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Micrographic surgery

Kathryn L Kreicher, Jeremy S Bordeaux
Importance: Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. Objective: To present the newest and best evidence to close common practice gaps in cutaneous surgery. Evidence Review: We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others...
October 20, 2016: JAMA Facial Plastic Surgery
Jenny T Chen, Steven J Kempton, Venkat K Rao
: The incidence and cost of nonmelanoma skin cancers are skyrocketing. Five million cases cost $8.1 billion in 2011. The average cost of treatment per patient increased from $1000 in 2006 to $1600 in 2011. We present a study of the economics and costs of skin cancer management in Medicare patients. METHODS: We studied data released by the Centers for Medicare and Medicaid Services in 2014. Treatment modalities for the management of skin cancer were reviewed, and costs of treatment were quantified for a sample of 880,000 providers...
September 2016: Plastic and Reconstructive Surgery. Global Open
Tiffany Loh, Ashley G Rubin, Shang I Brian Jiang
BACKGROUND: Basal cell carcinoma (BCC) is the most common malignancy in the United States. Most BCCs occur on cutaneous surfaces, but rare cases on the mucosal lip have also been documented. Because only a small number of mucosal BCC (mBCC) cases have been reported, data on their clinical characteristics and management are limited. OBJECTIVE: To perform an updated literature review of the management of mBCCs on the lip. METHODS: A comprehensive literature review was conducted through a search of the PubMed database with the key phrases "mucosal basal cell carcinoma," "basal cell carcinoma mucosa," and "basal cell carcinoma lip mucosa...
October 13, 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
Garrett C Lowe, Oluwakemi Onajin, Christian L Baum, Clark C Otley, Christopher J Arpey, Randall K Roenigk, Jerry D Brewer
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor with slow infiltrative growth and local recurrence if inadequately excised. OBJECTIVE: To compare long-term outcomes after Mohs micrographic surgery (MMS) and wide local excision (WLE). MATERIALS AND METHODS: Records of patients with DFSP surgically treated with WLE or MMS from January 1955 through March 2012 were retrospectively reviewed. RESULTS: Mean follow-up for patients treated with MMS (n = 67) and WLE (n = 91) was 4...
October 4, 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
Alexandra Schulz, Samira Daali, Mehreen Javed, Paul Christian Fuchs, Michael Brockmann, Alhadi Igressa, Patra Charalampaki
BACKGROUND: At present, no ideal diagnostic tools exist in the market to excise cancer tissue with the required safety margins and to achieve optimal aesthetic results using tissue-conserving techniques. OBJECTIVES: In this prospective study, confocal laser endomicroscopy (CLE) and the traditional gold standard of magnifying glasses (MG) were compared regarding the boundaries of in vivo basal cell carcinoma and squamous cell carcinoma. MATERIALS & METHODS: Tumour diameters defined by both methods were measured and compared with those determined by histopathological examination...
October 17, 2016: European Journal of Dermatology: EJD
Jung-In Kim, Young-Jun Choi, Hyun-Min Seo, Han-Saem Kim, Jae Yun Lim, Dong-Hoon Kim, Seoung Wan Chae, Ga-Young Lee, Won-Serk Kim
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm sharing histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumor necrosis and vascular/perineural invasion. It is not well documented in the literature because of its rarity, and its clinical course has been debated due to the lack of homogenous criteria. We describe here the case of a 91-year-old female with a 6-month history of a solitary, asymptomatic, well-defined, 3...
October 2016: Annals of Dermatology
Jin Kyung Chae, Jeong Hee Kim, Eun Jung Kim, Kun Park
BACKGROUND: The patient and observer scar assessment scale (POSAS) recently emerged as a promising method, reflecting both observer's and patient's opinions in evaluating scar. This tool was shown to be consistent and reliable in burn scar assessment, but it has not been tested in the setting of skin graft scar in skin cancer patients. OBJECTIVE: To evaluate facial skin graft scar applied to POSAS and to compare with objective scar assessment tools. METHODS: Twenty three patients, who diagnosed with facial cutaneous malignancy and transplanted skin after Mohs micrographic surgery, were recruited...
