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Sanabria A, Pinillos P, Chiesa-Estomba C, Guntinas-Lichius O, Kowalski LP, Mäkitie AA, Rao KN, Ferlito A. Comparing Mohs micrographic surgery and wide local excision in the management of head and neck dermatofibrosarcoma protuberans: a scoping review. J DERMATOL TREAT 2024; 35:2295816. [PMID: 38146660 DOI: 10.1080/09546634.2023.2295816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia-Biodonostia Research Institute, San Sebastian, Spain
| | | | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Karthik N Rao
- Department of Head Neck Surgical Oncology, All India Institute of Medical Sciences, Raipur, India
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Pulumati A, Algarin YA, Kim S, Latta S, Li JN, Nouri K. 3D bioprinting: a review and potential applications for Mohs micrographic surgery. Arch Dermatol Res 2024; 316:147. [PMID: 38698273 DOI: 10.1007/s00403-024-02893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
Mohs Micrographic Surgery (MMS) is effective for treating common cutaneous malignancies, but complex repairs may often present challenges for reconstruction. This paper explores the potential of three-dimensional (3D) bioprinting in MMS, offering superior outcomes compared to traditional methods. 3D printing technologies show promise in advancing skin regeneration and refining surgical techniques in dermatologic surgery. A PubMed search was conducted using the following keywords: "Three-dimensional bioprinting" OR "3-D printing" AND "Mohs" OR "Mohs surgery" OR "Surgery." Peer-reviewed English articles discussing medical applications of 3D bioprinting were included, while non-peer-reviewed and non-English articles were excluded. Patients using 3D MMS models had lower anxiety scores (3.00 to 1.7, p < 0.0001) and higher knowledge assessment scores (5.59 or 93.25% correct responses), indicating better understanding of their procedure. Surgical residents using 3D models demonstrated improved proficiency in flap reconstructions (p = 0.002) and knowledge assessment (p = 0.001). Additionally, 3D printing offers personalized patient care through tailored surgical guides and anatomical models, reducing intraoperative time while enhancing surgical. Concurrently, efforts in tissue engineering and regenerative medicine are being explored as potential alternatives to address organ donor shortages, eliminating autografting needs. However, challenges like limited training and technological constraints persist. Integrating optical coherence tomography with 3D bioprinting may expedite grafting, but challenges remain in pre-printing grafts for complex cases. Regulatory and ethical considerations are paramount for patient safety, and further research is needed to understand long-term effects and cost-effectiveness. While promising, significant advancements are necessary for full utilization in MMS.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA.
| | - Yanci A Algarin
- Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Sarah Kim
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Steven Latta
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Jeffrey N Li
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
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Otto TS, Ragi SD, John AM, Bhatti H. A Pearl for Pretibial and Forearm Repair Following Mohs Micrographic Surgery. J Drugs Dermatol 2024; 23:380. [PMID: 38709685 DOI: 10.36849/jdd.7139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Wound repair of the pretibial and forearm regions presents a challenge during dermatologic surgery as these areas are under significant tension and exhibit increased skin fragility. Various methodologies have been proposed for the closure and repair of such wounds, however, the use of the bilayered suture technique may be simpler and more effective than other techniques such as the pinch stitch, pully stitch, slip-knot stitch, pulley set-back dermal suture, horizontal mattress suture, pully stitch, and tandem pulley stitch. Our objective was to describe a novel method for the repair of pretibial and forearm wounds following Mohs micrographic surgery utilizing bilayered closure followed by tissue adhesive application. J Drugs Dermatol. 2024;23(5):380. doi:10.36849/JDD.7139  .
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Akella SS, Lee J, May JR, Puyana C, Kravets S, Dimitropolous V, Tsoukas M, Manwar R, Avanaki K. Using optical coherence tomography to optimize Mohs micrographic surgery. Sci Rep 2024; 14:8900. [PMID: 38632358 PMCID: PMC11024158 DOI: 10.1038/s41598-024-53457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
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Affiliation(s)
- Sruti S Akella
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jenna Lee
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Julia Roma May
- School of Medicine, University of Illinois-Chicago, Chicago, IL, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sasha Kravets
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA
| | | | - Maria Tsoukas
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Rayyan Manwar
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA.
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Erripi K, Paussen D, Svedberg K. Results of Mohs' Micrographic Surgery of Periocular Basal Cell Carcinoma: The Swedish Experience. Acta Derm Venereol 2024; 104:15765. [PMID: 38566404 PMCID: PMC11000588 DOI: 10.2340/actadv.v104.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
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.
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Affiliation(s)
- Kalliopi Erripi
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Daniel Paussen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Karin Svedberg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Darsha AK, Pousti BT, Loh TY, Hau JT, Brian Jiang SI. Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor. Dermatol Surg 2024; 50:327-330. [PMID: 38261759 DOI: 10.1097/dss.0000000000004081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest. OBJECTIVE Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery. METHODS A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed. RESULTS Of 13,464 Mohs surgery cases, 4.53% ( n = 610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% ( n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% ( n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications. CONCLUSION Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness.
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Affiliation(s)
- Adrija K Darsha
- Department of Dermatology, Baylor Scott & White Medical Center, Temple, Texas
| | - Bobak T Pousti
- Department of Dermatology, University of California, San Diego, San Diego, California
| | - Tiffany Y Loh
- Department of Surgery, City of Hope Cancer Center, Duarte, California
| | - Jennifer T Hau
- Complete Dermatology and Cypress Dermatology, Houston, Texas; and
| | - Shang I Brian Jiang
- Department of Dermatology, University of California, San Diego, San Diego, California
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Salih R, Ismail F, Orchard GE. Double Immunohistochemical Labelling of PRAME and Melan A in Slow Mohs Biopsy Margin Assessment of Lentigo Maligna and Lentigo Maligna Melanoma. Br J Biomed Sci 2024; 81:12319. [PMID: 38566933 PMCID: PMC10985170 DOI: 10.3389/bjbs.2024.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
Introduction: 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. Methods: 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. Results: 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. Discussion: 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.
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Hallier A, Callier P, Sauge J, Cristofari S, Lombardo GAG, Aubriot-Lorton MH, Stivala A. Novel role of fluorescent in situ hybridization technique (FISH) in recommended surgical margins of dermatofibrosarcoma protuberans: A preliminary study. ANN CHIR PLAST ESTH 2024; 69:124-130. [PMID: 37652836 DOI: 10.1016/j.anplas.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor. There is no standard recommendation for its surgical management. The currently used histological analysis are HES (hematoxylin eosin saffron) staining and immunohistochemistry for CD34 expression in particular cases. Fluorescent in situ hybridization (FISH) technique is only used to qualify the DFSP as translocated or non-translocated and is not used as a diagnostic method. The aim of our study was to determine by FISH (as a diagnostic method) whether cancerous cells that could not be identified through HES staining±immunohistochemistry were present at the two-centimeter margins that were found to be tumor-free. METHODS Samples from patients who underwent surgery between 2010 and 2018 were collected. Intralesional and peripheral (at 2cm margins) paraffin slides were included. An average of 7.4 slides per specimen was analyzed. Firstly, the preselected slides were reread by a senior pathologist to confirm the absence of microscopic findings of DFSP at 2cm margins. Secondly a FISH analysis was used as a quantitative diagnostic approach, in order to find the t(17;22) translocation. RESULTS Among the seven specimens that included 2cm margins, two samples presented one or more translocations, which were not visible in standard morphology assessments at two centimeters tumor-free margins. CONCLUSIONS FISH analysis can have a new role in defining tumor-free margins. This would reduce the incidence of disease recurrence after resection and improve the post-operative complementary care.
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Affiliation(s)
- A Hallier
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France
| | - P Callier
- Department of Human Genetics, Dijon University Hospital, Dijon, France
| | - J Sauge
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - S Cristofari
- Sorbonne University, 21, rue de l'École-de-Médecine, 75006 Paris, France
| | - G A G Lombardo
- Azienda Ospedaliera Cannizzaro, Burn & Plastic Surgery, Via Messina, 829 Catania, Italy; Università Unikore di Enna, Piazza dell'Università, 94100 Enna EN, Italy.
| | | | - A Stivala
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France; Plastic, Reconstructive and Aesthetic Surgery, Centre Hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
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Peirano D, Vargas S, Hidalgo L, Donoso F, Abusleme E, Sanhueza F, Cárdenas C, Droppelmann K, Castro JC, Uribe P, Zoroquiain P, Navarrete-Dechent C. Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study. An Bras Dermatol 2024; 99:202-209. [PMID: 37989688 PMCID: PMC10943309 DOI: 10.1016/j.abd.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 11/23/2023] Open
Abstract
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.
