Excision Of Skin Tumors Research Articles

The potential of x-ray virtual histology in the diagnosis of skin tumors.

Histopathological analysis represents the gold standard in clinical practice for diagnosing skin neoplasms. While the current diagnostic workflow has specialized in producing robust and accurate results, interpreting tissue architecture and malignant cellular morphology correctly remains one of the greatest challenges for pathologists. This paper aims to explore the prospect of applying x-ray virtual histology to human skin tumor excisions and correlating it with the histological validation. Seven skin biopsies containing intriguing melanoma types and pigmented skin lesions were scanned using x-ray Computed micro-Tomography (μCT) and then sectioned for conventional histology assessment. The tissue microarchitecture reconstructed by μCT offers detailed insights into diagnosing the malignancy or benignity of the skin lesions. Three-dimensional reconstruction via x-ray virtual histology reveals infiltrative patterns in basal cell carcinoma and evaluated invasiveness in melanoma. The technology enables the identification of pagetoid distributions of neoplastic cells and the assessment of melanoma depth in three dimensions. Although the proposed approach is not intended to replace conventional histology, the non-destructive nature of the sample and the clarity provided by virtual inspection demonstrate the promising impact of μCT as a valid support method prior to conventional histological sectioning. Indeed, μCT images can suggest the optimal sectioning position before using a microtome, as is commonly performed in histological practice. Moreover, the three-dimensional nature of the proposed approach paves the way for a more accurate assessment of significant prognostic factors in melanoma, such as Breslow thickness, by considering the whole micro-volume rather than a two-dimensional observation.

Perceptions and Attitudes of Primary Care Physicians Toward Dermatologic Surgery.

Dermatologic surgery is a well-established subspecialty in dermatology that involves various therapeutic and esthetic procedures. To date, perceptions of primary care physicians (PCPs) regarding dermatologic surgery are poorly understood. This study aimed to assess the perception and attitude of PCPs toward dermatologic surgery and explore the factors that might affect their perception and attitude toward it. This cross-sectional study used an online survey. The survey was distributed among PCPs working in various regions of Saudi Arabia and contained questions about demographics, medical training information, participants' awareness of dermatologic surgery, and a list of 10 cutaneous procedures to select the most qualified physician performing these procedures. Univariate and multivariate analyses were performed. P≤0.05 was considered statistically significant. In total, 440 PCPs participated in this study. Overall, 70% of the PCPs had heard about dermatologic surgery, whereas 30% had never heard about it. PCPs reported that dermatologic surgeons were the most qualified physicians to perform laser procedures (60.5%), hair transplantation (60.5%), excision of small benign and malignant skin tumors (46.1%), excision of small melanocytic nevi (55.7%), filler injection (44.8%), and injection of botulinum toxin (48.9%); 64.5% considered plastic surgeons to be the most qualified for liposuction. Both physicians were equally selected for performing cyst excision, procedures involving the fingernails and toenails, and scar correction. Multivariate analysis showed that female physicians had heard significantly more about dermatologic surgery (P=0.047, OR: 1.57, 95% CI: 1.006-2.45) and reported that dermatologic surgeons were the most qualified physicians (P=0.042, OR: 1.51, 95% CI: 1.016-2.25) than male physicians. PCPs working at secondary and tertiary health care hospitals heard more about dermatologic surgery (P=0.015, OR: 2.36, 95% CI: 1.18-4.71) than those working at primary health care centers. Most PCPs were aware of dermatologic surgery and recognized dermatologic surgeons as the most qualified physicians to perform most cutaneous procedures.

Acellular fish skin may be used to facilitate wound healing following wide surgical tumor excision in dogs: a prospective case series.

