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Archives of Dermatological Research Apr 2024This paper explores the role of teledermatology (TD) in Mohs micrographic surgery (MMS) at various stages of patient care. The study aims to assess the benefits,... (Review)
Review
This paper explores the role of teledermatology (TD) in Mohs micrographic surgery (MMS) at various stages of patient care. The study aims to assess the benefits, limitations, and patient experiences surrounding TD integration into MMS practices. We conducted a PubMed search using keywords related to TD and MMS, categorizing selected articles into pre-operative, intra-operative, and post-operative stages of MMS. TD reduced waiting times (26.10 days for TD compared to 60.57 days for face-to-face [FTF]) and consultation failure rates (6% for TD vs. 17% for FTF) for MMS preoperative consultations. It also shortened time to treatment by two weeks and led to notable travel savings (162.7 min, 144.5 miles, and $60.00 per person). Telepathology facilitated communication and decision-making during MMS, improving accuracy and efficiency, especially in challenging cases requiring collaboration where physical presence of another surgeon or pathologist is not feasible. Telepathology definitively diagnosed benign lesions and malignant tumors in 81.8% of cases (18/22). Additionally, there was a 95% agreement between conventional light microscopy diagnosis and telepathology in tumors (19/20), and 100% agreement for all 20 Mohs frozen section consultations. For post-operative follow-up, telephone follow-up (TFU) and text messaging proved effective, cost-efficient alternatives with high patient satisfaction (94% in New Zealand and 96% in the U.K.) and early complication identification. This study underscores TD's multifaceted benefits in MMS: enhanced patient experience preoperatively, improved communication during surgery, and cost-effective postoperative follow-up. Limitations include the financial expense and technical issues that can arise with TD (connectivity problems, delays in video/audio transmission, etc.). Further studies are needed to explore emerging TD modalities in post-operative patient management. The integration of TD into MMS signifies a progressive step in dermatological care, offering convenient, cost-effective, and better solutions with the potential to enhance patient experiences and outcomes.
Topics: Humans; Mohs Surgery; Communication; New Zealand; Pathologists; Patient Satisfaction
PubMed: 38625403
DOI: 10.1007/s00403-024-02851-2 -
OTO Open 2024
PubMed: 38618287
DOI: 10.1002/oto2.133 -
Medicine Apr 2024Basal cell carcinoma (BCC) represents the most prevalent cancer globally. The past decade has witnessed significant advancements in BCC treatment, primarily through... (Review)
Review
Basal cell carcinoma (BCC) represents the most prevalent cancer globally. The past decade has witnessed significant advancements in BCC treatment, primarily through bibliometric studies. Aiming to perform a comprehensive bibliometric analysis of BCC treatments to comprehend the research landscape and identify trends within this domain, a dataset comprising 100 scientific publications from the Web of Science Core Collection was analyzed. Country co-operation, journal co-citation, theme bursts, keyword co-occurrence, author co-operation, literature co-citation, and field-specific references were examined using VOSviewer and CiteSpace visualization tools. These articles, published between 2013 and 2020, originated predominantly from 30 countries/regions and 159 institutions, with the USA and Germany at the forefront, involving a total of 1118 authors. The keyword analysis revealed significant emphasis on the hedgehog pathway, Mohs micrographic surgery, and photodynamic therapy. The research shows developed nations are at the forefront in advancing BCC therapies, with significant focus on drugs targeting the hedgehog pathway. This treatment avenue has emerged as a crucial area, meriting considerable attention in BCC therapeutic strategies.
Topics: Humans; Bibliometrics; Carcinoma, Basal Cell; Hedgehog Proteins; Photochemotherapy; Skin Neoplasms
PubMed: 38608090
DOI: 10.1097/MD.0000000000037629 -
Indian Journal of Dermatology,... Apr 2024Background Dermatofibrosarcoma protuberans (DFSP) is one of the most challenging cutaneous cancers in surgical clinic practice. Excision with negative margins is...
