Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 5.695
Filter
1.
Arch Dermatol Res ; 316(6): 320, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38822894

ABSTRACT

Cutaneous malignancies affecting the ear, exacerbated by extensive ultraviolet (UV) exposure, pose intricate challenges owing to the organ's complex anatomy. This article investigates how the anatomy contributes to late-stage diagnoses and ensuing complexities in surgical interventions. Mohs Micrographic Surgery (MMS), acknowledged as the gold standard for treating most cutaneous malignancies of the ear, ensures superior margin control and cure rates. However, the ear's intricacy necessitates careful consideration of tissue availability and aesthetic outcomes. The manuscript explores new technologies like Reflectance Confocal Microscopy (RCM), Optical Coherence Tomography (OCT), High-Frequency, High-Resolution Ultrasound (HFHRUS), and Raman spectroscopy (RS). These technologies hold the promise of enhancing diagnostic accuracy and providing real-time visualization of excised tissue, thereby improving tumor margin assessments. Dermoscopy continues to be a valuable non-invasive tool for identifying malignant lesions. Staining methods in Mohs surgery are discussed, emphasizing hematoxylin and eosin (H&E) as the gold standard for evaluating tumor margins. Toluidine blue is explored for potential applications in assessing basal cell carcinomas (BCC), and immunohistochemical staining is considered for detecting proteins associated with specific malignancies. As MMS and imaging technologies advance, a thorough evaluation of their practicality, cost-effectiveness, and benefits becomes essential for enhancing surgical outcomes and patient care. The potential synergy of artificial intelligence with these innovations holds promise in revolutionizing tumor detection and improving the efficacy of cutaneous malignancy treatments.


Subject(s)
Carcinoma, Basal Cell , Ear Neoplasms , Mohs Surgery , Skin Neoplasms , Humans , Mohs Surgery/methods , Skin Neoplasms/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Ear Neoplasms/surgery , Ear Neoplasms/pathology , Ear Neoplasms/diagnostic imaging , Ear Neoplasms/diagnosis , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/diagnostic imaging , Tomography, Optical Coherence/methods , Microscopy, Confocal/methods , Spectrum Analysis, Raman/methods , Dermoscopy/methods , Margins of Excision
2.
Exp Dermatol ; 33(6): e15097, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38840370

ABSTRACT

Surgical management of basal cell carcinoma (BCC) typically involves surgical excision with post-operative margin assessment using the bread-loafing technique; or gold-standard Mohs micrographic surgery (MMS), where margins are iteratively examined for residual cancer after tumour removal, with additional excisions performed upon detecting residual tumour at margins. There is limited sampling of resection margins with bread loafing, with detection of positive margins 44% of the time using 2 mm intervals. To resolve this, we have developed three-dimensional (3D) Tissue Imaging for: (1) complete examination of cancer margins and (2) detection of tumour proximity to nerves and blood vessels. 3D Tissue optical clearing with a light sheet imaging protocol was developed for margin assessment in two datasets assessed by two independent evaluators: (1) 48 samples from 29 patients with varied BCC subtypes, sizes and pigmentation levels; (2) 32 samples with matching Mohs' surgeon reading of tumour margins using two-dimensional haematoxylin & eosin-stained sections. The 3D Tissue Imaging protocol permits a complete examination of deeper and peripheral margins. Two independent evaluators achieved negative predictive values of 92.3% and 88.24% with 3D Tissue Imaging. Images obtained from 3D Tissue Imaging recapitulates histological features of BCC, such as nuclear crowding, palisading and retraction clefting and provides a 3D context for recognising normal skin adnexal structures. Concurrent immunofluorescence labelling of nerves and blood vessels allows visualisation of structures closer to tumour-positive regions, which may have a higher risk for neural and vascular infiltration. Together, this method provides more information in a 3D spatial context, enabling better cancer management by clinicians.


Subject(s)
Carcinoma, Basal Cell , Imaging, Three-Dimensional , Margins of Excision , Mohs Surgery , Skin Neoplasms , Humans , Carcinoma, Basal Cell/diagnostic imaging , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgery , Skin Neoplasms/pathology
3.
Australas J Dermatol ; 65(3): 266-267, 2024 May.
Article in English | MEDLINE | ID: mdl-38757426

ABSTRACT

For small defects of the anterior nasal ala, a V-Y pedicle advancement flap within the subunit is a useful repair option. Here we propose a modification of this technique, utilising careful dissection to identify inferior perforators of the superior alar artery. Basing this flap on a visualised vascular pedicle aims to prevent common complications of internal mucosal buckling and free margin notching, by allowing more extensive dissection without compromising the vascularity of the flap.


