Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study

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 mm2 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.

Biopsy type does not affect the number of stages during Mohs micrographic surgery: A retrospective study

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy technique is the most appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience, and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCC treated with MMS. 42 (20.2%) biopsies were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs 1.69 stages with the punch technique (p-value=0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The best biopsy type is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping.

[Loxoscelism. Experience in 200 patients]

BACKGROUND

Loxoscelism is an important public health problem in Chile and South America, due to the higher rate of cutaneous-visceral involvement. The diagnosis of loxoscelism is mostly clinical without established diagnostic criteria. There is little evidence to support any treatment used in this condition.

AIM

To characterize the clinical features and epidemiology of loxoscelism among patients consulting at the Emergency and Dermatology Services of a clinical hospital between 2013 and 2017.

MATERIAL AND METHODS

Review of medical records of patients registered in the electronic clinical record system with a confirmed diagnosis of loxoscelism. Epidemiological, clinical, laboratory tests and treatment variables were analyzed.

RESULTS

We reviewed data from 200 patients. Ninety-four percent presented cutaneous loxoscelism and 5.5% cutaneous-visceral loxoscelism. Systemic symptoms were present in 73% of patients with cutaneous-visceral loxoscelism. Patients who developed systemic symptoms had an 18 times higher risk of developing cutaneous-visceral loxoscelism. Laboratory abnormalities were more common in patients with cutaneous-visceral loxoscelism. Not all patients with hematuria had cutaneous-visceral loxoscelism. Most patients required analgesia. Anti-loxosceles serum was not used in any patient.

CONCLUSIONS

Many questions remain to be answered regarding the diagnosis and treatment of the disease. Studies are required to validate diagnostic criteria for loxoscelism, predictors for visceral involvement and response to treatment.

[Nicotinic acid increases cellular transport of high density lipoprotein cholesterol in patients with hypoalphalipoproteinemia]

BACKGROUND

Plasma high density lipoproteins (HDL) are involved in reverse cholesterol transport mediated by the scavenger receptor class B type I (SR-BI). Nicotinic acid increases HDL cholesterol levels, even though its specific impact on SR-BI dependent-cellular cholesterol transport remains unknown.

AIM

To determine the effect of nicotinic acid on HDL particle functionality in cholesterol efflux and uptake mediated by SR-BI in cultured cells in hypoalphalipoproteinemic patients.

MATERIAL AND METHODS

In a pilot study, eight patients with low HDL (≤ 40 mg/dL) were treated with extended release nicotinic acid. HDL cholesterol and phospholipid levels, HDL2 and HDL3 fractions and HDL particle sizes were measured at baseline and post-therapy. Before and after nicotinic acid treatment, HDL particles were used for cholesterol transport studies in cells transfected with SR-BI.

RESULTS

Nicotinic acid treatment raised total HDL cholesterol and phospholipids, HDL2 levels as well as HDL particle size. Nicotinic acid significantly increased HDL cholesterol efflux and uptake capacity mediated by SR-BI in cultured cells.

CONCLUSIONS

Nicotinic acid therapy increases SR-BI-dependent HDL cholesterol transport in cultured cells, establishing a new cellular mechanism by which this lipid-lowering drug appears to modulate HDL metabolism in patients with hypoalphalipoproteinemia.