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Yonsei Medical Journal Jan 2022Digital pathology is being gradually adopted in hospitals due to technological advances. We propose that digital pathology can be used in Mohs micrographic surgery (Mohs...
Digital pathology is being gradually adopted in hospitals due to technological advances. We propose that digital pathology can be used in Mohs micrographic surgery (Mohs surgery) to precisely check residual tumor cells in frozen tumor margin tissues. This would aid surgeons and pathologists in accurately recording tumor margins and give patients the benefit of shorter operation time.
Topics: Humans; Mohs Surgery; Skin Neoplasms
PubMed: 35040612
DOI: 10.3349/ymj.2022.63.S112 -
Anais Brasileiros de Dermatologia 2016Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a... (Review)
Review
Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Margins of Excision; Mohs Surgery; Neoplasm Recurrence, Local; Practice Guidelines as Topic; Skin Neoplasms
PubMed: 27828636
DOI: 10.1590/abd1806-4841.20164808 -
Seminars in Plastic Surgery May 2018The authors provide an overview of lip reconstruction after Mohs surgery based on the senior author's practice. Lip reconstruction offers unique challenges to preserve... (Review)
Review
The authors provide an overview of lip reconstruction after Mohs surgery based on the senior author's practice. Lip reconstruction offers unique challenges to preserve not only lip function but also aesthetics. Lip reconstruction must take into consideration the three anatomical layers that comprise the lip and defects that involve the mucosa, the muscle, the skin or more than one layer will help determine the modality of repair. The authors offer an algorithm based on defect location, tissue involvement, and severity of defect to simplify an often complex decision-making process.
PubMed: 29765270
DOI: 10.1055/s-0038-1645882 -
Seminars in Plastic Surgery Feb 2022Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are... (Review)
Review
Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are traditionally reconstructed using primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer, the incorporation of biologic healing wound agents such as Integra and Cytal provides patients and surgeons with alterative reconstructive options without additional donor site morbidity. Herein, we review the use of biologic agents used in soft tissue reconstruction of the nose and scalp following Mohs surgery.
PubMed: 35706556
DOI: 10.1055/s-0042-1742750 -
BMJ Clinical Evidence Apr 2010Basal cell carcinoma (BCC) is the most common form of skin cancer, predominantly affecting the head and neck, and can be diagnosed clinically in most cases. Metastasis... (Review)
Review
INTRODUCTION
Basal cell carcinoma (BCC) is the most common form of skin cancer, predominantly affecting the head and neck, and can be diagnosed clinically in most cases. Metastasis of BCC is rare, but localised tissue invasion and destruction can lead to morbidity. Incidence of BCC increases markedly after the age of 40 years, but incidence in younger people is rising, possibly as a result of increased sun exposure.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions on treatment response/recurrence (within 1 year of therapy) in people with basal cell carcinoma? What are the effects of interventions on long-term recurrence (a minimum of 2 years after treatment) in people with basal cell carcinoma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: cryotherapy/cryosurgery, curettage and cautery/electrodesiccation, fluorouracil, imiquimod 5% cream, photodynamic therapy, and surgery (conventional or Mohs' micrographic surgery).
Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Photochemotherapy; Skin Neoplasms
PubMed: 21718567
DOI: No ID Found -
Experimental Dermatology Jul 2022Mohs micrographic surgery (MMS) is considered the gold standard for difficult-to-treat malignant skin tumors, whose incidence is on the rise. Currently, there are no...
Mohs micrographic surgery (MMS) is considered the gold standard for difficult-to-treat malignant skin tumors, whose incidence is on the rise. Currently, there are no agreed upon classifiers to predict complex MMS procedures. Such classifiers could enable better patient scheduling, reduce staff burnout and improve patient education. Our goal was to create an accessible and interpretable classifier(s) that would predict complex MMS procedures. A retrospective study applying machine learning models to a dataset of 8644 MMS procedures to predict complex wound reconstruction and number of MMS procedure stages. Each procedure record contained preoperative data on patient demographics, estimated clinical tumor size prior to surgery (mean diameter), tumor characteristics and tumor location, and postoperative procedure outcomes included the wound reconstruction technique and the number of MMS stages performed in order to achieve tumor-free margins. For the number of stages complexity classification model, the area under the receiver operating characteristic curve (AUROC) was 0.79 (good performance), with model accuracy of 77%, sensitivity of 71%, specificity of 77%, positive prediction value (PPV) of 14% and negative prediction value (NPV) of 98%. The results for the wound reconstruction complexity classification model were 0.84 for the AUROC (excellent performance), with model accuracy of 75%, sensitivity of 72%, specificity of 76%, PPV of 39% and NPV of 93%. The ML models we created predict the complexity of the components that comprise the MMS procedure. Using the accessible and interpretable tool we provide online, clinicians can improve the management and well-being of their patients. Study limitation is that models are based on data generated from a single surgeon.
