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Journal of the American Academy of... Jul 2022
Topics: Female; Humans; Mohs Surgery; Skin Neoplasms; Vulvar Neoplasms
PubMed: 34237353
DOI: 10.1016/j.jaad.2021.06.875 -
Dermatologic Surgery : Official... Apr 2022When treating Merkel cell carcinoma (MCC), the relation between wide local excision (WLE) margin and recurrence or survival is unclear. Mohs micrographic surgery (MMS)...
BACKGROUND
When treating Merkel cell carcinoma (MCC), the relation between wide local excision (WLE) margin and recurrence or survival is unclear. Mohs micrographic surgery (MMS) is an alternative surgical option for MCC, but it is unknown whether the local recurrence rate differs between MMS and WLE.
OBJECTIVE
To systematically assess the available literature to determine the recurrence and survival rates when treating MCC with MMS and different clinical excision margins.
MATERIALS AND METHODS
The MEDLINE, EMBASE, and CENTRAL databases were searched. Two independent reviewers selected studies that defined clear excision margins and either recurrence or survival. When possible, individual cases were extracted from case series and included in the analyses. Other studies were reviewed narratively.
RESULTS
Overall, 1108 studies were identified; of which, 19 case series (168 cases) and 12 cohort studies were eligible. None of the cohort studies showed significant differences in recurrence or survival for either excision margins or MMS. Equally, logistic and Cox regression analyses of the case series revealed no significant differences in recurrence or survival between different excision margins and MMS.
CONCLUSION
Synthesis of the available data does not indicate differences in recurrence and/or survival rates for MCC between different clinical excision margins and MMS.
Topics: Carcinoma, Merkel Cell; Humans; Margins of Excision; Mohs Surgery; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms
PubMed: 35165221
DOI: 10.1097/DSS.0000000000003402 -
International Journal of Dermatology Jun 2022Comprehensive treatment recommendations for Merkel cell carcinoma are complex. We aimed to systematically review the published data on recurrence and mortality rates... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Comprehensive treatment recommendations for Merkel cell carcinoma are complex. We aimed to systematically review the published data on recurrence and mortality rates associated with various treatment approaches for Merkel cell carcinoma.
METHODS
Search of MEDLINE, Embase, Web of Science, and Scopus from inception to August 2015. Studies were included that reported comparative survival and recurrence data for two or more treatment modalities. Two reviewers independently reviewed and abstracted recurrence and mortality rates. Event rates for individual treatment arms in each study were pooled and meta-analyzed across studies using a random-effects model.
RESULTS
Fifty-two retrospective studies met inclusion criteria, revealing a total of 1,804 patients with primary Merkel cell carcinoma with data available for analyses. The recurrence rate was higher for surgery alone (55.0%) versus a combination of surgery and radiotherapy (39.0%) (odds ratio, 2.089; 95% CI, 1.374-3.177; P < 0.001). Combination therapy including surgery, radiotherapy, and chemotherapy had a higher mortality rate (44.6%) than did combined surgery and radiotherapy (23.2%) (odds ratio, 2.688; 95% CI, 1.196-6.037; P = 0.02).
CONCLUSIONS
The treatment of Merkel cell carcinoma with surgery plus adjuvant radiotherapy may produce lower recurrence rates.
Topics: Carcinoma, Merkel Cell; Combined Modality Therapy; Humans; Radiotherapy, Adjuvant; Retrospective Studies; Skin Neoplasms
PubMed: 34227108
DOI: 10.1111/ijd.15753 -
International Journal of Dermatology Apr 2020Extraocular sebaceous carcinoma (EOSC) is an aggressive malignancy of the sebaceous gland. Surgery is considered the cornerstone of treatment, but there is lack of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extraocular sebaceous carcinoma (EOSC) is an aggressive malignancy of the sebaceous gland. Surgery is considered the cornerstone of treatment, but there is lack of clarity about extent and adjuvant treatment.
METHODS
We conducted a systematic review and analysis of individual patient data of all published cases of EOSC to look into demography, pattern of care, importance of type of surgery, and other adjuvant treatment and survival outcome. A search of PubMed and Google Scholar was done with the key words sebaceous carcinoma, extraocular sebaceous carcinoma, and Muir-Torre syndrome till December 2017. The data were compiled in an Excel chart and analyzed using SPSS IBM software.
