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Dermatologic Surgery : Official... Dec 2023Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional...
BACKGROUND
Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional surgical excision. Competing performance measures have fostered numerous histologic techniques for MMS.
OBJECTIVE
To analyze differences in primary outcomes in the published literature regarding the technique of tissue processing and embedding during the MMS process.
METHODS
A systematic review was performed of the published literature in MEDLINE, PubMed, Embase, and Cochrane library that included a description of the manipulation of tissue during the grossing and embedding steps of MMS.
RESULTS
Inclusion criteria were met by 61 articles. Of these studies, the cure/recurrence rate was assessed in 1 article (1.6%), tissue conservation was assessed in 47 (77%), time-saving was assessed in 35 (57%), cost-saving was assessed in 6 (10%), and decreased artifact were assessed in 20 (33%).
CONCLUSION
There is a lack of standardization for assessing clinical outcomes in the published literature regarding MMS process techniques. Cure is a critical outcome in studies comparing MMS processing methodologies.
Topics: Humans; Mohs Surgery; Skin Neoplasms; Patient Reported Outcome Measures; Neoplasm Recurrence, Local
PubMed: 37962132
DOI: 10.1097/DSS.0000000000004013 -
Dermatologic Surgery : Official... Jan 2024Lidocaine is the most commonly used local anesthetic for Mohs micrographic surgery (MMS), but given its limited half-life, postoperative pain remains a significant...
BACKGROUND
Lidocaine is the most commonly used local anesthetic for Mohs micrographic surgery (MMS), but given its limited half-life, postoperative pain remains a significant concern for patients. Bupivacaine is used in various surgical subspecialty procedures and has demonstrated improved pain control compared with lidocaine. However, its role in MMS is insufficiently explored.
OBJECTIVE
To systematically review the current literature for reports on use of bupivacaine, traditional nonliposomal and newer liposomal formulations, for MMS.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE, PubMed, and EMBASE databases were queried for articles presenting original data on the use of bupivacaine for MMS.
RESULTS
Of 483 potentially relevant articles, 3 studies met final inclusion criteria, capturing a total of 253 patients involved in primary investigations comparing bupivacaine to traditional local anesthesia for MMS. Bupivacaine was well-tolerated and associated with comparable or modestly reduced intraoperative and postoperative pain and opioid use.
CONCLUSION
Bupivacaine may have a role in prolonging intraoperative anesthesia, reducing acute postoperative pain, and reducing postoperative opioid use after MMS. However, large, prospective studies are needed to solidify the generalizability and clinical utility of these findings.
Topics: Humans; Bupivacaine; Mohs Surgery; Analgesics, Opioid; Anesthetics, Local; Pain, Postoperative; Lidocaine
PubMed: 37861355
DOI: 10.1097/DSS.0000000000003981 -
JAAD International Dec 2023During Mohs surgery for melanoma, evidence has demonstrated that many surgeons opt for smaller initial margins than traditionally recommended (0.5 cm for in situ and...
BACKGROUND
During Mohs surgery for melanoma, evidence has demonstrated that many surgeons opt for smaller initial margins than traditionally recommended (0.5 cm for in situ and 1 cm for invasive). Literature regarding surgical outcomes based on initial margin is sparse.
OBJECTIVE
To determine differences in disease-specific survival of melanoma after Mohs micrographic surgery for varied initial surgical margins.
METHODS
A literature search was conducted on February 14, 2022, from MEDLINE via PubMed (1946-present), Embase (1974-present), Central (1991-present), and Scopus (1960-present). The primary outcome was disease-specific mortality.
RESULTS
Nineteen studies were included for final analysis. The overall disease-specific mortality rate of melanoma in all included studies was 0.5% (CI, 0.1-0.8; , .010). Disease-specific mortality for 1 to 5, 5, and 6 to 10 mm categories were 0.4% (CI, 0.0-0.9; , .074), 0.7% (CI, 0.2-1.3; , .2-1.3), and 0.4% (CI, -0.9 to 1.8; , .524), respectively. None of the variances across initial margin categories were statistically significant.
LIMITATIONS
Early-stage melanomas have low overall mortality rates. In our associated article, initial margins of 5 to 10 mm were shown to have the lowest rates of local recurrence.
CONCLUSIONS
In this systematic review and meta-analysis, melanoma-specific mortality was not significantly impacted by the initial surgical margin taken during Mohs micrographic surgery.
PubMed: 37823046
DOI: 10.1016/j.jdin.2023.06.009 -
Archives of Dermatological Research Dec 2023
Review
Topics: Humans; Mohs Surgery; Melanoma; Skin Neoplasms; Staining and Labeling
PubMed: 37603089
DOI: 10.1007/s00403-023-02711-5 -
Journal of the American Academy of... Jan 2024Proliferating pilar tumors (PPTs) are rare cutaneous neoplasms arising from hair follicles that have both malignant and metastatic potential. (Review)
Review
BACKGROUND
Proliferating pilar tumors (PPTs) are rare cutaneous neoplasms arising from hair follicles that have both malignant and metastatic potential.
OBJECTIVE
To present a systematic review of the epidemiology, clinical characteristics, and treatment and outcome data on PPTs.
METHODS
Using the OVID platform, MEDLINE and Embase were searched from inception until May 26, 2022. All studies that provided original data on PPTs in English were included. References of these studies were also cross-checked to identify any additional relevant articles. Oxford's Levels of Evidence-Based Medicine was used for quality assessment.
