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Journal of Surgical Oncology Jul 2023Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive cutaneous malignancy. Complete resection is the primary treatment but there is debate over the... (Review)
Review
Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive cutaneous malignancy. Complete resection is the primary treatment but there is debate over the optimal method. Wide local excision was traditionally the standard of care; however, National Comprehensive Cancer Network guidelines now recommend Mohs micrographic surgery as the preferred approach. Medical therapy with imatinib can be used in advanced or unresectable disease. This review will discuss the current management of DFSP, focusing on optimal surgical approach.
Topics: Humans; Dermatofibrosarcoma; Skin Neoplasms; Neoplasm Recurrence, Local; Skin; Mohs Surgery
PubMed: 36999599
DOI: 10.1002/jso.27258 -
JAAD Case Reports Mar 2024
PubMed: 38379877
DOI: 10.1016/j.jdcr.2024.01.005 -
Dermatologic Surgery : Official... Nov 2023Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient satisfaction. Despite the use of anxiolytic medications in outpatient procedures, there is limited comparative evidence on the efficacy and safety of these agents in Mohs micrographic surgery.
OBJECTIVE
To compare the effectiveness and safety of different preprocedural anxiolytic agents in Mohs surgery on perioperative patient anxiety and patient satisfaction.
MATERIALS AND METHODS
A double-blinded, randomized, placebo-controlled trial was conducted of 6 different preprocedural anxiolytic agents (lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin) in 350 patients undergoing Mohs surgery. Anxiety and vital signs were recorded.
RESULTS
Diazepam demonstrated a statistically significant, sustained reduction in anxiety levels compared with placebo ( p = .03). Gabapentin significantly reduced early anxiety ( p = .02). Alprazolam showed a trend to early anxiety reduction ( p = .08). Lorazepam ( p = .73), pregabalin ( p = .53), and melatonin ( p = .24) failed to reduce patient anxiety compared with placebo at any time point. No anxiolytic significantly impacted any patient vital sign or cognition.
CONCLUSION
Although short-acting benzodiazepines and gamma-aminobutyric acid medications may have transient anxiolytic effects, a single oral dose of 5 mg of diazepam can provide a sustained anxiolytic effect in Mohs surgery, with excellent patient safety.
Topics: Humans; Alprazolam; Anti-Anxiety Agents; Anxiety; Diazepam; Double-Blind Method; Gabapentin; Lorazepam; Melatonin; Mohs Surgery; Pregabalin
PubMed: 37606659
DOI: 10.1097/DSS.0000000000003905