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Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenia Abusleme
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Sanhueza
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Consuelo Cárdenas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherine Droppelmann
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Camilo Castro
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Zoroquiain
- Department of Pathology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Kassotis AS, Grimes J, Samie FH, Lewin JM, Levenson JA, Glass LRD. Risk factors for developing depressive symptoms in the immediate postoperative period after Mohs micrographic surgery. Orbit 2024; 43:22-27. [PMID: 36847522 DOI: 10.1080/01676830.2023.2179639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a highly efficacious, tissue sparing method of skin cancer removal. Nevertheless, in the months to years after MMS, psychosocial distress has been described. The present study addressed the immediate period after MMS and assessed the frequency and risk factors for development of depressive symptoms. METHODS Subjects undergoing MMS at two physician practices (JL, FS) were included in this prospective cohort study. Preoperatively, a standardized depression screening, the Patient Health Questionnaire-8 (PHQ-8), was administered. After MMS, the PHQ-8 was readministered at weeks 1, 2, 4, 6, and 12. Average PHQ-8 score by week and change from baseline PHQ-8 score were the primary outcomes. RESULTS Sixty-three subjects were included of which 49 (78%) had a facial site. Twenty-two subjects (35%) had some increase in score during the 12-week follow-up period, of which 18 had a facial site. The oldest subjects (83-99 years, n = 14) had significantly higher PHQ-8 scores at week 4 (p < 0.01) and week 6 (p = 0.02) than all other age groups. There were no differences in scores between location groups. CONCLUSIONS One-third of subjects had some increase in score during the follow-up period. Those in the oldest age cohort were at highest risk of increased score. In contrast to prior literature, those with facial sites were not at higher risk. This difference may be explained by increased masking during the ongoing COVID-19 pandemic. Ultimately, consideration of patients' psychologic status in the immediate postoperative period after MMS, particularly in the elderly population, may enhance perceived patient outcomes.
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Affiliation(s)
- Alexis S Kassotis
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Grimes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Ichan School of Medicine at Mt. Sinai, New York, NY, USA
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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11
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Elgash M, Young J, White K, Leitenberger J, Bar A. An Update and Review of Clinical Outcomes Using Immunohistochemical Stains in Mohs Micrographic Surgery for Melanoma. Dermatol Surg 2024; 50:9-15. [PMID: 37738278 DOI: 10.1097/dss.0000000000003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) provides optimal margin control through complete peripheral and deep margin assessment. The treatment of melanoma using MMS has historically been limited by difficulty in interpreting melanocytes using frozen sections. Immunohistochemical (IHC) staining, a technique whereby chromogen-tagged antibodies are used to detect antigens of interest, has revolutionized the surgical treatment of melanoma. OBJECTIVES This article provides an update and literature review of current IHC stains used in MMS for melanoma, their sensitivities and specificities, and clinical outcomes. MATERIALS AND METHODS A PubMed search was performed using keywords including "immunohistochemistry," "staining," and "Mohs surgery." Articles related to the use of IHC staining for the treatment of melanoma with MMS were included. RESULTS Six IHC stains met the criteria for the review including melanoma antigen recognized by T cells (MART-1), SRY-related HMG-box (SOX10), microphthalmia-associated transcription factor, HMB-45, MEL-5, S-100, and preferentially expressed antigen in melanoma. CONCLUSION The adaptation of IHC methods to frozen sections has enabled MMS to become a preferred treatment option for melanoma in special-site areas. Future studies are needed to standardize IHC techniques and to define best practices when using frozen section in the treatment of melanoma.
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Affiliation(s)
- May Elgash
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jade Young
- Oregon Health and Science University, School of Medicine, Portland, Oregon
| | - Kevin White
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Justin Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Anna Bar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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12
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Jain M, Chang SW, Singh K, Kurtansky NR, Huang SL, Chen HH, Chen CSJ. High-resolution full-field optical coherence tomography microscope for the evaluation of freshly excised skin specimens during Mohs surgery: A feasibility study. J Biophotonics 2024; 17:e202300275. [PMID: 37703431 PMCID: PMC10841241 DOI: 10.1002/jbio.202300275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
Histopathology for tumor margin assessment is time-consuming and expensive. High-resolution full-field optical coherence tomography (FF-OCT) images fresh tissues rapidly at cellular resolution and potentially facilitates evaluation. Here, we define FF-OCT features of normal and neoplastic skin lesions in fresh ex vivo tissues and assess its diagnostic accuracy for malignancies. For this, normal and neoplastic tissues were obtained from Mohs surgery, imaged using FF-OCT, and their features were described. Two expert OCT readers conducted a blinded analysis to evaluate their diagnostic accuracies, using histopathology as the ground truth. A convolutional neural network was built to distinguish and outline normal structures and tumors. Of the 113 tissues imaged, 95 (84%) had a tumor (75 basal cell carcinomas [BCCs] and 17 squamous cell carcinomas [SCCs]). The average reader diagnostic accuracy was 88.1%, with a sensitivity of 93.7%, and a specificity of 58.3%. The artificial intelligence (AI) model achieved a diagnostic accuracy of 87.6 ± 5.9%, sensitivity of 93.2 ± 2.1%, and specificity of 81.2 ± 9.2%. A mean intersection-over-union of 60.3 ± 10.1% was achieved when delineating the nodular BCC from normal structures. Limitation of the study was the small sample size for all tumors, especially SCCs. However, based on our preliminary results, we envision FF-OCT to rapidly image fresh tissues, facilitating surgical margin assessment. AI algorithms can aid in automated tumor detection, enabling widespread adoption of this technique.
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Affiliation(s)
- Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shu-Wen Chang
- Graduate Institute of Photonics and Optoelectronics, National Taiwan University, Taipei, Taiwan
| | - Kiran Singh
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicholas R. Kurtansky
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheng-Lung Huang
- Graduate Institute of Photonics and Optoelectronics, National Taiwan University, Taipei, Taiwan
| | - Homer H. Chen
- Graduate Institute of Communication Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Shan Jason Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
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13
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Isaq NA, Demer AM, Vidal NY, Lohman ME. Dermatologic surgeons' approaches to acral lentiginous melanoma: a survey of the American College of Mohs Surgery. Arch Dermatol Res 2023; 316:17. [PMID: 38059993 DOI: 10.1007/s00403-023-02744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
Acral lentiginous melanoma (ALM) is a subtype of melanoma that primarily affects ethnic minorities and is associated with poor outcomes. Racial inequalities in melanoma survival, particularly between Blacks and Whites, have been well documented in the literature. There are limited data on the role of surgical approach to ALM and its contribution to the existing disparities in ALM survival. Thus, this study aimed to investigate the role of surgical approach to ALM among Mohs surgeons. The survey was distributed to members of the American College of Mohs Surgery (ACMS), with 43 physicians completing the survey. The results showed that there was no consensus among Mohs surgeons regarding the surgical approach for ALM, even for advanced stages. 74% respondents performed complete circumferential peripheral and deep margin assessment (CCPDMA) for ALM, including Mohs micrographic surgery (MMS) or en face staged excision. However, barriers such as limited training, low comfort operating on acral sites, and inadequate access to specialized biopsies were reported. Treatment recommendations varied widely regardless of the ALM stage, with no significant differences based on exposure to ALM during training, practice setting, or percent of skin of color patients served. These findings highlight the lack of guidelines and the need for more data on outcomes to support optimal management of ALM. The study emphasizes the importance of addressing healthcare disparities and improving survival outcomes, particularly for ethnic minorities affected by ALM. Consensus guidelines could help standardize treatment approaches and potentially reduce disparities in ALM management.
