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International Journal of Molecular... Mar 2024Wound healing is an intricate process involving coordinated interactions among inflammatory cells, skin fibroblasts, keratinocytes, and endothelial cells. Successful... (Review)
Review
Wound healing is an intricate process involving coordinated interactions among inflammatory cells, skin fibroblasts, keratinocytes, and endothelial cells. Successful tissue repair hinges on controlled inflammation, angiogenesis, and remodeling facilitated by the exchange of cytokines and growth factors. Comorbid conditions can disrupt this process, leading to significant morbidity and mortality. Stem cell therapy has emerged as a promising strategy for enhancing wound healing, utilizing cells from diverse sources such as endothelial progenitor cells, bone marrow, adipose tissue, dermal, and inducible pluripotent stem cells. In this systematic review, we comprehensively investigated stem cell therapies in chronic wounds, summarizing the clinical, translational, and primary literature. A systematic search across PubMed, Embase, Web of Science, Google Scholar, and Cochrane Library yielded 22,454 articles, reduced to 44 studies after rigorous screening. Notably, adipose tissue-derived mesenchymal stem cells (AD-MSCs) emerged as an optimal choice due to their abundant supply, easy isolation, ex vivo proliferative capacities, and pro-angiogenic factor secretion. AD-MSCs have shown efficacy in various conditions, including peripheral arterial disease, diabetic wounds, hypertensive ulcers, bullous diabeticorum, venous ulcers, and post-Mohs micrographic surgery wounds. Delivery methods varied, encompassing topical application, scaffold incorporation, combination with plasma-rich proteins, and atelocollagen administration. Integration with local wound care practices resulted in reduced pain, shorter healing times, and improved cosmesis. Stem cell transplantation represents a potential therapeutic avenue, as transplanted stem cells not only differentiate into diverse skin cell types but also release essential cytokines and growth factors, fostering increased angiogenesis. This approach holds promise for intractable wounds, particularly chronic lower-leg wounds, and as a post-Mohs micrographic surgery intervention for healing defects through secondary intention. The potential reduction in healthcare costs and enhancement of patient quality of life further underscore the attractiveness of stem cell applications in wound care. This systematic review explores the clinical utilization of stem cells and stem cell products, providing valuable insights into their role as ancillary methods in treating chronic wounds.
Topics: Humans; Endothelial Cells; Quality of Life; Wound Healing; Pluripotent Stem Cells; Intercellular Signaling Peptides and Proteins; Cytokines; Mesenchymal Stem Cell Transplantation
PubMed: 38474251
DOI: 10.3390/ijms25053006 -
Dermatologic Surgery : Official... Oct 2018Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm with high potential for morbidity and mortality. Due to its rarity, there is a paucity of data profiling... (Review)
Review
BACKGROUND
Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm with high potential for morbidity and mortality. Due to its rarity, there is a paucity of data profiling diagnosis, work-up, and management.
OBJECTIVE
To consolidate reported information on demographics, diagnostics, clinical behavior, treatment modalities, and patient outcomes in EPC to provide a reference tool to optimize diagnosis and management.
METHODS
A comprehensive PubMed search was performed from 1963 to November 2017 using PRISMA guidelines. This yielded 155 articles detailing 206 cases of porocarcinoma.
RESULTS
Eccrine porocarcinoma most often presents in elderly patients on the head and neck or lower limbs. Metastatic disease at presentation is not uncommon (22%). Primary tumor location is significantly correlated with presence of metastasis (p = .038). The most common treatment is excision followed by Mohs micrographic surgery (MMS), although the outcomes after MMS were superior to those after surgical excision.
CONCLUSION
This systematic review of individual patient data reveals that all patients should have a histological diagnosis with imaging considered for high-risk cases. Primary tumor location should also be considered in diagnostic and therapeutic decision-making. Although wide local excision (WLE) is currently the first-line treatment, MMS is becoming increasingly used, with evidence indicating improved outcomes as compared to those seen with WLE.
Topics: Aged; Eccrine Porocarcinoma; Female; Humans; Male; Middle Aged; Sweat Gland Neoplasms
PubMed: 29894433
DOI: 10.1097/DSS.0000000000001566 -
Archives of Dermatological Research May 2024The use of botulinum toxin for off-label indications has become more prevalent, but the specific benefits in Mohs micrographic surgery (MMS) have not yet been fully... (Review)
Review
The use of botulinum toxin for off-label indications has become more prevalent, but the specific benefits in Mohs micrographic surgery (MMS) have not yet been fully elucidated. A systematic review was performed of PubMed, Cochrane, EMBASE, and Scopus databases to identify all articles describing the use of botulinum toxin in MMS. Analysis was subdivided into scar minimization, parotid injury, and pain management. A total of nine articles were included. Scar minimization and treatment of parotid injury were the most reported uses. One case reported the use of botulinum toxin for pain management. Off label uses of botulinum toxin are being explored. Additional research is warranted to determine the efficacy and utility of botulinum toxin in MMS.
