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Actas Dermo-sifiliograficas Mar 2007Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy that is initially localized to the skin from where it can invade deep... (Review)
Review
Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy that is initially localized to the skin from where it can invade deep structures (fat, fascia, muscle and bone). It is the most frequent fibrohistiocytic tumor, comprising approximately 1.8 % of all soft tissue sarcomas and 0.1 % of all cancers. It has an estimated incidence of 0.8-5 cases per one million persons per year. Treatment of localized disease consists in complete surgical excision of the lesion by conventional surgery with wide margins (>3 cm) or by micrographic Mohs surgery. Although the cases of metastatic DFSP do not reach 5 % of the total, almost all of them appear after previous local relapses. The prognosis for metastatic cases is very poor with a survival of less than 2 years following detection of metastatic disease. Patients with locally advanced DFSP are not candidates for an initial radical surgical therapy therefore neoadyuvant treatment is required prior to surgery in order to reduce tumor burden. In this regard, chemotherapy and radiotherapy have not been highly efficacious so it is necessary to consider new alternatives. The demonstration of the oncogenic power of the translocation COL1A1-PDGFB in DFSP has allowed the successful introduction of drug therapy with antagonists of the PDGFB receptor for metastatic or locally advanced cases.
Topics: Antigens, CD34; Antineoplastic Agents; Benzamides; Biomarkers, Tumor; Chemotherapy, Adjuvant; Chromosomes, Human, Pair 17; Chromosomes, Human, Pair 22; Combined Modality Therapy; Dermatofibrosarcoma; Drug Design; Humans; Imatinib Mesylate; Mohs Surgery; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Proteins; Neoplasm Recurrence, Local; Oncogene Proteins, Fusion; Piperazines; Prognosis; Pyrimidines; Receptor, Platelet-Derived Growth Factor beta; Ring Chromosomes; Sarcoma; Skin Neoplasms; Translocation, Genetic
PubMed: 17397592
DOI: 10.1016/s0001-7310(07)70019-4 -
Cureus Mar 2023Purpose To report the first series of Mohs micrographic surgery (MMS) in Hong Kong, where the roles of a Mohs surgeon were shared and coordinated by a "mobile" surgeon.
UNLABELLED
Purpose To report the first series of Mohs micrographic surgery (MMS) in Hong Kong, where the roles of a Mohs surgeon were shared and coordinated by a "mobile" surgeon.
METHODS DESIGN
Prospective non-comparative interventional case series.
SUBJECTS
20 consecutive Chinese patients (10 male, age 78.5+10.4 years, range 55-91 years) with primary periocular basal cell carcinoma (pBCC) referred to the university oculoplastic unit between October 2007 and August 2013.
INTERVENTION
MMS were conducted according to a streamlined standard operating procedure emphasizing surgeon-driven mapping, specimen orientation, and on-site clinico-histological correlation with the dermatopathologist at the frozen-section laboratory.
MAIN OUTCOME MEASURES
Clinical and histological characteristics of tumors, layers of Mohs procedures, complications, and biopsy-confirmed recurrence at the same location. Results All 20 patients received MMS as planned. Sixteen pBCCs (80%) were diffusely pigmented, and three (15%) were focally pigmented. Sixteen were also nodular. The average tumor diameter was 7+3 (3-15) mm. Seven (35%) were within 2 mm of the punctum. Histologically, 11 (55%) were nodules, and four (20%) were superficial. An average of 1.8+0.8 Mohs levels were performed. Apart from the initial two patients, who required four and three levels, respectively, seven (35%) patients were cleared after the first level of MMS using a 1mm clinical margin. The remaining 11 patients required two levels with an additional 1-2mm margin, but only focally as guided histologically. Defects in 16 patients (80%) were reconstructed by local flaps, two by direct closure, and two with pentagon closure. Among the seven patients with pericanalicular BCC, three patients had their remaining canaliculi successfully intubated, while two developed stenotic upper and two lower punctae postoperatively. One patient had prolonged wound healing. Three patients had lid margin notching, two had medial ectropion, one had medial canthal rounding, and two had lateral canthal dystopia. No recurrence was detected at a mean follow-up of 80+23 months (43 to 113 months) in all patients. Conclusions MMS was successfully introduced in Hong Kong without a Mohs surgeon. Providing complete microscopic margin control and preserving tissues, it was proven to be a valuable treatment option for pBCC. Our multidisciplinary protocol demonstrated that these merits are possible and warrant validation in other resource-limited healthcare settings.
PubMed: 37069888
DOI: 10.7759/cureus.36235 -
Dermatologic Surgery : Official... Jul 2021The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as...
BACKGROUND
The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery.
OBJECTIVE
Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand.
MATERIALS AND METHODS
United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends.
RESULTS
Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level.
CONCLUSION
Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.
Topics: Ambulatory Surgical Procedures; Attitude to Health; COVID-19; Cosmetic Techniques; Elective Surgical Procedures; Humans; Mohs Surgery; Pandemics; Pneumonia, Viral; SARS-CoV-2; United States
PubMed: 33927090
DOI: 10.1097/DSS.0000000000003062 -
Dermatologic Surgery : Official... Mar 2010With the advent of incorporating the immunoperoxidase staining technique into the processing of frozen tissue, the use of Mohs micrographic surgery (MMS) has been... (Review)
Review
BACKGROUND
With the advent of incorporating the immunoperoxidase staining technique into the processing of frozen tissue, the use of Mohs micrographic surgery (MMS) has been expanded to include several high-risk tumors such as lentigo maligna, malignant melanoma, and dermatofibrosarcoma protuberans.