To prospectively evaluate clinical outcomes using acellular fish skin grafts (FSGs) for the management of complete wound healing by secondary intention after wide surgical excision of skin tumors in dogs. 5 dogs undergoing wide surgical excision of skin tumors on the distal extremity. FSGs were applied to surgical wound beds following wide excision of the tumor. Bandages were changed weekly and additional grafts placed when integration of the previous graft was complete. The wounds were assessed for the following: dimensions, tissue health (color), time to complete epithelialization, complications, and tumor recurrence. All masses were excised with 2-cm lateral margins and 1 fascial plane deep to the tumor. Tumor diagnoses included 3 mast cell tumors and 2 soft tissue sarcomas. Surgical wounds had a median area of 27.6 cm2 (range, 17.6 to 58.7 cm2). The median number of FSG applications was 5 (range, 4 to 9 applications). Complete epithelialization occurred within 7 to 9 weeks for uncomplicated wounds (3 of 5) and 12 to 15 weeks for complicated wounds (2 of 5) that sustained self-trauma. There were no adverse events related to the use of FSGs. Local recurrence was not seen over a follow-up period ranging from 239 to 856 days. Wide surgical excision of distal extremity skin tumors, followed by repeated application of acellular FSGs, resulted in complete healing of all wounds with no adverse events. This treatment method does not require advanced reconstructive surgical skills and may be useful for the management of skin tumors on the distal extremities.

Immediate reconstruction of nasal alar defects after malignant skin tumor excision without mohs surgery

Objectives: The National Comprehensive Cancer Network guidelines state that any nasal region with squamous or basal cell skin cancer is at high risk. Although Mohs surgery is the gold-standard procedure for many types of skin cancer, it is not applicable worldwide. A mean of 1.7 Mohs surgery stage is performed in cases of tumors. Nasal obstruction is a problem with Mohs surgery. In this study, we aimed to investigate nasal alar region nonmelanoma malignant skin tumor excision using immediate reconstruction without Mohs surgery. Methods: Ten patients underwent reconstruction surgery between 2018 and 2022. The inclusion criterion were ulcerated lesions in the nasal alar region measuring less than 1 cm in diameter, the lesions which were suspected either as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on dermatoscopic examination, the patients who had intact nasal mucosa during anterior rhinoscopy. Results: The mean follow-up duration was 26 months. No patient required re-operation because of an excisional biopsy result that involved border proximity. We observed no serious complications or long-term recurrences. Conclusion: We recommend our algorithm for patients for whom Mohs surgery is not applicable.

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case-Control Study.

The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

Experience of Vacuum-Assisted Closure in the Surgical Treatment of Malignant Skin Tumors after Skin Grafting

BACKGROUND: Skin grafts may be used to reconstruct large skin defects after the excision of malignant skin tumors. Vacuum-assisted closure (VAC) leads closer approximation of the free flap. AIM: The objective of this study was to estimate the engraftment of grafts using VAC and explore factors influencing this process. MATERIALS AND METHODS: This study included 31 patients with skin cancers after a wide tumor excision. The wound defects were closed using a split-thickness skin graft and the VAC dressing. RESULTS: Complete and partial engraftment was observed in 17 (54.8 %) and 14 (45.2%) cases, respectively. The mean area of the wound defects among patients with complete engraftment was 24.3 ± 20.6 cm2, while that of the group with partial engraftments was 56.5 ± 58.8 cm2 (p = 0.0017). In the complete engraftment group, the average number of days with the VAC dressing was 7.2 ± 0.44 days, versus 6.9 ± 0.27 days in the partial engraftment group (p = 0.032). CONCLUSION: VAC dressing after skin grafting in the surgical management of malignant skin tumors provided good results. The area of the wound defect and the average number of days with VAC dressing is significant factors influencing the outcomes of skin grafting.

