-
Anais Brasileiros de Dermatologia 2021The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such...
BACKGROUND
The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact.
OBJECTIVE
To describe the authors' experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods.
METHODS
Retrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years.
RESULTS
One hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection).
STUDY LIMITATIONS
Retrospective design and the absence of long-term follow-up of some cases.
CONCLUSIONS
The dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.
Topics: Humans; Mohs Surgery; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Surgical Flaps
PubMed: 34090728
DOI: 10.1016/j.abd.2020.12.008 -
The Pan African Medical Journal 2019Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It... (Comparative Study)
Comparative Study Meta-Analysis Review
Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.
Topics: Dermatofibrosarcoma; Dermatologic Surgical Procedures; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Skin Neoplasms; Treatment Outcome
PubMed: 31692830
DOI: 10.11604/pamj.2019.33.297.17692 -
Dermatology Online Journal Aug 2019Patient falls remain a major cause of adverse events in the medical setting. Many patients receiving Mohs micrographic surgery are at high risk, both for falling and... (Review)
Review
UNLABELLED
Patient falls remain a major cause of adverse events in the medical setting. Many patients receiving Mohs micrographic surgery are at high risk, both for falling and resultant injuries. Although the incidence of patient falls in dermatologic surgery is low, falls can have significant consequences for both patient and provider. Therefore, effective interventions to improve organizational safety are critical. Though there is a considerable amount of research pertaining to fall prevention strategies, the majority of studies have been confined to the inpatient setting and long-term care facilities. Implementation of fall prevention initiatives in the outpatient setting has rarely been evaluated and no studies have focused on the Mohs patient population to date.
METHODS
We reviewed the literature pertaining to fall risk and prevention guidelines in the inpatient and outpatient settings as it applies to the dermatologic surgery environment.
RESULTS
Herein we will discuss patient risk factors for falling relevant to the Mohs setting and review existing validated fall risk assessment tools and strategies for fall prevention.
CONCLUSION
Identifying fall risk factors can improve patient safety and reduce falls in the dermatologic surgery clinic.
Topics: Accidental Falls; Age Factors; Ambulatory Care; Ambulatory Care Facilities; Ambulatory Surgical Procedures; Humans; Mohs Surgery; Patient Safety; Risk Assessment
PubMed: 31553857
DOI: No ID Found -
Journal of Clinical Medicine Apr 2022Porocarcinoma is a rare malignant adnexal tumor. Little is known about the location of the disease in the head and neck. Our aim is to offer the largest analysis of...
UNLABELLED
Porocarcinoma is a rare malignant adnexal tumor. Little is known about the location of the disease in the head and neck. Our aim is to offer the largest analysis of demographic, pathological, and treatment patterns of head and neck porocarcinoma in comparison with other locations of the neoplasm from an epidemiologically representative cohort.
METHOD
The Surveillance, Epidemiology, and End Results program of the National Cancer Institute was searched for all cases of porocarcinomas diagnosed between 2000 and 2018. This database is considered representative of the US population. Demographic, pathological, and treatment variables were compared between the head and neck and other regions. Overall and disease-specific survival was calculated and compared between groups.
RESULTS
563 porocarcinomas were identified, with 172 in the head and neck. The mean age was 66.4 years. Males were more affected in the head and neck. Regional and distant invasion rates were low (2.9 and 2.3%, respectively). Local excision and Mohs surgery were the most frequent therapies. Five-year overall survival was 74.8%. Five-year disease-specific survival was 97%.
CONCLUSIONS
Head and neck porocarcinoma affects more males than females. Regional or distant metastatic rates are low and overestimated in previous literature. Disease-specific mortality is low. Surgery remains the mainstay of treatment.
PubMed: 35456278
DOI: 10.3390/jcm11082185 -
Acta Dermato-venereologica Apr 2019
PubMed: 30924505
DOI: 10.2340/00015555-3132 -
World Journal of Surgical Oncology May 2023Dermatofibrosarcoma protuberans (DFSP) of the breast is a dermal fibroblastic neoplasm requiring wide excisional margins due to recurrence rates ranging from 26 to 60%....
Wide local excision, Mohs micrographic surgery, and reconstructive options for treatment of dermatofibrosarcoma protuberans of the breast: A retrospective case series from Mayo Clinic.
BACKGROUND
Dermatofibrosarcoma protuberans (DFSP) of the breast is a dermal fibroblastic neoplasm requiring wide excisional margins due to recurrence rates ranging from 26 to 60%. The current literature on reconstructive options and utility of Mohs micrographic surgery for DFSP of the breast is scarce. We describe surgical management of DFSP of the breast at our institution with the largest case series reported to date.
