Fatores associados à ressecção incompleta do câncer não melanoma / Factors associated with incomplete resection of non-melanoma cancer

Introdução: Analisar fatores associados e taxa de positividade de margem cirúrgica após ressecção primária de Câncer de Pele Não Melanoma (CNM). Métodos: Estudo transversal, quantitativo, realizado mediante a revisão de prontuários de pacientes submetidos à ressecção cirúrgica de carcinoma basocelular (CBC) e espinocelular (CEC) de pele. Foram estudadas as seguintes variáveis: idade, tipo de câncer, localização, diâmetro, variante histológica, presença de ulceração, presença e ressecção de lesões associadas e presença de comprometimento de margens cirúrgicas. Resultados: Foram inclusos 183 paciente no estudo. Destes, 130 eram CBC (71%) e 53 eram CEC (29%). A taxa global de comprometimento de margem foi de 13,1%, sendo 21 CBC (16%) e 3 CEC (5,66%). Margens cirúrgicas positivas estiveram mais associadas a lesões do tipo CBC (p<0,05) e em lesões localizadas em nariz e pálpebra (p<0,05). Presença de ulceração, diâmetro das lesões e variante histológica não foram associadas a uma maior taxa de ressecções incompletas. Conclusão: Nossa taxa global de ressecção incompleta de Câncer de Pele (CNM) apresenta-se semelhante ao encontrado na literatura. Lesões por CBC ou localizadas em nariz e pálpebra têm maiores taxas de positividade de margem após ressecção primária (AU)

Introduction: To analyze associated factors and surgical margin positivity rate after primary resection of Non-Melanoma Skin Cancer (NMC). Methods: A cross-sectional, quantitative study was carried out by reviewing medical records of patients submitted to surgical resection of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. The following variables were studied: age, type of cancer, location, diameter, histological variant, presence of ulceration, presence and resection of associated lesions, and presence of surgical margins involvement. Results: 183 patients were included in the study. Of these, 130 were BCC (71%) and 53 were SCC (29%). The overall rate of margin involvement was 13.1%, of which 21 were CBC (16%) and 3 SCC (5.66%). Positive surgical margins were more associated with BCC lesions (p <0.05) and lesions located in the nose and eyelid (p <0.05). Presence of ulceration, lesion diameter and histological variant were not associated with a higher rate of incomplete resections. Conclusion: Our overall rate of incomplete resection of Skin Cancer is similar to that found in the literature. Lesions by BCC or located in the nose and eyelid have higher rates of margin positivity after primary resection (AU)

Natural Course of the Incompletely-Excised Basal Cell Carcinomas / 대한피부과학회지

BACKGROUND: Mohs micrographic surgery (MMS) is regarded as the standard therapeutic modality for high-risk basal cell carcinoma (BCC). However, wide local excision (WLE) is performed more frequently than MMS in Korea because of practical restrictions. For this reason, involvement of surgical margin after WLE may be detected postoperatively. OBJECTIVE: Our purpose was to compare the recurrence rate between histopathologically confirmed an "incomplete excision" group and a "complete excision" group to evaluate whether close follow-up could be an acceptable management option in incompletely-excised BCC patients when immediate re-excision or other adjunctive therapy was difficult to enforce. METHODS: From 1999 to 2008, a total of 227 primary BCC cases with more than 2 year follow-up after surgical resection were reviewed. We divided the cases into the completely-excised and incompletely-excised group and the recurrence rates of both groups were compared. RESULTS: The recurrence rate out of the total 227 cases was 1.3% (3/227). Eleven cases (4.8%, 11/227) were reported to be incompletely excised. Of the 11 surgical incompletely-excised BCC, only 1 (9.0%, 1/11) case recurred. Two (0.9%, 2/216) cases recurred in the 216 completely-excised patients. Difference of recurrence rate between the completely-excised group and incompletely-excised group was not statistically significant. CONCLUSION: When the initial excision of a primary BCC reveals incomplete excision and, more importantly, immediate further treatment is not eligible due to various causes such as old age or combined medical and surgical problems, close follow-up with detailed informed consent instead of prompt re-excision could be a reasonable alternative in carefully-selected patients.

The Effect of Topical Mitomycin C after Excisional Biopsy in Conjunctival-corneal Intraepithelial Neoplasia: Two cases

PURPOSE: To investigate the effect of topical Mitomycin C(MMC) as a medical adjunct to incompletely excised conjunctival-corneal intraepithelial neoplasia(CCIN) for removal of remaining neoplastic cells and prevention of recurrence. METHODS: The authors applied postoperative topical 0.02% MMC adjunctively on 2 eyes of 2 patients with incompletely excised and histopathologically confirmed conjunctival-corneal intraepithelial neoplasia(CCIN) for 2weeks and if the lesion is not regressed, topical MMC treatment with the same regimen was added. RESULTS: Remaining lesions were completely regressed and no recurrence has been found with follow up to 25 months and 26 months in each case. CONCLUSIONS: Topical MMC chemotherapy would be an effective treatment modality on incompletely excised conjunctival-corneal intraepithelial neoplasia(CCIN) for removal of remaining neoplatic cells and prevention of recurrence.