Excision Of Basal Cell Carcinoma Research Articles

Retalho de Rotação Súpero-Medial: Resultados em Três Doentes

INTRODUÇÃO: O retalho de rotação súpero-medial é um retalho cutâneo local, randomizado, e predominantemente de rotação, que permite encerrar defeitos de média e grande dimensão, nas regiões malar súpero-medial e pele palpebral inferior.
 MATERIAL E MÉTODOS: Dois homens e uma mulher foram submetidos a exérese alargada de lesões clinicamente sugestivas de carcinoma basocelular da face, sob anestesia local, seguida de reconstrução com retalho de rotação súpero-medial.
 RESULTADOS: Não se registaram complicações pós-operatórias imediatas ou tardias. Os resultados funcionais e morfológicos foram aceitáveis. Os doentes não apresentaram recidivas nos 12 meses de seguimento.
 DISCUSSÃO: O retalho de rotação súpero-medial é um procedimento simples, realizado em tempo operatório único, sob anestesia local. Constitui uma excelente opção dentre as várias técnicas cirúrgicas reconstrutivas perioculares clássicas. O ectrópio é uma complicação rara.
 CONCLUSÃO: O retalho de rotação súpero-medial revelou-se uma opção cirúrgica segura e eficaz nos três casos.

Excision of nodular basal cell carcinoma involving the lower eyelid tarsal skin using a grey line-splitting, posterior lamella-sparing technique

ABSTRACT Purpose: To describe a posterior lamella-sparing technique to resect nodular basal cell carcinoma involving the inferior part of the tarsal skin of the lower eyelid. Surgical Technique: Excision of nodular basal cell carcinoma of the tarsal skin using a grey-line-splitting technique with preservation of the posterior lamella. Specimen was sent for frozen section control. Additional excision was performed in caseof irradicality. The defect was closed with a free skin graft from the ipsi- or contralateral upper eyelid. Results: We show a case series of three patients with lower eyelid basal cell carcinoma and investigated radicality on histology, aesthetic outcome and clinical recurrence during a follow-up of 18 months. Pre, intra, and postoperative photographs were obtained. In all cases radicality was reached. In all patients, the skin graft was viable, with no recurrence after 18 months. Excellent aesthetic results were obtained. Conclusion: Anterior lamellar resection of nodular basal cell carcinomas involving the tarsal lower eyelid skin using a grey line lid-splitting technique is a simple and one-step technique with good clinical outcome. It may avoid the morbidity associated with full thickness eyelid resection and might be useful for other, nonmalignant eyelid lesions.

Fourth Dimension in Reconstruction of Defects Following Excision of Basal Cell Carcinoma of Head and Neck!

Background:Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction.Aim:To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction.Materials and Methods:This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III.Results:A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction.Conclusion:Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery.

Reflectance confocal microscopy as a tool for screening surgical margins of basal cell carcinoma

Surgical excision of basal cell carcinoma with minimum margins requires serial assessment of layers by frozen histopathology in the case of Mohs micrographic surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal microscopy is a potential alternative. We selected 12 basal cell carcinoma lesions that were analyzed by confocal microscopy to define margins. The lesions were excised by Mohs surgery. Six tumors showed negative margins in the first phase of Mohs micrographic surgery. We concluded that reflectance confocal microscopy can be useful in the preoperative definition of basal cell carcinoma margins.

Necrosis of skin graft entailed by smoking habits

Adequate healing of surgical wounds is influenced by the operative technique, the presence of postoperative complications and the patient's life habits. We report the case of a patient submitted to excision of basal cell carcinoma by Mohs micrographic surgery and reconstruction with palpebral cutaneous grafting. In the postoperative period there was graft necrosis due to poor perfusion of the surgical bed imputed to smoking. Smoking interferes with plasma embolization and graft neovascularization, as well as promoting oxidative stress and endothelial dysfunction. The surgeon should counsel the cessation of smoking for at least four weeks prior to the procedure in order to avoid further risks of complications.

Polimorbid Yaşlı Bir Hastada Kompleks Burun Ucu ve Kolumellanın Esnetilmiş Nazolabial Flep ile Rekonstrüksiyonu

In this article, we describe an extended variant of the traditional nasolabial flap, utilized for coverage of a complex nasal tip and columella defect originated after basal cell carcinoma excision in a polymorbid elder patient. Although not the standard option for nasal tip coverage, the extended nasolabial flap proves to be an appropriate choice in the context of elder and polymorbid patients, achieving satisfactory results with a reduced surgical time and a simple technique. Therefore, in certain patients with large nasal tip defects with scars that impair the use of the paramedian forehead flap, or that reject the use of the forehead as donor site, or in cases of patients that require oxygen masks, the extended nasolabial flap could be the technique of choice.