Background Dermatofibrosarcoma protuberans (DFSP) is one of the most challenging cutaneous cancers in surgical clinic practice. Excision with negative margins is essential for effective disease control. However, wide surgical margins and maximal tissue conservation are mutually exclusive. Mohs micrographic surgery conserves tissue but is time-consuming. Thus, we developed a novel specimen radiography system that can be used intraoperatively. Aims To introduce a specimen radiography system for evaluating intraoperative surgical margins in patients with dermatofibrosarcoma protuberans. Methods Since September 2017, we have treated seven biopsy-proven cases of local DFSPs via local excision with surgical margins of 2-4 cm. During operations, the operative specimens were screened using the specimen radiography system. All surgical specimens were pathologically examined intraoperatively. Results Five patients were men and two were women, of median age 36 years. The mean radiographic screening time was 9.7 ± 2.3 min. Radiographically negative margins were confirmed intraoperatively. The minimal margin width ranged from 5.0 to 35.4 mm (mean width 16.9 ± 10.4 mm). The intraoperatively negative radiographic margins were consistent with those revealed by postoperative pathology. The minimal pathological margin width ranged from 4.0 to 34.5 mm (mean 16.6 ± 10.1 mm) and was not significantly different from the intraoperative data. Limitations The sample size was small and positive or negative predictive values were not calculated. Conclusions We introduce a novel method of intraoperative surgical margin assessment for DFSP patients. It may find broad clinical and research applications during oncoplastic surgery.
PubMed: 38594975
DOI: 10.25259/IJDVL_959_2021 -
Dermatologic Surgery : Official... Jun 2024Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs.
BACKGROUND
Mohs micrographic surgery efficiently treats skin cancer through staged resection, but surgeons' varying resection rates may lead to higher medical costs.
OBJECTIVE
To evaluate the cost savings associated with a quality improvement.
MATERIALS AND METHODS
The authors conducted a retrospective cohort study using 100% Medicare fee-for-service claims data to identify the change of mean stages per case for head/neck (HN) and trunk/extremity (TE) lesions before and after the quality improvement intervention from 2016 to 2021. They evaluated surgeon-level change in mean stages per case between the intervention and control groups, as well as the cost savings to Medicare over the same time period.
RESULTS
A total of 2,014 surgeons performed Mohs procedures on HN lesions. Among outlier surgeons who were notified, 31 surgeons (94%) for HN and 24 surgeons (89%) for TE reduced their mean stages per case with a median reduction of 0.16 and 0.21 stages, respectively. Reductions were also observed among outlier surgeons who were not notified, reducing their mean stages per case by 0.1 and 0.15 stages, respectively. The associated total 5-year savings after the intervention was 92 million USD.
CONCLUSION
The implementation of this physician-led benchmarking model was associated with broad reductions of physician utilization and significant cost savings.
Topics: Humans; Retrospective Studies; Medicare; United States; Quality Improvement; Cost Savings; Skin Neoplasms; Mohs Surgery; Follow-Up Studies; Practice Patterns, Physicians'; Male; Female; Surgeons; Head and Neck Neoplasms
PubMed: 38578837
DOI: 10.1097/DSS.0000000000004165 -
JAAD Case Reports Apr 2024
PubMed: 38577501
DOI: 10.1016/j.jdcr.2024.02.012 -
World Journal of Clinical Cases Mar 2024Eccrine porocarcinoma (EPC) is a rare skin tumor that mainly affects the elderly population. Tumors often present with slow growth and a good prognosis. EPCs are usually...
BACKGROUND
Eccrine porocarcinoma (EPC) is a rare skin tumor that mainly affects the elderly population. Tumors often present with slow growth and a good prognosis. EPCs are usually distinguished from other skin tumors using histopathology and immunohistochemistry. However, surgical management alone may be inadequate if the tumor has metastasized. However, currently, surgical resection is the most commonly used treatment modality.
CASE SUMMARY
A seventy-four-year-old woman presented with a slow-growing nodule in her left temporal area, with no obvious itching or pain, for more than four months. Histopathological examination showed small columnar and short spindle-shaped cells; thus, basal cell carcinoma was suspected. However, immunohistochemical analysis revealed the expression of cytokeratin 5/6, p63 protein, p16 protein, and Ki-67 antigen (40%), and EPC was taken into consideration. The skin biopsy was repeated, and hematoxylin and eosin staining revealed ductal differentiation in some cells. Finally, the patient was diagnosed with EPC, and Mohs micrographic surgery was performed. We adapted follow-up visits in a year and not found any recurrence of nodules.
