Horizontal histological sections in the preliminary evaluation of basal cell carcinoma submitted to Mohs micrographic surgery

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.

Usefulness of the subunit principle in nasal reconstruction

Abstract The subunit principle in nasal reconstruction proposed the concept of reconstructing the specific topographic subunits that were identified as dorsum, tip, columella, the paired alae, sidewalls, and soft triangles. In patients with more than 50% of subunit loss, removing the remaining portion of the subunit and reconstructing the entire subunit may yield better results. The placement of incisions along the borders of the subunits minimizes scar lines. Furthermore, as trapdoor contraction occurs, the entire restored subunit bulges in a way that mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal reconstruction that followed this important principle are described.

Analysis of effectiveness of a surgical treatment algorithm for basal cell carcinoma

Abstract BACKGROUND: Surgical excision is the treatment of choice for basal cell carcinoma and micrographic surgery considered the gold standard, however not yet used routinely worldwide available, as in Brazil. Considering this, a previously developed treatment guideline, which the majority of tumors were treated by conventional technique (not micrographic) was tested. OBJECTIVE: To establish the recurrence rate of basal cell carcinomas treated according to this guideline. METHOD: Between May 2001 and July 2012, 919 basal cell carcinoma lesions in 410 patients were treated according to the proposed guideline. Patients were followed-up and reviewed between September 2013 and February 2014 for clinical, dermatoscopic and histopathologic detection of possible recurrences. RESULTS: After application of exclusion criteria, 520 lesions were studied, with 88.3% primary and 11.7% recurrent tumors. Histological pattern was indolent in 85.5%, 48.6% were located in high risk areas and 70% small tumors. Only 7.3% were treated by Mohs micrographic surgery. The recurrence rate, in an average follow-up period of 4.37 years, was 1.3% for primary and 1.63% for recurrent tumors. Study limitations: unicenter study, with all patients operated on by the same surgeon. CONCLUSION: The treatment guideline utilized seems a helpful guide for surgical treatment of basal cell carcinoma, especially if micrographic surgery is not available.

Paramedian forehead flap combined with hinge flap for nasal tip reconstruction

Abstract The paramedian forehead flap is a great option for restoration of complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. We present a patient with a basal cell carcinoma on the distal nose treated by Mohs micrographic surgery, and a resulting full-thickness defect repaired with paramedian forehead flap combined with a hinge flap. For optimal results with the paramedian forehead flap, adequate surgical planning, patient orientation and meticulous surgical technique are imperative.

Reconstrução em cirurgia micrográfica / Reconstruction in Mohs micrographic surgery

Introdução: A cirurgia micrográfica de Mohs é empregada para exérese de neoplasias cutâneas, especialmente carcinomas basocelulares de subtipos histológicos localmente agressivos, tumores recidivados ou localizados em regiões nobres. Apresenta elevados índices de cura e permite preservação tecidual. O objetivo é analisar a eficácia da cirurgia micrografia de Mohs e os métodos de reconstrução utilizados. Método: Foram coletados, retrospectivamente, dados de 50 pacientes submetidos à exérese de tumores cutâneos por meio da cirurgia micrográfica de Mohs e à reconstrução da perda de substância. Todos os pacientes foram operados no período entre janeiro de 2005 a dezembro de 2013 na Clínica de Cirurgia Plástica do Hospital Felício Rocho (Belo Horizonte, MG, Brasil). Os pacientes foram estudados com relação à idade, gênero, localização do tumor, tratamento prévio, tipo histológico, número de fragmentos analisados na cirurgia micrográfica, método de reconstrução empregado e proservação. Resultados: Trinta e um pacientes (62%) foram do gênero feminino e 19 (38%) do masculino. A média de idade foi de 63,8 anos. Todas as lesões encontravam-se na face, com 66% dos casos com acometimento da região nasal. Considerando o diagnóstico pré-operatório, 48 casos (96%) eram carcinoma basocelulares e dois casos (4%) correspondiam ao carcinoma microcístico anexial. Retalhos locais foram o tipo de reconstrução mais utilizado. Os pacientes foram acompanhados por média de 48,4 meses. Nenhum caso de recidiva tumoral foi observado. Conclusão: A cirurgia micrográfica de Mohs se mostrou altamente eficaz no tratamento dos 50 casos de neoplasias cutâneas. Recomenda-se que os defeitos cirúrgicos sejam reparados pelo cirurgião plástico.

Introduction: Mohs micrographic surgery is used for the excision of skin neoplasms, especially in locally aggressive histological subtypes of basal cell carcinoma, tumor recurrences, or tumors located in critical areas . This technique has a high cure rate and allows maximum preservation of tissues. In this study, we aimed to assess the effectiveness of Mohs micrographic surgery and reconstruction methods. Method: Data from 50 patients who underwent Mohs micrographic surgery to excise skin tumors and reconstruct lost tissue were collected retrospectively. All patients were operated on between January 2005 and December 2013 at the Plastic Surgery Clinic of the Felício Rocho Hospital (Belo Horizonte, MG, Brazil). The patients' age, sex, tumor location, previous treatment, histological type, number of segments analyzed by micrographic surgery, reconstruction method used, and preservation were studied. Results: Thirtyone patients (62%) were women and 19 (38%) were men. The mean age was 63.8 years. All lesions were facial, with 66% of cases affecting the nasal area. Pre-surgery, there were 48 cases (96%) of basal cell carcinoma and 2 cases (4%) of microcystic adnexal carcinoma. Local flaps were the most used reconstruction method. The patients were followed-up for a mean of 48.4 months. We did not observe any cases of tumor recurrence. Conclusion: Mohs micrographic surgery was shown to be effective in the treatment of 50 skin neoplasms. We recommend that surgical defects should be repaired by the plastic surgeon.

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence? / A excisão incompleta de carcinoma basocelular da pálpebra implica

INTRODUCTION: Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. Objective: To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. METHODS: This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. RESULTS: No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. CONCLUSION: A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus.

INTRODUÇÃO: O carcinoma basocelular é o tumor mais comum entre os tumores das pálpebras. Nesta região, a reconstrução é complexa e recomenda-se que haja perda mínima de tecido saudável. OBJETIVO: Para definir a relação entre margem livre de tumor na excisão e taxa de recidiva do carcinoma basocelular das pálpebras. MÉTODOS: Este estudo prospectivo incluiu 111 pacientes operados para remoção de carcinoma basocelular das pálpebras no período de 2001 a 2003, com acompanhamento subsequente de 5 anos. Os pacientes foram avaliados de acordo com a idade, localização do tumor, taxa de recidiva, e margem livre de tumor na excisão. RESULTADOS: Não se encontrou associação significativa entre a excisão incompleta do tumor e casos de recidiva, exceto em pacientes com idade inferior a 56 anos, pacientes do sexo feminino e em tumores do canto medial. CONCLUSÃO: Um risco maior de recidiva de carcinoma basocelular das pálpebras com excisão incompleta foi confirmado estatisticamente apenas em pacientes mais jovens, em mulheres, e nos tumores do canto interno.