Completeness of Basal Cell Carcinoma excisions in an Oral and Maxillofacial Surgery department

Completeness of Basal Cell Carcinoma excisions in an Oral and Maxillofacial Surgery department

Acute Pancreatitis due to Cephalexin: A Case Report and Review of Literature

Acute pancreatitis (AP) due to medication represents 0.3% to 1.4% of all cases of AP and is the fourth most common cause of pancreatitis after alcohol, gallstones, and hypertriglyceridemia. Although more than 500 drugs have been reported as a culprit medication triggering AP, Cephalosporins are rarely reported. Moreover, Cephalexin has never been reported as a cause of AP. A 55 years old female patient with past medical history significant for multiple sclerosis (MS), basal cell carcinoma (BCC), history laparoscopic cholecystectomy due to gallstones had excision of BCC done in a dermatology clinic and received a dose of 500 mg Cephalexin for prophylaxis. Three hours later, she presented to the emergency department (ED) for sudden onset of upper abdominal pain radiating to her back. The pain was associated with severe nausea and poor appetite. She denied history of drinking alcohol, trauma, insect or scorpion bite and previous history of pancreatitis. Her medication list included Fingolimod (Gilenya) and Oxcarbazepine both of which she was taking for years without any side effects. The patient was afebrile and hemodynamically stable on presentation. Abdominal examination revealed epigastric tenderness, with no rebound or palpable masses. Initial laboratory workup revealed lipase of 889 Units/L (6 times upper normal limit which confirmed the diagnosis of AP. The patient denied taking any other new medication except Cephalexin. AST was slightly elevated (66 IU/L) and the rest of liver enzymes within normal. Serum triglyceride was 68 mg/dl. IgG subclasses were normal. Ultrasound showed unremarkable liver, absent gallbladder, and extrahepatic duct measured 10 mm. Gastroenterology was consulted, and MRCP was obtained, which showed mild extrahepatic duct up to 11 mm, and central intrahepatic biliary dilation compatible with reservoir effect of cholecystectomy. No choledocholithiasis or dominant stricture were identified. Cephalexin has been discontinued. Four days later, her appetite has improved and she was discharged home on low fat diet. In the absence of other causes of AP, cephalosporins such as Cephalexin should be considered as a potential cause of AP in patients who present with abdominal pain and elevated serum lipase levels.Figure: Coronal MRCP image demonstrating mild extra-hepatic (Blue arrow) and central intrahepatic (Red arrow) biliary dilatation compatible with reservoir effect status post cholecystectomy. There is no choledocholithiasis or dominant stricture identified.

Acute Pancreatitis due to Cephalexin: A Case Report and Review of Literature

Acute pancreatitis (AP) due to medication represents 0.3% to 1.4% of all cases of acute pancreatitis. Acute pancreatitis due to cephalosporins is rarely reported with only five cases reported in literature thus far. Cephalexin is a Beta lactam antibiotic which is classified as a first-generation cephalosporin. Although GI side effects including nausea, vomiting, transient hepatitis, and pseudomembranous colitis have been reported, acute pancreatitis has never been reported.To our knowledge, this is the first of probable primary Cephalexin-induced acute pancreatitis. A 55 years old female patient with past medical history significant for multiple sclerosis (MS), basal cell carcinoma (BCC), history laparoscopic cholecystectomy due to gallstones had excision of BCC done in dermatology clinic and received a dose of 500 mg Cephalexin for prophylaxis. Three hours later, she presented to emergency department (ED) for sudden onset of upper abdominal pain radiating to back. The pain was associated with severe nausea and poor appetite. She denied history of drinking alcohol, trauma, insect or scorpion bite and previous history of pancreatitis. Her medication list included Fingolimod (Gilenya) and Oxcabazepine both of which she was taking for years without any side effects. Abdominal examination revealed epigastric tenderness, with no rebound or palpable masses. Initial laboratory workup revealed lipase of 889 Units/L (6 times upper normal limit). However, CT abdomen in the ED was negative for peripancreatic fat stranding, fluid collection, and pancreatic focal lesions. Based on abdominal pain and elevated lipase three-time upper normal limit, the patient was diagnosed with acute pancreatitis. She was admitted and started on aggressive intravenous hydration. Further work up showed normal liver enzymes and serum triglyceride of 68 mg/dl. IgG subclasses were normal. Ultrasound showed unremarkable liver, absent gallbladder, and extra hepatic duct measured 10 mm. MRCP was obtained, which showed mild extrahepatic duct dilatation up to 11 mm without any dominant stricture or stone. Cephalexin was discontinued. Four days later her appetite improved and pain resolved and she was discharged home on low fat diet. In the absence of other causes of acute pancreatitis, cephalosporins such as Cephalexin should be considered as a potential etiologic factor of acute pancreatitis in patients who present with abdominal pain and elevated serum lipase levels.Table: Characteristics findings of published case reports of Cephalosporin induced pancreatitis.

