Incidence Of Incomplete Excision Research Articles

Global incidence of incomplete surgical excision in adult patients with non-melanoma skin cancer: study protocol for a systematic review and meta-analysis of observational studies

BackgroundNon-melanoma skin cancer, which includes basal cell carcinoma and cutaneous squamous cell carcinoma, is the commonest malignancy worldwide. The mainstay of treatment is surgical excision. Despite this being an exceptionally common procedure, it is not known what the accepted standard is for incomplete excision. Multiple single-centre, regional and national studies have previously reported their incidence of incomplete excision in isolation. Furthermore, is it not known what effect potential risk factors such as the operating group, location of lesions, type of reconstruction, histological components or use of loupe magnification have on the incidence of incomplete excisions. The objective of this study will be to systematically evaluate observational data that present incidence of incomplete surgical excision amongst adult patients with non-melanoma skin cancer worldwide.MethodsWe designed and registered a study protocol for a systematic review and meta-analysis of descriptive epidemiology data. A comprehensive literature search will be conducted (from January 2000 onwards) in MEDLINE, EMBASE, Scopus, CINAHL, EMCare and Cochrane Library. Grey literature will be identified through searching Open Grey, dissertation databases (e.g. Open Access Theses and Dissertations) and clinical trial registers (e.g. WHO ICTRP). Observational studies (cohort, cross-sectional, case series and clinical audits) reporting the incidence of incomplete surgical excision and conducted in adult patients with non-melanoma skin cancer will be included. The primary outcome will be the incidence of incomplete surgical excision (defined as residual tumour at either the peripheral or deep margin). Secondary outcomes will be risk factors that may affect incomplete excision (e.g. operating group, location of lesions, types of reconstruction, histological components). Data will not be extracted if the study uses other surgical techniques such as Mohs micrographic surgery, intra-operative frozen section, incision, shave or punch biopsies. Two investigators will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. No limitations will be imposed on publication status or language of publication. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effect meta-analysis of observational data. Incidence estimates will be stratified according to cancer type (e.g. basal cell carcinoma vs squamous cell carcinoma) and operating group (e.g. dermatology, plastic surgery and general practice). Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. methodological quality, sample size).DiscussionThis systematic review will summarise the best available evidence and definitively establish the incidence of incomplete surgical excision in non-melanoma skin cancer. It will determine if there is variation observed amongst different operating groups and provide some evidence for potential other factors causing this difference. This knowledge will provide a standard for future audits and will contribute to improving the treatment of non-melanoma skin cancer treatment.Systematic review registrationPROSPERO CRD42019157936

C-LETZ versus large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia: a randomized controlled trial

To compare large loop excision of the transformation zone (LLETZ) with contour-loop excision of the transformation zone (C-LETZ) in management of cervical intraepithelial neoplasia (CIN) with respect to number of specimens obtained, weight of specimen, surgical margin, treatment time, and morbidity associated with those procedures. Women were randomly allocated to receive LLETZ or C-LETZ. Inclusion criteria were the following circumstances: (1) presence of biopsy-proved CIN 2/3, (2) persistent biopsy-proved CIN 1, (3) discrepancy between cytology and histology, or 4) an endocervical curettage was positive. Ninety-eight women were eligible for the study. Mean weight of specimens in C-LETZ group was significantly more than LLETZ group (4.35 ± 1.39 vs. 3.55 ± 1.48 g, p = 0.007). Duration of treatment were similar in both groups (p = 0.39). After multiple logistic regressions were analyzed, C-LETZ was more likely to result in a single pathologic specimen (76 vs. 29.16 %, p < 0.001; adjusted RR 8.33, CI 3.23-21.47). There was no statistical significant difference in the frequency of positive margins between the groups (40 vs. 39.5 %, p = 0.64; adjusted RR 1.27, CI 0.46-3.50). The morbidity associated with those procedures was not different between the two groups. C-LETZ has a clear clinical benefit in term of a higher rate of a single pathologic specimen. It removes more cervical tissue than LLETZ. The incidence of incomplete excision and complication seem to be similar in both groups.

