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Archives of Dermatological Research Jan 2023The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice everywhere. The aim of this study was to quantify the specific impact of COVID-19...
The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice everywhere. The aim of this study was to quantify the specific impact of COVID-19 on skin cancer treatment at an academic dermatologic surgery practice. We conducted a retrospective chart review to compare metrics such as patient visits, histological upgrading, and Mohs stages per tumor between 60-day periods immediately before and after COVID-19 was declared a pandemic. Out of 1138 total encounters, decreases of 58% in total in-person visits and 38% in Mohs surgeries performed were observed following declaration of the pandemic. More squamous cell carcinoma and squamous cell carcinoma in situ (SCC/SCCIS) and less basal cell carcinoma (BCC) tumors were treated post-declaration compared to pre-declaration. There was a significantly higher histological upgrade rate for total tumors, as well as for the BCC subgroup, but not the SCC/SCCIS subgroup. While the overall number of dermatologic surgeries decreased after declaration of the pandemic, the higher histological upgrade rate reflects an appropriate triage of higher risk skin cancers. These findings may be useful both to assess the effectiveness of protocols for COVID-19 and to prepare for future resource-limited scenarios.
Topics: Humans; Retrospective Studies; COVID-19; Skin Neoplasms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Mohs Surgery
PubMed: 34628518
DOI: 10.1007/s00403-021-02284-1 -
Journal of Otolaryngology - Head & Neck... Sep 2021Head and neck cutaneous squamous cell carcinoma (HNCSCC) is a non-melanoma skin cancer that is mostly caused by solar ultraviolet radiation exposure. While it usually... (Review)
Review
BACKGROUND
Head and neck cutaneous squamous cell carcinoma (HNCSCC) is a non-melanoma skin cancer that is mostly caused by solar ultraviolet radiation exposure. While it usually has an excellent prognosis, a subset of patients (5%) develops nodal metastasis and has poor outcomes. The aim of this study was to systematically review the literature and evaluate the prognostic factors of HNCSCC in order to better understand which patients are the most likely to develop metastatic disease.
METHODS
A comprehensive literature search was performed on PubMed and EMBASE to identify the studies that evaluated the prognostic factors of HNCSCC. Prognostic factors were deemed significant if they had a reported p-value of < 0.05. Proportions of studies that reported a given factor to be statistically significant were calculated for each prognostic factor.
RESULTS
The search yielded a total of 958 citations. Forty studies, involving a total of 8535 patients, were included in the final analysis. The pre-operative/clinical prognostic factors with the highest proportion of significance were state of immunosuppression (73.3%) and age (53.3%); while post-operative/pathological prognostic factors of importance were number of lymph nodes involved with carcinoma (70.0%), margins involved with carcinoma (66.7%), and tumor depth (50.0%).
CONCLUSION
This systematic review is aimed to aid physicians in assessing the prognosis of HNCSCC and identifying the subsets of patients that are most susceptible to metastasis. It also suggests that immunosuppressed patients with a high-risk feature on biopsy, such as invasion beyond subcutaneous fat, could possibly benefit from a sentinel lymph node biopsy.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Neoplasm Staging; Prognosis; Retrospective Studies; Skin Neoplasms; Ultraviolet Rays
PubMed: 34493343
DOI: 10.1186/s40463-021-00529-7 -
Acta Dermato-venereologica Nov 2021Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a...
Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery).
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the "real-life" results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1-1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3-6.1), being constant over time (0-5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.
Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Prospective Studies; Registries; Risk Factors; Skin Neoplasms
PubMed: 34694418
DOI: 10.2340/actadv.v101.544 -
OncoTargets and Therapy 2016Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. If left untreated, BCCs can become locally aggressive or even metastasize. Currently available... (Review)
Review
Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. If left untreated, BCCs can become locally aggressive or even metastasize. Currently available treatments include local destruction, surgery, and radiation. Systemic options for advanced disease are limited. The Hedgehog (Hh) pathway is aberrantly activated in a majority of BCCs and in other cancers. Hh pathway inhibitors are targeted agents that inhibit the aberrant activation of the Hh pathway, with smoothened being a targeted component. Sonidegib is a novel smoothened inhibitor that was recently approved by the US Food and Drug Administration. This review focuses on BCC pathogenesis and the clinical efficacy of sonidegib for the treatment of advanced BCC.
PubMed: 27695345
DOI: 10.2147/OTT.S108171 -
JAMA Dermatology Apr 2019Although overall antibiotic use among dermatologists is decreasing, there has been an increase in use associated with dermatologic procedures during the past decade....
IMPORTANCE
Although overall antibiotic use among dermatologists is decreasing, there has been an increase in use associated with dermatologic procedures during the past decade. This higher antibiotic use may increase antibiotic-associated adverse events and promote the development of antibiotic resistance.