Surgical Management of Periocular Cancers: High- and Low-Risk Features Drive Treatment.

Recent advances in the treatment of eyelid tumors have centered on the excision, evaluation of margins, role of sentinel lymph node biopsy, and adjunctive/adjuvant systemic and radiation therapy. The purpose of this review is to elaborate on these advances. Mohs excision of basal cell carcinoma and squamous cell carcinoma continues to provide the greatest success in complete excision of the cancer, especially in those cases of high-risk disease including medial canthal location and recurrent disease. Sentinel lymph node biopsy has proven useful in the assessment of early regional metastasis in sebaceous cell carcinoma, melanoma, and Merkel cell carcinoma. The pathologic finding of perineural invasion is a high-risk feature in all periocular cancers, and adjuvant therapy should be considered. Targeted therapy shows great potential in situations that are not amenable to complete excision without sacrificing the globe. Identification of high- and low-risk features in eyelid cancers allows a stratified approach to treatment. While high-risk features may require adjuvant therapy, larger margins, and sentinel lymph node biopsy, low-risk features may allow topical therapy to adequately address the condition. Monoclonal antibodies and small molecule inhibitors show great promise in the treatment of extensive disease.

Perineural invasion present exclusively in central tissue blocks of Mohs surgical excisions of basal cell carcinoma.

Perineural invasion (PNI) may be present in basal cell carcinomas (BCC) treated with Mohs micrographic surgery. This single-centre, non-randomised, prospective study demonstrates the potential for PNI to exist exclusively within the central tissue blocks of Mohs specimens.

Use of Cyanoacrylate Glue Casting for Stabilization of Periocular Skin Grafts and Flaps.

To examine a novel technique for periocular skin graft and flap stabilization using cyanoacrylate glue applied to the host bed around the perimeter of the graft or flap to create an immobile cast in the immediate postoperative period to promote successful graft take and stable anatomic position. Retrospective review was performed of a single surgeon's patients who underwent periocular skin graft or flap between August 1, 2011, and February 29, 2016, in which cyanoacrylate glue was applied postoperatively for graft stabilization. Data examined included indication for procedure, location and size of graft, postoperative complications, and length of follow up postoperatively. Of 164 cases reviewed, 9 cases were identified in which cyanoacrylate glue was used as the sole means of graft or flap stabilization. Indications for surgery included repair of cicatricial ectropion (3 cases) and repair of Mohs defect status after excision of basal or squamous cell carcinoma (6 cases). All cases involved reformation of the lower eyelid. Five cases employed full-thickness skin grafts and 4 cases employed adjacent tissue rearrangement. Size of defect repaired ranged from 8 mm to 35 mm when largest diameter was measured. Complications included mild residual ectropion or mild punctal ectropion in 2 patients who was asymptomatic and did not require further surgery. No cases were complicated by hematoma, infection, or graft necrosis. Cyanoacrylate glue can be used to successfully stabilize skin grafts and flaps in the immediate postoperative period.

Wide excision of giant basal cell carcinoma on the right cheek using radial forearm free flap reconstruction: a case report

Wide excision of giant basal cell carcinoma on the right cheek using radial forearm free flap reconstruction: a case report

Incomplete excision of basal cell carcinoma (BCC) in the head and neck region: to wait, or not to wait?

IntroductionRecurrence rates for incompletely excised basal cell carcinoma (BCC) vary widely in the literature. Clinical observation is a commonly accepted method of follow up, however such management of these lesions still remains controversial.AimTo evaluate the rate and factors associated with the recurrence of BCC of the head and neck region after incomplete excision.Material and methodsMedical records of 135 patients with 156 incompletely excised BCCs of the head and neck region were analyzed retrospectively. The primary outcome was the rate of recurrence. Additionally, a correlation of recurrence to clinical and morphological factors was analyzed.ResultsRecurrence occurred in 72 (46%) lesions. The mean interval to recurrence was 20 months. In each category of factors, the highest relative risk of recurrence was correlated to: location on the scalp – 2.27, diameter over 2 cm – 1.21, nodular clinical form – 1.29, morpheaform histopathological type – 1.67, recurrent lesion – 1.88, irradicality of excision in the lateral margin – 1.24 and closure of the skin defect with the split-thickness skin graft – 1.42 relative risk.ConclusionsObservation is an acceptable management option as less than a half of incompletely excised BCCs recurred and needed further treatment. As 85% of recurrences occur within 3 years after operation, clinical observation should be particularly careful during this period, however long-term recurrence should not be underestimated.

Reconstruction with Dorsal Nasal Flap after Excision of Basal Cell Carcinoma of the Nose.

Reconstruction with Dorsal Nasal Flap after Excision of Basal Cell Carcinoma of the Nose.

