Resection Of Basal Cell Carcinoma Research Articles

Esthetic Posterior Reconstruction of Lower Eyelid Using Stripe-Shaped Antihelix Cartilage With Perichondrium.

Eyelid malignancies are often resected in the entire layer, typically requiring anterior and posterior lamellae reconstruction. Posterior lamella reconstruction has been reported using grafts from the nasal septum, palatal mucosa, and auricular cartilage, which have advantages and disadvantages. The authors performed anterior and posterior lamellar reconstruction using a local skin flap and stripe-shaped anti-helical cartilage with the perichondrium in 3 total defect cases after basal cell carcinoma resection of the lower eyelid. The auricular cartilage was excised in strips with the surrounding perichondrium attached and simultaneously reconstructed, with the auricular cartilage as the tarsal and the perichondrium as the conjunctival substitute. In all 3 cases, good results were obtained without eyelid ectropion or corneal irritation 1 year postoperatively. No auricular deformities were observed. However, partial lower eyelid ptosis was observed in 2 cases. In future cases, correctively over-fixating the lower eyelid morphology is necessary.

Reconstruction of Skin Defects in the Medial Canthal Region Using the Novel Hug Flap.

Various methods of reconstructing skin defects in the medial canthal region have been reported. We report 2 skin flaps for the upper and lower eyelids designed to reconstruct soft tissue defects in the medial canthal region based on the approach used for the orbit during surgeries for facial bone fractures. The skin flap was elevated without tension until it reached the defect. The skin flaps of the upper and lower eyelids were moved around the defect as rotational flaps and sutured. Two patients with skin defects in the medial canthal region after basal cell carcinoma resection were treated with this technique. No complications occurred, and good cosmetic and functional outcomes were obtained. This method can be used to reconstruct the eyelid with an elevated skin flap and is considered useful for repairing defects in the medial canthal region.

Narrow Histopathological Margins are Acceptable in Surgical Resection of Basal Cell Carcinoma in Japanese: A Single-Center Retrospective Study.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy. BCCs occur mainly in exposed areas, such as the face and scalp. Therefore, surgical resection with narrow margins is highly desirable. However, narrow margins may increase the risk of positive histopathological margins. Outcomes for such treatment might be unfavorable, but evidence for such a conclusion is lacking. Between April 2015 and November 2023, a total of 230 Japanese cases with BCC which underwent surgical resection with 2-mm, 3-mm, or 5-mm margins were followed in our hospital. We conducted a retrospective review that focused on the recurrence rate and histopathological margins. Recurrence was recorded if the follow-up time was longer than 3 months. One of the 198 cases (0.5%) developed a recurrence. The mean lateral and deep histopathological margins were 2,525.4 μm (30.8-14,034.6 μm) and 3,409 μm (199.9-16,523.6 μm), respectively. Recurrence rate was associated with tumor size and clinical tumor border. However, histopathological margin was not associated with recurrence rate, even when it was less than 1,000 μm. A narrow histopathological margin is acceptable for surgical resection of BCC in Japanese patients.

Tenzel flap for reconstruction of full-thickness inferior ocular defects following basal cell carcinoma resection: Case report

The relevance of this study lies in the development and implementation of an effective method of the Tenzel flap for the reconstruction of full-layer defects of the lower eyelid after resection of basal cell carcinoma. The purpose of this scientific study was to reconstruct the lower eyelid after resection of basal cell carcinoma using the Tenzel flap method and to investigate its effectiveness and results. The main feature of the surgical procedure was the use of a semicircular rotary Tenzel flap to repair moderate eyelid defects. This method involved the formation of a flap that starts from the outer corner of the eye, then moves up and along the temple, without crossing the outer edge of the eyebrow. After that, lateral cantolysis was used. The uniqueness lies in the ability to effectively correct moderate eyelid defects in one step, which simplifies the surgical process and minimises trauma to the patient. A significant condition in this procedure is the preservation of the tarsal plate on both sides of the excision, which allows preserving the structural integrity of the eyelid. Furthermore, this modification involves the use of the chondrocytic part of the nasal septum as a substitute and shows the effectiveness of this approach in the reconstruction of the eyelid after removal of basal cell carcinoma. Thus, the specific feature of the described surgical intervention is its effectiveness for moderate eyelid defects and the possibility of using modified methods of substitutes for complex defects. Given the results of the study, this modified method may become a major step in the treatment of patients with basal cell carcinoma, contributing to satisfactory cosmetic and functional results

