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Acta Dermato-venereologica Feb 2021Facial high-risk basal cell carcinomas are preferably treated with Mohs micrographic surgery, but only 10% of patients are offered Mohs micrographic surgery in Sweden....
Facial high-risk basal cell carcinomas are preferably treated with Mohs micrographic surgery, but only 10% of patients are offered Mohs micrographic surgery in Sweden. The aim of this retrospective study was to examine the differences between primary and recurrent or incompletely excised facial high-risk basal cell carcinomas undergoing Mohs micrographic surgery, with regard to the number of stages, final defect sizes, reconstructive techniques and other consequences. The study was performed during the period 2012 to 2019 at our centre. A total of 903 basal cell carcinomas in 813 patients (70.1% primary, 10.4% incompletely excised and 19.5% recurrences) were included. The mean number of Mohs micrographic surgery stages was significantly lower for primary basal cell carcinomas compared with recurrences (p = 0.03), and the mean final defect size was significantly smaller in primary basal cell carcinomas compared with both recurrent (p < 0.0001) and incompletely excised (p = 0.003) tumours. Primary basal cell carcinomas tended to more often be reconstructed by primary closure (p = 0.08). Mohs micrographic surgery indications for facial high-risk basal cell carcinomas should be respected and used more frequently on primary basal cell carcinomas, in order to enable better utilization of resources and improved outcomes for the patient.
Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms; Sweden
PubMed: 33205823
DOI: 10.2340/00015555-3698 -
International Journal of Surgery... Feb 2024The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of... (Review)
Review
BACKGROUND
The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence.
MATERIALS AND METHODS
The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence.
RESULTS
Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation.
CONCLUSIONS
Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.
Topics: Humans; Male; Anti-Bacterial Agents; Antibiotic Prophylaxis; Randomized Controlled Trials as Topic; Meta-Analysis as Topic
PubMed: 38016138
DOI: 10.1097/JS9.0000000000000923 -
Cureus Feb 2022Surgical defects involving multiple facial cosmetic subunits can be challenging to reconstruct. We report on a patient with a complex temporal defect following Mohs...
Surgical defects involving multiple facial cosmetic subunits can be challenging to reconstruct. We report on a patient with a complex temporal defect following Mohs micrographic surgery (MMS) for a basal cell carcinoma (BCC). The extension of the defect across the left temple, cheek, and forehead hindered the utilization of linear closures or flaps. Healing by secondary intention was considered but was determined to be a suboptimal approach given the involvement of the convex cheek. A modified full-thickness skin graft (FTSG) with linear closures of the distal poles of the wound was ultimately utilized, with excellent cosmetic results at three-month follow-up. Herein, the authors summarize this case and the indications for FTSG and secondary intention healing (SIH) for surgical defects involving the face.
PubMed: 35371669
DOI: 10.7759/cureus.22621 -
Anais Brasileiros de Dermatologia 2020The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is...
BACKGROUND
The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy.
OBJECTIVES
a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery.
METHODS
Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery.
RESULTS
The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases.
STUDY LIMITATIONS
Retrospective nature, sample size, and biopsies performed by different professionals.
CONCLUSIONS
The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.
Topics: Biopsy; Carcinoma, Basal Cell; Humans; Mohs Surgery; Retrospective Studies; Skin Neoplasms
PubMed: 32693938
DOI: 10.1016/j.abd.2020.04.005 -
JAMA Facial Plastic Surgery Mar 2018Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the...
IMPORTANCE
Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate.
OBJECTIVE
To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient- and surgery-specific variables, especially timing of repair.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records.
MAIN OUTCOMES AND MEASURES
Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss.
RESULTS
A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications.
CONCLUSIONS AND RELEVANCE
We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts.
LEVEL OF EVIDENCE
3.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Mohs Surgery; Postoperative Complications; Retrospective Studies; Risk Factors; Skin Neoplasms; Time Factors; Treatment Outcome
PubMed: 28880987
DOI: 10.1001/jamafacial.2017.1154 -
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 Journal of Dermatological Treatment Dec 2023Mohs micrographic surgery (MMS) is the preferable surgery for difficult -to-treat basal cell carcinoma (BCC) but is an expensive, labor-intensive, and time-consuming...
BACKGROUND
Mohs micrographic surgery (MMS) is the preferable surgery for difficult -to-treat basal cell carcinoma (BCC) but is an expensive, labor-intensive, and time-consuming technique. The aim of this study is to compare the efficacy and safety of photodynamic therapy combined with surgery(S-PDT) versus Mohs micrographic surgery (MMS) for the treatment of difficult-to-treat BCC.
METHODS
This was a retrospective, comparative study. A total of 32 patients, 16 patients with 48 lesions, were treated with S-PDT, and the other 16 patients with 17 lesions treated by MMS were enrolled in this study. Follow-up was at least 36 months posttreatment.