550 A Systematic Review of Aesthetic Outcome Using Dermal Regeneration Templates in Nasal Reconstruction

Abstract Aim Nasal reconstruction using Dermal Regeneration Templates (DRT) has been proposed due to their ability to reduce contour defects, avoid donor site morbidity, and facilitate reconstruction. This review aims to determine the aesthetic outcomes of DRT's in nasal reconstruction. Method A full systematic literature review of DRT use in nasal reconstruction was performed by two authors in December 2021. Cochrane Central Register of Controlled Trials, Ovid EMBASE and Ovid MEDLINE were searched and included papers reporting objective measures of aesthetic outcome. Of the 385 papers identified, 5 were included. Results 75 patients were included. Defects resulted from excision of skin tumors (74) and vascular malformation (1). 1 study used Hyalomatrix, 1 used Integra or Matriderm and 3 used Integra only. 2 papers using Integra left the defect to heal secondarily without a skin graft and healing time was 6 weeks or less, while 3 studies performed a second stage with a full thickness skin graft at 2 weeks or later. Mean defect size was poorly reported, and several subunits were reconstructed. Using the Vancouver Scar Scale and Visual Analogue Cosmetic Scale, significant improvements compared to pre-operative assessment were observed and good to high patient satisfaction. Complications were infrequent. Subsequent flap reconstruction was performed in 12 patients. Conclusions Nasal reconstruction using DRT is reliable however data on aesthetic outcomes are limited. The re-operation rate is reasonably high and data comparing aesthetic outcomes to flaps and skin grafts are lacking. More research reporting objective outcomes is warranted to further evaluate the utility of DRT's.

New Skin Flaps for Triangular Surgical Defects: Design, Assessment on Experimental Model, and Clinical Outcomes.

Most skin flaps are designed to repair circular surgical defects after skin tumor excisions, but few flaps have been described to reconstruct triangular defects. The aim of this study was to describe new skin flaps for triangular surgical defects using an innovative experimental model. We tested new flap designs in an experimental pig skin model using a tension sensor to measure maximum tension and tension augmentation when the flap is performed in an area of increased basal tension. The results were compared with those from classic flaps. Finally, the new flaps were performed on a series of patients with triangular surgical defects. Six new flaps with adequate levels of tension were obtained and named after their morphology: spider crab, mantis, toy windmill, nautilus, origami bird, and clover. These new flaps were successfully performed on a series of 40 patients; among them, spider crab and mantis flaps showed a better response to basal tension augmentation. Six new flaps for triangular surgical defects were proposed and successfully performed in a series of 40 patients, using an experimental pig skin model and a tensiometer.

Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study).

Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.

Photoacoustic imaging of periorbital skin cancer ex vivo: unique spectral signatures of malignant melanoma, basal, and squamous cell carcinoma.

Radical excision of periorbital skin tumors is difficult without sacrificing excessive healthy tissue. Photoacoustic (PA) imaging is an emerging non-invasive biomedical imagi--ng modality that has potential for intraoperative micrographic control of surgical margins. This is the first study to assess the feasibility of PA imaging for the detection of periocular skin cancer. Eleven patients underwent surgical excision of periocular skin cancer, one of which was a malignant melanoma (MM), eight were basal cell carcinomas (BCCs), and two squamous cell carcinomas (SCCs). Six tumors were located in the eyelid, and five in periocular skin. The excised samples, as well as healthy eyelid samples, were scanned with PA imaging postoperatively, using 59 wavelengths in the range 680-970 nm, to generate 3D multispectral images. Spectral unmixing was performed using endmember spectra for oxygenated and deoxygenated Hb, melanin, and collagen, to iden--tify the chromophore composition of tumors and healthy eyelid tissue. After PA scanning, the tumor samples were examined histopathologically using standard hematoxylin and eosin staining. The PA spectra of healthy eyelid tissue were dominated by melanin in the skin, oxygenated and deoxygenated hemoglobin in the orbicularis oculi muscle, and collagen in the tarsal plate. Multiwavelength 3D scanning provided spectral information on the three tumor types. The spectrum from the MM was primarily reconstructed by the endmember melanin, while the SCCs showed contributions primarily from melanin, but also HbR and collagen. BCCs showed contributions from all four endmembers with a predominance of HbO2 and HbR. PA imaging may be used to distinguish different kinds of periocular skin tumors, paving the way for future intraoperative micrographic control.

