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The Journal of Dermatological Treatment Dec 2024Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and... (Meta-Analysis)
Meta-Analysis Review
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
Topics: Adult; Humans; Dermatofibrosarcoma; Mohs Surgery; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms
PubMed: 38146660
DOI: 10.1080/09546634.2023.2295816 -
Dermatologic Surgery : Official... Dec 2021Mohs micrographic surgery (MMS) for cutaneous melanoma is becoming more prevalent, but surgical technique varies.
BACKGROUND
Mohs micrographic surgery (MMS) for cutaneous melanoma is becoming more prevalent, but surgical technique varies.
OBJECTIVE
To define variations in published techniques for MMS for melanoma.
METHODS AND MATERIALS
A systematic review was performed of PubMed, EMBASE, and Scopus databases to identify all articles describing surgical techniques for MMS for melanoma. Technical details were recorded for the preoperative, intraoperative, and postoperative phases of MMS.
RESULTS
Twenty-four articles were included. Mohs surgeons vary in how they assess clinical margins, how wide a margin they excise on the first MMS layer, and how they process tissue to determine tumor stage and margin clearance during MMS for melanoma.
CONCLUSION
Mohs micrographic surgery for melanoma is performed with varied surgical techniques. To establish best practices, additional research is necessary to determine how different techniques affect outcomes.
Topics: Humans; Melanoma; Mohs Surgery; Skin Neoplasms
PubMed: 34743123
DOI: 10.1097/DSS.0000000000003268 -
Cutis Dec 2023Toluidine blue (TB) is a metachromatic dye used as a stain in frozen sections in Mohs micrographic surgery (MMS). The current literature on the use of TB is sparse and... (Review)
Review
Toluidine blue (TB) is a metachromatic dye used as a stain in frozen sections in Mohs micrographic surgery (MMS). The current literature on the use of TB is sparse and generally qualitative in nature. The aim of this systematic review was to summarize and evaluate the existing literature analyzing TB use in MMS. The PubMed and Cochrane databases were searched for relevant studies published before December 1, 2019. Studies that analyzed the use of TB in frozen sections applicable to MMS were included. A total of 25 articles were reviewed, of which 12 fit the inclusion criteria. Our analysis showed that TB may play an important role in the successful diagnosis and treatment of particular cutaneous tumors.
Topics: Humans; Mohs Surgery; Tolonium Chloride; Skin Neoplasms; Coloring Agents; Neoplasm Recurrence, Local
PubMed: 38290073
DOI: 10.12788/cutis.0915 -
Cureus Nov 2021The objective of this study was to quantitatively compare outcomes between standard excision (SE) and Mohs micrographic surgery (MMS) for basal cell... (Review)
Review
The objective of this study was to quantitatively compare outcomes between standard excision (SE) and Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC). A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic databases was conducted to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of SE versus MMS for BCC. The primary outcome was the recurrence rate for primary and recurrent BCC. The secondary outcomes included the cost of treatment, aesthetic results, the rate of incomplete excision, and the surgical defect size post excision. Five studies enrolling 2060 lesions were identified. There was a statistically significant difference between MMS and SE groups in terms of recurrence rate for primary BCCs (odds ratio (OR) = 0.44, confidence interval (CI) = 0.16 to 0.97, P = 0.04) and recurrent BCCs (OR = 0.33, CI = 0.12 to 0.97, P = 0.04). For secondary outcomes, MMS had improved results compared with SE, except for mean cost. In conclusion, both primary and secondary BCCs treated with MMS have a reduced recurrence rate and defect size thus simplifying reconstruction. However, due to higher costs and operative time attributed to MMS, it should be reserved for high-risk BCCs.
PubMed: 34984139
DOI: 10.7759/cureus.19981 -
Dermatologic Surgery : Official... Aug 2023Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown.
OBJECTIVE
To evaluate the differences in LR rates of nail apparatus MIS treated with Mohs micrographic surgery (MMS) versus nail unit excision (NUE) versus amputation.
METHODS
Studies of nail/subungual MIS treated with MMS, NUE, or amputation were identified through multiple literature databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library. Pooled data were assessed through meta-analyses and Fisher exact test.
RESULTS
Of 280 studies identified, 20 met inclusion criteria (7 comparative studies and 13 single-arm studies). Among the 7 comparative studies, the LR was 4.38% (5/114) after NUE and 2.94% (1/34) after amputation (odds ratio: 0.937; 95% CI: 0.237-3.703). In the 13 noncomparative studies, 23 patients underwent MMS (pooled LR estimate: 11.07%; 95% CI: 3.22%-31.81%) and 140 patients underwent NUE (pooled LR estimate:8.04%, 95% CI: 4.43%-14.16%). The difference in LR rate between MMS, NUE, and amputation was not statistically significant ( p = .578).