OBJECTIVE
To characterize antibiotic use associated with dermatologic procedures, including geographic variation.
DESIGN, SETTING, AND PARTICIPANTS
Using Optum Clinformatics DataMart deidentified commercial claims data, we performed a repeated cross-sectional analysis of antibiotic prescribing by dermatologists from 2008 to 2016. Dermatology clinicians were identified by their National Uniform Claim Committee taxonomy codes, encounters for surgical procedures were identified by Common Procedure Terminology codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes.
EXPOSURES
Claims for oral antibiotic prescriptions associated with encounters with dermatologists associated with dermatologic procedures.
MAIN OUTCOMES AND MEASURES
Frequency of antibiotic prescribing and associated procedures. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time.
RESULTS
Between 2008 and 2016, among 1 934 633 encounters (1 128 244 unique patients, 854 072 [44.1%] were women and the median [interquartile range] age was 66 [52-76] years) for dermatologic procedures, oral antibiotic prescribing associated with benign excisions increased from 2.9% to 4.4% of visits (52.5% relative change; incidence rate ratio [IRR], 1.04; 95% CI, 1.03-1.04), antibiotic prescribing associated with malignant excisions increased from 4.2% to 6.3% of visits (49.5% relative change; IRR, 1.06; 95% CI, 1.05-1.06), and antibiotic prescribing associated with Mohs surgery increased from 9.9% to 13.8% of visits (39.7% relative change; IRR, 1.04; 95% CI, 1.03-1.04). There was greater than 2-fold variation in antibiotic prescribing rates across geographic census divisions. If higher prescribing divisions were to develop antibiotic prescribing rates similar to lower prescribing divisions, antibiotic use could be decreased by over 50%.
CONCLUSIONS AND RELEVANCE
Oral antibiotic prescribing by dermatologists associated with benign excisions, malignant excisions, and Mohs surgery is increasing over the past decade and there is substantial geographic variation. These findings highlight that there may be opportunities to optimize antibiotic use associated with dermatologic procedures.
Topics: Adult; Aged; Anti-Bacterial Agents; Cross-Sectional Studies; Databases, Factual; Dermatologic Surgical Procedures; Dermatologists; Dermatology; Drug Resistance, Microbial; Drug Utilization; Female; Humans; Incidence; Male; Middle Aged; Mohs Surgery; Retrospective Studies; Risk Assessment
PubMed: 30825412
DOI: 10.1001/jamadermatol.2019.0152 -
Dermatology and Therapy Sep 2018In this article, the first coauthor, a patient with a basal cell carcinoma on her upper lip, discusses her experience with Mohs micrographic surgery for the treatment of...
In this article, the first coauthor, a patient with a basal cell carcinoma on her upper lip, discusses her experience with Mohs micrographic surgery for the treatment of the skin cancer. The second coauthor, who is the patient's physician (a dermatologist who shares her last name but is not a relative), diagnosed her skin cancer and referred her for Mohs surgery. The third coauthor, who is the patient's son and not only a dermatologist, but also a dermatopathologist and a Mohs surgeon (and also shares her last name), summarizes the presentation and treatment of the basal cell carcinoma.
PubMed: 29860652
DOI: 10.1007/s13555-018-0245-2 -
Acta Dermato-venereologica May 2015Despite advances in treatment and surveillance, melanoma continues to claim approximately 9,000 lives in the US annually (SEER 2013). The National Comprehensive Cancer... (Review)
Review
Despite advances in treatment and surveillance, melanoma continues to claim approximately 9,000 lives in the US annually (SEER 2013). The National Comprehensive Cancer Network currently recommends ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma. Little data exists to guide management of cutaneous and subcutaneous metastases despite the fact that they are relatively common. Existing options include intralesional Bacillus Calmette-Guérin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation therapy, interferon therapy, and intratumoral interleukin-2 injections. Newly emerging treatments include the anti-programmed cell death 1 receptor agents (nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec). Available treatments for select sites include adoptive T cell therapies and dendritic cell vaccines. In addition to reviewing the above agents and their mechanisms of action, this review will also focus on combination therapy as these strategies have shown promising results in clinical trials for metastatic melanoma treatment.
Topics: Biological Products; Cancer Vaccines; Clinical Trials, Phase I as Topic; Combined Modality Therapy; Female; Humans; Immunotherapy; Injections, Intralesional; Interferons; Male; Melanoma; Mohs Surgery; Molecular Targeted Therapy; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; SEER Program; Skin Neoplasms; Treatment Outcome
PubMed: 25520039
DOI: 10.2340/00015555-2035 -
Actas Dermo-sifiliograficas Dec 2020Micrographic Mohs Surgery (MMS) offers the highest cure rates and healthy skin tissue sparing effect compared with standard excision.
BACKGROUND
Micrographic Mohs Surgery (MMS) offers the highest cure rates and healthy skin tissue sparing effect compared with standard excision.