Skin tumour specimen shrinkage with excision and formalin fixation-how much and why: a prospective study and discussion of the literature.

Surgical skin specimens are known to undergo significant shrinkage when excised and processed. The degree of shrinkage is important for medical care, research and third-party assessment. Studies to date have shown variable degrees of shrinkage. Most have included multiple and sometimes unspecified variables-different surgeons, varied sites, ill-defined excision patterns and/or multiple pathologies. This study tries to exclude many of these variables to try to ascertain a more accurate predictor of shrinkage with a single surgeon, lower limb only site using a controlled excision pattern and restricted pathology cohort. 100 previously untreated malignant BCC's and SCC's on the lower limb were excised and measurements made of the resulting wound and the specimen removed. Measurements were subsequently made after pathologic processing and statistically compared. With excision of lower limb skin tumours the surgical defect enlarges significantly (15%) and the specimen shrinks significantly (20%) in both length (12%) and width (9%). The specimen shrinks a further 11%-again shrinking in length (8%) and width (2.6%) with formalin processing. The pathology specimen is 28.6% smaller than the specimen marked for excision. Anatomical site contributes to the degree of shrinkage. The pathologic specimen is only 75% of the suture repaired wound length. Skin specimens shrink significantly both with excision and processing. Most shrinkage (70%) takes place with excision while the remaining 30% with processing. The shrinkage takes place disproportionately in the normal tissue component of the specimen. Age, anatomical location, and pathology appear to play a part.

Bevelling the margins of primary defects on the nose with a surgical curette prior to full thickness skin grafting (FTSG), reduces the skin level discrepancy between the defect and the graft

Introduction: Nasal defects following the excision of skin tumours usually require complex reconstruction. Grafting these defects with a full thickness skin graft can result in a significant contour defect.

General surgery in Canada: current scope of practice and future needs

The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.

Usefulness of a Novel Pinwheel-shaped Incision Technique for Skin Tumor Excision.

Summary:Use of the fusiform ellipse excision technique is the most common method for direct closure of circular and elliptical defects. To prevent dog-ear formation after suturing, the long-axis length of the fusiform ellipse should be ≥3 times the transverse dimension and the angle formed by the 2 lines at both ends should be <30°. We devised a pinwheel-shaped incision technique for skin tumor excision that could reduce the scar size. We aim to present this technique and report its results and usefulness. We included 50 patients (55 cases; 54% women; mean age, 39.8 years) who underwent surgery using our pinwheel-shaped incision technique between January 2016 and December 2018. The incision line was designed like a pinwheel around the tumor, and the excess skin was trimmed after suturing at the center. The length-to-width ratio was calculated using the width before the operation and the suture length at the end of the operation. The operation site was primarily the face, and the maximum tumor width was 48 mm. The postoperative suture line length was 2.1 ± 0.2 (mean ± SD) times the width of the excision area. There were no complications such as skin necrosis, and no patient required reoperation because of dog-ear formation. Our new pinwheel-shaped incision technique allows shortening of the length-to-width ratio compared with that required in the conventional method and helps avoid dog-ear formation. We successfully used this technique in 55 cases and confirmed its usefulness.

Evaluation of digital staining for exvivo confocal laser scanning microscopy.

