Ed. impr.) ; 103(7): 614-623, sept. 2012. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-103848


Introducción: El tratamiento estándar del lentigo maligno (LM) es la escisión quirúrgica con márgenes de 0,5 cm. Sin embargo, dada la mala delimitación de muchos tumores, es frecuente que esta exéresis sea incompleta. Objetivo: identificar parámetros clínicos que puedan predecir qué LM localizados en la cabeza, extirpados de forma primaria o tras recidivar, se extienden más allá de los límites visibles y por tanto, puedan requerir márgenes quirúrgicos más amplios. Material y métodos: se revisó retrospectivamente la información clínica de los pacientes con LM localizado en la cabeza cuyo tratamiento quirúrgico definitivo, mediante cirugía convencional o cirugía de Mohs diferida, fue realizado en el Servicio de Dermatología del Instituto Valenciano de Oncología (IVO) entre enero de 1993 y abril de 2011. Resultados: un 69,2% de los LM recidivados y un 26,5% de los tumores primarios requirieron márgenes de más de 0,5 cm. La administración previa de tratamientos que puedan interferir en la delimitación clínica, la localización centro facial y las lesiones que se presentan en pacientes con fototipos altos (III-V) fueron los factores asociados a la necesidad de márgenes quirúrgicos más amplios. Conclusiones: la utilización de márgenes de 0,5 cm para el tratamiento del LM es insuficiente para un número importante de casos localizados en la cabeza, especialmente los recidivados. La cirugía de Mohs diferida, con el estudio de todos los márgenes en parafina, parece el tratamiento de elección en particular para los casos recidivados o en los que la delimitación clínica pueda verse dificultada (AU)

Introduction: Surgical excision with margins of 0.5 cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders. Objective: To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins. Material and methods: We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April2011. Results: Surgical margins larger than 0.5 cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V. Conclusions: Surgical margins of 0.5 cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension (AU)

Humanos , Masculino , Feminino , Idoso , Sarda Melanótica de Hutchinson , Sarda Melanótica de Hutchinson/complicações , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/prevenção & controle , Sarda Melanótica de Hutchinson/terapia , Sarda Melanótica de Hutchinson/cirurgia , Melanoma , Cirurgia de Mohs , Cirurgia de Mohs/tendências , Cirurgia de Mohs , Recidiva Local de Neoplasia , Estudos Retrospectivos
Dermatol Surg ; 38(9): 1427-34, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22681892


BACKGROUND: Mohs micrographic surgery (MMS) is the criterion standard treatment for high-risk skin cancers. Few data on current MMS Utilization are available. OBJECTIVE: To better understand current trends in MMS use in the Medicare population. METHODS AND MATERIALS: The 2009 Medicare Limited Data Set Standard Analytic File (LDSSAF), carrier claims, 5% sample and the Physician Supplier Procedure Master File (PSPMF) 100% summary were analyzed. RESULTS: In 2009, 558,447 Medicare MMS cases were performed, with an average of 1.75 stages per case. In the 5% claims sample, 0.3% and 1.3% of MMS cases were performed for melanoma and carcinoma in situ, respectively. Total annual volume predictions for 1,777 providers showed a left-shifted curve. 65.8% of LDSSAF cases had same-day MMS repairs: 48.7% of repairs were complex, 9.8% intermediate, 32.4% flaps, and 7.4% full-thickness skin grafts. CONCLUSIONS: The 5% LDSSAF is highly predictive of total claim volumes and is useful for modeling practice trends. There is wide variation in MMS provider annual case volume. These data reflect only Medicare Part B enrollees in 2009; 5% LDDSAF extrapolations are predictions based on sampling.

Carcinoma in Situ/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Medicare/estatística & dados numéricos , Melanoma/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Neoplasias da Orelha/cirurgia , Neoplasias Palpebrais/cirurgia , Humanos , Neoplasias Labiais/cirurgia , Extremidade Inferior , Cirurgia de Mohs/tendências , Pescoço , Couro Cabeludo , Transplante de Pele/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Tronco , Estados Unidos , Extremidade Superior
Arch Dermatol ; 148(4): 473-7, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22508870


OBJECTIVES: To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. DESIGN: A retrospective analysis of Medicare beneficiaries. SETTING: Surveillance, Epidemiology, and End Results database. PATIENTS: Patients undergoing MMS or other surgical intervention for the treatment of NMSC from January 1, 2001, through December 31, 2006. MAIN OUTCOME MEASURES: Surgical treatment, patient, and lesion characteristics. RESULTS: A total of 26,931 operations were performed for the treatment of NMSC from 2001 through 2006, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period (1.8 vs 2.1 per 100 Medicare beneficiaries), the rate of MMS doubled (0.75 vs 1.5 per 100 Medicare beneficiaries). In 46.9% of facial lesions, MMS was performed, whereas MMS was used to treat 14.7% of total body lesions. Atlanta, Georgia, had the highest proportion of patients treated with MMS (45.1%); Louisiana had the lowest (11.0%). Age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use (all P < .001). CONCLUSIONS: Surgical treatment of NMSC increased substantially from 2001 through 2006, primarily because of a doubling in the rate of MMS procedures. Significant differences in surgical rates, depending on patient age, race, lesion location, and geographic region, of treatment were found.

Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs/tendências , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , Medicare/estatística & dados numéricos , Cirurgia de Mohs/estatística & dados numéricos , Estudos Retrospectivos , Programa de SEER/estatística & dados numéricos , Estados Unidos