CONCLUSION
Local recurrence of nail/subungual MIS in cases treated with MMS was not statistically different than in cases treated with NUE and was comparable to amputation. Further studies investigating the use of MMS for the treatment of nail/subungual MIS are warranted.
Topics: Humans; Mohs Surgery; Treatment Outcome; Skin Neoplasms; Melanoma; Nail Diseases; Neoplasm Recurrence, Local; Retrospective Studies; Melanoma, Cutaneous Malignant
PubMed: 37249515
DOI: 10.1097/DSS.0000000000003840 -
Journal of the European Academy of... Jun 2024The use of Mohs micrographic surgery (MMS) in melanoma treatment has divided opinion and evidence-based guidelines are lacking. (Review)
Review
BACKGROUND
The use of Mohs micrographic surgery (MMS) in melanoma treatment has divided opinion and evidence-based guidelines are lacking.
OBJECTIVES
This systematic review aimed to analyse clinical outcomes for patients with invasive melanomas treated with Mohs rather than wide local excision (WLE).
METHODS
Embase, MEDLINE and Cochrane databases (to 30 August 2023) were searched for studies using Mohs to treat invasive melanoma. Outcomes of interest were local recurrence and death from melanoma.
RESULTS
Thirty-five articles involving 41,499 patients with invasive melanoma treated with Mohs were identified. Sixteen studies compared Mohs with WLE and 19 were Mohs-only, non-comparative studies. Patients treated with Mohs differed significantly from those undergoing WLE, in particular Mohs patients were older and had thinner melanomas. Two comparative studies using the same data source reported adjusted hazard ratios for melanoma-specific death and both showed no significant difference between Mohs and WLE-treated patients; 0.87 (95% CI 0.55-1.35) and 1.20 (95% CI 0.71-20.36). There was also no statistically significant difference in local recurrence risk; the unadjusted risk ratio for patients treated with Mohs was 0.46 (95% CI 0.14-1.51 p = 0.20) with moderate heterogeneity (I = 62%). No studies reported multivariable analyses for risk of local recurrence. Many studies generated from relatively few and often overlapping data sets have reported the use of Mohs to treat patients with invasive melanoma. Fewer studies were comparative between Mohs and WLE and these reported substantially different baseline risks of recurrence and death from melanoma between the groups. Mohs has generally been used for thinner melanomas in older patients; therefore, comparisons based on univariable analyses are likely to have been misleading.
CONCLUSIONS
On the basis of currently available data, it is not possible to reliably assess whether outcomes differ if invasive melanomas with comparable features are treated with Mohs or WLE, and randomized trial evidence will be required for reliable conclusions to be reached.
PubMed: 38842170
DOI: 10.1111/jdv.20138 -
International Journal of Molecular... May 2024Porocarcinoma (PC) is a rare adnexal tumor, mainly found in the elderly. The tumor arises from the acrosyringium of eccrine sweat glands. The risk of lymph node and... (Review)
Review
Porocarcinoma (PC) is a rare adnexal tumor, mainly found in the elderly. The tumor arises from the acrosyringium of eccrine sweat glands. The risk of lymph node and distant metastasis is high. Differential diagnosis with squamous cell carcinoma is difficult, although NUT expression and YAP1 fusion products can be very useful for diagnosis. Currently, wide local excision is the main surgical treatment, although Mohs micrographic surgery is promising. To date, there is no consensus regarding the role of sentinel lymph node biopsy and consequential lymph node dissection. No guidelines exist for radiotherapy, which is mostly performed based on tumor characteristics and excision margins. Only a few studies report systemic treatment for advanced PC, although therapy with pembrolizumab and EGFR inhibitors show promise. In this review, we discuss epidemiology, clinical features, histopathological features, immunohistochemistry and fusion products, surgical management and survival outcomes according to stage, surgical management, radiotherapy and systemic therapy.
Topics: Humans; Eccrine Porocarcinoma; Immunohistochemistry; Sweat Gland Neoplasms; Biomarkers, Tumor; YAP-Signaling Proteins
PubMed: 38891945
DOI: 10.3390/ijms25115760 -
Journal of the American Academy of... Jul 2021Few data exist to guide the application of Mohs micrographic surgery (MMS) in the pediatric population.