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Affiliation(s)
- Nasro A Isaq
- Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Addison M Demer
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Nahid Y Vidal
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mary E Lohman
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Sharma AN, Peterman N, Juhasz M, Shive M. MMS hotspots: a cross-sectional comparison of U.S. counties with and without Mohs micrographic surgery. Arch Dermatol Res 2023; 316:21. [PMID: 38060044 PMCID: PMC10703960 DOI: 10.1007/s00403-023-02751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/17/2023] [Accepted: 10/18/2023] [Indexed: 12/08/2023]
Abstract
Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist future policy and clinical decisions to correct them. For the years 2014-2018, the CPT codes for MMS (17,311 and 17,313) were counted on a per county level across the United States per the Medicare Centers for Medicare & Medicaid Services (CMS) Medicare Prescriber Database. Any county with 0 MMS CPT codes recorded were classified as "without MMS cases." MMS "hotspots" were identified as counties that possessed a high average number of MMS cases compared to the national average, while also being surrounded by counties that possessed a low average number of MMS cases compared to the national average. Three thousand eighty-four counties in the United States were analyzed; 785 (25%) counties were designated as "with MMS cases" and 2301 (75%) "without MMS cases." There were no significant differences in age, ethnicity distribution, or cost per enrollee between the two designations. 74% of counties with MMS cases were considered urban, while only 25% of those without cases were urban (p < 0.01). The median household income was markedly higher in counties with MMS cases ($71,428 vs. $58,913, p < 0.01). With respect to education, more individuals in counties with MMS cases possessed their General Education Development (GED) (89% vs. 86%, p < 0.01) or a college degree (30% vs. 19%, p < 0.01). Forty-nine counties were considered MMS "hotspots." The density of MMS procedures varies greatly based on geography, maintaining the urban-rural disparity matched by the distribution of MMS surgeons. Additionally, there remains a wide income and educational gap between counties with and without MMS. Identifying MMS hotspots may facilitate further investigation into potential surgical access disparities.
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Affiliation(s)
- Ajay Nair Sharma
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA
| | - Nicholas Peterman
- Carle College of Medicine, University of Illinois, Urbana-Champaign, USA
| | - Margit Juhasz
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA
| | - Melissa Shive
- Department of Dermatology, University of California, Irvine, 118 Med Surg I, Irvine, CA, 92697, USA.
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15
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Kromer CM, Jefferson J, Crowe D, Knackstedt T. Outcomes of Upper Lip Mohs Surgery Repairs Using Standardized Scar Scales With Particular Emphasis on Vermillion Border Involvement. Dermatol Surg 2023; 49:1085-1090. [PMID: 37712745 DOI: 10.1097/dss.0000000000003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND The lips are a common location for skin cancer, and thus, a common site for Mohs micrographic surgery (MMS). As an important cosmetic and functional facial unit, MMS defects and reconstruction can affect patient perception on functional and aesthetic outcomes. OBJECTIVE The objective of this study was to compare aesthetic and functional outcomes after upper lip MMS between patients with vermillion sparing repairs (VSR) versus vermillion crossing repairs (VCR). MATERIALS AND METHODS Patients from a single institution from 2018 to 2022 undergoing MMS of the upper lip with linear or select flap repairs were included. Patients were assessed at a minimum of 6-week follow-up for self-assessment of functional and cosmetic outcomes, as well as physician assessment of scar cosmesis using validated Patient and Observed Scar Assessment Scale and Scar Cosmesis Assessment and Rating scale. The results were compared between VSR and VCR groups. RESULTS Forty-five patients were included in this study. No significant difference between patient assessment of functional and cosmetic outcome was identified between VSR and VCR. CONCLUSION Patient satisfaction with lip reconstruction can be high. Crossing the vermillion border does not affect patient assessment of aesthetic and functional results and should be considered if needed to optimize reconstructive outcomes.
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Affiliation(s)
| | | | | | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology and Mohs Surgery Center, Pinehurst, North Carolina
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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16
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Xiong DD, Bordeaux JS. Incidence and Survival Outcomes of Dermatofibrosarcoma Protuberans From 2000 to 2020: A Population-Based Retrospective Cohort Analysis. Dermatol Surg 2023; 49:1096-1103. [PMID: 37962980 DOI: 10.1097/dss.0000000000004018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Recent changes in the incidence and survival of dermatofibrosarcoma protuberans (DFSP) have not been described. OBJECTIVE To characterize the incidence and survival of DFSP. MATERIALS AND METHODS A retrospective cohort study of patients with DFSP from 2000 to 2020 in the Surveillance, Epidemiology, and End Results database was performed. Cox and Fine-Gray regression models were used to assess overall and DFSP-specific survival. RESULTS The incidence of DFSP has not changed from 2000 to 2020 with 4.6 cases/million person-years, with higher rates in dark-skinned and middle-age individuals. Factors associated with overall mortality in DFSP patients include advanced age ( p < .0001), male sex (hazard ratio [HR] 1.8, p < .0001), larger tumors (HR 1.002 per millimeter, p < .001), lower household income (HR 1.8, p = .0002), and lower extremity location (HR 1.7, p = .008). Mohs surgery is associated with improved overall survival (HR 0.4, p = .02). Large tumor size (6.0+ cm, HR 6.7, p = .01) and advanced age (age 80+ years, HR 21.3, p = .003) were associated with worse DFSP-specific mortality. CONCLUSION Dermatofibrosarcoma protuberans incidence has remained constant from 2000 to 2020. Increasing age and tumor size, decreased income, male sex, and lower extremity location are associated with worsened survival. Mohs surgery is associated with improved overall survival. Increased age and tumor size are associated with worsened DFSP-specific mortality.
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Affiliation(s)
- David D Xiong
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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17
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Nadir U, Le K, Shi K, Srivastava D, Nijhawan RI. Outcomes of Squamous Cell Carcinoma of the Lip Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study. Dermatol Surg 2023; 49:1108-1111. [PMID: 37910651 DOI: 10.1097/dss.0000000000003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinomas (cSCCs) of the lip have been reported to be at higher risk for poorer post-treatment outcomes. OBJECTIVE To examine outcomes of patients with SCC of the lip treated with Mohs micrographic surgery (MMS) and identify factors for recurrence. MATERIALS AND METHODS This retrospective review of a single tertiary referral center's Mohs case logs from 2010 to 2019 identified cases of lip SCC. Clinicopathologic characteristics and outcomes (local recurrence [LR], metastasis, and disease-specific death) were reviewed. RESULTS One hundred ninety cases of SCC of the lip were identified and demonstrated that MMS offered a disease-free survival of 96.8% over an average follow-up period of 42 months. Younger age (61 vs 74 years p = .006), increased MMS stages ( p = .009), and higher American Joint Committee on Cancer and Brigham and Women's Hospital T stages were risk factors for LR. Immunosuppression, large tumor size, mucosal lip involvement, aggressive histology, and perineural invasion were not associated with LR. CONCLUSION The results of this study show that SCC of the lip behaved similarly to cSCC outside the lip area, and that both primary and recurrent lesions can be treated effectively with MMS.
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Affiliation(s)
- Umer Nadir
- All authors are affiliated with the Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
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18
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Tran AX, Barriera P, Xiong D, Knackstedt T. Racial-Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis. Dermatol Surg 2023; 49:1134-1138. [PMID: 37962949 DOI: 10.1097/dss.0000000000004005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown. OBJECTIVE To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables. MATERIALS AND METHODS A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998-2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization. RESULTS A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998-2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64-0.80; p < .001), third (OR 0.74; 95% CI 0.63-0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35-0.55; p < .001) were less likely to undergo MMS for their MIS/LM. CONCLUSION Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
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Affiliation(s)
- Andrew X Tran
- Department of Dermatology, MetroHealth System, Cleveland, Ohio
| | - Paola Barriera
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Xiong
- Department of Dermatology, University Hospitals, Cleveland, Ohio
| | - Thomas Knackstedt
- Department of Dermatology, Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina
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Govas P, Ha MV, Wessel CB, Hurst A, Gordon BR, Carroll BT. Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review. Dermatol Surg 2023; 49:1116-1121. [PMID: 37962132 DOI: 10.1097/dss.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional surgical excision. Competing performance measures have fostered numerous histologic techniques for MMS. OBJECTIVE To analyze differences in primary outcomes in the published literature regarding the technique of tissue processing and embedding during the MMS process. METHODS A systematic review was performed of the published literature in MEDLINE, PubMed, Embase, and Cochrane library that included a description of the manipulation of tissue during the grossing and embedding steps of MMS. RESULTS Inclusion criteria were met by 61 articles. Of these studies, the cure/recurrence rate was assessed in 1 article (1.6%), tissue conservation was assessed in 47 (77%), time-saving was assessed in 35 (57%), cost-saving was assessed in 6 (10%), and decreased artifact were assessed in 20 (33%). CONCLUSION There is a lack of standardization for assessing clinical outcomes in the published literature regarding MMS process techniques. Cure is a critical outcome in studies comparing MMS processing methodologies.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles B Wessel
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania
| | - Anne Hurst
- Atlantic Skin Cancer Surgery, Virginia Beach, Virginia
| | - Beth R Gordon
- Department of Internal Medicine, NYU Langone Health, New York, New York
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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20
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Kim GW, Bae YC, Hong JH, Kim HS, Yi CC. Effective resection of dermatofibrosarcoma protuberans using the novel Saturn's rings technique. Medicine (Baltimore) 2023; 102:e36031. [PMID: 37986363 PMCID: PMC10659602 DOI: 10.1097/md.0000000000036031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/16/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
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.
