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SAGE Open Medical Case Reports 2023Proliferating pilar tumors are rare, benign, exophytic neoplasms, which can closely resemble a squamous cell carcinoma. We describe a patient with a large benign...
Proliferating pilar tumors are rare, benign, exophytic neoplasms, which can closely resemble a squamous cell carcinoma. We describe a patient with a large benign exophytic tumor on the scalp that had been slowly growing over 10 years. While this class of benign follicular tumors is rare, the standard of care is typically excision with clear histologic margins. In this case, this large scalp tumor was surgically excised with clear margins/permanent section margin control using "Slow Mohs" technique, with subsequent repair using a skin substitute dressing, followed by a delayed skin graft.
PubMed: 38022863
DOI: 10.1177/2050313X231213928 -
Cureus Oct 2023Radiation dermatitis is a common side effect of radiotherapy in patients with acute and chronic changes affecting the skin. While acute changes occur within 90 days of...
Radiation dermatitis is a common side effect of radiotherapy in patients with acute and chronic changes affecting the skin. While acute changes occur within 90 days of radiation exposure, chronic changes manifest thereafter. This paper presents a case of a 70-year-old male with squamous cell carcinoma in situ (SCCIS) on the right zygoma who was treated with superficial radiation therapy (SRT), which resulted in a hypo-pigmented atrophic scar. The scar was successfully treated with a single session of Erbium:YAG laser therapy. The findings highlight the need for improved treatment options for radiation-induced skin changes and demonstrate the efficacy of fractionated laser therapy in addressing SRT-induced dermal atrophy.
PubMed: 38022065
DOI: 10.7759/cureus.47339 -
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 -
Dermatology Practical & Conceptual Oct 2023Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing... (Review)
Review
INTRODUCTION
Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing properties of MMS are appealing. The nasal tip is a common location of nonmelanoma skin cancer and can be a challenging anatomical structure for reconstructive surgery due to its prominent location in the face, the shortage of spare tissue, as well as the stiffness and composition of different skin types, cartilage and bone.
OBJECTIVES
The aim of the present paper is to review and demonstrate how reconstruction of the nasal tip can be done successfully to improve the care for patients undergoing MMS in this area.
METHODS
Using selected literature on the area and the surgeons experience, each method of repair are described including their individual advantages and challenges. Pictures and consent were selected from one patient who underwent each repair method and three photos are presented in this paper: one after tumor resection, one immediately after repair, and one minimum 6 months post-surgery.
RESULTS
We present eight surgical methods as well as pictures from previous surgeries.
CONCLUSIONS
The results demonstrate obtainable results using very different surgical methods and the importance of an individualized approach to repairing cutaneous defects of the nasal tip.
PubMed: 37992361
DOI: 10.5826/dpc.1304a228 -
Anais Brasileiros de Dermatologia 2024Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular...
BACKGROUND
Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision.
OBJECTIVE
To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile.
METHODS
A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded.
RESULTS
One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm were more likely to require complex reconstruction.
STUDY LIMITATIONS
Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly.
CONCLUSION
The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
Topics: Humans; Female; Middle Aged; Aged; Male; Retrospective Studies; Carcinoma, Basal Cell; Eyelid Neoplasms; Mohs Surgery; Neoplasm Recurrence, Local; Skin Neoplasms; Keratinocytes
PubMed: 37989688
DOI: 10.1016/j.abd.2023.05.004 -
Medicine Nov 2023Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade sarcoma with locally infiltrative characteristics. A wide excision is made with a 5 cm gross margin....
Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade sarcoma with locally infiltrative characteristics. A wide excision is made with a 5 cm gross margin. However, recently, Mohs micrographic surgery has emerged as an alternative. In this study, we evaluate a novel method (Saturn's Rings technique) for removing tumors that combines the advantages of wide excision and Mohs micrographic surgery. Between September 2001 and March 2020, 29 patients with DFSP, excluding the head and neck, were treated using Saturn's rings technique. Frozen biopsies were performed at regular intervals under various conditions and depths. If the biopsy was positive, a negative margin was obtained through an additional session. The depth and breadth of excision, reconstruction method, and postoperative recurrence were analyzed. The breadth of excision was evaluated at 1 cm intervals. Only 1 session was required in 12 cases, 2 sessions were needed in 13 cases, and 3 or more sessions were performed in 4 cases. In 24 cases, the depth of excision was limited to above the superficial fascia, with a negative biopsy of the superficial fascia. Local flaps were the most common reconstruction method (n = 21, 72.4%). No cases of recurrence were observed at follow-up (average, 45.7 months). Saturn's rings technique for DFSP maximized the preservation of normal tissue with minimal resection, was advantageous for reconstruction, and yielded good results without recurrence.
