Résumé
Abstract: Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.
Sujets)
Humains , Tumeurs cutanées/chirurgie , Carcinome basocellulaire/chirurgie , Carcinome épidermoïde/chirurgie , Chirurgie de Mohs/normes , Guides de bonnes pratiques cliniques comme sujet , Récidive tumorale locale/chirurgie , Tumeurs cutanées/anatomopathologie , Carcinome basocellulaire/anatomopathologie , Carcinome épidermoïde/anatomopathologie , Chirurgie de Mohs/méthodes , Marges d'exérèseRésumé
ABSTRACT PURPOSE: To validate the innovative Dry Ice method, comparing it with two standard methods currently used for tissue processing in Mohs surgery, the Heat Sink method and the Miami Special. METHODS: Forty eight samples of pigs kin with the standard beveled Mohs technique were used, and randomly allocated into six groups. Each group was processed with one of the 3 methods and evaluated for: The freezing time, the depth required to cut into the block to obtain a complete section, and the quality of histological slides analyzed with a image software. The statistical analysis was performed with the software SAS(r) System. The inferential analysis was made by one-way ANOVA. RESULTS: The Miami Special showed a processing time significantly shorter than Dry Ice method and Heat Sink method. There was no significant difference in the depth required to cut into the blocks, and area of surgical margins visualized. CONCLUSION: The Dry Ice method was as efficient as the other two methods currently used in Mohs surgery, considering the individual advantages and disadvantages of each method.
Sujets)
Animaux , Chirurgie de Mohs/normes , Inclusion de tissu/méthodes , Coupes minces congelées/méthodes , Tumeurs cutanées/chirurgie , Suidae , Analyse de variance , Chirurgie de Mohs/instrumentation , Modèles animaux de maladie humaine , Neige carboniqueRésumé
Se plantean los criterios a considerar a fin de escoger la terapéutica a seguir ante un carcinoma basocelular y, en particular, los casos en que la cirugía micrográfica de Mohs es la más adecuada. Esta técnica ofrece la tasa más alta de curación, con máxima preservación de tejido sano y sus indicaciones son: localización de alto riesgo, histología agresiva, tamaño mayor de 2 cm, tumores recidivados e interés cosmético