RESULTS
Data of 206 patients were retrieved. Median age at presentation was 65 years (range: 11-96 years). Surgery was performed in all except 13 patients. Of these 13, eight were deemed inoperable for extensive disease, and five had metastatic disease. Median PFS and OS for the entire cohort were 84 months (95% CI: 10-158 months) and 92 months (95% CI: 59-126 months). Univariate analysis revealed significantly poor survival for patients with a metastatic disease, regional nodal metastasis, and those with Mohs micrographic or incomplete surgery.
CONCLUSION
EOSC is a disease of elderly patients with good prognosis. Complete surgery with regional lymph node dissection is standard treatment. The role of adjuvant radiotherapy is debatable but can be considered in patients with incomplete surgery or high-risk factors.
Topics: Adenocarcinoma, Sebaceous; Adolescent; Adult; Aged; Aged, 80 and over; Chemoradiotherapy, Adjuvant; Chemotherapy, Adjuvant; Child; Cohort Studies; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mohs Surgery; Prognosis; Progression-Free Survival; Radiotherapy, Adjuvant; Sebaceous Gland Neoplasms; Sebaceous Glands; Young Adult
PubMed: 31850516
DOI: 10.1111/ijd.14739 -
Dermatologic Clinics Jul 2019Given the opposing pressures placed on dermatologists and dermatologic surgeons by the need for adequate postoperative analgesia and the current US opioid epidemic, a...
Given the opposing pressures placed on dermatologists and dermatologic surgeons by the need for adequate postoperative analgesia and the current US opioid epidemic, a systematic review was performed to analyze postoperative pain management in outpatient dermatologic surgery. Dermatologic procedures are generally associated with minor postoperative pain of short duration. Anxiety reduction may lead to less postoperative pain. Studies vary on which anatomic locations and repair types are more or less associated with pain. Evidence supports the use of acetaminophen and ibuprofen for first-line postoperative analgesia in dermatologic surgery. Opioids, if given, should only be prescribed in small quantities.
Topics: Acetaminophen; Analgesics; Analgesics, Opioid; Dermatologic Surgical Procedures; Humans; Ibuprofen; Mohs Surgery; Pain, Postoperative
PubMed: 31084728
DOI: 10.1016/j.det.2019.03.004 -
The American Journal of Dermatopathology Dec 2021Malignant proliferating trichilemmal tumors of the scalp can exhibit aggressive presentation and recurrences. Our objective was to perform an evidence-based systematic...
OBJECTIVES
Malignant proliferating trichilemmal tumors of the scalp can exhibit aggressive presentation and recurrences. Our objective was to perform an evidence-based systematic review evaluating clinical presentation, tumor characteristics, and treatment modalities used to determine which treatment strategies had the best outcomes.
METHODS
The databases PubMed, Embase, and Cochrane Library were searched for relevant literature by the authors. Patient demographics, imaging, treatments, and other clinical characteristics were obtained. The results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines.
RESULTS
Thirty-nine studies with a total of 65 patients were identified. The most common presentation was a history of slow-growing, painless swollen mass on the scalp. In total, 10 patients (15.4%) presented with spread to the regional lymph nodes and 6 (9.2%) additional patients presented with metastasis to distant locations. In total, 61 patients (93.8%) underwent surgery. Various chemotherapy and radiation therapy regimens were used. Of the 45 cases with documented follow-up, 11 (24.4%) patients had one or multiple instances of local, lymph node or metastatic tumor recurrence.
CONCLUSIONS
Surgery is favored, and the exact approach should be based on clinical judgment. However, Mohs micrographic surgery should strongly be considered because of its superior margin control against such an invasive tumor. Radiotherapy and chemotherapy have been used as adjuvant therapy in aggressive cases or recurrence. Patients should be followed closely and examined often to frequently assess recurrence or metastasis. Randomized controlled trials are needed to further clarify these findings.
Topics: Humans; Neoplasms, Adnexal and Skin Appendage; Scalp; Skin Neoplasms
PubMed: 34797787
DOI: 10.1097/DAD.0000000000001991 -
Journal of the European Academy of... Jun 2024The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: A systematic review and meta-analysis.