OBJECTIVES
To thoroughly review the English medical literature pertaining to the use of immunohistochemical staining techniques on frozen sections during MMS and to summarize the basic relevant outcomes from the different relevant studies.
MATERIALS AND METHODS
Medline search was conducted, with the following words used in the search criteria: "Mohs surgery,""staining,""immunostaining," and "immunoperoxidase." RESULTS Generally, all immunostains showed advantage over the traditional hematoxylin and eosin approach. Studies of MART-1 in melanoma chemosurgery indicated that it is typically crisp and has less background staining than MEL-5 and better staining consistency than HMB-45. In cases of desmoplastic melanomas, S100 is the stain of choice.
CONCLUSION
Immunostaining offers an advantage in MMS. Large, randomized, prospective studies comparing the different immunostains are still lacking in the literature. The authors have indicated no significant interest with commercial supporters.
Topics: Antigens, Neoplasm; Dermatofibrosarcoma; Frozen Sections; Humans; Hutchinson's Melanotic Freckle; Immunoenzyme Techniques; Immunohistochemistry; MART-1 Antigen; Melanoma; Melanoma-Specific Antigens; Mohs Surgery; Neoplasm Proteins; S100 Proteins; Sensitivity and Specificity; Skin Neoplasms
PubMed: 20100275
DOI: 10.1111/j.1524-4725.2009.01432.x -
Journal of Graduate Medical Education Dec 2017
Topics: Fellowships and Scholarships; Hospitals; Humans; Internship and Residency; Mohs Surgery; Personnel Management; Physicians; San Francisco
PubMed: 29270280
DOI: 10.4300/JGME-D-17-00494.1 -
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 -
Dermatologic Surgery : Official... Jun 2018Studies show that patients recall less than half of the information given by their physicians. Use of video in medicine increases patient comprehension and satisfaction...
BACKGROUND
Studies show that patients recall less than half of the information given by their physicians. Use of video in medicine increases patient comprehension and satisfaction and decreases anxiety. However, studies have not elaborated on video content.
OBJECTIVE
To use principles of learning with multimedia to improve the Mohs surgery consultation.
MATERIALS AND METHODS
The authors developed 2 informational videos on Mohs surgery: traditional versus narrative. The focus of the traditional video was purely didactic. The narrative video included patient testimonials, patient-physician interaction, and animations. New Mohs surgery patients viewed either the traditional (n = 40) or the narrative video (n = 40). Existing Mohs surgery patients (n = 40) viewed both videos. Both groups answered questionnaires about their satisfaction.
RESULTS
For new Mohs surgery patients, no significant difference was found between the traditional and the narrative video groups because respondent satisfaction was high for both video formats. For existing Mohs surgery patients, all respondents (100%) reported that videos were helpful for understanding Mohs surgery; however, the majority would recommend the narrative over the traditional format (72.5% vs 27.5%, p = .01).
CONCLUSION
Technology is useful for patient education because all patients preferred seeing a video to no video. Further research is needed to optimize effective multimedia use in patient education.
Topics: Aged; Carcinoma, Basosquamous; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Patient Education as Topic; Patient Satisfaction; Physician-Patient Relations; Referral and Consultation; Skin Neoplasms; Surveys and Questionnaires; Video Recording
PubMed: 29642110
DOI: 10.1097/DSS.0000000000001473 -
Current Oncology (Toronto, Ont.) Feb 2019The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.
OBJECTIVE
The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.
METHODS
The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews.
RECOMMENDATION 1
Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer.
RECOMMENDATION 2
Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face.
RECOMMENDATION 3
Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
Topics: Guidelines as Topic; Humans; Mohs Surgery; Treatment Outcome
PubMed: 30853814
DOI: 10.3747/co.26.4439 -
Cureus Apr 2022Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive malignancy with wide local excision (WLE) or Mohs micrographic surgery (MMS) representing the...
BACKGROUND
Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive malignancy with wide local excision (WLE) or Mohs micrographic surgery (MMS) representing the treatment of choice. This article illustrates the experience of a single academic institution in treating DFSP with MMS and adds two particularly large, difficult closures of the glabella/central forehead and sternum to the body of literature.
OBJECTIVE
To report the results of 15 patients with DFSP treated with MMS over a five-year period by a single Mohs surgeon at the University of Arkansas for Medical Sciences (UAMS).
METHODS
A total of 15 patients between the ages of 16 and 80 years were diagnosed with DFSP and treated with MMS and were contacted in October 2021 to assess for recurrence.
RESULTS
None of the 15 patients had a recurrence of DFSP following MMS, with a mean follow-up interval of 22.4 months and an average of 1.93 Mohs layers required for tumor clearance.
CONCLUSION
This experience reaffirms that MMS is an effective treatment for DFSP and adds additional examples of closure techniques of large, ovoid surgical defects on the glabella/central forehead and sternum to the literature.
PubMed: 35573491
DOI: 10.7759/cureus.24147 -
Ophthalmology Apr 2004
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyelid Neoplasms; Humans; Mohs Surgery; Treatment Outcome
PubMed: 15051190
DOI: 10.1016/S0161-6420(03)01003-0