Stretch Test

Basal cell carcinoma (BCC) is the most common malignant tumor in the world. Total tumor ablation is the gold standard of treatment. Our aim in this study was to evaluate the effectiveness of a new clinical method, we dubbed the "stretch test," in reducing the incidence of incomplete excision of BCC. All BCCs excised between October 2001 and June 2007, by 1 plastic surgeon, served as the treatment population. Until September 2004, BCCs were excised in the traditional manner and this group served as a control. From October 2004, the stretch test was used in all patients with BCC and this group served as a study group. Overall, the incomplete excision rate was 3.7% (22/596). The rate of incompletely excised BCC until 2004 was 6.4% (16/249) and it decreased significantly (P < 0.05) from 2004 to 1.7% (6/347) in the group in which the stretch test maneuver was used. We found a significant decrease in the rate of incomplete excision of BCC when the stretch test was employed. This reduces the need for reexcision, improves patient recovery, and satisfaction, and helps reduce healthcare costs.

Basal cell carcinomas of the inner canthus: incidence of incomplete excision according to topographical localization of tumours

Basal cell carcinomas of the inner canthus: incidence of incomplete excision according to topographical localization of tumours

Incomplete Excision of Basal Cell Carcinoma: A Prospective Trial

As a measure of the standard of surgical care, incomplete excision of skin malignancy is an important clinical indicator, developed by the Royal Australasian College of Surgeons and the Australian Council on Healthcare Standards. Reported rates of incomplete excision of basal cell carcinoma vary widely (5 to 25 percent) among centers worldwide. This prospective study reports on the incidence of incomplete excision at a tertiary referral public hospital and determines the factors that may influence this. From January of 2001 to December of 2002, 1214 basal cell carcinomas were excised at Peter MacCallum Cancer Centre. Data were collected prospectively and analyzed using the FileMaker Pro program and SPSS software. The overall percentage of incomplete excision was 11.2 percent for primary excisions. Risk factors for incomplete excision are the head site; morpheic, superficial, and infiltrative subtypes; lesions larger than 20 mm in diameter; the presence of multiple lesions; repair by skin graft; and recurrent and previously incompletely excised basal cell carcinomas. The type of anesthetic used did not affect outcome. There was no significant difference in the percentage of incomplete excision between consultants, registrars, and the clinical assistant, but this was probably attributable to the small number of cases performed by consultants at Peter MacCallum Cancer Centre. This is the largest prospective study of incomplete excision of basal cell carcinomas. The authors' result is within the range reported in the current literature but is higher than anticipated. Preoperative "red-flagging" of basal cell carcinomas most at risk of incomplete excision may lead to a better result.

Incidence of incomplete excision in surgically treated basal cell carcinoma: a retrospective clinical audit

All the patients who had excision of basal cell carcinoma at the regional plastic surgery unit at Manchester over a period of 2 years from January 1995 to December 1996 were included in a retrospective audit. A total of 879 lesions were excised in 754 patients. In 41 lesions (4.7%) the tumour was incompletely excised, 16 of these lesions were further excised; the rest were managed by regular follow-up. The mean age of the incomplete excision group was slightly higher. The site where the incomplete excision rate was highest was the scalps followed by the ear, canthi,eyebrows and nose. There was a higher incidence of squamous differentiation and presence of foci of squamous cell carcinoma in the lesions excised incompletely. There was no statistically significant difference among the different groups of surgeons but in individual grades the rate was lower where more wounds were repaired by direct closure. The concept of a complexity ratio (number of wounds repaired by other methods/number of wounds repaired by direct closure) can be helpful in comparing the incomplete excision rates of different grades of surgeons or departments. The excision of basal cell carcinoma is one of the commonest procedures performed by all grades of surgeons in a plastic surgery department. Incomplete excision leads to further surgery or prolonged follow-up, thus significantly affecting the outcome. As the incidence of incomplete excision can be precisely monitored, it may be a useful tool for clinical governance.