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1.
Am Surg ; 86(9): 1208-1211, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32683914

RESUMO

Atypical spindle cell lipomatous neoplasm, also known as well-differentiated spindle cell liposarcoma, represents a newly discovered entity of adipocytic tumors. Recent research has shown this tumor variant to be more related to spindle cell lipoma, rather than the originally hypothesized atypical lipomatous tumor spectrum. Here we present a case of a 58-year-old man with a history of chronic lymphocytic leukemia with an enlarging mass on the posterior left shoulder, initially hypothesized to be a benign lipoma. However, magnetic resonance imaging showed a large, multiseptated, heterogeneous mass concerning for soft tissue sarcoma. After resection, pathologic analysis showed cells closely resembling spindle cell lipoma, with additional cellular and fascicular zones containing lipoblasts and mitotic figures. Molecular analysis showed no MDM2 amplification. This lack of amplification indicates this tumor is distinctly different from an atypical lipomatous tumor, which characteristically displays MDM2 amplification. However, tumor expression of RB1 was normal. The majority of atypical spindle cell lipomatous neoplasms are associated with RB1 deletions. We conclude that we have a unique example of an atypical spindle cell lipomatous tumor.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Leucemia Linfocítica Crônica de Células B/complicações , Lipossarcoma/cirurgia , Neoplasias Cutâneas/cirurgia , Biópsia , Diagnóstico Diferencial , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Lipossarcoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/diagnóstico
3.
Hautarzt ; 71(8): 580-587, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32533202

RESUMO

Basal cell carcinoma is the most common type of cancer in Central Europe and has a high medical relevance. Due to its high tendency of recurrence, an important parameter in the planning of therapy is the risk of recurrence. After clinical and histological diagnosis, the majority of tumors are treated surgically, although radiation and topical procedures are also possible therapeutic alternatives in certain constellations. Hedgehog inhibitors, a completely new class of substances, have recently been approved for rare metastatic and locally advanced diseases, thus significantly expanding the range of treatments. This article provides an overview of the current guideline-based diagnosis and therapy of basal cell carcinomas in Germany.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/terapia , Procedimentos Cirúrgicos Dermatológicos/métodos , Guias de Prática Clínica como Assunto , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Carcinoma Basocelular/patologia , Europa (Continente) , Alemanha , Proteínas Hedgehog , Humanos , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Cutâneas/patologia
4.
Hautarzt ; 71(8): 597-606, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32583034

RESUMO

Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers of the Caucasian population and accounts for 20% of all skin tumours. An S3 guideline of the German Guideline Program in Oncology has been available since 2019. The diagnosis is based on the clinical examination. Excision and histological confirmation is required for all clinically suspicious lesions to allow prognostic assessment and correct treatment. The therapy of first choice is complete excision with histological control of the surgical margin. In cSCC with risk factors such as tumor thickness >6 mm, sentinel lymph node biopsy may be discussed, but there is currently no clear evidence of its prognostic and therapeutic relevance. Adjuvant radiation therapy may be considered in cases of high risk of recurrence and should be tested in cases of inoperable tumors. The indication for electrochemotherapy should also be considered in the treatment of local or locoregional recurrence. The immune checkpoint inhibitor cemiplimab is approved for the treatment of inoperable or metastasized cSCC. In case of contraindications, chemotherapeutic agents, epidermal growth factor receptor (EGFR) inhibitors or palliative radiotherapy can be used. Since the evidence is low in these cases, a systemic therapy should be used preferentially within clinical studies. Follow-up care should be risk-adapted and includes a dermatological control, supplemented by ultrasound examinations in high-risk patients.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Carcinoma de Células Escamosas/patologia , Humanos , Recidiva Local de Neoplasia , Guias de Prática Clínica como Assunto , Prognóstico , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologia , Resultado do Tratamento
5.
J Surg Res ; 255: 135-143, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543379

RESUMO

BACKGROUND: The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model. MATERIALS AND METHODS: A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator. RESULTS: Mean maximum pulling force: 5.69 N (standard deviation [SD], 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress). CONCLUSIONS: The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Teste de Materiais , Técnicas de Sutura , Suturas , Resistência à Tração
9.
Cochrane Database Syst Rev ; 4: CD012124, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32271475