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Affiliation(s)
- Geon Woo Kim
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Hyun Hong
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Republic of Korea
| | - Changryul Claud Yi
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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21
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Yuan X, Xue R, Cao X. Network meta-analysis of treatments for perineal extramammary paget's disease: Focusing on performance of recurrence prevention. PLoS One 2023; 18:e0294152. [PMID: 37956192 PMCID: PMC10642846 DOI: 10.1371/journal.pone.0294152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaobin Yuan
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ruizhi Xue
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
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22
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Farrell J, Moreno G. Slice by slice: An Australian state-by-state analysis of Mohs micrographic surgery over 5 years. Australas J Dermatol 2023; 64:497-503. [PMID: 37621104 DOI: 10.1111/ajd.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In November 2018, Mohs micrographic surgery (MMS) was restricted to fellows registered with the Australasian College of Dermatologists. Three new item numbers for the provision of MMS were also introduced. We examine the national and state usage of MMS item numbers based on Medicare claim statistics and Mohs surgeons' self-reported data, noting the impact of the pandemic and the usage of individual item numbers. METHODS Medicare item number data were obtained from the Medicare Benefits Schedule website for January 2017-December 2021. Self-reported data were collected on an annual basis by the Royal College of Pathologists of Australasia (RCPA) as part of the Quality Assurance Program (QAP) from 2019 onwards. Data were analysed with the Holt-Winters smoothing method for forecasting. RESULTS An increasing number of MMS claims were processed each year, with a total of 89,183 for the study period. Since November 2018, 97.7% of procedures have been conducted on the head, neck, genitalia, hand, digits, leg (below the knee) or foot. The provision of services across the country was maintained during the pandemic years of 2020-2021, with an increase in services in Queensland. There were discrepancies between the states for procedures performed in greater than six sections; these constituted more than 35% of claims in Queensland and Western Australia compared to less than 15% in other states. The pandemic impacted certain states more than others, with Victoria and the Northern Territory having significantly fewer presentations than predicted (p < 0.05). CONCLUSIONS Overall, the use of MMS in Australia is in keeping with peer-developed guidelines, despite discrepancies between states. Although certain states were more severely affected by the pandemic, MMS is increasingly used in Australia.
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Affiliation(s)
- Joshua Farrell
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Kensington, New South Wales, Australia
| | - Gilberto Moreno
- Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The Skin Hospital, Westmead, New South Wales, Australia
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Pagliaro T, Read J. Curettage and colour-A technique for defining tumour depth on the ear in the Mohs and non-Mohs setting. Australas J Dermatol 2023; 64:526-528. [PMID: 37715356 DOI: 10.1111/ajd.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
For tumours of the ear that are suspected to involve auricular cartilage, precise definition of the extent of involved deep margin can be difficult. As large resections of cartilage can be cosmetically disfiguring with limited repair options, we propose a simple and effective technique to facilitate a targeted deep margin resection using a curette and a surgical marking pen.
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Affiliation(s)
- Thomas Pagliaro
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jazlyn Read
- Dermatology Specialist Centre, Clayfield, Queensland, Australia
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24
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Thompson KG, Manoharan D, Tripathi R, Rizk E, Lai J, Carpenter J, Gage D, Jilani S, Lin S, Bibee KP, Scott JF. Predictors of patient satisfaction with Mohs micrographic surgery at time of surgery and 3 months postsurgery: A prospective cohort study. J Am Acad Dermatol 2023; 89:992-1000. [PMID: 37422015 DOI: 10.1016/j.jaad.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Despite the importance of patient satisfaction in ensuring high-quality care, studies investigating patient satisfaction in Mohs micrographic surgery (MMS) are limited. OBJECTIVE We investigated the factors associated with patient satisfaction in MMS for nonmelanoma skin cancer and how patient satisfaction changes in the postoperative period. METHODS In this prospective cohort study including 100 patients, patient satisfaction surveys were administered at the time of surgery and at 3 months postsurgery. Sociodemographic characteristics, medical history, and surgical parameters were collected by chart review. Univariate linear and logistic regression models were created to examine these relationships. RESULTS Decreased satisfaction was observed in patients requiring 3 or more MMS stages both at the time of surgery (P = .047) and at 3 months post-surgery (P = .0244). Patients with morning procedures ending after 1:00 pm had decreased satisfaction at the time of surgery (P = .019). A decrease in patient satisfaction between the time of surgery and 3 months postsurgery was observed in patients with surgical sites on the extremities (P = .036), larger preoperative lesion sizes (P = .012), and larger defect sizes (P = .033). LIMITATIONS Single-institution data, self-selection bias, and recall bias. CONCLUSION Patient satisfaction with MMS is impacted by numerous factors and remains dynamic over time.
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Affiliation(s)
| | - Divya Manoharan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Emanuelle Rizk
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Lai
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jenny Carpenter
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Davies Gage
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Sumrah Jilani
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shirley Lin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kristin P Bibee
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland; Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland; Clinical Skin Center of Northern Virginia, Fairfax, Virginia
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Abrantes T, Robbins A, Kahn B, Yumeen S, Bukoski RS, Wisco O, Robinson-Bostom L, Kawaoka J, Libby T, Goldbach H, Imbriano D, Lizbinski L, Tran M, Wahood S, Mehta A, Miner T. Understanding melanoma in situ: Lentigo maligna surgical treatment terminology and guideline adherence, a targeted review. J Am Acad Dermatol 2023; 89:734-744. [PMID: 37307991 DOI: 10.1016/j.jaad.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Malignant melanoma in-situ, lentigo maligna (MMIS-LM) can be successfully treated with several different surgical techniques; however, the literature is inconsistent in defining them. OBJECTIVE To comprehensively define and describe the national guideline recommended surgical techniques used to treat MMIS-LM to help clarify and standardize this terminology to ensure compliance with the guidelines. METHODS A targeted literature review was performed from 1990 to 2022 focusing on articles that discussed the national guideline recommended surgical techniques of wide local excision, Mohs micrographic surgery (MMS), modified Mohs surgery, and staged excision/Slow-Mohs for MMIS-LM, as well as the related methods of tissue processing. National Comprehensive Cancer Network and American Academy of Dermatology guidelines were reviewed to identify how the techniques need to be employed to be compliant with guideline recommendations. RESULTS We describe the various surgical and tissue processing techniques and discuss advantages and disadvantages of each. LIMITATIONS This paper was styled as a narrative review defining and clarifying terminology and technique and does not investigate these topics more broadly. CONCLUSION Understanding the methodology and terminology for these surgical procedures and tissue processing methods is critical so that both general dermatologists and surgeons can employ these techniques effectively for optimal patient care.
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Affiliation(s)
- Tatiana Abrantes
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Allison Robbins
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Benjamin Kahn
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sara Yumeen
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - R Scott Bukoski
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Oliver Wisco
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie Robinson-Bostom
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John Kawaoka
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tiffany Libby
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hayley Goldbach
- Dermatology Department, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dillon Imbriano
- University of New England, College of Osteopathic Medicine, Biddeford, Maine
| | - Leonardo Lizbinski
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Megan Tran
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Samer Wahood
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Aakash Mehta
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas Miner
- Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Shaffrey EC, Grotting AG, Michelotti BF, Siebert JW, Larson JD, Bentz ML. Making Headway in Surgical Education at Home and Abroad: Use of an Inexpensive Three-Dimensional Learning Model to Improve Plastic Surgery Resident Confidence in Mohs Defect Assessment and Closure Planning. Plast Reconstr Surg 2023; 152:540e-546e. [PMID: 36790792 DOI: 10.1097/prs.0000000000010308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The development of simulation, particularly low-cost models, has become a focus of interest within plastic surgery education. Current simulators for Mohs reconstruction are either expensive or not reusable. The authors hypothesize that using a Styrofoam head model during an interactive teaching session will positively affect plastic surgery trainee comfort in designing Mohs reconstructive options. METHODS A cohort of integrated plastic surgery residents at a single institution performed a preactivity questionnaire to obtain baseline comfort in defect assessment and design for five Mohs defects. They subsequently underwent an interactive learning session and were instructed to design flaps on life-size Styrofoam heads with feedback from the senior author (M.L.B.). A postactivity questionnaire was completed to assess improvement in comfort in defect assessment and flap design. Three attending surgeons then compared trainee designs with the senior author's design to assess accuracy. All surveys were based on a five-point Likert scale. RESULTS When analyzing all defects, average postactivity scores increased by 0.63 (SD, ±0.24) ( P = 0.008). Junior residents ( n = 8) had a greater increase in average score responses [mean, 1.07 (0.5 to 1.75)] compared with senior residents ( n = 9) [mean, 0.27 (0 to 1)] ( P < 0.001). When assessed by senior-level surgeons, senior residents had significantly greater accuracy in design for each defect ( P < 0.05) except cheek advancement flap ( P = 0.08). CONCLUSION Participation in an interactive educational activity using a Styrofoam head model demonstrated significant improvements in trainee assessment and design of reconstructive options for Mohs defects.