Mid-cheek reconstruction flap for basal cell carcinoma resection defect. A case report

Mid-cheek reconstruction flap for basal cell carcinoma resection defect. A case report

Cheek reconstruction after basal cell carcinoma resection. A case report

Cheek reconstruction after basal cell carcinoma resection. A case report

Uncertainty estimation for margin detection in cancer surgery using mass spectrometry.

Rapid evaporative ionization mass spectrometry (REIMS) is an emerging technology for clinical margin detection. Deployment of REIMS depends on construction of reliable deep learning models that can categorize tissue according to its metabolomic signature. Challenges associated with developing these models include the presence of noise during data acquisition and the variance in tissue signatures between patients. In this study, we propose integration of uncertainty estimation in deep models to factor predictive confidence into margin detection in cancer surgery. iKnife is used to collect 693 spectra of cancer and healthy samples acquired from 91 patients during basal cell carcinoma resection. A Bayesian neural network and two baseline models are trained on these data to perform classification as well as uncertainty estimation. The samples with high estimated uncertainty are then removed, and new models are trained using the clean data. The performance of proposed and baseline models, with different ratios of filtered data, is then compared. The data filtering does not improve the performance of the baseline models as they cannot provide reliable estimations of uncertainty. In comparison, the proposed model demonstrates a statistically significant improvement in average balanced accuracy (75.2%), sensitivity (74.1%) and AUC (82.1%) after removing uncertain training samples. We also demonstrate that if highly uncertain samples are predicted and removed from the test data, sensitivity further improves to 88.2%. This is the first study that applies uncertainty estimation to inform model training and deployment for tissue recognition in cancer surgery. Uncertainty estimation is leveraged in two ways: by factoring a measure of input noise in training the models and by including predictive confidence in reporting the outputs. We empirically show that considering uncertainty for model development can help improve the overall accuracy of a margin detection system using REIMS.

Basal cell carcinoma resection in an Ecuadorian patient with Gorlin-Goltz syndrome

Basal cell carcinoma resection in an Ecuadorian patient with Gorlin-Goltz syndrome

The Use of a Hemi Glabellar Flap for Reconstruction of Medial Canthus Defects.

Background: Medial canthal reconstruction is a challenging task due to its complex anatomy. The glabellar flap is a common viable technique; however, this results in narrowing of the eyebrows, bulky nasal dorsum horizontal scarring, which is aesthetically displeasing, and possible injury of the supratrochlear artery. Multiple variations have been proposed in the literature, which is often complex. In this paper, the senior author (AK) has developed an intuitive, simple technique by utilising half of the glabellar skin in 12 patients with good clinical outcomes.Materials and methods: A rotational advancement flap involving the upper lateral nasal wall with the hemi glabellar was formed and transferred to the medial canthal defect. The donor site was closed in a V-Y manner. Complete closure of defect was achieved in all patients.Results: Reconstruction using the hemi glabellar technique was performed on 12 patients following resection of basal cell carcinoma (BCC) in or near the medial canthus area. Superficial cellulitis was noted in two patients; they were managed on oral antibiotics. Bruising was reported in seven patients which resolved spontaneously in 4-7 days. All patients had a good outcome at two months and six months follow up; there was no flap loss, and all patients were satisfied with the aesthetic outcome.Conclusion: The technique highlighted in this article can be performed quickly and applies to the reconstruction of medial canthus defects with excellent aesthetic outcomes, an inconspicuous scar and supple skin with matching colour.