RESUMO

BACKGROUND: Following surgery, surgical wounds can be closed using a variety of devices including sutures (subcuticular or transdermal), staples and tissue adhesives. Subcuticular sutures are intradermal stitches (placed immediately below the epidermal layer). The increased availability of synthetic absorbable filaments (stitches which are absorbed by the body and do not have to be removed) has led to an increased use of subcuticular sutures. However, in non-obstetric surgery, there is still controversy about whether subcuticular sutures increase the incidence of wound complications. OBJECTIVES: To examine the efficacy and acceptability of subcuticular sutures for skin closure in non-obstetric surgery. SEARCH METHODS: In March 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: All randomised controlled trials which compared subcuticular sutures with any other methods for skin closure in non-obstetric surgery were included in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently identified the trials, extracted data and carried out risk of bias and GRADE assessment of the certainty of the evidence. MAIN RESULTS: We included 66 studies (7487 participants); 11 included trials had more than two arms. Most trials had poorly-reported methodology, meaning that it is unclear whether they were at high risk of bias. Most trials compared subcuticular sutures with transdermal sutures, skin staples or tissue adhesives. Most outcomes prespecified in the review protocol were reported. The certainty of evidence varied from high to very low in the comparisons of subcuticular sutures with transdermal sutures or staples and tissue adhesives; the certainty of the evidence for the comparison with surgical tapes and zippers was low to very low. Most evidence was downgraded for imprecision or risk of bias. Although the majority of studies enrolled people who underwent CDC class 1 (clean) surgeries, two-thirds of participants were enrolled in studies which included CDC class 2 to 4 surgeries, such as appendectomies and gastrointestinal surgeries. Most participants were adults in a hospital setting. Subcuticular sutures versus transdermal sutures There may be little difference in the incidence of SSI (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.80 to 1.52; 3107 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce wound complications (RR 0.83; 95% CI 0.40 to 1.71; 1489 participants; very low-certainty evidence). Subcuticular sutures probably improve patient satisfaction (score from 1 to 10) (at 30 days; MD 1.60, 95% CI 1.32 to 1.88; 290 participants; moderate-certainty evidence). Wound closure time is probably longer when subcuticular sutures are used (MD 5.81 minutes; 95% CI 5.13 to 6.49 minutes; 585 participants; moderate-certainty evidence). Subcuticular sutures versus skin staples There is moderate-certainty evidence that, when compared with skin staples, subcuticular sutures probably have little effect on SSI (RR 0.81, 95% CI 0.64 to 1.01; 4163 participants); but probably decrease the incidence of wound complications (RR 0.79, 95% CI 0.64 to 0.98; 2973 participants). Subcuticular sutures are associated with slightly higher patient satisfaction (score from 1 to 5) (MD 0.20, 95% CI 0.10 to 0.30; 1232 participants; high-certainty evidence). Wound closure time may also be longer compared with staples (MD 0.30 to 5.50 minutes; 1384 participants; low-certainty evidence). Subcuticular sutures versus tissue adhesives, surgical tapes and zippers There is moderate-certainty evidence showing no clear difference in the incidence of SSI between participants treated with subcuticular sutures and those treated with tissue adhesives (RR 0.77, 95% CI 0.41 to 1.45; 869 participants). There is also no clear difference in the incidence of wound complications (RR 0.62, 95% CI 0.35 to 1.11; 1058 participants; low-certainty evidence). Subcuticular sutures may also achieve lower patient satisfaction ratings (score from 1 to 10) (MD -2.05, 95% CI -3.05 to -1.05; 131 participants) (low-certainty evidence). In terms of SSI incidence, the evidence is uncertain when subcuticular sutures are compared with surgical tapes (RR 1.31, 95% CI 0.40 to 4.27; 354 participants; very low-certainty evidence) or surgical zippers (RR 0.80, 95% CI 0.08 to 8.48; 424 participants; very low-certainty evidence). There may be little difference in the incidence of wound complications between participants treated with subcuticular sutures and those treated with surgical tapes (RR 0.90, 95% CI 0.61 to 1.34; 492 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce the risk of wound complications compared with surgical zippers (RR 0.55, 95% CI 0.15 to 2.04; 424 participants; very low-certainty evidence). It is also uncertain whether it takes longer to close a wound with subcuticular sutures compared with tissue adhesives (MD -0.34 to 10.39 minutes; 895 participants), surgical tapes (MD 0.74 to 6.36 minutes; 169 participants) or zippers (MD 4.38 to 8.25 minutes; 424 participants) (very low-certainty evidence). No study reported results for patient satisfaction compared with surgical tapes or zippers. AUTHORS' CONCLUSIONS: There is no clear difference in the incidence of SSI for subcuticular sutures in comparison with any other skin closure methods. Subcuticular sutures probably reduce wound complications compared with staples, and probably improve patient satisfaction compared with transdermal sutures or staples. However, tissue adhesives may improve patient satisfaction compared with subcuticular sutures, and transdermal sutures and skin staples may be quicker to apply than subcuticular sutures. The quality of the evidence ranged from high to very low; evidence for almost all comparisons was subject to some limitations. There seems to be no need for additional new trials to explore the comparison with staples because there are high-quality studies with large sample sizes and some ongoing studies. However, there is a need for studies exploring the comparisons with transdermal sutures, tissue adhesives, tapes and zippers, with high-quality studies and large sample sizes, including long-term assessments.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Técnicas de Sutura , Cicatriz , Humanos , Incidência , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Grampeamento Cirúrgico , Fita Cirúrgica , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/economia , Fatores de Tempo , Adesivos Teciduais
10.
J Plast Reconstr Aesthet Surg ; 73(6): 1166-1173, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32269011

