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Plastic and Reconstructive Surgery.... Mar 2023Basal cell carcinoma (BCC) is the most common malignancy worldwide. The incidence of BCC is increasing up to 10% per year worldwide. Surgical excision and Mohs surgery...
UNLABELLED
Basal cell carcinoma (BCC) is the most common malignancy worldwide. The incidence of BCC is increasing up to 10% per year worldwide. Surgical excision and Mohs surgery are the gold standard treatment modalities. However, patients may not be candidates for surgery. Pulsed dye laser (PDL) is a novel technique for treating BCC.
METHODS
Patients with biopsy-proven BCC underwent two treatments with PDL at 6-week intervals at Berkshire Cosmetic and Reconstructive Surgery Center. Patients returned 6 weeks after the second treatment for evaluation for response to treatment. Follow-up examinations were conducted at 6, 12, and 18 months after treatment with PDL.
RESULTS
Twenty patients with 21 biopsy-proven BCCs were treated with PDL at Berkshire Cosmetic and Reconstructive Surgery Center between 2019 and 2021. Nineteen BCCs had a complete response after two treatments, for a clearance rate of 90%. Two of the 21 lesions did not respond for an incomplete response rate of 10%.
CONCLUSION
PDL is an effective nonsurgical treatment option in the management of BCC.
PubMed: 36891564
DOI: 10.1097/GOX.0000000000004850 -
Archives of Dermatological Research Dec 2023Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist...
Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist future policy and clinical decisions to correct them. For the years 2014-2018, the CPT codes for MMS (17,311 and 17,313) were counted on a per county level across the United States per the Medicare Centers for Medicare & Medicaid Services (CMS) Medicare Prescriber Database. Any county with 0 MMS CPT codes recorded were classified as "without MMS cases." MMS "hotspots" were identified as counties that possessed a high average number of MMS cases compared to the national average, while also being surrounded by counties that possessed a low average number of MMS cases compared to the national average. Three thousand eighty-four counties in the United States were analyzed; 785 (25%) counties were designated as "with MMS cases" and 2301 (75%) "without MMS cases." There were no significant differences in age, ethnicity distribution, or cost per enrollee between the two designations. 74% of counties with MMS cases were considered urban, while only 25% of those without cases were urban (p < 0.01). The median household income was markedly higher in counties with MMS cases ($71,428 vs. $58,913, p < 0.01). With respect to education, more individuals in counties with MMS cases possessed their General Education Development (GED) (89% vs. 86%, p < 0.01) or a college degree (30% vs. 19%, p < 0.01). Forty-nine counties were considered MMS "hotspots." The density of MMS procedures varies greatly based on geography, maintaining the urban-rural disparity matched by the distribution of MMS surgeons. Additionally, there remains a wide income and educational gap between counties with and without MMS. Identifying MMS hotspots may facilitate further investigation into potential surgical access disparities.
Topics: Aged; Humans; United States; Mohs Surgery; Cross-Sectional Studies; Medicare; Skin Neoplasms; Surgeons; Retrospective Studies
PubMed: 38060044
DOI: 10.1007/s00403-023-02751-x -
Journal of Visualized Experiments : JoVE May 2017The incidence of skin cancer (e.g., squamous cell carcinoma, basal cell carcinoma, and melanoma) has been increasing over the past several years. It is expected that...
The incidence of skin cancer (e.g., squamous cell carcinoma, basal cell carcinoma, and melanoma) has been increasing over the past several years. It is expected that there will be a parallel demand for cutaneous tumor samples for biomedical research studies. Tissue availability, however, is limited due the cost of establishing a biorepository and the lack of protocols available for obtaining clinical samples that do not interfere with clinical operations. A protocol was established to collect and process cutaneous tumor and associated blood and saliva samples that has minimal impact on routine clinical procedures on the date of a Mohs surgery. Tumor samples are collected and processed from patients undergoing their first layer of Mohs surgery for biopsy-proven cutaneous malignancies by the Mohs histotechnologist. Adjacent normal tissue is collected at the time of surgical closure. Additional samples that may be collected are whole-blood and buccal swabs. By utilizing tissue samples that are normally discarded, a biorepository was generated that offers several key advantages by being based in the clinic versus the laboratory setting. These include a wide range of collected samples; access to de-identified patient records, including pathology reports; and, for the typical donor, access to additional samples during follow-up visits.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Melanoma; Mohs Surgery; Skin Neoplasms
PubMed: 28605380
DOI: 10.3791/55583 -
Dermatology Online Journal Apr 2020Mohs micrographic surgery (MMS) is a breakthrough surgical technique that has changed the management of neoplasms in dermatology. Through continued practice and...