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Affiliation(s)
- Ellen C Shaffrey
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics
| | | | - Brett F Michelotti
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics
| | - John W Siebert
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics
| | - Jeffrey D Larson
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics
| | - Michael L Bentz
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics
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Van Coile L, Brochez L, Verhaeghe E, Boone B, Meertens A, Ongenae K, Hoorens I. A critical re-evaluation of Mohs micrographic surgery for a facial basal cell carcinoma in older adults: Should we waive this treatment in certain patients? J Eur Acad Dermatol Venereol 2023; 37:1792-1798. [PMID: 37147863 DOI: 10.1111/jdv.19158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Skin cancer incidences are increasing. Treatment for basal cell carcinomas (BCCs) can be questioned in certain patients. Treatment options are various, but Mohs micrographic surgery (MMS) has the highest cure rate. It is, however, time-consuming and results in high logistical burden and treatment costs for both patients and society. OBJECTIVES This study critically re-evaluates MMS for facial BCCs in older adults. The main objective is to examine all clinical, tumour and patient characteristics in relation to safety and survival to detect a subgroup in which MMS was not the best choice. The overall aim is to identify characteristics that support clinical decision-making in daily practice. METHODS Patients that received MMS between November 1998 and December 2012 were included. Only patients >75 years with a facial BCC were withheld for analysis. This is a retrospective cohort study, since evaluating the outcome of MMS in accordance with life expectancy is the main objective. Patient charts were evaluated towards comorbidities, complications and survival. RESULTS This cohort comprises 207 patients. Median survival was 7.85 years. The age-adjusted Charlson comorbidity index (aCCI) was divided into low/medium scores (aCCI < 6) and high scores (aCCI ≥ 6). Median survival was 11.58 years in the low aCCI group and 3.60 years in the high aCCI group (p < 0.001). There was a very strong association between high aCCI and survival (HR, 6.25; 95% CI, 3.83-10.21). Other characteristics were not associated with survival. CONCLUSIONS Clinicians should assess the aCCI in older patients presenting with a facial BCC before deciding if MMS is an eligible treatment option. High aCCI has shown to be an indicator for low median survival, even in MMS patients with usually high functional status. MMS should be waived as treatment in older patients with high aCCI scores in favour of other, less intensive and less expensive treatment options.
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Affiliation(s)
- Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Barbara Boone
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Annick Meertens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Katia Ongenae
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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Shearman H, Yap SM, Zhao A, Passby L, Barrett A, Nikookam Y, Stoneham S, Myint NA, Phillips D, Dalal F, Wylie G, Costley M, Odedra S, Phillips M, Abbott RA, Wernham A, Tso S. A UK-wide study to describe resource consumption and waste management practices in skin surgery including Mohs micrographic surgery. Clin Exp Dermatol 2023; 48:1024-1029. [PMID: 37192414 DOI: 10.1093/ced/llad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed. OBJECTIVES To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS. METHODS A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma. Twelve participating sites from England, Northern Ireland, Scotland and Wales provided data from 115 skin surgery lists involving 495 patients and 547 skin surgery procedures between 1 March 2022 and 30 June 2022. RESULTS Mean total weight of nonsharps skin surgery waste was 0.52 kg per procedure (0.39 kg clinical waste, 0.05 kg general waste and 0.08 kg recycling waste). Data from a single site using disposable surgical instruments reported a mean of only 0.25 kg of sharps waste per procedure. The recycling rate ranged between 0% and 44% across the cohort with a mean recycling rate of 16%. CONCLUSIONS We advocate that staff transition to the British Society of Dermatological Surgery 2022 sustainability guidance, which made wide-ranging recommendations to facilitate staff to transition to sustainable practices in skin surgery.
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Affiliation(s)
| | - Soo Min Yap
- Jephson Dermatology Centre, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - Andrew Zhao
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lauren Passby
- Department of Dermatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Amy Barrett
- Jephson Dermatology Centre, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - Yasmin Nikookam
- Department of Dermatology, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Sophie Stoneham
- Department of Dermatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nan Akari Myint
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Derrick Phillips
- Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - Fatima Dalal
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Grant Wylie
- Department of Dermatology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew Costley
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, UK
| | - Sunita Odedra
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mirain Phillips
- Department of Dermatology, University Hospital of Wales, Cardiff, UK
| | - Rachel A Abbott
- Department of Dermatology, University Hospital of Wales, Cardiff, UK
| | - Aaron Wernham
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - Simon Tso
- Jephson Dermatology Centre, South Warwickshire University NHS Foundation Trust, Warwick, UK
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Sooksamran A, Pichai P, Suphannaphong M, Singthong S. Previous therapy and the recurrence rate of basal cell carcinoma after Mohs surgery: a meta-analysis. Arch Dermatol Res 2023; 315:1747-1754. [PMID: 36847828 DOI: 10.1007/s00403-023-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) is indicated for patients at high risk of recurrence; other therapies, including standard surgical excision, cryotherapy, electrodesiccation and curettage, and radiotherapy, are used in low-risk BCC and in patients who cannot undergo surgery. However, in the case of recurrence following treatment with any of these methods, MMS is indicated. This study aimed to examine how preoperative treatment before MMS affects the recurrence rate after surgery. We conducted a meta-analysis to compare the recurrence rates of primary BCC and previously treated BCC in patients undergoing MMS, with a 5-year follow-up. The secondary outcomes were the recurrence rate after MMS based on previous radiation therapy status, mean time to recurrence, and number of cases undergoing more than one stage of MMS. The recurrence rate in the previously treated group was 2.44 times greater than that of the primary BCC group. In the previous treatment group, the patients who underwent previous radiation showed a 2.52-fold higher recurrence rate than those with no previous radiation therapy. However, there was no significant difference in the mean time to recurrence and the number of cases requiring MMS > 1 stage between the previously treated and non-treated groups. Patients with previously treated BCC, especially those treated using radiation, had a higher likelihood of recurrence.
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Affiliation(s)
- Apasee Sooksamran
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand.
| | - Pitchayasak Pichai
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Mingkwan Suphannaphong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
| | - Sasathorn Singthong
- Department of Medical Services, Institute of Dermatology, Phayathai, Bangkok, 10400, Thailand
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30
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Alsharif SH, AlFada M, Alaqeel AA. A retrospective review of Mohs micrographic surgery trends over more than 10 years in Saudi Arabia. Saudi Med J 2023; 44:667-673. [PMID: 37463713 PMCID: PMC10370377 DOI: 10.15537/smj.2023.44.7.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To review Mohs micrographic surgery (MMS) trends in Saudi Arabia.Mohs micrographic surgery is a precise surgical technique that has been proven to have the highest cure rate with maximum normal tissue preservation. It is the treatment of choice for non-melanoma skin cancer (NMSC), especially the aggressive histopathological forms, and tumors located in high-risk regions or where tissue preservation is a mandate. METHODS A multicentric retrospective study was performed on patients who underwent MMS between January 2010 and September 2022. The information was extracted from the database of King Saud University Medical City and Prince Sultan Military Medical City in Saudi Arabia. RESULTS A total of 70 participants were enrolled in this study. Two-thirds (67%) of the tumors that were treated using MMS were basal-cell carcinomas (BCC), 18.6% were squamous cell carcinomas (SCC), 5.7% were sebaceous carcinoma, 4.3% were dermatofibrosarcoma protuberans (DFSP), and 1.4% were rare tumors such as primary mucinous carcinoma. The most common type of reconstruction used to repair post-MMS defect was primary closure in more than half of the patients followed by secondary intention healing (20%). There were no side effects apart from a hematoma in one patient and wound infection in two patients. CONCLUSION Although MMS is still generally underutilized in Saudi Arabia, its use has increased in the last decade.
