RESUMO
BACKGROUND: Surgical treatment options for facial melanomas include conventional excision with postoperative margin assessment, Mohs micrographic surgery (MMS) with immunostains (MMS-I), and slow MMS. Patient preferences for these surgical options have not been studied. OBJECTIVES: To evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes. METHODS: Participants completed a 2-part study consisting of a stated preference survey and a choice-based conjoint analysis experiment. RESULTS: Patients overwhelmingly (94.3%) rated local recurrence risk as very important and ranked it as the most important attribute of surgical treatment for facial melanoma. Via choice-based conjoint analysis, patients ranked the following surgical attributes from highest to lowest in importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, more than 73% of respondents selected MMS-I or slow MMS as their preferred treatment option for a facial melanoma. LIMITATIONS: Data were obtained from a single health system. CONCLUSION: Patients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.
Assuntos
Neoplasias Faciais/cirurgia , Melanoma/cirurgia , Recidiva Local de Neoplasia , Preferência do Paciente , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento de Escolha , Tomada de Decisões , Feminino , Gastos em Saúde , Humanos , Consentimento Livre e Esclarecido , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cirurgia de Mohs , Visita a Consultório Médico , Estudos Prospectivos , Reoperação , Fatores de Risco , Fatores de Tempo , Adulto Jovem , Melanoma Maligno CutâneoRESUMO
El síndrome de Adams-Oliver es un desorden congénito raro, caracterizado por la presencia de aplasia cutis congénita y defectos terminales transversos de los miembros. Comunicamos el caso de una niña de 4 años de edad con síndrome de Adams-Oliver que presenta venas congénitas, tortuosas y dilatadas en el cuero cabelludo, aplasia cutis congénita con defectos parciales del hueso craneal subyacente, calcificaciones intracraneales y anomalías leves de los pies.
Adams-Oliver syndrome is a rare congenital disorder characterized by aplasia cutis congenita and terminal transverse limb defects. We report a case of a 4-year-old girl with Adams-Oliver syndrome with congenital dilated and tortuous scalp veins, aplasia cutis congenita with partial underlying skull defects, intracranial calcifications, and mild foot anomalies.
Assuntos
Humanos , Feminino , Lactente , Couro Cabeludo/anormalidades , Displasia Ectodérmica/diagnóstico , Veias/anormalidades , Couro Cabeludo/patologia , Deformidades Congênitas das Extremidades Superiores/diagnóstico , Veias/patologiaRESUMO
We report a case of a 3-year-old girl with a 9-month history of focal neurologic finding and signs of increased intracranial pressure. Radiological imaging studies showed a minimally heterogeneous enhancing large tumor involving left parietal region and partly filling the left lateral ventricle. Microscopically, the tumor contained prominent small true rosettes set into areas of fibrillar neuropil-like matrix. Foci of cellular tumor with extensive apoptosis were present. The neuropil-like areas and true rosettes were positive for synaptophysin immunostain. The tumor was negative for GFAP and neurofilament protein immunostains. MIB-1 proliferation index was high focally approaching 80%.