Subject(s)
Surgical Flaps , Humans , Surgical Flaps/blood supply , Nose Neoplasms/surgery , Rhinoplasty/methods , Nose/blood supply , Nose/surgery , Male , Skin Neoplasms/surgery , Female , Carcinoma, Basal Cell/surgery
4.
Laryngorhinootologie ; 103(S 01): S100-S124, 2024 May.
Article in English, German | MEDLINE | ID: mdl-38697144

ABSTRACT

The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.


Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Interdisciplinary Communication , Skin Neoplasms , Skin Neoplasms/therapy , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Humans , Carcinoma, Squamous Cell/therapy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Basal Cell/therapy , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Patient Care Team , Carcinoma, Merkel Cell/therapy , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/surgery , Intersectoral Collaboration , Neoplasm Staging
5.
Arch Dermatol Res ; 316(6): 255, 2024 May 25.
Article in English | MEDLINE | ID: mdl-38795216

ABSTRACT

Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. The objective of this systematic review is to provide a thorough overview of scrotal BCC, including a summary of its clinical characteristics, and microscopic subtypes. It also seeks to discuss the many techniques used in the management of this uncommon clinical presentation. Utilizing data from 1957 to October 2023, a systematic review of PubMed and Wiley Online Library was conducted to identify all cases of scrotal BCC with various presentations and managements. A total of 73 patients were included. The median patient age was 65.9 years (range 42 to 87). All studies were either case reports or case series. Our review shows that treatment with Mohs micrographic surgery (MMS), leads to a superior patient outcome based on anecdotal evidence in select cases. To deepen our understanding of Mohs surgery's efficacy in treating scrotal BCC, it is imperative to conduct more robust research in the form of randomized clinical trials.


Subject(s)
Carcinoma, Basal Cell , Mohs Surgery , Scrotum , Skin Neoplasms , Humans , Scrotum/pathology , Scrotum/surgery , Male , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/therapy , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Aged , Middle Aged , Aged, 80 and over , Adult , Treatment Outcome
7.
Acta Derm Venereol ; 104: 15765, 2024 Apr 02.
Article in English | MEDLINE | ID: mdl-38566404

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.


Subject(s)
Carcinoma, Basal Cell , Skin Neoplasms , Humans , Mohs Surgery/adverse effects , Mohs Surgery/methods , Sweden/epidemiology , Retrospective Studies , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Skin Neoplasms/surgery , Skin Neoplasms/pathology , Neoplasm Recurrence, Local/surgery
8.
A A Pract ; 18(4): e01783, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38619143

ABSTRACT

Implanting neuromodulation devices requires that pain medicine physicians be well-versed in proper surgical technique and postoperative wound management. To be able to identify abnormal wound healing, a basic understanding of normal wound healing is required. When postoperative wounds deviate from expected healing, it is important that pain medicine physicians entertain a broad differential diagnosis, including nonsurgical dermatologic pathology.


Subject(s)
Carcinoma, Basal Cell , Skin Neoplasms , Humans , Cicatrix , Carcinoma, Basal Cell/surgery , Skin Neoplasms/surgery , Spinal Cord , Pain
10.
Med J Aust ; 220(9): 472-479, 2024 May 20.
Article in English | MEDLINE | ID: mdl-38685827

ABSTRACT

OBJECTIVES: To examine recent changes in the numbers of Medicare-subsidised keratinocyte cancer excisions, particularly for younger people exposed to primary prevention campaigns since the early 1980s. STUDY DESIGN: Retrospective cohort study; analysis of administrative data. SETTING, PARTICIPANTS: Analysis of Medicare Benefits Schedule (MBS) claims data for procedures related to the diagnosis and treatment of keratinocyte cancer in Australia, 2012-2021. MAIN OUTCOME MEASURES: Age-standardised rates for MBS-subsidised claims for first surgical squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) excisions, Mohs surgery, surgical excisions of benign lesions, skin biopsies, and cryotherapy or serial curettage of premalignant and malignant lesions, overall, and by sex, state/territory, and age group; average annual percentage change in rate for time intervals determined by joinpoint regression. RESULTS: In men, the age-standardised rate of BCC/SCC excisions increased by 1.9% (95% confidence interval [CI], 1.4-2.4%) per year during 2012-2019 (from 2931 to 3371 per 100 000 men) and then declined by 3.8% (95% CI, 0.5-7.0%) per year during 2019-2021 (to 3152 per 100 000). In women, the age-standardised rate increased by 2.2% (95% CI, 1.7-2.8%) per year during 2012-2019 (from 1798 to 2093 per 100 000 women); the decline to 1967 excisions per 100 000 women in 2021 was not statistically significant. BCC/SCC excision rates declined for men under 55 years of age (by 1.0-3.4% per year) and women under 45 years of age (by 1.7-2.3% per year). Age-standardised biopsy rates increased during 2012-2021 in all age groups (by 2.8-6.9% per year). CONCLUSIONS: Rates of MBS-subsidised treatment for keratinocyte cancers increased during 2012-2019, but BCC/SCC treatment rates declined among younger Australians, who have probably been exposed to less sunlight than earlier generations because of public health interventions and population-wide lifestyle changes related to technology use.


Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Skin Neoplasms , Humans , Retrospective Studies , Male , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Skin Neoplasms/therapy , Female , Australia/epidemiology , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/therapy , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Middle Aged , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Aged , Adult , Keratinocytes/pathology , Aged, 80 and over , Mohs Surgery/statistics & numerical data , Young Adult , Cryotherapy/statistics & numerical data , Age Factors
11.
Actas Dermosifiliogr ; 115(6): T555-T571, 2024 Jun.
Article in English, Spanish | MEDLINE | ID: mdl-38648936

ABSTRACT

Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.


Subject(s)
Carcinoma, Basal Cell , Margins of Excision , Mohs Surgery , Paraffin Embedding , Skin Neoplasms , Humans , Skin Neoplasms/surgery , Skin Neoplasms/pathology , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Neoplasm Recurrence, Local/prevention & control , Paget Disease, Extramammary/surgery , Paget Disease, Extramammary/pathology , Hutchinson's Melanotic Freckle/surgery , Hutchinson's Melanotic Freckle/pathology , Dermatofibrosarcoma/surgery , Dermatofibrosarcoma/pathology
12.
J Craniofac Surg ; 35(4): e354-e357, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38587387

ABSTRACT

Scalp reconstruction has always been a challenging problem for even the most experienced surgeon to provide good aesthetic and functional results. This is mainly because the scalp is less mobile and tight, requiring a much larger dissection for the size of the original defect. We hypothesized that the omega variant perforator-based keystone island flap at the subgaleal plane provides a versatile and easily reproducible reconstructive option for scalp reconstruction after wide skin cancer excision. We reviewed all patients who underwent reconstruction with the keystone flap or its modification to repair scalp defects following wide resection of skin cancer in the scalp abutting calvarium from May 2021 to July 2023. We designed the flap width 50% wider than original keystone flap design first introduced by Dr. Behan. We reconstructed medium- to large-sized scalp defects ranging from 2×2 to 5×5 cm 2 using an omega variant perforator-based keystone island flap. All patients were satisfied with the aesthetic outcomes without complications. Keystone flaps are a versatile option for reconstructing the scalp after cancer resection. This strategy obviates the need for skin grafting, myocutaneous flap or free flap after cancer removal in the scalp.


Subject(s)
Carcinoma, Basal Cell , Perforator Flap , Plastic Surgery Procedures , Scalp , Skin Neoplasms , Humans , Scalp/surgery , Skin Neoplasms/surgery , Skin Neoplasms/pathology , Male , Female , Carcinoma, Basal Cell/surgery , Aged , Middle Aged , Plastic Surgery Procedures/methods , Skull/surgery , Aged, 80 and over , Neoplasm Invasiveness , Head and Neck Neoplasms/surgery , Adult
13.
Arq Bras Oftalmol ; 87(3): e20220357, 2024.
Article in English | MEDLINE | ID: mdl-38537041

ABSTRACT

We present a rare case of primary caruncle basal cell carcinoma (BCC), a condition with limited occurrences. Our patient, an 80-year-old woman without prior ocular pathological history, presented a 2x2mm pedunculated blackish nodular lesion on the caruncle of her left eye, without local conjunctival or cutaneous involvement. Histological analysis following complete excision confirmed the presence of basal cell carcinoma within the caruncle. Over a span of 30 months, no recurrence has been observed. While scant cases are documented in the literature, we conducted a review of these instances. Despite its infrequent manifestation, this condition should be taken into account when evaluating caruncular tumors, given its tendency to invade the orbit. Complete excision with free surgical margins is the treatment of choice, and adjuvant radiotherapy or chemotherapy might be considered.