Ex vivo confocal laser scanning microscopy (CLSM) is a novel diagnostic tool for the fast examination of native tissue. However, CLSM produces black/white/green images, depending on the refraction indices of the tissue structures, complemented by nuclear fluorescence staining, which the vast majority of Mohs surgeons and dermatopathologists are not trained to interpret. Digital staining is applicable to exvivo CLSM investigations to simulate the images of conventional slides stained with haematoxylin and eosin (H&E). The aim of our study was to evaluate in detail the appearance of human skin structures using digitally stained exvivo CLSM images and compare the results to that of conventional H&E slides of the same specimen. After providing informed consent, 26 patients donated their Burow's triangles (healthy skin) that resulted from plastic reconstruction after the R0 excision of skin tumours. After being investigated by exvivo CLSM, including automated digital staining (VivaScope 2500M-4G, MAVIG GmbH), the specimens were fixed in formalin, embedded in paraffin and stained with H&E. Almost all skin structures in the digitally stained exvivo CLSM images morphologically resembled the structures in the histopathological images acquired from H&E slides. Due to the high refraction index of melanin, the hair shafts appeared bright pink, and the melanocytes and melanophages were poorly imaged, resulting in a strong pink appearance that vastly differed from the appearance of conventional H&E-stained histopathology. Digital staining of exvivo CLSM images is an easy and highly useful tool to facilitate the interpretation of black-field images generated by confocal laser scanning microscopy for dermatopathologists and Mohs surgeons who are familiar with H&E staining. Unlike the pigmented structures, the cutaneous and subcutaneous structures had excellent visualization with only minimal differences from their appearance on H&E slides.

Association of PAX3 and TMTC2 gene polymorphism with the face morphology change after excision of skin tumors

Background/Aim. The group of genes, known as PAX (paired box), has a great role in organogenesis, as well as in maintaining the normal function of certain cells after the birth. In addition to these genes, the impact on the organogenesis, at the cellular level, has a transmembrane tetratricopeptid group of genes (TMTC). The term polymorphism in the human genome implies variations in the hereditary basis that occur in human populations, the presence of two or more different alleles of one genome in the population. The aim of the work was to determine whether there is an association of PAX3 and TMTC2 genes polymorphism with changes of the face morphology after skin tumor excision and direct suture closure. Methods. The study included 130 patients of both sexes, older than 50 years, with the medical indication for the elliptical surgical excision of the skin tumor. DNA was isolated from 5 mL of peripheral blood. Gene polymorphisms were analyzed with pre-designed single nucleotide polymorphisms (SNP) assays, by allelic discrimination method on REAL-TIME apparatus. The patients were subjected to a laser scanning preoperatively, and 7 and 90 days postoperatively, in order to obtain x, y and z coordinates of 5 cephalometric points on the face, which determined the shape of the medial cheek region. The shape of the medial cheek region, as well as the coordinates of 5 cepahlometric points, were compared among genotypes of both genes preoperatively, as well as 7 days and 90 days postoperatively. Results. A statistically significant difference in the shape of the medial cheek region between wildtype and mutant of PAX3 gene was found preoperatively, while the statistically significant difference in the shape of the medial cheek region was not found between wild-type and heterozygote, nor between wild-type and heterozygote and mutant of PAX3 gene, nor among genotypes of TMTC2 gene. Seven days and 90 days postoperatively, there were no statistically significant differences in the shape of the examined region among genotypes of both genes. Conclusion. Polymorphisms of PAX3 and TMTC2 genes are not associated with the change in the face morphology after the skin tumor excision and direct suture closure of the defect.

Successful application of modified keystone flaps following skin tumor ablation.

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability.We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers.We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded.Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention.Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

Acute tissue expansion by pretaping to achieve elliptical excision and closure for skin tumours and soft tissue tumours

An elliptical excision of skin for treating a tumour is technically simple. Our objective was to recruit lateral laxity by stretching the skin prior to surgical excision of a tumour. A retrospective cohort of 20 consecutive patients who were treated with pretaping over a period of 7 years is presented. The surgeon used pretaping in patients with skin and soft tissue tumours where the pinch test for the planned ellipse failed to simulate easy closure. Data collated and analysed included patient demographic profile, tumour profile, parameters associated with pretaping and clinical outcome. A descriptive account demonstrating the technique is provided. The average age in the cohort was 44 years. The sample represents 24 sets of pretaping applications prior to 24 excisions. Twenty-three (96%) of these were performed on limbs. The 24 lesions treated were made up of five melanomas, 16 non-melanoma cutaneous neoplasms and three soft tissue sarcomas. The total time period of each set of applications per lesion varied from 15 min to 26 days. The mean width of the ellipse removed was 27 mm for cutaneous neoplasms (n = 21) and 84 mm for soft tissue sarcomas (n = 3). The pretaping allowed for simple direct wound closure with healing in all cases. Pretaping applied for as little as 30 min to several days prior to surgery can, within limits, expand skin tissue to achieve simple skin closure following elliptical excision of skin and soft tissue tumours in patients that would otherwise require skin grafting or skin flaps. Level of Evidence: IV Type of Study: Therapeutic

