Efficacy of Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans: systematic review.

OBJECTIVE To summarize evidence about the recurrence of dermatofibrosarcoma protuberans (DFSP) following Mohs micrographic surgery (MMS). DATA SOURCES MEDLINE, Cochrane Library, EMBASE, Pascal, Biosis, CisMef, BDSP, Scopus, and Web of Knowledge databases were searched for the period January 1, 1995, to August 31, 2011. Search terms were Mohs micrographic surgery, dermatofibrosarcoma protuberans, and their synonyms. No language restriction was used. STUDY SELECTION Two of us selected randomized controlled trials or nonrandomized trials comparing the recurrence of DFSP among patients undergoing MMS vs wide local excision. The search retrieved 384 references, of which 31 were reviewed in detail. DATA EXTRACTION Twenty-three nonrandomized trials (4 comparative and 19 noncomparative) were included, from which data were extracted by 2 of us independently. The methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. DATA SYNTHESIS Moderate-quality evidence (level B) was found for recurrence of DFSP after MMS (1.11%; 95% CI, 0.02%-6.03%) vs after wide local excision (6.32%, 95% CI, 3.19%-11.02%). A mean raw recurrence rate of 1.03% (95% CI, 0.37%-2.22%) was found after MMS among 19 nonrandomized noncomparative trials (low-quality evidence [level C]). The mean follow-up periods ranged from 26 to 127 months. The mean time to recurrence was 68 months. CONCLUSIONS A weak recommendation is given in favor of MMS or similar surgical techniques with meticulous histologic evaluation of all margins as the first-line therapy for DFSP, particularly in recurrence-prone regions. Attention should be given to longer than a 5-year follow-up period. High-quality trials with sufficient follow-up periods should be encouraged.

Prevalence analysis of fungi in chronic lower extremity ulcers .

UNLABELLED: Background. Lower extremity ulcers are a major cause of morbidity in elderly patients and can be colonized by many different microorganisms, including fungi. The purpose of this prospective study was to determine the prevalence of fungal colonization and/or infection at the ulcer site and the surrounding skin. METHODS: Swabs were taken from 152 lower extremity ulcers and the surrounding skin. Direct microscopic examination and cultures for fungal and bacteriological investigations were obtained. The characteristics of the patients, ulcers, and surrounding skin were studied. RESULTS: Fungi were isolated from 6% of ulcers and 27.6% of the skin samples. Three species were found: Candida albicans (2% of ulcers, 4.6% of surrounding skin), Candida parapsilosis (2% of ulcers, 11% of surrounding skin), and Candida ciferrii (0.6% of surrounding skin). Fungal infections were found in 2% of ulcers and 8.5% of skin samples from the surrounding skin. CONCLUSION: The prevalence of fungal colonization was less robust than that observed in previous studies. No relationship was found between fungal infection and patient or ulcer characteristics. However, there was significant Corynebacteria colonization in the fungal infection group (P = 0.02). It would be interesting to conduct similar studies in order to evaluate the effect of antifungal treatment on infected wounds.