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Affiliation(s)
- Sahar H. Alsharif
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed AlFada
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah A. Alaqeel
- From the Department of Dermatology (Alsharif, AlFada), College of Medicine, King Saud University; and from the Department of Dermatology (Alaqeel), College of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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Dirr MA, Christensen RE, Anvery N, Nadir U, Schaeffer M, Veledar E, Minkis K, Nodzenski M, Whittington A, Brieva JC, Tung R, Poon E, Alam M. Pain of local anesthetic injection of lidocaine during subsequent stages of Mohs micrographic surgery: A multicenter prospective cohort study. J Am Acad Dermatol 2023; 89:114-118. [PMID: 36907555 DOI: 10.1016/j.jaad.2023.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/26/2023] [Accepted: 02/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Patients awake during staged cutaneous surgery procedures may experience procedure-related pain. OBJECTIVE To determine whether the level of pain associated with local anesthetic injections prior to each Mohs stage increases with subsequent Mohs stages. METHODS Multicenter longitudinal cohort study. Patients rated pain (visual analog scale: 1-10) after anesthetic injection preceding each Mohs stage. RESULTS Two hundred fifty-nine adult patients presenting for Mohs who required multiple Mohs stages at 2 academic medical centers were enrolled; 330 stages were excluded due to complete anesthesia from prior stages, and 511 stages were analyzed. Mean visual analog scale pain ratings were nominally but not significantly different for subsequent stages of Mohs surgery (stage 1: 2.5; stage 2: 2.5; stage 3: 2.7: stage 4:2.8: stage 5: 3.2; P = .770). Between 37% and 44% experienced moderate pain, and 9.5% and 12.5% severe pain, during first as versus subsequent stages (P > .05) LIMITATIONS: Both academic centers were in urban areas. Pain rating is inherently subjective. CONCLUSIONS Patients did not report significantly increased anesthetic injection pain level during subsequent stages of Mohs.
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Affiliation(s)
- McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Umer Nadir
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew Schaeffer
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Florida; Department of Biostatistics, Robert Stempel College of Public Health, Miami, Florida; Department of Biostatistics, Florida International University, Miami, Florida; Division of Cardiology Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kira Minkis
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Michael Nodzenski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adam Whittington
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joaquin C Brieva
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rebecca Tung
- Department of Dermatology, University of Central Florida, Orlando, Florida; Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology- Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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32
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Razi S, Ouellette S, Khan S, Oh KS, Truong TM, Rao BK. Role of VivaScope 2500 ex vivo confocal microscopy in skin pathology: Advantages, limitations, and future prospects. Skin Res Technol 2023; 29:e13388. [PMID: 37357649 PMCID: PMC10250963 DOI: 10.1111/srt.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Vivascope 2500 ex vivo confocal microscopy (EVCM) is an emerging optical imaging device that allows nuclear level resolution of freshly excised tissues. EVCM provides, rapid real-time pathological examination in many subspecialties of pathology including skin, prostate, breast, liver, etc. In contrast to traditional time-consuming frozen sectioning and histological analysis. AIMS To evaluate the current state of EVCM utilization. MATERIALS AND METHODS This study highlights the advantages, limitations, and prospects of EVCM in skin pathology. RESULTS Our findings demonstrate that EVCM is a promising adjunctive tool to assess margins in Mohs surgery and to provide rapid, accurate diagnosis of cutaneous tumors, infectious and inflammatory diseases. CONCLUSION EVCM is a revolutionary device that can be used as an adjunct to paraffin-fixed, hematoxylin and eosin-stained slides and frozen sectioning. Additional refinements are required before EVCM can be used as an alternative to frozen sectioning or traditional tissue processing.
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Affiliation(s)
- Shazli Razi
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
| | - Samantha Ouellette
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Samavia Khan
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Kei Shing Oh
- Department of Pathology and Laboratory MedicineMount Sinai Medical CenterMiami BeachFloridaUSA
| | - Thu M. Truong
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
- Department of MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Babar K. Rao
- Department of Dermatology and PathologyRao DermatologyNew YorkNew YorkUSA
- Center for Dermatology, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
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Neill B, Seger E, Downing M, Rajpara A, Hocker T. Comparing Histological Preparation and Tumor Debulking Techniques in Mohs Micrographic Surgery: A Cross-Sectional Survey. J Drugs Dermatol 2023; 22:514-516. [PMID: 37133466 DOI: 10.36849/jdd.4952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Visconti MJ, Archibald LK, Shahwan KT, Kimyon RS, Bakker C, Mattox AR, Alam M, Maher IA. Nasal reconstructive techniques following Mohs surgery or excisions: a systematic review. Arch Dermatol Res 2023; 315:333-337. [PMID: 36152047 DOI: 10.1007/s00403-022-02390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
Numerous reconstructive techniques for nasal defects following skin cancer removal have been described; however, the literature lacks a comprehensive systematic review. Our objective was to systematically review nasal reconstruction methods after tumor removal, correlate the use of specific techniques to the nasal subunits involved, assess the quality of the available evidence, and set the stage for future research on this topic. Eight databases were searched for studies published in English from January 2004 to December 2018 containing repair data for nasal defects following Mohs or excision for four or more subjects. Recorded data included author specialties, study design, subject number, demographics, defect characteristics, procedure type, reconstructive methods, outcome measures, and complications. One-hundred and eleven studies were included. Study types included case series (73%), observational cohort studies (25%), and clinical trials (2%). Most authors were dermatologic surgeons (61%). Resection was most commonly performed via Mohs (82%). Flaps (42%), linear closures (28%) and grafts (25%) were most utilized for reconstruction. In Zones I and II, transposition flaps were the most common followed by advancement flaps. In Zone III, full thickness skin grafts were the most common repair. Most studies were case series or small cohort studies, representing low level evidence. Flaps are the most common method described in the literature for nasal reconstruction. The overall quality of the evidence available on this topic is low.
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Affiliation(s)
| | - Laura K Archibald
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 4-240, Minneapolis, MN, 55455, USA
| | - Kathryn T Shahwan
- University of North Dakota Medical School, Grand Forks, ND, USA
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rebecca S Kimyon
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 4-240, Minneapolis, MN, 55455, USA
| | | | - Adam R Mattox
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 4-240, Minneapolis, MN, 55455, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 4-240, Minneapolis, MN, 55455, USA.
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Knackstedt TJ. Differences in sentinel lymph node biopsy utilization in eligible melanoma patients treated with Mohs micrographic surgery or wide local excision: A population-based logistic regression model and survival analysis. J Am Acad Dermatol 2023; 88:848-855. [PMID: 36368376 DOI: 10.1016/j.jaad.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary melanoma management relies on tumor extirpation and staging sentinel lymph node biopsy (SLNB) in eligible patients. This study compares SLNB utilization in patients undergoing wide local excision (WLE) or Mohs micrographic surgery (MMS). METHODS American Joint Committee on Cancer seventh edition ≥ patients with T1b melanoma undergoing WLE or MMS in the Surveillance, Epidemiology, and End Results program were included. Propensity score matching was performed to compare patients who underwent MMS or WLE. Kaplan-Meier analysis and Fine-Gray cumulative incidence functions were used for overall and melanoma-specific survival. RESULTS Eight hundred twenty-five MMS cases and 38,760 WLE cases were identified. SLNB was performed in 32.61% of MMS patients and 61.77% of WLE patients with positive rates of 12.5% and 14.82%, respectively. Multiple logistic regression of factors associated with SLNB utilization revealed that WLE, male gender, younger age, extremity location, and nodular and rare melanoma subtypes were significantly associated with increased odds of receiving SLNB whereas head and neck location and lentigo maligna melanoma subtype were significantly less likely to receive SLNB. LIMITATIONS Potential selection bias from a retrospective data set. CONCLUSION Patients receiving WLE for ≥ T1b melanoma are more likely to receive a SLNB than patients undergoing MMS.
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Affiliation(s)
- Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
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Yerneni S, Murad F, Schmults CD, Ruiz ES. Improved Margin Control of Microcystic Adnexal Carcinoma After Mohs Micrographic Surgery Compared With Wide Local Excision. Dermatol Surg 2023; 49:317-321. [PMID: 36716422 DOI: 10.1097/dss.0000000000003705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Microcystic adnexal carcinoma (MAC) is a locally aggressive and deeply infiltrative cutaneous tumor primarily treated with excision; however, there are limited data comparing outcomes by surgical approach. OBJECTIVE To compare surgical outcomes of MAC treated with Mohs micrographic surgery (MMS) and wide local excision (WLE). METHODS A 27-year retrospective cohort study of primary MAC was performed. Surgical (i.e. margin status after resection) and recurrence outcomes (including local recurrence [LR], nodal metastases [NM], and distance metastases [DM]) were analyzed by type of surgical approach (MMS and WLE). RESULTS Sixty-nine MACs were included, of which 34 (49.3%) were treated with MMS and 35 (50.7%) with WLE. All MMS-treated tumors had negative margins after the first surgery attempt. Twenty-one (60.0%) tumors treated with WLE had positive margins after the first surgical attempt and required additional procedures. More tumors treated with WLE developed LR, NM, or DM, although this did not meet statistical significance. LIMITATIONS Retrospective single institution study. CONCLUSION Greater than half of MAC tumors treated with WLE had positive margins after the initial surgery and required multiple procedures for complete removal. Real-time complete margin assessment is important for this locally aggressive and infiltrative tumor.