Subject(s)
Carcinoma, Basal Cell , Eye Neoplasms , Skin Neoplasms , Humans , Female , Aged, 80 and over , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Conjunctiva/pathology , Skin Neoplasms/surgery
14.
J Prim Health Care ; 16(1): 90-95, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38546776

ABSTRACT

Introduction The New Zealand population has one of the highest incidences of skin cancer in the world. Hospital waiting lists for surgical excision of keratinocytic skin cancers (basal cell carcinoma and squamous cell carcinoma) are lengthy, and increasingly, excisions are undertaken in primary care. Teledermatology, in response to general practitioners' electronic referrals (e-referrals), can improve clinical communication between general practitioners and dermatologists. Aim The aim of this study was to evaluate an excision pathway for keratinocytic cancers diagnosed by teledermatology. Methods A retrospective observational descriptive review of a 3-month cohort of primary care e-referrals was undertaken. Results Three hundred and fifty eight suspected keratinocytic cancers (KCs) were diagnosed by teledermatology; histology reports confirmed KC in 201 of 267 excisions (75%). The majority (77.2%) were excised by general practitioners an average of 25 days after the dermatologist's recommendation. The rest were excised by plastic surgeons in private (3.4%) or at a public hospital (19.5%) after an average of 40 or 134 days, respectively. Discussion E-referral pathways are now widely implemented. However, the ideal workflow for skin cancer management is unknown. We have demonstrated in New Zealand that surgery can be undertaken in primary care within a month of a teledermatology diagnosis and excision recommendation. Conclusion This study reports prompt excision of KCs by general practitioners after an e-referral and a teledermatology response.


Subject(s)
Carcinoma, Basal Cell , Dermatology , Skin Neoplasms , Telemedicine , Humans , Retrospective Studies , Dermatology/methods , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Skin Neoplasms/epidemiology , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/epidemiology , Keratinocytes/pathology , Telemedicine/methods
19.
Article in English | MEDLINE | ID: mdl-38380962

ABSTRACT

Basal cell carcinoma is an exceedingly rare cause of spinal metastatic disease for which the treatment algorithm is poorly defined. We present a positive patient outcome after treatment of T8 metastatic basal with posterior decompression and fusion followed by later anterior reconstruction, in addition to targeted radiation therapy and pharmacologic therapy. In general, a personalized and comprehensive treatment approach should be used, incorporating surgical, oncologic, and pharmacologic methods as able. Moreover, primary preventive medical and mental health care can help prevent delayed presentation and increased access to timely care.


Subject(s)
Carcinoma, Basal Cell , Skin Neoplasms , Humans , Decompression, Surgical , Spine , Carcinoma, Basal Cell/surgery , Skin Neoplasms/surgery
20.
J Craniofac Surg ; 35(4): e325-e329, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38385685

ABSTRACT

PURPOSE: To describe a modified approach for full-thickness lower eyelid defect reconstruction. METHODS: This is a retrospective review of 5 patients with large full-thickness lower eyelid defects after tumor resection requiring reconstruction. For these lower eyelid defects, a lateral-based or superior-based tarsoconjunctival pedicle flap from the upper eyelid was used to rebuild the posterior lamella. In all cases, the anterior lamella was supplied from an adjacent myocutaneous flap in a bucket handle configuration. Data collection included tumor type and location, size of eyelid defect, presence of canalicular involvement, postoperative eyelid position, patient satisfaction, and complication rates. RESULTS: Five eyelids of 5 patients underwent Mohs micrographic excision of basal cell carcinoma followed by reconstruction with a bucket handle flap. Age range was 68 to 96 years old (mean of 81 y). Five patients presented with lower eyelid involvement. The defect size ranged from 80% to 100% of the eyelid. Three patients had canalicular involvement and required bicanalicular nasolacrimal stent placement. After reconstruction, all patients showed good eyelid apposition to the globe with excellent esthetic outcome. No revision procedures were done. Average follow-up time was 13 months (range of 8 to 21 mo). CONCLUSION: The bucket handle flap for full-thickness eyelid reconstruction is a simple technique that allows for preservation of all anatomical layers of the anterior lamella. This technique shows promising functional and esthetic outcomes.


Subject(s)
Carcinoma, Basal Cell , Eyelid Neoplasms , Mohs Surgery , Surgical Flaps , Humans , Aged , Eyelid Neoplasms/surgery , Aged, 80 and over , Retrospective Studies , Male , Female , Carcinoma, Basal Cell/surgery , Treatment Outcome , Plastic Surgery Procedures/methods , Blepharoplasty/methods , Eyelids/surgery , Patient Satisfaction
SELECTION OF CITATIONS
SEARCH DETAIL
...