Mohs micrographic surgery (MMS) is a breakthrough surgical technique that has changed the management of neoplasms in dermatology. Through continued practice and evolution, MMS now can successfully treat a variety of rare non-melanocytic cutaneous malignancies for which achieving remission and the optimal aesthetic result after surgery was previously challenging. Mohs micrographic surgery has utility for conditions besides melanoma. Herein, we discuss this versatility of Mohs micrographic surgery. Specifically, Mohs micrographic surgery can be successfully used for cases such as dermatofibrosarcoma protuberans, atypical fibroxanthomas, extramammary Paget disease, Merkel cell carcinoma, sebaceous carcinoma, and microcystic adnexal carcinoma.
Topics: Humans; Mohs Surgery; Skin Neoplasms
PubMed: 32621679
DOI: No ID Found -
American Family Physician Oct 2020
Topics: Aged; Dermatofibrosarcoma; Diagnosis, Differential; Humans; Male; Mohs Surgery; Neoplasm Recurrence, Local; Skin Neoplasms; Thigh
PubMed: 32996753
DOI: No ID Found -
Journal of Plastic, Reconstructive &... Mar 2022Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients'...
BACKGROUND
Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients' satisfaction after reconstruction for nasal defects following Mohs micrographic surgery.
METHODS
Patients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer - Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative).
RESULTS
A total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39).
CONCLUSION
Patients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.
Topics: Female; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps
PubMed: 34903490
DOI: 10.1016/j.bjps.2021.11.028 -
Advances in Medical Education and... 2017Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning...
BACKGROUND
Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents' ability to plan surgical reconstructions.
MATERIALS AND METHODS
The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale.
RESULTS
Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50-2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00-3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25-0.50 Likert scale points among all residents participating in the educational activity and 0.50-1.00 Likert scale points in the dermatology resident subset. All residents participating in the educational activity somewhat or completely agreed with the statement, "I am faster at planning reconstructions after my Mohs rotation." In addition, 88% of participants "somewhat or completely agreed" that the exercise was a good educational experience.
CONCLUSION
The Mohs Surgical Reconstruction Educational Activity is a valuable novel tool for learning reconstructive planning that is easy to incorporate into existing dermatology residency curricula, inexpensive, and utilizes active learning.
PubMed: 28223854
DOI: 10.2147/AMEP.S125454 -
Plastic and Reconstructive Surgery.... Dec 2020Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally... (Review)
Review
Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs micrographic surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs micrographic surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs micrographic surgery is not readily available.
PubMed: 33425610
DOI: 10.1097/GOX.0000000000003300 -
Dermatologic Surgery : Official... Jun 2016Mohs micrographic surgery (MMS) with melanoma antigen recognized by T-cell (MART-1) immunostaining is an effective treatment of cutaneous melanoma.
BACKGROUND
Mohs micrographic surgery (MMS) with melanoma antigen recognized by T-cell (MART-1) immunostaining is an effective treatment of cutaneous melanoma.
OBJECTIVE
To determine the efficacy of MMS with MART-1 immunostain in the management of invasive and in situ melanoma.
METHODS AND MATERIALS
A retrospective cohort study evaluated 2,114 melanomas in 1,982 patients excised using MMS and MART-1 immunostain. The margins required for excision were calculated based on Breslow thickness, location, and size. Survival and local recurrence rates were calculated and compared with those of historical controls.
RESULTS
The mean follow-up period was 3.73 years. Local recurrence was identified in 0.49% (7/1,419) of primary melanomas. Approximately 82% of melanomas were excised with ≤6-mm margins. The surgical margin was significantly related to tumor location and size but not to Breslow thickness. The five-year Kaplan-Meier local recurrence and disease-specific survival rates were 0.59 ± 0.30 and 98.53 ± 0.42, respectively. Mohs micrographic surgery with MART-1 immunostain achieved lower local recurrence rates and equivalent or higher Kaplan-Meier survival rates than conventional wide local excision.
CONCLUSION
Mohs micrographic surgery with MART-1 immunostain is an effective treatment of melanoma as evidenced by low local recurrence rates. It offers the advantage of more tissue-conserving margins than those recommended for conventional excision.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma in Situ; Child; Female; Humans; MART-1 Antigen; Male; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Retrospective Studies; Skin Neoplasms; Survival Rate; Treatment Outcome
PubMed: 27158886
DOI: 10.1097/DSS.0000000000000725