RESUMO

BACKGROUND: Cell-assisted lipotransfer (CAL) promotes the survival of fat grafts with high vascular density and improves skin quality by increasing collagen content. However, no study has quantified the changes on the skin surface, and rigorous methodological evaluations are still lacking. DESIGN: Fifty patients were recruited and randomly divided into two groups: an experimental group (n = 25) that underwent a stromal vascular fraction (SVF)-assisted fat graft and a control group (n = 25) that underwent fat graft only. METHODS: The SVF cells were counted, tested in terms of viability, and characterized. The volumes of whole faces were determined by using a 3D scanner and Geomagic software preoperation, immediately after surgery, and 6 months postoperation. Facial skin qualities, including spots, wrinkles, texture, pores, UV spots, brown spots, red areas, and porphyrins, were detected by a VISIA skin detector preoperation and 6 months postoperation. A visual analog scale was used for clinical evaluation. RESULTS: The cell pellet contained 1-3 × 107/mL of fresh SVF cells. The cell viability exceeded 98%. The immunophenotyping characteristics and stemness were consistent with the features of adipose- derived stem cells (ADSCs). The survival rate of SVF-enriched fat grafts was significantly higher than that of control grafts: 77.6%±11.6% versus 56.2%±9.5% (p<0.001). The VISIA values of wrinkles (19.3 ±â€¯6.6 versus 10.9 ±â€¯5.5, p<0.001) and texture (15.8 ±â€¯7.0 versus 10.3 ±â€¯5.0, p<0.01) were significantly higher in SVF-enriched group than in control group at 6 months postoperation. During long-term follow-up, the majority of patients in both groups were satisfied with the final facial esthetic results. CONCLUSIONS: Our results demonstrated the positive outcomes of autologous SVF-assisted fat graft in improving facial skin quality and its promising application potential in clinical settings. This study is registered at www. ClinicalTrials.gov, number NCT02923219.


Assuntos
Tecido Adiposo/transplante , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Células Estromais/transplante , Adulto , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Transplante Autólogo , Adulto Jovem
12.
Khirurgiia (Mosk) ; (3): 48-55, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271737

RESUMO

OBJECTIVE: To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). MATERIAL AND METHODS: There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). RESULTS: Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). CONCLUSION: Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.


Assuntos
Estenose das Carótidas/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Endarterectomia das Carótidas/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ferida Cirúrgica , Estenose das Carótidas/complicações , Estenose das Carótidas/mortalidade , Técnicas Cosméticas , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Resultado do Tratamento
13.
Plast Reconstr Surg ; 145(4): 754e-756e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221211

RESUMO

With a growing massive weight loss population, upper arm contouring continues to rise in popularity. Refinements in technique, such as modification of skin excision patterns and the adjunct use of liposuction, have allowed for safe and reproducible results. This article helps to understand the evolution of upper arm contouring and provides an update on the limited-incision medial brachioplasty. Details of preoperative markings and operative technique are clearly illustrated in the video included.