RESULTS
The recurrence rate was no statistical difference between the S-PDT and MMS ( = 1.000, Fishers exact test). The median follow-up was 42.5 months (range 36-63 months). The mean healing time in the S-PDT [17.9 d (SD 9.8)] is longer than in MMS [7.5 d (SD 1.5)] during follow-up (<.001, Independent -test). On the whole, the cosmetic outcome of patients in S-PDT was statistically no significant difference with that in MMS according to a 4-point scale ( = .719, chi-squared test).
CONCLUSIONS
S-PDT is a safe, effective, and novel cosmetic treatment, which holds the potential to be an alternative treatment to MMS for some cases.
Topics: Humans; Skin Neoplasms; Mohs Surgery; Retrospective Studies; Treatment Outcome; Neoplasm Recurrence, Local; Carcinoma, Basal Cell; Photochemotherapy
PubMed: 37036184
DOI: 10.1080/09546634.2023.2200871 -
Journal of Graduate Medical Education Dec 2017
Topics: Fellowships and Scholarships; Hospitals; Humans; Internship and Residency; Mohs Surgery; Personnel Management; Physicians; San Francisco
PubMed: 29270280
DOI: 10.4300/JGME-D-17-00494.1 -
JAAD International Jun 2023Patients with chronic lymphocytic leukemia (CLL) are immunocompromised and have both a higher incidence of and more aggressive skin cancers, often requiring treatment...
BACKGROUND
Patients with chronic lymphocytic leukemia (CLL) are immunocompromised and have both a higher incidence of and more aggressive skin cancers, often requiring treatment with Mohs micrographic surgery.
OBJECTIVE
Characterize operative expectations for Mohs surgery in patients with CLL.
METHODS
Multicenter retrospective cohort study.
RESULTS
One hundred fifty-nine tumors from 99 patients with CLL were matched 1:4 with controls. Cases had higher odds for requiring at least 3 stages during Mohs surgery compared to controls (odds ratio = 1.91; 95% CI [1.21-3.02]; = .01). The mean number of Mohs stages in cases was 1.97 (±0.92) compared with 1.67 (±0.87) in controls ( = .0001). A regression analysis showed that cases had larger postoperative tumor areas (cm) versus controls (mean = 5.57 vs 4.47; estimate difference Δβ = 1.10 cm; 95% CI [0.18-2.03]; = .02). In logistic regression, cases were twice as likely to receive a flap repair compared to controls (odds ratio = 2.45; 95% CI [1.58-3.8]).
LIMITATIONS
Retrospective cohort study and lack of histologic subtyping of tumors.
CONCLUSION
Patients with CLL require more Mohs stages to attain clear surgical margins, have larger postoperative defect areas, and require more advanced repair techniques compared to a control population without CLL. These findings are essential for preoperative planning and patient counseling and further support the use of Mohs surgery in patients with CLL.
PubMed: 37138831
DOI: 10.1016/j.jdin.2023.02.014 -
JAMA Dermatology Mar 2021Concerns have been raised about the use of radiotherapy (RT) by dermatologists. Little is known about temporal trends in payment for RT among dermatologists.
IMPORTANCE
Concerns have been raised about the use of radiotherapy (RT) by dermatologists. Little is known about temporal trends in payment for RT among dermatologists.
OBJECTIVE
To characterize changes in RT use and payment among dermatologists treating patients enrolled in Medicare.
DESIGN, SETTING, AND PARTICIPANTS
A cross-sectional, population-based retrospective analysis of dermatologists submitting Medicare claims was conducted. Dermatologists identified in the 2013-2017 Medicare Physician and Other Supplier Public Use File, which includes information on fee-for-service payments and service use among physicians caring for Medicare beneficiaries, were included in the analysis. The study was conducted from March 18 to October 22, 2020.
MAIN OUTCOMES AND MEASURES
Numbers and types of RT, current terminology codes billed by dermatologists, number of dermatologists providing RT services, total payments and median payments per dermatologist for RT services, total services and median services per dermatologist, and number of dermatologists billing for both RT and Mohs micrographic surgery services.
RESULTS
From 2013 to 2017, dermatologists billed RT codes, which included RT planning, preparation, delivery, and management services with varying levels of complexity. The number of dermatologists using RT increased from 115 to 198 between 2013 to 2017. Total payments and total services for RT have fluctuated over time. Median payments per dermatologist and median services provided per dermatologist for RT reached their highest level in 2017 ($80 810 and 629 services). In 2013, RT delivery was the highest reimbursed RT service type (total paid, $9 121 505). By 2017, clinical treatment planning and simulation was the highest reimbursed service type (total paid, $20 288 796).
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study indicate that dermatologist use of RT continues to increase. A wide variety of RT services are billed by dermatologists. Further research is needed to ensure expanded use is safe, efficacious, and cost-effective.
Topics: Cross-Sectional Studies; Dermatologists; Dermatology; Fee-for-Service Plans; Humans; Medicare; Mohs Surgery; Practice Patterns, Physicians'; Retrospective Studies; United States
PubMed: 33355610
DOI: 10.1001/jamadermatol.2020.4931