CONCLUSION
This case report emphasizes the diagnosis and differentiation of EPC.
PubMed: 38576807
DOI: 10.12998/wjcc.v12.i8.1523 -
Annals of Dermatology Apr 2024
PubMed: 38576250
DOI: 10.5021/ad.21.101 -
British Journal of Biomedical Science 2024Lentigo maligna (LM) and lentigo maligna melanoma (LMM) predominantly affect the head and neck areas in elderly patients, presenting as challenging ill-defined...
Lentigo maligna (LM) and lentigo maligna melanoma (LMM) predominantly affect the head and neck areas in elderly patients, presenting as challenging ill-defined pigmented lesions with indistinct borders. Surgical margin determination for complete removal remains intricate due to these characteristics. Morphological examination of surgical margins is the key form of determining successful treatment in LM/LMM and underpin the greater margin control provided through the Slow Mohs micrographic surgery (SMMS) approach. Recent assessments have explored the use of immunohistochemistry (IHC) markers, such as Preferentially Expressed Antigen in Melanoma (PRAME), to aid in LM/LMM and margin evaluation, leveraging the selectivity of PRAME labelling in malignant melanocytic neoplasms. A Novel double-labelling (DL) method incorporating both PRAME and MelanA IHC was employed to further maximise the clinical applicability of PRAME in the assessment of LM/LMM in SMMS biopsies. The evaluation involved 51 samples, comparing the results of the novel DL with respective single-labelling (SL) IHC slides. The findings demonstrated a significant agreement of 96.1% between the DL method and SL slides across the tested samples. The benchmark PRAME SL exhibited a sensitivity of 91.3% in the SMMS specimens and 67.9% in histologically confirmed positive margins. This study highlights the utility of PRAME IHC and by extension PRAME DL as an adjunctive tool in the assessment of melanocytic tumours within staged excision margins in SMMS samples.
Topics: Humans; Aged; Hutchinson's Melanotic Freckle; Melanoma; MART-1 Antigen; Skin Neoplasms; Biopsy; Mohs Surgery; Antigens, Neoplasm
PubMed: 38566933
DOI: 10.3389/bjbs.2024.12319 -
Acta Dermato-venereologica Apr 2024The Department of Ophthalmology, Sahlgrenska University Hospital, has until recently been the only eye clinic in the Nordic countries to perform Mohs' micrographic...
The Department of Ophthalmology, Sahlgrenska University Hospital, has until recently been the only eye clinic in the Nordic countries to perform Mohs' micrographic surgery of basal cell carcinoma. This has led to the practice of only the most complicated basal cell carcinomas being operated on with this technique. The purpose of this study was to present the results of these surgeries in patients with at least 5 years of follow-up. A retrospective study of all patients operated upon in 2010-2015 was performed. Data were gathered from their medical charts. Primary outcome was recurrence of basal cell carcinoma. One-hundred and sixty-seven patients were operated on. Mohs' micrographic surgery was used for tumours that were judged as highly aggressive on preoperative biopsy, had ill-defined borders, had recurred after previous surgery, or a combination of these factors. Nine recurrences (5.4% of all radical Mohs' micrographic surgeries) were diagnosed after a mean postoperative time of 37 months (4-84 months). Interestingly, all of these 9 recurrences after Mohs' micrographic surgery were in patients who had such surgery because of a recurrent basal cell carcinoma to start with. Good results can be achieved when operating on the most complicated periocular basal cell carcinomas with Mohs' micrographic surgery but special care has to be taken to ensure radical borders when operating on recurring basal cell carcinomas.
Topics: Humans; Mohs Surgery; Sweden; Retrospective Studies; Carcinoma, Basal Cell; Skin Neoplasms; Neoplasm Recurrence, Local
PubMed: 38566404
DOI: 10.2340/actadv.v104.15765