Topics: Humans; Dermatofibrosarcoma; Skin Neoplasms; Mohs Surgery; Dermatologic Surgical Procedures; Biopsy; Neoplasm Recurrence, Local
PubMed: 37986363
DOI: 10.1097/MD.0000000000036031 -
JMIR Dermatology Nov 2023
PubMed: 37966874
DOI: 10.2196/50381 -
PloS One 2023Perineal extramammary paget's disease (EMPD) is characterized with high recurrence rate. Although numerous therapeutic measures for this disease have been reported so... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Perineal extramammary paget's disease (EMPD) is characterized with high recurrence rate. Although numerous therapeutic measures for this disease have been reported so far, it is unknown whether there is significant difference in their recurrence-preventing efficiency. This study aims to compare the recurrence outcomes of reported perineal EMPD treatments.
METHODS
We searched public databases of for published studies concerning perineal EMPD treatments. After screening by inclusion and exclusion criteria, we extracted the data relevant to recurrence rate, and conducted network meta-analysis (NMA) by using Bayesian random-effects approach.
RESULTS
Our analysis included 29 previous studies (involving both male and female patients) and 11 treatment designs which are wide local excision (WLE), local excision (LE), Mohs micrographic surgery (MMS), radiotherapy (RT), radical vulvectomy (RV), photodynamic therapy (PDT), lasers (LS), imiquimod, and WLE+RT, WLE+PDT, WLE+LS. Comparing with WLE, the MMS showed significant advantage in reducing recurrence [OR: 0.18 (0.03-0.87)], while none of the rest treatments has statistically significant results. After removing outlier studies, MMS still has the significant advantages [OR: 0.35 (0.11-0.82)], and LE turned to be the treatment with worst performance [OR: 13 (2.50-110)]. Covariance analysis of follow-up length, gender differences, and lesion locations indicated only short follow-up time could affect the recurrence statistics, which tend to conceal the real differences. Funnel plot demonstrated there is no significant small study effect.
CONCLUSION
MMS has the best performance on reducing perineal EMPD recurrence, while LE exhibits the worst capability in such regard. Recurrence-preventing abilities of other treatments have no significant difference between each other.
Topics: Humans; Male; Female; Paget Disease, Extramammary; Bayes Theorem; Network Meta-Analysis; Mohs Surgery; Imiquimod; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 37956192
DOI: 10.1371/journal.pone.0294152 -
Kansas Journal of Medicine 2023
PubMed: 37954884
DOI: 10.17161/kjm.vol16.21184 -
Cureus Oct 2023This case study examines using a 40-gene expression profile (40-GEP) as an independent predictor of metastatic risk in a 74-year-old male with cutaneous squamous cell...
This case study examines using a 40-gene expression profile (40-GEP) as an independent predictor of metastatic risk in a 74-year-old male with cutaneous squamous cell carcinoma on the scalp. The patient's previous medical history included melanoma and non-melanoma skin cancers. While conventional staging methods, such as the American Joint Committee on Cancer 8th edition (AJCC8) and Brigham and Women's Hospital (BWH) staging, indicated a higher metastatic risk, the 40-GEP testing classified the patient as low risk (Class 1 result) for metastasis within three years. The patient underwent successful Mohs surgery with no evidence of perineural invasion. This case highlights the discrepancy between current staging techniques and gene expression profile testing, demonstrating the potential of the 40-GEP as a more accurate predictor of metastatic risk. The study contributes to the growing body of literature on the use of gene expression profile testing in cutaneous cancers, emphasizing the need for further research in this area to improve patient care outcomes using 40-GEP testing.
PubMed: 37954812
DOI: 10.7759/cureus.46853