Topics: Humans; Incidence; Machine Learning; Mohs Surgery; Retrospective Studies; Skin Neoplasms
PubMed: 35213063
DOI: 10.1111/exd.14550 -
Computational Intelligence and... 2022Dermatofibrosarcoma protuberans (DFSP) is a type of skin cancer that is extremely rare. Its standard treatment is either surgical wide-local excision (WLE) or Mohs... (Review)
Review
Dermatofibrosarcoma protuberans (DFSP) is a type of skin cancer that is extremely rare. Its standard treatment is either surgical wide-local excision (WLE) or Mohs micrographic surgery (MMS). Which method has the lowest recurrence rate is unknown. Dermatofibrosarcoma protuberans is an uncommon soft tissue sarcoma with a high propensity for recurrence. It has always remained a clinical challenge. More technology is needed to treat the disease. We reviewed our cases and published experience and evaluated whether 3D modeling could precisely define tumor morphological characteristics and assist excision in slow Mohs surgery. There were 18 dermatofibrosarcoma protuberan cases enrolled. They were treated in Shanghai Ninth People's Hospital from 2014 to 2019. All the 18 included patients presented with primary disease and no metastasis. All subjects had undergone thorough imaging examinations including CT and MRI. The 3D tumor reconstruction models were created for their tumors. We precisely estimated tumor boundaries and sizes according to those 3D models. Afterward, patients underwent slow Mohs surgery and surgical repair of tissue defects following tumor resection. The 3D tumor reconstruction models were successfully established. The predicted tumor volumes were measured in all 18 cases. The average volume was 38.5 cm (range: 8.4 cm-183.6 cm), which allowed for accurately locating the tumor. Tumors were completely removed in one stage of slow MMS surgery. In the second-stage surgery, the defects were repaired by different surgical methods including direct soft tissue closure, skin grafting, local flaps, or free flaps. Most patients experienced no significant complications. This practice indicated that the combination of a 3D reconstruction model and slow Mohs surgery achieves more precise and complete DFSP resection to decrease the recurrence rate.
Topics: China; Dermatofibrosarcoma; Humans; Imaging, Three-Dimensional; Mohs Surgery; Neoplasm Recurrence, Local
PubMed: 35432518
DOI: 10.1155/2022/5509129 -
Diseases of the Colon and Rectum May 2021A 78-year-old woman with a complaint of fecal incontinence was noted to have a perianal rash. Despite improvement of the incontinence with medical management, the rash...
A 78-year-old woman with a complaint of fecal incontinence was noted to have a perianal rash. Despite improvement of the incontinence with medical management, the rash persisted. She had no symptoms related to the rash, but due to its persistence after two years, she saw a dermatologist who performed a punch biopsy of the area. The biopsy revealed extramammary Paget’s disease that was positive for CAM5.2, CK7, and CDX2 and equivocal for CK20. On physical examination, she had a 2×3cm raised and erythematous lesion on the right buttock extending to the anal margin without anal canal involvement (see Figure 1). Subsequent work-up including upper endoscopy, colonoscopy, CT of the chest and abdomen and pelvis, and small bowel follow through was negative. This patient’s case was discussed at the multi-disciplinary conference, and wide local excision was recommended. The patient underwent wide local excision with healing via secondary intention. Closure was foregone due to the small size of the wound and the patient’s medical comorbidities. Pathological examination confirmed negative margins.
Topics: Administration, Cutaneous; Aged; Anal Canal; Antineoplastic Agents; Female; Humans; Imiquimod; Mohs Surgery; Paget Disease, Extramammary; Photochemotherapy; Radiotherapy; Skin Neoplasms
PubMed: 33661234
DOI: 10.1097/DCR.0000000000002000 -
Journal of the American Academy of... Jan 2023The incidence of cutaneous squamous cell carcinoma (cSCC) continues to increase, and it is now predicted that the number of deaths from cSCC will surpass that of...
Clinical outcomes of high-risk cutaneous squamous cell carcinomas treated with Mohs surgery alone: An analysis of local recurrence, regional nodal metastases, progression-free survival, and disease-specific death.
BACKGROUND
The incidence of cutaneous squamous cell carcinoma (cSCC) continues to increase, and it is now predicted that the number of deaths from cSCC will surpass that of melanoma within the next 5 years. Although most cSCCs are successfully treated, there exists an important subset of high-risk tumors that have the highest propensity for local recurrence (LR), nodal metastasis (NM), and disease-specific death (DSD).
OBJECTIVE
We investigated the clinical outcomes of high-risk cSCCs treated with Mohs surgery (MS) alone, analyzing LR, NM, distant metastasis, and DSD. In addition, we analyzed progression-free survival and DSD in patients who underwent salvage head/neck dissection for regional NMs.
METHODS
Retrospective review of all high-risk cSCC treated in our clinics between January 1, 2000, and January 1, 2020, with follow-up through April 1, 2020.
SETTING
Two university-affiliated, private-practice MS referral centers.
RESULTS
In total, 581 high-risk primary cSCCs were identified in 527 patients, of which follow-up data were obtained for 579 tumors. The 5-year disease-specific survival was 95.7%, with a mean survival time of 18.6 years. The 5-year LR-free survival was 96.9%, the regional NM-free survival was 93.8%, and the distant metastasis-free survival was 97.3%. The 5- and 10-year progression-free survival rates from metastatic disease were 92.6 and 90.0%, respectively. In patients who experienced regional NMs and underwent salvage head and neck dissection with or without radiation, the 2-year disease-specific survival was 90.5%.
CONCLUSION
Our cohort, which is the largest high-risk cSCC cohort treated with MS to date, experienced lower rates of LR, NM, and DSD than those reported with historical reference controls using both the Brigham and Women's Hospital and American Joint Committee on Cancer, Eighth Edition, staging systems. We demonstrated that MS confers a disease-specific survival advantage over historical wide local excision for high-risk tumors. Moreover, by improving local tumor control, MS appears to reduce the frequency of regional metastatic disease and may confer a survival advantage even for patients who develop regional metastases.
Topics: Humans; Female; Carcinoma, Squamous Cell; Mohs Surgery; Progression-Free Survival; Skin Neoplasms; Neoplasm Staging; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 35760236
DOI: 10.1016/j.jaad.2022.06.1169