October 2016: Annals of Dermatology
Breanne Mordorski, Adam J Friedman, Leon H Kircik
Dermatologists frequently create cutaneous defects that heal by second intention, yet there is no universal protocol for wound care in this setting. Several ointments commonly used for wound healing are not cost effective as they contain known contact allergens, contribute to antimicrobial resistance, and do not enhance the healing process. Recent studies indicate that Bensal HP, a commercially available ointment used for a variety of dermatologic conditions, may be useful for wound healing; although clinical data is currently limited...
October 1, 2016: Journal of Drugs in Dermatology: JDD
Saisindhu Narala, Philip R Cohen
Basal cell carcinoma (BCC) typically occurs in sun-exposed sites. Only 16 individuals with umbilical BCC have been described in the literature, and the characteristics of patients with umbilical BCC are summarized. PubMed was used to search the following terms: abdomen, basal cell carcinoma, basal cell nevus syndrome, and umbilicus. Papers with these terms and references cited within these papers were reviewed. BCC of the umbilicus has been reported in five men and 11 women; one man had two tumors. Two patients had basal cell nevus syndrome (BCNS)...
September 7, 2016: Curēus
Joshua J Clark, Anneli R Bowen, Glen M Bowen, John R Hyngstrom, Michael L Hadley, Keith Duffy, Scott R Florell, David A Wada
BACKGROUND: Cutaneous carcinosarcoma is a rare tumor with distinct malignant epithelial and mesenchymal cell populations. The histologic subtypes of epithelial and mesenchymal components in cutaneous carcinosarcoma are variable, as an assortment of carcinomatous and sarcomatous patterns have been described in the literature. METHODS: Clinical information was obtained from patient charts and archival slides were retrieved and reviewed. RESULTS: We present a novel series of six distinct cases of cutaneous carcinosarcoma and review the literature...
October 11, 2016: Journal of Cutaneous Pathology
Andrew R Styperek, Leonard H Goldberg, Laura E Goldschmidt, Arash Kimyai-Asadi
BACKGROUND: Histologic examination of tissue is the foundation of Mohs micrographic surgery because determination of surgical margins influences whether additional tissue will be taken. Currently, there is no large focused study comparing toluidine blue (TB) and hematoxylin and eosin (H&E) stains in the evaluation of squamous cell carcinoma (SCC). OBJECTIVE: This study evaluates whether TB and H&E are comparable in assessing the presence of tumor in frozen sections of SCC...
September 21, 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
Emily Stamell Ruiz, Pritesh S Karia, Frederick C Morgan, Christine A Liang, Chrysalyne D Schmults
No abstract text is available yet for this article.
October 2016: Journal of the American Academy of Dermatology
Adriana Martín-Fuentes, Esther De Eusebio-Murillo, Consuelo Sánchez Herreros, Adrian Ballano-Ruiz, Esther Jiménez Blázquez, Jesús Cuevas-Santos
BACKGROUND: Dermatofibrosarcoma protuberans is a rare malignant tumor with a high rate of recurrence after surgery. Moh's micrographic surgery allows examination of all surgical margins to ensure complete removal. OBJECTIVE: To evaluate the use of Moh's micrographic surgery using paraffin-embedded sections for the treatment of dermatofibrosarcoma protuberans. METHODS: We performed a retrospective analysis of 33 patients with dermatofibrosarcoma protuberans treated in our department with paraffin-embedded micrographic surgery between January 2002 and June 2015...
September 19, 2016: Indian Journal of Dermatology, Venereology and Leprology
Tiffany Y Loh, Ashley G Rubin, Shang I Brian Jiang
BACKGROUND: Ultraviolet radiation is a well-known risk factor for basal cell carcinoma (BCC). Therefore, the high incidence of BCCs in sun-exposed areas such as the head and neck is unsurprising. However, unexpectedly, BCCs on the sun-protected dorsal foot have also been reported, and tumor occurrence here suggests that other factors besides ultraviolet radiation may play a role in BCC pathogenesis. Because only few dorsal foot BCCs have been reported, data on their clinical features and management are limited...