BACKGROUND
Few data exist to guide the application of Mohs micrographic surgery (MMS) in the pediatric population.
OBJECTIVE
We sought to summarize the clinical characteristics of children undergoing MMS, identify challenges that limit the use of MMS in this population, and examine how these challenges can be overcome.
METHODS
A systematic review of PubMed and EMBASE, from inception of databases to November 2, 2019, identified all cases of pediatric skin lesions treated with MMS.
RESULTS
A total of 111 patients were included. The median patient age was 11 years (range 6 weeks to 17 years). The most commonly treated tumor was dermatofibrosarcoma protuberans (n = 62), followed by basal cell carcinoma (n = 30). The most common location was the head and neck (n = 34), followed by the trunk (n = 28) and the extremities (n = 23). The most commonly cited challenges in the application of MMS in children included patient cooperation, concerns for the safety of prolonged general anesthesia, availability of a MMS service in the pediatric setting, and access to a histopathology laboratory experienced in MMS sectioning.
LIMITATIONS
Many articles did not report specific patient characteristics.
CONCLUSION
Multiple obstacles limit the application of MMS in pediatric patients. This review describes practical methods to circumvent these obstacles to facilitate the appropriate use of MMS in children.
Topics: Adolescent; Anesthesia, General; Carcinoma, Basal Cell; Child; Child, Preschool; Clinical Laboratory Services; Dermatofibrosarcoma; Extremities; Head and Neck Neoplasms; Health Services Accessibility; Humans; Infant; Mohs Surgery; Neoplasm, Residual; Operative Time; Patient Compliance; Skin Neoplasms; Torso
PubMed: 33011324
DOI: 10.1016/j.jaad.2020.09.052 -
Laser Applications in Wound and Scar Management Post-Mohs Micrographic Surgery: A Systematic Review.Journal of Cutaneous Medicine and... 2024Mohs micrographic surgery (MMS) can lead to complications such as scarring and delayed wound healing, particularly in sensitive areas such as the face, neck, and chest.... (Review)
Review
Mohs micrographic surgery (MMS) can lead to complications such as scarring and delayed wound healing, particularly in sensitive areas such as the face, neck, and chest. This study aims to assess the evidence regarding the use of lasers post-MMS for wound healing and scar revision. A comprehensive systematic review of the literature was performed using databases including MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL from inception until July 25, 2022. A total of 2147 unique studies were identified, from which 17 were included in the analysis. A total of 17 studies reported applications of lasers with favourable efficacy including wound healing (n = 1), resurfacing of full-thickness skin grafts and split-thickness skin grafts (n = 4), periscar telangiectasias (n = 1), functional scar contractures (n = 2), and scar texture (n = 9). Minimal adverse effects were reported with the use of lasers post-MMS. Overall, the use of lasers post-MMS is a safe and well-tolerated option for scar revision with high patient satisfaction and is less invasive than surgical interventions.
Topics: Humans; Mohs Surgery; Cicatrix; Treatment Outcome; Wound Healing; Lasers; Skin Neoplasms
PubMed: 38353226
DOI: 10.1177/12034754241227629 -
The Cochrane Database of Systematic... Dec 2014Basal cell carcinoma (BCC) is the commonest skin cancer in the white population. It is traditionally treated by surgical excision (SE) or by Mohs micrographic surgery... (Review)
Review
BACKGROUND
Basal cell carcinoma (BCC) is the commonest skin cancer in the white population. It is traditionally treated by surgical excision (SE) or by Mohs micrographic surgery (MMS).
OBJECTIVES
The objective of this review was to compare the effectiveness, cost, complications and acceptability of periocular BCCs when operated by MMS or SE.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to February 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 February 2014.
SELECTION CRITERIA
We planned to include only randomised controlled trials (RCTs) comparing SE with MMS for treatment of periocular BCC.
DATA COLLECTION AND ANALYSIS
We did not find any studies that met the inclusion criteria for this review.
MAIN RESULTS
We did not find any studies that met the inclusion criteria for this review and hence none were included for analysis. Results of non-randomised studies describing the individual techniques are reported.
AUTHORS' CONCLUSIONS
No reliable conclusions could be reached regarding which method of treatment (SE or MMS) resulted in a lower recurrence or complication rate for periocular BCC. No studies were found comparing the cost of either method directly. High quality RCTs are therefore needed to improve the evidence base for the management of this condition.
Topics: Carcinoma, Basal Cell; Facial Neoplasms; Humans; Mohs Surgery; Skin Neoplasms
PubMed: 25503105
DOI: 10.1002/14651858.CD007041.pub4