Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma.

BACKGROUND: The two main tumors treated with Mohs micrographic surgery (MMS) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There are no studies analyzing whether MMS is different when treating these two types of tumors. OBJECTIVE: We aim to compare the characteristics of the patients, the tumors, and MMS, and first-year follow-up of MMS in BCC and SCC. METHODS: REGESMOHS is a prospective cohort study of patients treated with MMS. The participating centers are 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patients, tumors, and surgery were recorded. The follow-up was done with two visits: the first visit within 1 month after surgery and the second one within the first year. RESULTS: From July 2013 to April 2017, a total of 2,669 patients who underwent MMS were included in the registry. Of them, 2,448 (93%) were diagnosed with BCC, and 181 (7%) were diagnosed with SCC. Patients with SCC were older than those with BCC (median age 73 years vs. 68 years) and presented immunosuppression more frequently. The tumor size was significantly larger in the SCC group. Regarding surgery, deeper invasion was more frequent in SCC, resulting in larger defects. Despite this, SCC did not require more stages to get clear margins or more time in the operating room. Incomplete Mohs was more frequent in the SCC group (6%) than in the BCC group (2%). The incidence of perioperative complications was higher when treating SCC. There were more relapses in the first-year follow-up in the SCC group. CONCLUSION: There are significant differences when comparing MMS in BCC and SCC. Knowledge of these differences can help to prepare the patient and plan the surgery, optimizing results.

Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases.

BACKGROUND: Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009. OBJECTIVES: To assess the utility and tolerance of titanium mesh as a substitute of the osteocartilaginous portion of the nose. MATERIALS AND METHODS: Eleven patients were identified who had a nasal reconstruction with titanium mesh. We retrospectively searched for infection, extrusion, nasal valve collapse, second surgery, and patient satisfaction in the patients' records. All patients presented with various types of non-melanoma skin cancer in the nasal pyramid. In the reconstruction of full-thickness nasal defects, local flaps were used, employing titanium mesh as a support structure. RESULTS: No mesh extrusions, infections, or collapse of the nasal valve were noted in patients with a mean follow-up of five years. Only one patient needed a second surgery to debulk the flap. Patient satisfaction achieved a mean score of 7.5 out of 9 in 10 patients. CONCLUSIONS: As cartilage grafts need a second surgical site, with consequent morbidity, the use of titanium mesh proves useful and safe in the reconstruction of nasal full-thickness defects. The results of our series of patients demonstrate the suitability of this material in the repair of nasal osteochondral defects, as well as its low rate of complications.

[A new case of nevus oligemicus]. / Un nuevo caso de nevus oligemicus.

UNLABELLED: Nevus oligemicus is a rare lesion characterized by selective vasoconstriction of the deep dermal vascular plexus compared with the superficial one. It has been suggested that it may be caused by increased sympathetic tone in the deep dermal vascular plexus or an abnormality of hormone receptors, which is why it is considered a functional nevus. Clinically, it presents as an asymptomatic, fixed, livid erythematous macule with a striking decrease in local temperature compared with surrounding healthy skin. CASE REPORT: We report the case of a 59-year-old man with a 2-year history of three large areas of persistent and asymptomatic livid erythema on trunk and flanks. These areas blanched under light pressure. Measurement of the surface temperature of the patch revealed a decrease of up to 2.5 degrees C with respect to surrounding skin. Histology showed superficial dermal capillary dilatation without other significant findings. The fixed nature of the lesions, consistent histopathology, and the finding of localized hypothermia allowed the diagnosis of nevus oligemicus. CONCLUSIONS: The diagnosis is mainly clinical. Our case is the eleventh case of nevus oligemicus reported in the literature.