The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, Embase, Scopus, Web of Science, CINHAL and Cochrane until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. There were 82 recurrences in 3050 tumours submitted to MS, with an overall recurrence rate of 3.1% (95% CI 2.0%-4.7%). For CS, there were 209 recurrences in 3453 tumours, with a recurrence rate of 5.3% (95% CI 2.9%-9.3%). The combined estimate of RR was 0.48 (95% CI 0.36-0.63), without heterogeneity nor evidence of publication bias (p > 0.3). The RD resulted in 2.9% (95% CI 1.0%-4.9%; NNT = 35). Regarding subgroup analysis, the RR for BBC was 0.37 (95% CI 0.25-0.54), and RD was 3.7% (95% CI 0.8%-6.5%; NNT = 28). For SCC, RR was 0.57 (95% CI 0.29-1.13), and RD was 1.9% (95% CI 0.8%-4.7%; NNT = 53). Among primary tumours, RR was 0.39 (95% CI 0.28-0.54), and for recurrent tumours was 0.67 (95% CI 0.30-1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumours. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount.
Topics: Humans; Carcinoma, Basal Cell; Skin Neoplasms; Mohs Surgery; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell
PubMed: 38116955
DOI: 10.1111/jdv.19743 -
Cutis Feb 2023Epithelioma cuniculatum (EC) is a subtype of verrucous carcinoma (VC) that affects the feet. Treatment involves complete tumor removal by wide local excision (WLE) or...
Epithelioma cuniculatum (EC) is a subtype of verrucous carcinoma (VC) that affects the feet. Treatment involves complete tumor removal by wide local excision (WLE) or Mohs micrographic surgery (MMS). Extensive local destruction may require amputation. We sought to compare reported treatment methods for EC and determine their efficacy by assessing for tumor recurrence and treatment-associated complications. A systematic review of the literature spanning multiple databases was performed. To date, surgical excision is recommended as the standard of care for treatment of EC, with amputation considered in more advanced cases. Mohs micrographic surgery appears to be a promising treatment modality for EC and may have lower recurrence rates than WLE but requires further investigation.
Topics: Humans; Carcinoma, Verrucous; Foot Diseases; Mohs Surgery; Amputation, Surgical; Male; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged, 80 and over; Aged; Skin Neoplasms; Treatment Outcome
PubMed: 37075193
DOI: 10.12788/cutis.0720 -
Archives of Dermatological Research Mar 2023Incidence of basal cell carcinoma (BCC) with perineural invasion (PNI) ranges from 0.178 to 10% depending upon whether conventional pathology (formalin fixed, paraffin... (Review)
Review
Incidence of basal cell carcinoma (BCC) with perineural invasion (PNI) ranges from 0.178 to 10% depending upon whether conventional pathology (formalin fixed, paraffin embedded) or Mohs micrographic surgery (MMS) (frozen sections) is used. To determine the incidence of BCC with PNI determined by conventional pathology versus MMS. A review of PubMed and EMBASE databases, from their inception to December 18th, 2020, identified articles that determined the incidence of BCC with PNI using conventional pathology or MMS. The general (average) incidence of BCC with PNI as determined by studies that used conventional histopathology and MMS was 0.85 and 2.51%, respectively. The observed incidence of BCC with PNI was not significantly higher using MMS compared to conventional pathology (p = 0.82).
Topics: Humans; Skin Neoplasms; Mohs Surgery; Incidence; Neoplasm Invasiveness; Carcinoma, Basal Cell; Neoplasm Recurrence, Local
PubMed: 35467131
DOI: 10.1007/s00403-022-02354-y -
Dermatologic Surgery : Official... May 2022Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown.
OBJECTIVE
To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS).
MATERIALS AND METHODS
Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946-2018), Embase (1988-2018), Web of Science (1975-2018), and Scopus (1970-2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses.
RESULTS
Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710-3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%-2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%-11.3%; p < .001).
CONCLUSION
The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
Topics: Databases, Factual; Dermatofibrosarcoma; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms
PubMed: 35353755
DOI: 10.1097/DSS.0000000000003411