RESULTS
A total of 114 articles, providing data on 361 cases of PPTs, were included in our synthesis. Every study included was either a case series or case report. The mean age at diagnosis was 61.7. Most patients in the synthesis were female (71%), and the majority of cases occurred on the scalp (73.1%). The presence or absence of cytological atypia was only reported in one-third of the cases; 36.8% of cases were classified as malignant and 7.5% metastasized. Although no lesions treated with Mohs micrographic surgery required adjuvant radiation and only one reported recurrence occurred after Mohs surgery, there is insufficient data to make conclusions on a superior treatment modality.
LIMITATIONS
All studies in this review were either case reports or case series.
CONCLUSIONS AND RELEVANCE
Our study supports the notion that PPTs occur most commonly on the scalp of elderly female patients. Moreover, our findings confirm that PPT is capable of demonstrating aggressive biology and metastasis. Given the lack of uniformity in histologic description, pathologists should be encouraged to comment on the presence and degree of cytological atypia when reporting cases of rare neoplasms such as the PPT. Greater consensus on diagnosis and classification as well as more robust data is needed regarding optimal management.
Topics: Aged; Female; Humans; Male; Hair Diseases; Hair Follicle; Neoplasms, Adnexal and Skin Appendage; Radiotherapy, Adjuvant; Skin Neoplasms
PubMed: 37364614
DOI: 10.1016/j.jaad.2023.05.097 -
Journal of the American Academy of... Oct 2023
Meta-Analysis
Topics: Humans; Mohs Surgery; Surgical Wound Infection; Skin Neoplasms; Neoplasm Recurrence, Local
PubMed: 37364613
DOI: 10.1016/j.jaad.2023.06.032 -
Facial Plastic Surgery : FPS Jun 2024Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to... (Comparative Study)
Comparative Study
Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format-population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.
Topics: Humans; Mohs Surgery; Postoperative Complications; Time-to-Treatment; Skin Neoplasms; Facial Neoplasms; Time Factors
PubMed: 37336502
DOI: 10.1055/a-2112-7073 -
Dermatologic Surgery : Official... Aug 2023Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Local recurrence (LR) rates of melanoma in situ (MIS) of the nail apparatus treated with different surgical modalities are unknown.
OBJECTIVE
To evaluate the differences in LR rates of nail apparatus MIS treated with Mohs micrographic surgery (MMS) versus nail unit excision (NUE) versus amputation.
METHODS
Studies of nail/subungual MIS treated with MMS, NUE, or amputation were identified through multiple literature databases, including PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library. Pooled data were assessed through meta-analyses and Fisher exact test.
RESULTS
Of 280 studies identified, 20 met inclusion criteria (7 comparative studies and 13 single-arm studies). Among the 7 comparative studies, the LR was 4.38% (5/114) after NUE and 2.94% (1/34) after amputation (odds ratio: 0.937; 95% CI: 0.237-3.703). In the 13 noncomparative studies, 23 patients underwent MMS (pooled LR estimate: 11.07%; 95% CI: 3.22%-31.81%) and 140 patients underwent NUE (pooled LR estimate:8.04%, 95% CI: 4.43%-14.16%). The difference in LR rate between MMS, NUE, and amputation was not statistically significant ( p = .578).
CONCLUSION
Local recurrence of nail/subungual MIS in cases treated with MMS was not statistically different than in cases treated with NUE and was comparable to amputation. Further studies investigating the use of MMS for the treatment of nail/subungual MIS are warranted.
Topics: Humans; Mohs Surgery; Treatment Outcome; Skin Neoplasms; Melanoma; Nail Diseases; Neoplasm Recurrence, Local; Retrospective Studies; Melanoma, Cutaneous Malignant
PubMed: 37249515
DOI: 10.1097/DSS.0000000000003840 -
Archives of Dermatological Research Nov 2023Mohs micrographic surgery (MMS) may be an effective treatment modality for oral cavity cancers (OCC) due to possibility of more effective visualization of tumor margins... (Review)
Review
Mohs micrographic surgery (MMS) may be an effective treatment modality for oral cavity cancers (OCC) due to possibility of more effective visualization of tumor margins and greater preservation of benign tissue. The objective of this study is to review the existing literature on the use of MMS for the treatment of OCC and categorize its uses and limitations. A systematic review was performed in accordance with Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. PubMed, Scopus, and Google Scholar from inception of databases to January 20, 2023 identified all published studies on the use of MMS for OCC. Nine studies met inclusion criteria. Seventy-seven patients were treated with MMS for OCC, 74 of which (96%) were treated for squamous cell carcinoma (SCC). The tongue was the most common site (n = 57). Six out of seven studies showed no recurrence of disease during the follow-up periods, which ranged from 8 to 42 months, and one study reported significantly lower loco-regional recurrence over a 2-years follow-up period (10.5% vs 25.7%). Mohs technique did not cause a statistically significant increase in operating time. Applicability of MMS is limited by operator comfort with surgical technique and pathological interpretation of specimens in the oral cavity. The main limitation was that various studies did not report specific patient characteristics. In conclusion, MMS may be an effective treatment for OCC, especially for squamous cell carcinomas, and tumors involving the tongue.
Topics: Humans; Carcinoma, Squamous Cell; Mohs Surgery; Mouth Neoplasms; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms; Systematic Reviews as Topic
PubMed: 37173597
DOI: 10.1007/s00403-023-02632-3 -
Dermatologic Surgery : Official... Aug 2023
Topics: Humans; Timolol; Wound Healing
PubMed: 37146181
DOI: 10.1097/DSS.0000000000003829