Assuntos
Braço/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Lipectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Perda de Peso , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Feminino , Humanos , Lipectomia/efeitos adversos , Pessoa de Meia-Idade , Posicionamento do Paciente , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
14.
Cancer Res ; 80(10): 2045-2055, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32132111

RESUMO

Keratinocyte carcinomas, including basal and squamous cell carcinomas, are the most common human cancers worldwide. While 75% of all keratinocyte carcinoma (4 million annual cases in the United States) are treated with conventional excision, this surgical modality has much lower cure rates than Mohs micrographic surgery, likely due to the bread-loaf histopathologic assessment that visualizes <1% of the tissue margins. A quenched protease-activated fluorescent probe 6qcNIR, which produces a signal only in the protease-rich tumor microenvironment, was topically applied to 90 specimens ex vivo immediately following excision. "Puzzle-fit" analysis was used to correlate the fluorescent images with histology. Probe-dependent fluorescent images correlated with cancer determined by conventional histology. Point-of-care fluorescent detection of skin cancer had a clinically relevant sensitivity of 0.73 and corresponding specificity of 0.88. Importantly, clinicians were effectively trained to read fluorescent images within 15 minutes with reliability and confidence, resulting in sensitivities of 62%-78% and specificities of 92%-97%. Fluorescent imaging using 6qcNIR allows 100% tumor margin assessment by generating en face images that correlate with histology and may be used to overcome the limitations of conventional bread-loaf histology. The utility of 6qcNIR was validated in a busy real-world clinical setting, and clinicians were trained to effectively read fluorescent margins with a short guided instruction, highlighting clinical adaptability. When used in conventional excision, this approach may result in higher cure rates at a lower cost by allowing same-day reexcision when needed, reducing patient anxiety and improving compliance by expediting postsurgical specimen assessment. SIGNIFICANCE: A fluorescent-probe-tumor-visualization platform was developed and validated in human keratinocyte carcinoma excision specimens that may provide simple, rapid, and global assessment of margins during skin cancer excision, allowing same-day reexcision when needed.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Imagem Óptica/métodos , Neoplasias Cutâneas/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Queratinócitos/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Sensibilidade e Especificidade
15.
Pediatr Surg Int ; 36(4): 501-512, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32125501

RESUMO

PURPOSE: The role of surgery in the management of congenital melanocytic nevi (CMN) is controversial. Data on surgical outcomes and predictors of satisfaction remain scarce. METHODS: An online survey was employed following worldwide recruitment of youth aged 14-25 years (n = 44) and parents of children ≤ 18 years (n = 249) with CMN to query patterns of treatment and satisfaction with and opinions about the benefits of surgery. RESULTS: In proxy-reports, 121 of 249 (49%) and in self-reports 30 of 44 (75%) participants underwent CMN excision. The most common reasons for surgery were psychosocial determinants, aesthetic improvement, and melanoma risk reduction. The overall satisfaction with surgical management was good, although no predictors for satisfaction could be identified. Higher current age of the child was found to predict decision regret in proxy-reports. Most participants indicated that having a scar is more socially acceptable than a CMN. Opinions differed on whether surgery should be deferred until the child is old enough to be involved in the decision-making process. CONCLUSIONS: Whether and when to perform surgery in children with CMN is a multifaceted question. Awareness of common concerns as well as risks and benefits of surgery are essential to ensure critical reflection and balanced decision-making.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Estadiamento de Neoplasias , Nevo Pigmentado/cirurgia , Autorrelato , Neoplasias Cutâneas/cirurgia , Pele/patologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Nevo Pigmentado/congênito , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/diagnóstico , Resultado do Tratamento , Adulto Jovem
16.
Adv Skin Wound Care ; 33(3): 1-3, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32058445

