RESUMO
BACKGROUND: Brigham and Women's Hospital stage T2a squamous cell carcinomas, demonstrating a single high-risk feature, have a low risk of metastasis and death but an increased risk of local recurrence. Little evidence exists for the best treatment modality and associated outcomes in T2a squamous cell carcinoma. OBJECTIVE: We aimed to compare outcomes for T2a squamous cell carcinoma treated by Mohs micrographic surgery compared with wide local excision with permanent sections. METHODS: Retrospective review of an institutional review board-approved single-institution registry of T2a squamous cell carcinoma. RESULTS: Three hundred sixty-six primary T2a tumors were identified, including 240 squamous cell carcinomas (65.6%) treated with Mohs micrographic surgery and 126 (34.4%) treated with wide local excision. A total of 32.5% of patients were immunosuppressed and mean oncologic follow-up was 2.8 years. Local recurrence was significantly more likely after wide local excision (4.0%) than after Mohs micrographic surgery (1.2%) (P = .03). Multiple logistic regression demonstrated immunocompromised state (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.1-23.3; P = .03) and wide local excision (OR 4.8; 95% CI 1.1-21.6; P = .04) associated with local recurrence; and wide local excision (OR 7.8; 95% CI 2.4-25.4; P < .001), high-risk head and neck location (OR 8.3; 95% CI 1.8-38.7; P = .004), and poor histologic differentiation (OR 4.7; 95% CI 1.4-15.4; P = .03) associated with poor outcomes (overall recurrence or disease-specific death). CONCLUSION: Mohs micrographic surgery provides improved outcomes in Brigham and Women's Hospital T2a squamous cell carcinoma.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Pele/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoAssuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Fidelidade a Diretrizes , Margens de Excisão , Guias de Prática Clínica como Assunto , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Massachusetts , Metástase Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been made against requiring consent for such examinations are reviewed and refuted. The implications of requiring consent for examinations under anesthesia are discussed as they relate to patient autonomy, medical student education, and society at large. Finally, we outline a solution and offer sample language that balances the interests of patients, learners, and society.