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Affiliation(s)
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Rutkowski D, Collier NJ, Telfer N, Ghura V. Lines under the eyes: a large prospective case series of linear basal cell carcinomas. Arch Dermatol Res 2023; 315:621-624. [PMID: 35962197 DOI: 10.1007/s00403-022-02385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Basal cell carcinomas (BCC) are the most common form of cancer globally. Linear BCCs are an unusual variant which are generally defined by having a length three times longer than the width and exhibiting relatively straight edges. In this report, we describe the largest global cohort (n = 31) with this rare subtype. Within this cohort, 22 were in the periocular region, 27 underwent Mohs micrographic surgery and 12 involved oculoplastic reconstruction. These results suggest that, whilst this subtype is relatively rare, it may be more prevalent than previously thought. Dermatologists and other specialities managing skin cancer, particularly ophthalmologists, should, therefore, be aware of this subtype, as it is often more aggressive than other BCC subtypes, often requiring multi-disciplinary management.
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Affiliation(s)
- D Rutkowski
- Mohs Unit, Department of Dermatology, Salford Royal Hospital NHS Foundation Trust, Northern Care Alliance NHS Group, Salford, England.
- Dermatology Research Centre, NIHR Biomedical Research Centre, University of Manchester, Manchester, UK.
| | - N J Collier
- Mohs Unit, Department of Dermatology, Salford Royal Hospital NHS Foundation Trust, Northern Care Alliance NHS Group, Salford, England
- Dermatology Research Centre, NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - N Telfer
- Mohs Unit, Department of Dermatology, Salford Royal Hospital NHS Foundation Trust, Northern Care Alliance NHS Group, Salford, England
| | - V Ghura
- Mohs Unit, Department of Dermatology, Salford Royal Hospital NHS Foundation Trust, Northern Care Alliance NHS Group, Salford, England
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Vickers C, Tupchong S, Aphale A. Validation of contactless smartphone measurement application in clinical context of Mohs micrographic surgery patients. Skin Res Technol 2023; 29:e13325. [PMID: 37113096 PMCID: PMC10234163 DOI: 10.1111/srt.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Conor Vickers
- Department of DermatologyTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Sarah Tupchong
- Department of DermatologyTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Abhishek Aphale
- Department of DermatologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
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Young JN, Nguyen TA, Freeman SC, Hill E, Johnson M, Gharavi N, Bar A, Leitenberger J. Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis. J Am Acad Dermatol 2023; 88:1060-1065. [PMID: 36720365 DOI: 10.1016/j.jaad.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) for melanoma practices vary among dermatologic surgeons. The implementation of immunohistochemical staining in MMS for melanoma mitigates challenges associated with slide interpretation; however, the reliability of melanoma antigen recognized by T cells 1 (MART-1), the preferred immunostain for melanoma, has yet to be compared with permanent section pathology. OBJECTIVE To assess concordance rates of MART-1 frozen sections and permanent section pathologic interpretation of melanoma treated with MMS. METHODS A dual-center retrospective analysis was conducted to collect concordance and demographic data. Chi-square tests were performed for group comparisons of categorical variables. RESULTS Of the 379 permanent sections sent, 367 were concordant with frozen section pathology for an overall concordance rate of 96.8%. Cases were stratified into indeterminately concordant and indisputably concordant. Twenty-two (6%) of cases were indeterminately concordant, whereas 345 (94.0%) of cases were indisputably concordant. LIMITATIONS The concordance rate is derived from a comparison of adjacent tissue margins, an inevitable consequence of utilizing 2 techniques. CONCLUSION To the author's knowledge, this study represents the largest investigation examining concordance rates of MART-1 frozen sections in Mohs for melanoma. High concordance disputes the ongoing need for additional permanent margins when using MART-1 in routine cases.
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Affiliation(s)
- Jade N Young
- School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Tuyet A Nguyen
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - S Caleb Freeman
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Emma Hill
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Nima Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anna Bar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Justin Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
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Parashar K, Torres AE, Boothby-Shoemaker W, Kohli I, Veenstra J, Neel V, Ozog DM. Imaging technologies for presurgical margin assessment of basal cell carcinoma. J Am Acad Dermatol 2023; 88:144-151. [PMID: 34793927 DOI: 10.1016/j.jaad.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/20/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Basal cell carcinoma is the most common cancer worldwide, necessitating the development of techniques to decrease treatment costs through efficiency and efficacy. Mohs micrographic surgery, a specialized surgical technique involving staged resection of the tumor with complete histologic evaluation of the peripheral margins, is highly utilized. Reducing stages by even 5% to 10% would result in significant improvement in care and economic benefits. Noninvasive imaging could aid in both establishing the diagnosis of suspicious skin lesions and streamlining the surgical management of skin cancers by improving presurgical estimates of tumor sizes. Herein, we review the current state of imaging techniques in dermatology and their applications for diagnosis and tumor margin assessment of basal cell carcinoma prior to Mohs micrographic surgery.
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Affiliation(s)
| | | | - Wyatt Boothby-Shoemaker
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Victor Neel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
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Shoham G, Berl A, Shir‐az O, Shabo S, Shalom A. Predicting Mohs surgery complexity by applying machine learning to patient demographics and tumor characteristics. Exp Dermatol 2022; 31:1029-1035. [PMID: 35213063 PMCID: PMC9543558 DOI: 10.1111/exd.14550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Gon Shoham
- Department of Plastic SurgeryMeir Medical CenterKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- The Department of Biomedical EngineeringThe Iby and Aladar Fleischman Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Ariel Berl
- Department of Plastic SurgeryMeir Medical CenterKfar SabaIsrael
| | - Ofir Shir‐az
- Department of Plastic SurgeryMeir Medical CenterKfar SabaIsrael
| | - Sharon Shabo
- Department of Plastic SurgeryMeir Medical CenterKfar SabaIsrael
| | - Avshalom Shalom
- Department of Plastic SurgeryMeir Medical CenterKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Huang J, Zhou X, Ai S, Chen J, Yang J, Sun D. Preoperative 3D Reconstruction Model in Slow Mohs Surgery for Dermatofibrosarcoma Protuberans. Comput Intell Neurosci 2022; 2022:5509129. [PMID: 35432518 PMCID: PMC9010166 DOI: 10.1155/2022/5509129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
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 cm3 (range: 8.4 cm3-183.6 cm3), 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.
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Affiliation(s)
- Jia Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Xiaobo Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Jun Chen
- Department of Dermatology and Dermatologic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, China
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Dowdle TS, Nguyen JM, Steadman JN, Layher H, Sturgeon ALE, Akin R. Online Readability Analysis: Mohs Micrographic Surgery Postsurgical Wound Care. Adv Skin Wound Care 2022; 35:213-218. [PMID: 35026774 DOI: 10.1097/01.asw.0000816960.79821.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although various treatment modalities exist for skin cancer care, Mohs micrographic surgery (MMS) is one of the most effective and cosmetically sensitive surgical techniques. The readability of online informational materials specifically related to MMS postsurgical wound care is extremely relevant for patients given the high rates of skin cancer in the US and the number of patients utilizing the internet for information. METHODS Investigators conducted Google searches to evaluate the current state of readability on MMS postsurgical wound care using the specific keywords "healing after Mohs surgery" and "wound care Mohs surgery." The readabilities of individual websites were analyzed using the WebFX online software. Health-specific click-through rate was used to select the number of samples assessed. RESULTS Based on the 33 unique websites evaluated, the aggregate readability of online MMS postsurgical wound care materials was 11.3, corresponding to an 11th-grade reading level by US standards. CONCLUSIONS Although this level of readability is an improvement in online MMS postsurgical wound care information relative to prior literature, there is still considerable work to be done by the dermatologic community in improving the readability of online patient materials regarding MMS.