Superficial temporal artery capillary perforator-based island flap for conchal bowl and external auditory canal reconstruction

Reconstruction of the auricle is challenging to surgeons as a result of its complex anatomy. Defects including the conchal bowl and the external auditory canal (EAC) do not accept imperfection as functional consequences may add to aesthetic ones. Local flaps that are relying mainly on posteriorly based auricle flaps do not represent ideal solutions. This study aims to report the perforator modification of an anteriorly based pre-auricular flap that matches all requires goals of reconstruction. From 2015 to 2019, three capillary perforator-based island flaps (c-PBIF), with the Superficial Temporal Artery (STA) as source pedicle, were performed to reconstruct a combined Conchal Bowl-External Auditory Canal (CB-EAC) defect, secondary to basal cell carcinoma resection. Free margins were obtained via the Tubigen micrographic approach. All three flaps were raised on the perforator originating from the superficial temporal pedicle. In 2 of the cases, the perforator was found at the level of the tragus while in the last case, it was found 1cm more distal. Capillary perforators were isolated and dissected down to their origin from the STA thereby increasing their arc of rotation and pliability. The median follow-up time was 4 years. All flaps survived. Aesthetic results were excellent leaving no distortion of the external ear and the hollow aspect of the conchal was well supported. The tragus mount was preserved, EAC lining was secured, and good audition was restored with no bulging of the flap into the canal in all the cases. Harvesting pre-auricular flaps as c-PBIFs are safe and acts as an excellent solution for the reconstruction of the challenging combined CB-EAC defect. It allows a one-stage reconstruction that does not need a secondary revision, it also gives excellent correction and functional results. We would recommend it as a useful option for the reconstruction of the conchal-EAC defects.

OP4: Posterior Auricular Perichondrial Cutaneous Graft for Stable Reconstruction of Nasal Defects: Long-Term Outcomes

INTRODUCTION: The posterior auricular perichondrial cutaneous graft (PCCG) was described in 2005 by Kalbermatten et al. as a functional, stable and aesthetic reconstructive option in case of cartilage or fibrofatty tissue defects of the nasal tip or ala. The composite graft is harvested using a posterior auricular donor site which is closed with a postauricular transposition flap, thus avoiding resection from the anterior conchal bowl. The present study aims at reporting long-term outcomes of the procedure. MATERIALS AND METHODS: We conducted a retrospective review of all patients undergoing nasal tip reconstruction with PCCG between 2005 and 2020. Graft survival, donor-site morbidity, nostril stability, reoperation rate and aesthetic outcomes were assessed at long follow-up. RESULTS: We identified 13 patients undergoing PCCG nasal reconstruction to cover defects presenting an average size of 2 cm2 on the ala and 2.5 cm2 on the tip after basal cell carcinoma resection. Twelve patients showed primary complete healing, while reoperation was required in one case due to partial necrosis of the graft. At a mean follow-up of 14.5 months, nostril stability and symmetry were achieved in all patients, while all donor sites healed uneventfully. Aesthetic outcomes were judged as satisfactory by both patients and surgeons. Oncological control was ensured by this reconstruction, allowing detection of relapse in three cases. CONCLUSION: This follow-up study confirmed the findings initially presented with a shorter 6months follow-up. The PCCG demonstrated to be a reliable and effective reconstructive option, able to restore function and aesthetic with minimal morbidity rate. Notably, the procedure allows optimal oncological control.

Split Lateral Forehead Flap for Reconstruction of Upper and Lower Eyelids

Background: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Patient and Operation Techniques: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre “choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

Complex techniques of eyelid reconstruction following extensive basal cell carcinoma resection

Complex techniques of eyelid reconstruction following extensive basal cell carcinoma resection

Value of Intraoperative Retakes During Standard Resection of Basal Cell Carcinoma (BCC) of the Head and Neck

Value of Intraoperative Retakes During Standard Resection of Basal Cell Carcinoma (BCC) of the Head and Neck