METHODS
A retrospective review was performed of women who underwent surgery for DFSP of the breast at our institution between 1990 and 2019. Continuous data was summarized using mean, median, and range; categorical data was summarized with frequency count and percentage. Preoperative lesion size and postoperative defect size were evaluated using 2-sided Fisher exact test, and p-values < 0.05 were considered statistically significant.
RESULTS
Nine patients underwent wide local excision (WLE) with reconstruction including pedicled latissimus dorsi flaps (n = 2), local flap advancement (n = 2), mastectomy with implant (n = 1), oncoplastic breast reduction (n = 1), and skin grafts (n = 3). Nine underwent Mohs micrographic surgery (MMS) with complex primary closure. Mean postoperative maximum wound defect size for WLE was 10.8 cm versus 7.0 cm for MMS with no statistical significance (p = 0.77). Mean preoperative maximum lesion size for WLE was 6.4 cm versus 3.3 cm for MMS with no statistical significance (p = 0.07). Complications with WLE included wound dehiscence in three patients and seroma in one patient. No complications were reported with MMS and primary closure. Recurrence was reported in one WLE patient, which was successfully detected despite flap coverage and resected without complications. Median follow-up for the patients without recurrence was 5.0 years, with two patients in MMS cohort lost to follow-up. Five-year overall survival was 100%.
CONCLUSIONS
MMS and WLE are both viable surgical options for managing DFSP of the breast. MMS could potentially minimize reconstructive needs due to smaller average defect size and result in fewer complications but may also result in asymmetry. Immediate flap reconstruction, especially in larger defects, can achieve excellent aesthetic outcomes for patients with DFSP of the breast without compromising detection of disease recurrence.
Topics: Humans; Female; Mohs Surgery; Retrospective Studies; Dermatofibrosarcoma; Breast Neoplasms; Skin Neoplasms; Neoplasm Recurrence, Local; Mastectomy
PubMed: 37147611
DOI: 10.1186/s12957-023-03022-9 -
Journal of Healthcare Engineering 2018The bacterium is responsible for significant morbidity, mortality, and financial burden in healthcare. It easily colonizes susceptible patients and can cause recurrent... (Review)
Review
The bacterium is responsible for significant morbidity, mortality, and financial burden in healthcare. It easily colonizes susceptible patients and can cause recurrent infections, especially in populations at risk. In addition to treating sequelae of infections, there is a growing body of literature aimed at decolonizing susceptible patients in order to prevent infection and also to prevent spread. Such strategies are widely employed in surgical, intensive care, and hospitalist fields. involvement has been implicated in the pathogenesis and persistence of many dermatologic diseases that are treated in the outpatient setting. This review serves to summarize current evidence for the management of colonized patients, as well as the evidence available for decolonization. We further characterize the role that colonization may play in atopic dermatitis, recurrent infections, hand eczema, cutaneous T-cell lymphoma, and also in surgical infections after Mohs surgery.
Topics: Anti-Bacterial Agents; Carrier State; Dermatitis, Atopic; Drug Resistance, Bacterial; Humans; Lymphoma, T-Cell, Cutaneous; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus aureus
PubMed: 30675332
DOI: 10.1155/2018/2382050 -
Facial Plastic Surgery & Aesthetic... 2022Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to... (Observational Study)
Observational Study
Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery. Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures-flaps and full-thickness skin grafts (FTSG). This retrospective case-control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair. The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression. The study population consisted of 143 propensity score-matched pairs ( = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection ( = 0.004), poor scar cosmesis ( < 0.0001), scar revision ( < 0.0001), or reoperation ( = 0.0007). Postoperative complication rates for placental reconstructions did not exceed those demonstrated by autologous tissue counterparts, indicating this is a safe alternative to flap and FTSG in cosmetically sensitive repairs.
Topics: Adult; Aged; Aged, 80 and over; Amnion; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chorion; Female; Humans; Male; Middle Aged; Mohs Surgery; Postoperative Complications; Propensity Score; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous; Treatment Outcome
PubMed: 34714143
DOI: 10.1089/fpsam.2021.0167 -
JAAD Case Reports Mar 2022
PubMed: 35242964
DOI: 10.1016/j.jdcr.2021.11.033 -
BMJ Case Reports Aug 2018Proliferating trichilemmal tumours are benign but locally aggressive skin neoplasms arising from hair follicles. Rarely, they can become malignant and must be...
Proliferating trichilemmal tumours are benign but locally aggressive skin neoplasms arising from hair follicles. Rarely, they can become malignant and must be appropriately managed to prevent recurrence and metastasis. One must have a low threshold for diagnosing this rare neoplasm.
Topics: Diagnosis, Differential; Female; Hair Follicle; Humans; Middle Aged; Mohs Surgery; Neoplasm Recurrence, Local; Scalp; Skin Neoplasms
PubMed: 30121565
DOI: 10.1136/bcr-2018-224460