Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases

Abstract Background: The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact. Objective: To describe the authors' experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods. Methods: Retrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years. Results: One hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection). Study limitations: Retrospective design and the absence of long-term follow-up of some cases. Conclusions: The dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.

Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations

Abstract Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or "roots" that may be missed if an excised tumor is serially cross-sectioned in a "bread-loaf" fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs's initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.

Reconstrução nasal após cirurgia micrográfica de Mohs: análise de 208 casos / Nasal reconstruction after Mohs micrographic surgery: analysis of 208 cases

Introdução: O nariz é frequentemente acometido por carcinomas cutâneos. Devido à importância funcional e estética, tem como primeira indicação a cirurgia micrográfica de Mohs, método com a maior taxa de cura. Para reparo das feridas operatórias, inúmeras opções estão disponíveis incluindo cicatrização por segunda intenção, fechamento primário, enxertos cutâneos e retalhos. Em certos casos, deve-se considerar a combinação de métodos. Objetivo: Descrever a experiência dos autores na reconstrução nasal após cirurgia de Mohs e avaliar se o número de subunidades anatômicas acometidas influenciou no uso de métodos combinados de reparo. Métodos: Estudo retrospectivo de casos consecutivos submetidos à cirurgia de Mohs e à reconstrução nasal por um dos autores, num período de três anos. Resultados: Foram incluídos 208 casos e o método de reparo mais comum foram os retalhos (n=82). A combinação de métodos foi utilizada em 44/154 (29%) casos com acometimento de apenas uma subunidade anatômica nasal e em 29/54 (54%) casos com múltiplas subunidades nasais envolvidas. Conclusões: O cirurgião dermatológico deve se familiarizar com as diferentes opções de reconstrução nasal. A combinação de métodos de reparo foi frequentemente utilizada, principalmente para feridas com acometimento de mais do que uma subunidade nasal.

Introduction: The nose is frequently affected by cutaneous carcinomas. Due to its functional and cosmetic importance, tumors on this location are preferably treated by Mohs micrographic surgery, which provides the highest cure rates. For repairing of surgical wounds, several options are available, including healing by second intention, primary closure, skin grafts, and flaps. In certain cases, one should consider a combination of methods. Objective: To describe the authors' experience in nasal reconstruction after Mohs surgery and to assess if the number of involved subunits influenced the use of combined repairs. Methods: Retrospective study of consecutive cases submitted to Mohs surgery and nasal reconstruction by one of the authors during a 3-year period. Results: 208 cases were included, and the most common repair method were flaps (n = 82). Combined methods were performed in 44/154 (29%) cases with involvement of only one nasal anatomical subunit and 29/54 (54%) cases with multiple nasal subunits involved. Conclusions: The dermatologic surgeon should be familiar with different options for nasal reconstruction. The combination of repair methods was often performed, mainly for wounds that affected more than one nasal subunit