SUN-168 Case Series of ACTH-Secreting Pheochromocytoma: Diagnosis and Management

INTROACTH-secreting pheochromocytoma is rare, posing challenges in diagnosis and management. Here we report two cases with different presentations and pre-operative approaches.CASES Patient 1 A 59 yo female who presented for basal cell carcinoma resection experienced hypertensive crisis intra-op and NSTEMI due to stress cardiomyopathy. The patient reported spells of palpitations, diaphoresis, tremors and pallor since 2015. She had elevated plasma metanephrine (M) 19.4 (0-0.49nmol/L), normetanephrine (NM) 24.7 (0-0.89nmol/L), 24-hour urine M 18711 (30-180mcg) and NM 11897 (128-484mcg). Imaging demonstrated a 5.6 x 5.5 x 5.8cm left adrenal mass. After pre-operative alpha and beta blockade, patient underwent left adrenalectomy.Pre-op 24-hour urine cortisol was checked as part of secondary HTN evaluation and found to be elevated at 219 (3.5-45mcg). She did not have any features of Cushing’s and this was initially felt to be an appropriate stress response. Due to persistent post-op hypotension and a low 10PM random cortisol level of 3.4mcg/dL, which was inappropriate given patient’s clinical status, hydrocortisone was started with subsequent hemodynamic improvement. Our suspicion was that she had an ACTH-secreting pheochromocytoma, which would have resulted in hypercortisolism pre-op, and secondary AI post-op. Pathology report later confirmed ectopic ACTH production with 25% cells positive with immunostaining. Patient 2 A 48 yo female was admitted for hypertensive urgency with symptoms of palpitations, facial and abdominal swelling, easy bruising and proximal muscle weakness. Her labs showed elevated 24-hour urine epinephrine 115 (0-20mcg), norepinephrine 366 (0-135mcg), plasma M 288 (0-62pg/mL) and NM 475 (0-145pg/mL), and an AM cortisol was 47.9mcg/dL. Aldosterone and renin levels were <1ng/dL and 0.775ng/mL/hr. Imaging revealed 3.4 x 3.1cm right adrenal mass with portal venous phase of 53 HU and no washout. AM cortisol level post 1mg dexamethasone was 62.6mcg/dL with an ACTH level of 222pg/mL. An ACTH-producing pheochromocytoma was suspected. Despite progressive uptitration of alpha and beta blockade, her BP remained poorly controlled. Her blood glucose also increased to 300s range. Ketoconazole 400mg BID was subsequently added to the regimen with rapid and marked improvement in BP and glycemic control. She underwent right adrenalectomy. Post-op plasma M, NM and ACTH were <0.20nmol/L, 0.36nmol/L and <5pg/mL.DISCUSSIONWithin the past 6 months, we have seen 2 cases of ACTH-secreting pheochromocytoma with different clinical symptoms and pre-op courses. Ectopic ACTH secretion may not cause classic Cushingoid features as in patient 1. Failure to recognize ectopic ACTH pre-op can lead to post-op complications such as AI. Patient 2 demonstrates that treatment of the hypercortisolemia may be necessary in order to adequately control BP and glucose levels prior to surgery.

Gabor-domain optical coherence tomography to aid in Mohs resection of basal cell carcinoma

Gabor-domain optical coherence tomography to aid in Mohs resection of basal cell carcinoma

Median Forehead Flap in Reconstruction of the Cutaneous Midface Defects Following Resection of Basal Cell Carcinoma