Реконструктивные аспекты хирургического лечения новообразований кожи наружного носа

The unsatisfactory results of treatment of external nose skin neoplasms is a serious social problem. The nose is the central and most visible part of the face, therefore, the patients are very sensitive even to minor defects in this area. The social significance of the location of skin tumors on the face is the predominant factor of the choice of a treatment method. Radiation therapy, cryodestruction and laser excision of malignant skin tumors provide equally favorable results at stages I–II of the process. However, with these types of treatment, the percentage of tumor recurrences is rather high. In most cases, the cause of recurrence is the inadequate excision of the tumor due to the desire of simultaneous replacement of the defect with local tissues. The more radical the treatment is and the earlier it is carried out, the lower is the probability of recurrence. The objective of study: to improve the oncological and functional results of surgical treatment of external nose skin neoplasms. The authors have analyzed the results of surgical treatment of external nose skin neoplasms in 93 patients, including 45 men and 48 women. The operation included wide excision of neoplasm with simultaneous closure of the formed defect with the help of some kind of plastics. The average age of patients was 70.5 years. According to the histological structure, 62 patients had basal cell carcinoma of the nasal skin, 21 had squamous cell carcinoma, 5 had metatypical cancer, 4 had melanoma, and 1 patient had ganglioneuroblastoma. The distribution of patients according to TNM system was as follows: T1 – 50 patients; T2 – 29; T3 – 3; T4 – 11. The reconstruction of external nose defects was performed using various types of flaps. The wound healing by primary intention was observed in 75 of 93 patients, which accounted for 80.6%. Complicated wound healing was observed in 18 patients (19.4%): trophic disorders were observed in 3 patients (3.2%), postoperative wound suppuration – in 4 (4.3%); partial flap necrosis – in 11 (11.8%). The suggested new method of external nose plastics provides safe healing of postoperative wounds and good cosmetic results.

Correlation Between Surgical and Histologic Margins in Melanoma Wide Excision Specimens.

Wide surgical excision is the standard treatment for localized primary cutaneous melanomas, with a narrow histologic margin associated with an increased risk of local recurrence. The correlation between surgical and histologic margins is poorly documented in the literature. An audit was performed to (1) document the shrinkage of formalin-fixed specimens, and (2) use a precisely measured surgical margin in vivo to predict the histologic margin. For patients presenting for wide excision of melanomas and other malignant skin tumors, measured surgical margin, in vivo and ex vivo specimen width, and histologic margins after formalin fixation were recorded. The effects of clinicopathologic characteristics, including age, sex, body mass index (BMI), tumor type, anatomic site, and presence of visible tumor in predicting specimen shrinkage and histologic margin were assessed. In total, 252 specimens were evaluated. When compared with measured width in vivo, the formalin-fixed specimens showed a mean shrinkage of 14% (R2 = 0.98), regardless of patient age, sex, BMI, or site of the lesion. The measured surgical margin was not a strong predictor of the histologic margin, with a high degree of variability (R2 = 0.55) not explained by patient factors, tumor subtype, or presence of visible tumor at the time of excision (p > 0.05). A consistent 14% shrinkage rate of wide excision specimens was found across all patients and excision sites, and we propose a clinically useful 15% correction factor that will account for fixation and shrinkage of cutaneous excision specimens. Excision margins measured by the surgeon were a poor predictor of the histologic margins.