OBJECTIVE
To quantify the tissue-sparing properties of MMS in squamous cell carcinoma (SCC) in comparison with standard excision (SE).
METHODS
A bidirectional, descriptive study, including 94 cases of SCC, was performed, on patients with histologic diagnosis of SCC (in situ, well differentiated, moderately differentiated, and undifferentiated), that where operated with MMS between 2013 and 2018 at Hospital de Clínicas Dr. Manuel Quintela in Montevideo, Uruguay. Tumor size and defect area after MMS were measured in 2 perpendicular directions. The suspected defect area was calculated with standard excision using a 4-mm margin for low risk lesions and a 10-mm margin for high risk lesions. The primary outcome of this study was the size of the defect area post MMS compared with the calculated defect area with standard excision.
RESULTS
The median tumor size was 1,41mm, and the median defect size after MMS was 4,12mm. The median defect size calculated for standard surgical excision was 8,36mm.
LIMITATIONS
We do not use all National Comprehensive Cancer Network (NCCN) criteria. We define low and high risk lesions just taking into account anatomical location, size, histopathology and whether it was a primary or recurrent tumor.
CONCLUSION
Our results show that MMS has a tissue-sparing effect of at least 52% compared to SE.
Topics: Carcinoma, Squamous Cell; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Skin Neoplasms; Uruguay
PubMed: 32717186
DOI: 10.1016/j.ad.2020.07.002 -
JAMA Facial Plastic Surgery Jul 2017Nasal reconstruction after Mohs surgery is a unique challenge in that it must satisfy both functional and aesthetic goals. Despite some advocacy in the literature for... (Comparative Study)
Comparative Study
IMPORTANCE
Nasal reconstruction after Mohs surgery is a unique challenge in that it must satisfy both functional and aesthetic goals. Despite some advocacy in the literature for using structural reinforcement to achieve both functional and aesthetic outcomes in soft-tissue reconstruction, no study has validated this claim by comparing reconstruction with and without structural support.
OBJECTIVE
To evaluate the effectiveness of and need for structural reinforcement when reconstructing the nasal alar and sidewall subunits.
DESIGN, SETTING, AND PARTICIPANTS
This study was a retrospective review of the medical records of 190 patients 18 years or older who underwent nasal reconstruction after Mohs surgery in a tertiary care academic center between January 1, 2013, and August 31, 2015. Data on each patient included demographics, comorbidities, smoking status, details of the lesion, size of defect, subunits involved, and reconstructive technique. Patients were divided into 2 cohorts composed of those who had reconstruction with structural reinforcement (ie, cartilage grafting or suspension suture) and those with only soft-tissue reconstruction. Patients with nasal obstruction from the functional collapse of the reconstructed area and no history of nasal obstruction were included (n = 38). Patients who had a follow-up of less than 2 months, no alar or sidewall involvement, nasal obstruction secondary to turbinate hypertrophy, septal deflection or other nonstructural causes, and incomplete documentation for analysis were excluded (n = 102).
MAIN OUTCOMES AND MEASURES
Rates of postoperative nasal obstruction secondary to nasal sidewall collapse and need for revision surgery.
RESULTS
Of the 38 patients who met the inclusion criteria, 22 were men and 16 were women with a mean (range) age of 64.5 (35-92) years. Twenty-three patients (61%) underwent reconstruction by a facial plastic surgeon and 15 (39%) by 2 dermatologic surgeons. Three (8%) underwent reconstruction without reinforcement and experienced postoperative nasal obstruction. The mean size of reconstructed defects that resulted in nasal valve collapse was 2.1 cm in diameter (range, 1.2-2.6 cm). Defect size was associated with incidence of postoperative nasal obstruction. For defects greater than 1.2 cm in diameter, patients reconstructed without reinforcement had a statistically significant increase of nasal obstruction secondary to functional nasal collapse compared with patients reconstructed with reinforcement (3 of 14 [21%] vs 0 of 17; 95% CI, 0.005-0.358; P = .04).
CONCLUSIONS AND RELEVANCE
Nasal defects greater than 1.2 cm in diameter and involving the alar and sidewalls were associated with lower incidence of postoperative nasal obstruction when a structural reinforcement technique was used in reconstruction. The findings of this study support the structural reinforcement of the nasal functional subunits during Mohs reconstructive surgery to achieve optimal outcomes.
LEVEL OF EVIDENCE
3.
Topics: Adult; Aged; Aged, 80 and over; Cartilage; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Nasal Cartilages; Nasal Obstruction; Postoperative Complications; Reoperation; Retrospective Studies; Rhinoplasty; Sutures
PubMed: 28334371
DOI: 10.1001/jamafacial.2017.0001 -
JMIR Dermatology Nov 2023
PubMed: 37966874
DOI: 10.2196/50381