Objective: The current work attempted to assess the median forehead flap (MFF) for reconstruction of mild and moderate defects of the midface after resection of basal cell carcinoma (BCC).Patients and Methods: A total of 20 patients with T1-T2 midface basal cell carcinoma (BCC) were included in this study. Patient’s ages ranged from 60 to 70 years. According to the size of the postsurgical defects> At Tanta Tumor Institute, the patients were categorized into two groups: Group I (GI) included 10 patients with mild defects (2 cm or less) repair using median forehead flap(MFF) and Group II (GII), included 10 patients with moderate defects (more than 2 cm) repair using median forehead flap(MFF).The patients were prospectively evaluated by parameters such as; Flap viability (capillary refill time, bleeding on puncture with a needle and the color of the skin paddle) and esthetic results. Preparation of patients and planning of the surgical technique were necessary to determine the size of the defect were employed for reconstruction of all defects. Results : On comparing the results of GI and GII, the flap viability, patient satisfaction and donor site morbidity were found to be 80%, 70% and 0% in GI compared to 60 %, 60% and 20% in GII respectively (the overall results were: 70%, 65% and 10%respectively). Postoperative infection and partial wound necrosis, were diagnosed in one patient of GI (20%) and was successfully treated with specific antibiotics and local measures; and in 2 (10%) patients of GII that failed to conventional treatment and lost most of the flap (the overall partial and complete flap necrosis was 30%). One patient (5%) of G II showed temporary fistula formation, which disappeared few weeks postoperatively. We conclude that, the median forehead flap insures skin coverage, muscle bulk and good blood supply therefore; it can remain viable additional it is a feasible and reliable technique.

Levator alae nasi muscle V–Y island flap for nasal tip reconstruction

Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V–Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V–Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian.

EFFECTIVENESS OF MODIFIED Zitelli BILOBED FLAPS FOR REPAIRING SOFT TISSUE DEFECT OF LOWER ONE-THIRD NOSE

To investigate the clinical application of the modified Zitelli bilobed flaps in repairing soft tissue defect of lower one-third nose. Between February 2009 and February 2014, 26 patients with soft tissue defect of lower one-third nose after resection of basal cell carcinoma underwent reconstruction using modified Zitelli bilobed flaps. There were 15 males and 11 females, aged 48-65 years (mean, 56 years). Tumor involved the skin layer in all patients. According to TNM staging, 19 cases were rated as TisN0M0 and 7 cases as T1N0M0. The disease duration was 1-5 years (mean, 3 years). The mass size ranged from 1.0 cm×0.5 cm to 1.5 cm×1.0 cm. The defect size ranged from 1.5 cm×1.0 cm to 2.0 cm×1.5 cm after resection of basal cell carcinoma. The modified ipsilateral Zitelli bilobde flaps were designed and harvested for one-stage repair of defect, and the double-leaf flap size ranged from 2.5 cm×2.0 cm to 3.0 cm×2.5 cm and 1.5 cm×1.0 cm to 2.0 cm×1.5 cm. The donor site defects were sultured directly. Twenty-six flaps survived and incision healed primarily. No postoperative complications of hematoma, infection, and necrosis of skin flap occurred. No stretching deformation of local organs, the shape of the nose and face was symmetric. Twenty-six patients were followed up 3-24 months (mean, 13 months). Nasal and facial appearance was good and had no obvious scar formation, and patients were satisfied with the appearance. There was no tumor recurrence during follow-up. The modified Zitelli bilobed flap to repair soft tissue defect of lower one-third nose (the defect diameter within 2.0 cm) can obtain satisfactory effectiveness in appearance.

Repair of midfacial defects with bilobe flaps after surgical resection of basal cell carcinoma: 19 case reports

Objective To develop an efficient method for the repair of midfacial defects with optimally designed bilobe flaps after resection of cutaneous carcinomas.Methods Nineteen patients with midfacial basal cell carcinoma (BCC) were included in this study.All the patients underwent surgical resection of BCC.To repair the defects,bilobe flaps were regularly designed outside the lesions according to the location and size of masses,then undermined and transferred to the exact sites followed by layer-layer intermittent suture.Results Of the 19 patients,four suffered from disturbance of blood supply and necrosis of skin graft sized 0.1 cm × 0.2 cm in the top of the second flap which healed after dressing changes.The first lobe of the flap survived in all the patients,and the second lobe survived in 15 patients.No obvious deformity was observed in the appearance of eyes,nose or mouth in these patients.Conclusion Bilobe flaps designed outside skin defects provide a favorable approach to plastic repair of midfacial defects. Key words: Carcinoma, basal cell; Face; Surgical flaps; Reconstructive surgical procedures