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Affiliation(s)
- Travis S Dowdle
- Travis S. Dowdle, BS, is Medical Student, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas, United States. Jeannie M. Nguyen, MD, is Dermatology Resident, Texas Tech University Health Sciences Center. Jesse N. Steadman, BS, is Medical Student, University of Utah, School of Medicine, Salt Lake City. At the Texas Tech University Health Sciences Center, Heather Layher, DO, is Mohs Fellow; Ashley L. E. Sturgeon, MD, is Mohs Fellow and Professor; and Russell Akin, MD, is Mohs Fellow and Professor
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Shao K, Zullo SW, Fix W, Taylor L, Zhang J, Miller CJ, Etzkorn JR, Shin TM, Giordano CN, Higgins WH, Sobanko JF. Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers. Dermatol Surg 2022; 48:418-422. [PMID: 35165219 DOI: 10.1097/dss.0000000000003405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. OBJECTIVE To identify differences in perceived scar outcomes by different stakeholders. METHODS AND MATERIALS Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. RESULTS At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). CONCLUSION Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Shannon W Zullo
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - William Fix
- Division of Dermatology, Albert Einstein College of Medicine, New York, New York
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junqian Zhang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William H Higgins
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ning AY, Levoska MA, Zheng DX, Carroll BT, Wong CY. Treatment Options and Outcomes for Squamous Cell Carcinoma of the Nail Unit: A Systematic Review. Dermatol Surg 2022; 48:267-273. [PMID: 34889218 DOI: 10.1097/dss.0000000000003319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nail squamous cell carcinoma (nSCC) is the most common nail unit malignancy. However, no studies to date have evaluated treatment options for nSCC based on recurrence data while controlling for invasion. OBJECTIVE To identify temporal trends in nSCC treatment modalities and compare treatment outcomes based on invasion. METHODS AND MATERIALS The authors performed a systematic review of articles published on PubMed, MEDLINE, and Scopus from inception to April 2020 reporting treatment of nSCC. The primary outcome was disease recurrence. RESULTS Reports of nSCC treatments have increased in the past decade. Mohs micrographic surgery (MMS) is the most common treatment reported overall. The lowest recurrence rates for in situ nSCC were seen with wide surgical excision (WSE) and MMS. For invasive disease, the recurrence rates were lowest with amputation, MMS, and WSE. CONCLUSION Complete surgical excision of nSCC with either WSE or MMS is associated with lower recurrence rates than limited excision and nonsurgical therapies, regardless of degree of invasion. The prognostic significance of in situ versus invasive disease remains unclear. Confirmation of complete excision may improve outcomes. Digital amputation is indicated for nSCC with bone invasion. Prospective studies and randomized controlled trials are needed to directly compare surgical modalities for nSCC.
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Affiliation(s)
- Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David X Zheng
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christina Y Wong
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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Ahn GS, Pousti B, Singh G, Elsensohn A, Jiang SIB. No Recurrence in Primary Invasive Stage 1a and 1b Melanoma and Melanoma in Situ Treated With Serial Disk Staged Excision. Dermatol Surg 2022; 48:276-282. [PMID: 34935746 DOI: 10.1097/dss.0000000000003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal surgical treatment modality for invasive melanoma (IM) and melanoma in situ (MIS) has been debated with proponents for standard wide local excision (WLE), serial disk staged excision, and Mohs micrographic surgery. OBJECTIVE The purpose of this study is to identify the recurrence rates and surgical margins of invasive stage 1 melanoma and MIS lesions using serial disk staged excision technique with rush permanent processing and "bread loafing" microscopic analysis. MATERIALS AND METHODS Recurrence rates and surgical margins of 63 IM and 207 MIS at the University of California Dermatology Surgery Unit were retrospectively reviewed. RESULTS No recurrences were observed with average follow-up of 34 and 36 months for IM and MIS, respectively (range, 10-92 months). Average surgical margins were 19.8 mm (SD 9.7) for IM and 12.1 mm (SD 12.2) for MIS. CONCLUSION This SSE technique for the treatment of IM and MIS is comparable in efficacy to other SSE techniques, and it offers physicians a simple and accessible alternative to WLE and MMS.
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Affiliation(s)
- Grace Sora Ahn
- All authors are affiliated with the Department of Dermatology, University of California San Diego, La Jolla, California
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47
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Pride RLD, Miller CJ, Murad MH, Erwin PJ, Brewer JD. Local Recurrence of Melanoma Is Higher After Wide Local Excision Versus Mohs Micrographic Surgery or Staged Excision: A Systematic Review and Meta-analysis. Dermatol Surg 2022; 48:164-170. [PMID: 34889212 DOI: 10.1097/dss.0000000000003309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complete removal of melanoma is a primary goal of excision, and local recurrence is one measure to evaluate the efficacy of surgical technique. OBJECTIVE To compare published local recurrence rates for melanoma treated with Mohs micrographic surgery (MMS) or staged excision versus wide local excision (WLE). METHODS AND MATERIALS Search of 6 databases identified comparative and noncomparative studies that reported local recurrence rates after MMS, staged excision, or WLE for melanoma. Random-effects meta-analysis was used to estimate odds ratios and 95% confidence interval (CI) from comparative studies and event rates from noncomparative studies. RESULTS Of the 71 studies included (16,575 patients), 12 were comparative studies (2,683 patients) and 56 were noncomparative studies (13,698 patients). Comparative studies showed increased recurrence after WLE compared with MMS or staged excision (odds ratio [OR], 2.5; 95% CI, 1.4-4.6) and compared with MMS alone (OR, 3.3; 95% CI, 1.8-5.9). Pooled data from comparative and noncomparative studies showed a local recurrence rate of 7% after WLE (95% CI, 5%-11%), 3% after staged excision (95% CI, 2%-4%), and less than 1% after MMS (95% CI, 0%-1%). Statistical heterogeneity was moderate to high. CONCLUSION Local recurrence of melanoma is significantly lower after MMS (<1%) and staged excision (3%) compared with WLE (7%).
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Affiliation(s)
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
| | | | - Jerry D Brewer
- Department of Dermatology Mayo Clinic, Rochester, Minnesota
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48
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Serra-Guillén C, Llombart B, Nagore E, Guillén C, Sanmartín O. Determination of Margins for Tumor Clearance in Dermatofibrosarcoma Protuberans: A Single-Center Study of 222 Cases Treated With Modified Mohs Surgery. Dermatol Surg 2022; 48:51-56. [PMID: 34743125 DOI: 10.1097/dss.0000000000003269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS). OBJECTIVE To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor. MATERIALS AND METHODS Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin). RESULTS We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages. CONCLUSION Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.
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Affiliation(s)
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, Spain
| | - Carlos Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, Spain
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49
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Krausz AE, Higgins HW, Etzkorn J, Sobanko J, Shin T, Giordano C, McMurray SL, Golda N, Maher IA, Leitenberger JJ, Bar A, Nijhawan RI, Srivastava D, Brewer JD, Baum CL, Holmes TE, Goldman GD, Bordeaux J, Carroll B, Macarthur K, Miller CJ. Systematic Review of Technical Variations for Mohs Micrographic Surgery for Melanoma. Dermatol Surg 2021; 47:1539-1544. [PMID: 34743123 DOI: 10.1097/dss.0000000000003268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) for cutaneous melanoma is becoming more prevalent, but surgical technique varies. OBJECTIVE To define variations in published techniques for MMS for melanoma. METHODS AND MATERIALS A systematic review was performed of PubMed, EMBASE, and Scopus databases to identify all articles describing surgical techniques for MMS for melanoma. Technical details were recorded for the preoperative, intraoperative, and postoperative phases of MMS. RESULTS Twenty-four articles were included. Mohs surgeons vary in how they assess clinical margins, how wide a margin they excise on the first MMS layer, and how they process tissue to determine tumor stage and margin clearance during MMS for melanoma. CONCLUSION Mohs micrographic surgery for melanoma is performed with varied surgical techniques. To establish best practices, additional research is necessary to determine how different techniques affect outcomes.
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Affiliation(s)
- Aimee E Krausz
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - H William Higgins
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Etzkorn
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Sobanko
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar Shin
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbus, Missouri
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Justin J Leitenberger
- Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Anna Bar
- Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Todd E Holmes
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont
| | - Glenn D Goldman
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont
| | - Jeremy Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bryan Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kelly Macarthur
- Divison of Dermatology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Christopher J Miller
- Penn Dermatology Oncology Center, University of Pennsylvania, Philadelphia, Pennsylvania
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50
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Lee J, Russell MA. Gauze eye cover for an improved patient experience during Mohs surgery. J Am Acad Dermatol 2021; 86:e39-e40. [PMID: 34582841 DOI: 10.1016/j.jaad.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/12/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jack Lee
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia.
| | - Mark A Russell
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
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