RESUMO

Basal cell carcinoma (BCC) is the most common skin cancer type in humans. Various factors play a role in BCC occurrence, but sunlight exposure is the most common etiologic factor. This case series presents three patients who had scarring after severe traumas (a deep abrasion, burn, and puncture injury); a long time after the respective traumatic events, a BCC occurred in the scar tissue. The lesions were excised, and BCCs were diagnosed based on histopathology. Although several etiologic factors may play a role in trauma-related BCC, the main mechanism remains unclear. A correct diagnosis with biopsy and an assessment of the lymphatic system are crucial to prevent aggressive procedures, and BCC should be kept in mind when lesions are found in scar tissue.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Cicatriz/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Ferimentos e Lesões/complicações , Idoso , Biópsia por Agulha , Carcinoma Basocelular/etiologia , Transformação Celular Neoplásica/patologia , Cicatriz/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Amostragem , Neoplasias Cutâneas/etiologia , Transplante de Pele/métodos , Cicatrização/fisiologia , Ferimentos e Lesões/diagnóstico
18.
Bull Cancer ; 107(3): 328-332, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32059813

RESUMO

INTRODUCTION: Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS: It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS: R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION: DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.


Assuntos
Dermatofibrossarcoma/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Países em Desenvolvimento , Neoplasias Cutâneas/cirurgia , Adulto , Burkina Faso/epidemiologia , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/patologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Queloide/etiologia , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Fotografação , Complicações Pós-Operatórias/etiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Cicatrização
19.
J Plast Reconstr Aesthet Surg ; 73(4): 690-695, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31928958

RESUMO

BACKGROUND: Breast reconstruction is routinely used to alleviate the psychological adverse effects of mastectomy. Nipple preservation further improves the cosmetic result, and causes less trauma on the body surface. Nipple-sparing mastectomy, however, comes with challenges, especially in the case of large, ptotic breasts to the degree that large-sized breasts have conventionally been a contraindication for nipple preservation. In this report, we describe a novel technique for nipple preservation in immediate reconstruction of large, ptotic breasts. METHODS: From 2013 to 2018, 24 patients (30 breasts) with large, ptotic breasts were treated with mastectomy and immediate reconstruction with nipple preservation. Median BMI was 28 and 8 patients were smokers. The technique involves the de-epithelialisation of a large area of the breast skin, the mastectomy through a lateral full-thickness incision within the de-epithelialised area, imbrication of the de-epithelialised skin, lifting of the nipple to a higher position and finally closure of wound. RESULTS: There were no full, 4 partial nipple necroses and 3 re-operations were done under local anaesthetic to correct partial peripheral necrosis of the areola. Six patients needed seroma aspiration and 4 presented with cellulitis. No implants were lost and there were no delays to adjuvant treatment. CONCLUSIONS: The proposed technique has significant advantages and may be ideal when large skin reductions are necessary in immediate breast reconstruction with nipple preservation. The low complication rate makes the method ideal when adjuvant treatment is to follow and/or patients are of high risk for surgical complications.


Assuntos
Mama/anormalidades , Mama/patologia , Mama/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Hipertrofia/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos , Tamanho do Órgão
20.
Sensors (Basel) ; 20(1)2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31947903

RESUMO

Laser lights have been used by dermatologists for tattoo removal through photothermal interactions. However, most clinical studies used a visual scoring method to evaluate the tattoo removal process less objectively, leading to unnecessary treatments. This study aimed to develop a simple and quantitative imaging method to monitor the degree of tattoo removal in in vivo skin models. Sprague Dawley rat models were tattooed with four different concentrations of black inks. Laser treatment was performed weekly on the tattoos using a wavelength of 755 nm over six weeks. Images of non-treated and treated samples were captured using the same method after each treatment. The intensities of the tattoos were measured to estimate the contrast for quantitative comparison. The results demonstrated that the proposed monitoring method quantified the variations in tattoo contrast after the laser treatment. Histological analysis validated the significant removal of tattoo inks, no thermal injury to adjacent tissue, and uniform remodeling of epidermal and dermal layers after multiple treatments. This study demonstrated the potential of the quantitative monitoring technique in assessing the degree of clearance level objectively during laser treatments in clinics.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Epiderme/cirurgia , Terapia a Laser/métodos , Tatuagem/efeitos adversos , Animais , Modelos Animais de Doenças , Epiderme/patologia , Humanos , Ratos , Pele/patologia
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