Local flap for reconstruction of nasal defect following excision of basal cell carcinoma of nose

Reconstruction of soft tissue at the nose following excision of basal cell carcinoma is always challenging, because of both functional and aesthetic importance of nose. The local flap is always preferable to skin graft as this produces “like with like” replacement, pliable cover and vascularized tissue over the skeletal framework. In this paper, we discussed six cases of nasal reconstruction with bilobed flap, forehead flap, and nasolabial flap. All flaps survived and the patients had satisfactory outcome.

The Importance of Frozen Section-Controlled Excision in Recurrent Basal Cell Carcinoma of the Eyelids.

Objectives: To show the importance of frozen section-controlled excision to avoid the re-recurrence of recurrent basal cell carcinoma (BCC) of the eyelids.Materials and Methods: Thirty-five cases who underwent eyelid tumor excision in different centers and were admitted to our clinic with recurrent eyelid tumors. Recurrent tumors were resected by excision 1-2 mm from the tumor’s visible margin and sent to pathology for frozen section examination. Eyelid reconstructions with flap and graft were performed after confirming that the surgical margins were negative.Results: Twenty-one (60%) of our patients were male and 14 (40%) were female. Median age of our group was 63.4±14.2 years. Excision and sending the excised material for frozen section control was performed once for 11 patients, twice for 12 patients, 3 times for 8 patients and 4 times for 4 patients to confirm that the surgical margins were clean. All pathology samples were reported as BCC. All patients had eyelid reconstruction with flap and graft. Recurrence was detected in 2 patients (5.7%) during 1 to 8 years (mean 4.3 years) of follow-up and those patients were reoperated; no recurrence was detected in the remaining 33 patients (94.3%).Conclusion: Frozen section control can provide low re-recurrence rate in patients with recurrent BCC of the eyelids.

A practical decision-tree model to predict complexity of reconstructive surgery after periocular basal cell carcinoma excision.

Periocular basal cell carcinomas (pBCC) have unpredictable growth. The authors seek to derive a decision rule for predicting surgical complexity in pBCC. This study was conducted at two centres in New Zealand from September 2010 to November 2015. Baseline demographic information and an initial assessment of operative complexity (a four-point grading scale) were collected. Assessment of operative complexity was repeated at the time of reconstruction. Univariate analysis was applied to identify the associative factors and supervised machine learning was used to determine the best predictive models to construct a clinical decision rule. A total of 156 patients and 156 periocular BCC were analysed. Univariate analysis revealed that older age, recurrent skin cancer, large tumour size, being a public patient and high complexity at pre-operative assessment were associated with high actual operative complexity. Tumour histology was not associated with more complex surgery. Machine learning analyses revealed that Naive Bayesian classifier was able to distinguish surgical complexity with an average area under the receiver operating characteristic curve (AUC) of 0.854 (95% CI: 0.762-0.946) whereas a simpler, alternating decision tree (ADT) that used only three clinical variables achieved an AUC of 0.853 (95% CI: 0.739-0.931). The ADT model was 10.1 times more likely to correctly identify a high complexity case. The three predictive variables were pre-operative assessment of complexity (high vs. low), surgical delays [early (<75 days) or delayed (≥75 days)], and tumour size [small (<14 mm), or large (≥14 mm)]. For the subgroup with large tumours but low initial assessed complexity, late surgery was associated with a 6.7-fold increase in risk of high-risk surgery. A simple, three-variable risk stratification system was able to predict the operative complexity of pBCC.

Three-layer reconstruction of lower third nasal defects using forehead flap, reversed nasolabial flap, and auricular cartilage

The reconstruction of a full-thickness defect of the distal third of the nose requires the restoration of all three anatomical layers. A practical method for three-layer reconstruction of the lower third of the nose and the long-term results of this technique are presented herein. A combined reconstruction technique was utilized, including a reverse subcutaneous pedicled nasolabial flap to restore the nasal mucosa, an auricular cartilage graft for structural support, and a forehead flap for cutaneous coverage of the defect. This technique was applied in 21 patients following the full-thickness excision of basal cell carcinoma of the lower part of the nose. All patients (12 male and nine female; mean age 59.8 years) were treated successfully and were satisfied with the aesthetic and functional outcomes. The wound had to be further revised in three cases for the correction of contour or residual deformities; however, no further complications were experienced. One patient had a wound infection and the cartilage had to be removed. The grafting procedure was repeated successfully after resolution of the infection. Donor site morbidity was unremarkable. Combined flaps from the forehead and nasolabial regions with an incorporated auricular cartilage graft can be used to reconstruct full-thickness defects of the lower third of the nose.

Clinical and pathologic parameters predicting recurrence of facial basal cell carcinoma: a retrospective audit in an advanced care center.

This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center. A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05. A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates. Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.