Topics: Humans; Mohs Surgery; Off-Label Use; Cicatrix; Skin Neoplasms; Botulinum Toxins, Type A; Botulinum Toxins; Pain Management; Parotid Gland
PubMed: 38787406
DOI: 10.1007/s00403-024-02904-6 -
Dermatologic Surgery : Official... Mar 2024Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs...
BACKGROUND
Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs micrographic surgery. Given variable training and experience, dermatologic surgeons may seek additional references to help reconstruct certain advanced defects. We sought to synthesize literature from dermatologic surgery, plastic surgery, and otolaryngology to review repair options and considerations for repair of nasal lining defects.
OBJECTIVE
To present a comprehensive literature review of repair options for nasal lining reconstruction and discuss advantages, disadvantages, specific anatomic considerations, and techniques to execute such options.
MATERIALS AND METHODS
Articles from several different reconstructive specialties including dermatologic/Mohs surgery, otolaryngology, and plastic and reconstructive surgery were reviewed. Instructive images were compiled to illustrate several techniques, with additional medical illustration recreations included to help showcase important reconstructive approaches.
RESULTS
A comprehensive descriptive review of nasal lining repair options for the reconstructive surgeon.
CONCLUSION
Advanced tumors can result in full-thickness nasal defects, and this review describes various reconstructive options for reconstruction based on the extent of the defect.
Topics: Humans; Mohs Surgery; Nose; Otolaryngology; Plastic Surgery Procedures; Surgeons
PubMed: 38170669
DOI: 10.1097/DSS.0000000000004063 -
Dermatologic Surgery : Official... Jul 2020Although there is a large body of evidence demonstrating the safety and efficacy of Mohs micrographic surgery (MMS) in adults, little is known regarding the safety and...
BACKGROUND
Although there is a large body of evidence demonstrating the safety and efficacy of Mohs micrographic surgery (MMS) in adults, little is known regarding the safety and efficacy of MMS in children and adolescents.
METHODS
The authors searched all publications from 1993 to 2018 reporting on the use of MMS for the treatment of cutaneous neoplasms in patients aged 0 to 18 years. Patient demographics, surgical characteristics, outcomes, and complications were extracted from each report.
RESULTS
Forty-one publications describing 58 patients were included in the final analysis. The mean age was 8.3 years, and the most commonly treated tumor was dermatofibrosarcoma protuberans. There were no recurrences noted at a mean follow-up of 2 years. Two (3.4%) patients experienced complications after MMS.
CONCLUSION
In this systematic review, the authors present aggregate data demonstrating high safety and efficacy of MMS in children and adolescents. Further research is necessary to develop guidelines for the use of MMS in children and adolescents.
Topics: Adolescent; Child; Humans; Mohs Surgery; Skin Neoplasms; Treatment Outcome
PubMed: 31834072
DOI: 10.1097/DSS.0000000000002282 -
The British Journal of Dermatology Jun 2021Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates.
OBJECTIVES
We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta-analysis of primary clinical studies.
METHODS
A PRISMA-compliant systematic review and meta-analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000-27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random-effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta-analysis and meta-regression, which were presented as risk ratios (RRs).
RESULTS
Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7-12·4] and for SCC 9·4% (95% CI 7·6-11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0-7·3) and SCCs (RR 4·8, 95% CI 1·0-22·8). Studies were heterogeneous (I = 98%) and at high risk of bias.
CONCLUSIONS
The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Keratinocytes; Mohs Surgery; Skin Neoplasms
PubMed: 33131067
DOI: 10.1111/bjd.19660 -
Dermatologic Surgery : Official... Jan 2022Recommendations for the approved use of Mohs surgery for cutaneous melanoma on the trunk and extremities remain uncertain. (Comparative Study)
Comparative Study
BACKGROUND
Recommendations for the approved use of Mohs surgery for cutaneous melanoma on the trunk and extremities remain uncertain.
OBJECTIVE
To compare survival and recurrence between patients treated with Mohs surgery versus wide excision for melanoma on the trunk and extremities.
METHODS
The databases Medline, Embase, Web of Science, CENTRAL, and EMCare were searched from inception on January 11, 2021. Contemporary comparisons were included exclusively. Meta-analysis was conducted using generic inverse variance and a fixed effects model.
RESULTS
Four studies were eligible for inclusion. The study population (n = 279,556) was 52.1% men and 97.2% White. There were no observed differences in 5-year overall survival (hazard ratio 0.98, 95% confidence interval 0.90-1.07, I2 = 0%), disease-free survival (HR 0.89, 95% CI 0.12-6.47, I2 = 0), or local recurrence among patients treated with Mohs surgery relative to wide excision. Quality of the evidence was very low.