September 14, 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
Euphemia W Mu, Jesse M Lewin, Mary L Stevenson, Shane A Meehan, John A Carucci, Daniel S Gareau
Importance: Confocal microscopy has the potential to provide rapid bedside pathologic analysis, but clinical adoption has been limited in part by the need for physician retraining to interpret grayscale images. Digitally stained confocal mosaics (DSCMs) mimic the colors of routine histologic specimens and may increase adaptability of this technology. Objective: To evaluate the accuracy and precision of 3 physicians using DSCMs before and after training to detect basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Mohs micrographic surgery fresh-tissue specimens...
September 7, 2016: JAMA Dermatology
Christina R Vargas, Jennifer DePry, Bernard T Lee, Jeremy S Bordeaux
BACKGROUND: Mohs micrographic surgery has become increasingly used in the treatment of cutaneous malignancies over the past decade. Concurrently, more patients are using the Internet as a resource for medical information than ever before. The average American adult reads at an eighth grade level. The American Medical Association and National Institutes of Health have recommended a sixth grade target reading level for patient health materials. OBJECTIVE: This study evaluates the readability of currently available online information about Mohs micrographic surgery in the context of these recommendations...
October 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
John T Mullen
Dermatofibrosarcoma protuberans (DFSP) is a rare dermal soft tissue sarcoma characterized by a typically indolent clinical course. The greatest clinical challenge in management of DFSP is achieving local control. There is vigorous debate in the literature as to the optimal surgical approach to these tumors. The choice between wide local excision and Mohs micrographic surgery for DFSP should be governed by the attainment of three goals: (1) to completely excise the tumor with negative margins, tantamount to cure; (2) to preserve function, optimize cosmesis, and minimize morbidity of resection; and (3) to minimize cost and inconvenience to the patient and the health care system at large...
October 2016: Surgical Oncology Clinics of North America
Justin J Leitenberger, Howard Rogers, John C Chapman, Ian A Maher, Matthew C Fox, Chris B Harmon, Evans C Bailey, Peter Odland, Ashley Wysong, Tim Johnson, Oliver J Wisco
BACKGROUND: Standardized definitions and methods of surveillance for local recurrence of nonmelanoma skin cancer are critical in determining cure rates attributed to treatment modalities. OBJECTIVE: We sought to offer a standard definition of local recurrence after surgical treatment of nonmelanoma skin cancer and to propose an acceptable surveillance period and tracking methods. METHODS: A literature search was performed for background definitions of local recurrence and tracking methods...
November 2016: Journal of the American Academy of Dermatology
A Bieniek, Ł Matusiak, Z Woźniak, M Lichtenstein, J Szymkowski, M Kozioł, A Salwa, J C Szepietowski
Mohs micrographic surgery (MMS) is a treatment method aiming at thorough, personalized eradication of skin cancers by mean of staged excision of tissues surrounding the tumor with complete (100%) histopathological examination of their margins. In many MMS laboratories, the excised tissue is divided, shaped, frozen in a cryostat with a heat extractor and positioned manually (with the block on the object disc) in an articulated cryostat chuck during cutting. However, these activities may be difficult, time-consuming and associated with the risk of imprecise tissue sectioning...
June 2016: Polish Journal of Pathology: Official Journal of the Polish Society of Pathologists
Marco Stieger, Robert E Hunger
BACKGROUND: Gorlin syndrome, also known as the basal cell nevus syndrome (OMIM #109400), is a rare autosomal-dominant genetic disease. The disease, which shows mutation of the patched receptor gene (PTCH1) of the sonic hedgehog pathway, is characterized by developing multiple basal cell carcinomas (BCCs) in adolescent patients. Other clinical features include mandibular keratocysts, palmar and plantar pits, skeletal abnormalities and malformations central nervous system and genital tract...
2016: Dermatology: International Journal for Clinical and Investigative Dermatology
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