CONCLUSION
This systematic review found survival and local recurrence were comparable among patients treated with Mohs surgery or wide excision for melanoma on the trunk and extremities. Future prospective contemporary studies with more diverse representation that report surgical complications and costs may facilitate more definitive recommendations.
Topics: Disease-Free Survival; Extremities; Humans; Melanoma; Mohs Surgery; Neoplasm Recurrence, Local; Skin Neoplasms; Torso
PubMed: 34608076
DOI: 10.1097/DSS.0000000000003250 -
Journal of the American Academy of... Nov 2018Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates but low metastatic potential. Wide local excision (WLE) and Mohs... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates but low metastatic potential. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are common treatments, although no consensus exists regarding optimal therapy.
OBJECTIVE
To systematically review evidence of AFX recurrence and metastatic rates after different surgical modalities.
METHODS
A comprehensive search was performed for articles published from 1946 or database inception to March 20, 2017. Studies selected included those that had 5 or more patients with atypical fibroxanthoma treated surgically. Two reviewers independently abstracted the data. Risk of bias was assessed with the Newcastle-Ottawa scale. Main outcomes and measures included recurrence and metastasis.
RESULTS
In total, 23 studies were selected (907 patients and 914 tumors); 175 patients were treated with MMS (recurrence rate 2.0%, 95% confidence interval [CI] 0%-4.1%; metastatic rate 1.9%, 95% CI 0.1%-3.8%), and 732 were treated with WLE (recurrence rate 8.7%, 95% CI 5%-12.3%; metastasis rate 1%, 95% CI 0.2%-1.9%). Among immunocompromised patients, no recurrence or metastases developed in the MMS subgroup, although 4 of 10 recurred and 1 of 10 metastasized in the WLE subgroup.
LIMITATIONS
Low quality of the studies published.
CONCLUSION
MMS for atypical fibroxanthoma is associated with a lower recurrence rate than WLE.
Topics: Dermatologic Surgical Procedures; Disease-Free Survival; Female; Histiocytoma, Malignant Fibrous; Humans; Male; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Risk Assessment; Skin Neoplasms; Survival Analysis
PubMed: 29981390
DOI: 10.1016/j.jaad.2018.06.048 -
Archives of Dermatological Research Apr 2023Repair of auricular defects following tumor removal can be challenging. Many techniques have been described, but the literature lacks a comprehensive review of these...
Repair of auricular defects following tumor removal can be challenging. Many techniques have been described, but the literature lacks a comprehensive review of these methods. To perform a systematic review to compile and describe methods of reconstruction for post-surgical defects on the ears, eight databases were searched using terms related to ear anatomy, Mohs and excisions, and repair methods. Articles were eligible for inclusion if they contained repair data for ear defects following Mohs or excision for at least 4 subjects and were published in English between 2004 and 2019. Two reviewers screened all abstracts, and then evaluated the remaining full text articles to determine eligibility. The authors' specialties, study design, subject information, tumor and defect characteristics, procedure, repair methods, outcomes, and complications were then extracted. Most articles were written by dermatologic surgeons (66.7%). Repair methods included wedge excisions (19 cases), second intention healing (376), linear closures (294), purse strings (4), locoregional flaps (221), and grafts (2003). Most studies were small observational case series or cohort studies that lacked clear outcome measures. The available evidence on this topic is low quality. Further research utilizing improved study designs and standardized outcome measures is needed.
Topics: Humans; Skin Neoplasms; Mohs Surgery; Skin Transplantation; Surgical Flaps; Ear
PubMed: 35951108
DOI: 10.1007/s00403-022-02373-9 -
European Urology Focus May 2022Penile intraepithelial neoplasia (PeIN) is a rare skin condition with potential to progress to invasive penile cancer. We performed a systematic review of treatment... (Review)
Review
Penile intraepithelial neoplasia (PeIN) is a rare skin condition with potential to progress to invasive penile cancer. We performed a systematic review of treatment options and outcomes for PeIN. Topical agents showed response and recurrence rates of 40-100% and 20% for imiquimod, and 48-74% and 11% for 5-fluorouracil, respectively. Discontinuation of topical agents because of side effects was observed in 12% of cases. Response rates for laser therapies were 52-100%, with recurrence in 7-48% of cases and a change in penile sensitivity in 50%. Circumcision cleared preputial PeIN. Rates of recurrence after surgical treatment of glans PeIN were 25% for wide local excision, 4% for Mohs surgery, 5% for total glans resurfacing, and 10% for glansectomy. There are limited data on factors predictive of treatment response and on sequencing of treatment options. PATIENT SUMMARY: Several treatment options are available for men with precancerous lesions of the foreskin or glans. Close follow-up is necessary as lesions can recur or progress to invasive penile cancer.
Topics: Carcinoma in Situ; Carcinoma, Squamous Cell; Humans; Male; Penile Neoplasms; Penis; Precancerous Conditions
PubMed: 33994168
DOI: 10.1016/j.euf.2021.04.026