Radical Wide Local Excision Research Articles

Survival Outcomes of Mohs Surgery versus Wide Local Excision for Less Common Nonmelanoma Skin Cancers: A Stabilized Inverse Probability of Treatment Weighting Analysis

Background: Compared with wide local excision (WLE), Mohs micrographic surgery (MMS) can not only remove the tumor tissue but also ensure a negative margin. However, there is limited evidence on whether there is a difference in prognosis between the two techniques for less common nonmelanoma skin cancers (NMSCs). Objectives: The aim of our study was to compare the survival outcomes of MMS and WLE for less common NMSCs. Methods: This study retrospectively analyzed data from the Surveillance, Epidemiology, and End Results dataset between 2003 and 2018. The less common NMSCs include Merkel cell carcinoma, skin appendage neoplasm, fibromatous malignancy, and other rare NMSCs. The stabilized inverse probability of treatment weighting (SIPTW) and the Kaplan-Meier methods were adopted to assess the overall survival (OS) and cancer-specific survival (CSS). Furthermore, the Cox proportional hazards, Fine-and-Gray regression analysis, and subgroup analysis models were applied to examine the effects of MMS versus WLE based on all-cause and cancer-specific mortality. Results: We identified 6,582 individuals with less common NMSCs for survival analysis, among which 1,946 patients (29.5%) had undergone MMS and 4,636 (70.5%) had received WLE. Diseases diagnosed in the most recent year, older age, the White race, married status, eyelid/face site, small tumor size, and localized disease were factors significantly associated with MMS treatment. Compared with the WLE group, the MMS group had comparable OS before and after the SIPTW analysis. Additionally, after adjusting for other confounding covariates, the surgery type (WLE vs. MMS) did not show significant associations with all-cause mortality (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.94–1.14, p = 0.517) and disease-specific mortality (HR: 1.16, 95% CI: 0.95–1.42, p = 0.134). Moreover, the subgroup analysis validated these findings. Conclusion: MMS and WLE have comparable OS and CSS for less common NMSCs.

Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases from a Single Practice Cohort.

Lentigo maligna is a subtype of melanoma in situ that typically affects the head and neck region with an increasing incidence. Margin-controlled techniques, such as spaghetti technique (ST), have gained popularity over wide local excision (WLE) with a margin of 5 mm. To evaluate the outcomes of lentigo maligna cases in the head and neck area treated by either WLE or ST in a tertiary referral hospital. The secondary goal was to describe the demographic and clinical characteristics of our series. Cohort study of patients diagnosed with lentigo maligna on the head and neck region between January 2014 and February 2022 in a tertiary hospital. In total, 79 lentigo maligna were studied, corresponding to 77 patients. Fifty-three lesions (67%) were treated with WLE and 26 (33%) with ST. The mean age of the patients was 73 years and 58% were men. Most of the tumors were located on the cheek (50%) and mean lesion diameter was 2.2 cm for the ST group and 1.2 cm for the WLE group. Mean duration follow-up was 44 months. There were two local recurrences in the WLE group (2/53; 3.7%) and none in the ST group. Both WLE and ST are appropriate surgical approaches for lentigo maligna. ST offers an efficient alternative to Mohs surgery for treating lentigo maligna in the head and neck area, especially when guided by reflectance confocal microscopy.

Prognostic Analysis of Patients With Extramammary Paget Disease Treated With Conservative Excision.

Extramammary Paget disease (EMPD) is a malignant skin tumor with a relatively good prognosis. The standard treatment is wide local resection or Mohs micrographic surgery. However, conservative excision may be a better option when radical wide local excision is difficult to perform due to the patients' mental or physical condition. There have been no studies on the prognosis of patients with EMPD who underwent conservative excision. To compare the prognosis of conservative excision cases to wide excision cases of EMPD. The authors retrospectively analyzed the clinical data of 69 cases of EMPD without metastases to lymph nodes or organs (11 cases treated with conservative excision, 58 cases treated with wide local excision) who underwent resection of the primary tumor from 2002 to 2022 in the Department of Dermatology at Hokkaido University Hospital. The log-rank test showed no significant differences in overall survival or metastasis-free survival between the wide excision group and the conservative excision group, although conservative surgery was often chosen in elderly patients or patients with lower performance status. This study suggests that conservative surgery should be considered as a treatment option for EMPD.

EP-573 Does type of surgery influence recurrence of breast cancer in younger patients?

Abstract It is well established that young age is a risk factor for outcome of breast cancer, and younger women are more likely to have adverse prognostic factors. Our aim was to investigate whether type of surgery (wide local excision vs mastectomy) had any effect on local or distant recurrence in women under the age of 35. All women with breast cancer under the age of 35 treated between 1st January 2010 and 31st December 2020 were included. Data including age at diagnosis, comorbidities, type of surgery, neoadjuvant/adjuvant treatment, histology, lymph node positivity, expression of receptors, local/distant recurrence was collected. There were 34 patients included, age range 21–34. Ten patients had a wide local excision (WLE) while the rest had a mastectomy. Four patients had local recurrence while nine patients had distal recurrence. In WLE group 1 out of 10 had local recurrence and 2 out of 10 had distant metastasis (one of these patients had both). In mastectomy group 2 out of 24 had local recurrence and 7 out of 24 had distant metastasis (two patients had both). The average recurrence time was 1.7 years after initial diagnosis. Using a Chi-square test, there was no significant difference found for local, distant or overall recurrence between patients having wide local excision or mastectomy (p=0.719, p=0.554, p=0.462 respectively). Type of surgery did not affect the local or distant recurrence rate. The sample size is small, and a larger series is required to determine whether it is equally safer to offer WLE to younger women.

The application of Wood's lamp combined with 5-aminolevulinic acid for defining tumor margins in patients with extramammary Paget's disease

Objective: To evaluate the value of Wood's lamp examination combined with 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) to determine positive tumor margins in patients with extramammary Paget's disease (EMPD) before surgery. Methods: We admitted 36 patients with EMPD from January 2016 to June 2019. The experimental group was the 5-ALA-PDT group, and the control group was the wide local excision (WLE) group. In the 5-ALA-PDT group, Wood's lamp examination combined with 5-ALA-PDT was used to trace the fluorescence range, and multipoint biopsy was performed according to the pathology to determine the final excision scope. We applied the standard partial expansion excision method for the WLE group, while frozen pathology assessment was applied to confirm the excision range. We measured the overall resection area of the WLE group and 5-ALA-PDT group. We analyzed the overall duration of surgery, the number of frozen pathology sections, patient satisfaction with appearance and function, the rate of functional sequelae, and the recurrence rate for both groups. Results: The results suggested that the difference in final resection margin between the WLE group and the 5-ALA-PDT group was significant. The number of frozen pathology sections, overall surgery time, and recurrence rate were significantly lower in the experimental group than in the control group (p<0.05). The occurrence rate of functional sequelae in the experimental group was lower, and patient satisfaction with appearance and function was significantly higher than that of the control group (p<0.05). Conclusion: Wood's lamp examination combined with 5-ALA-PDT may predict tumor margins in EMPD.

Treatment and Survival Outcomes of Surgery for Carcinoma Vulva

To study treatment and survival outcomes of carcinoma vulva. The electronic charts of 30 patients with carcinoma vulva operated between October 2010 and December 2015 were reviewed. Univariate cox-proportional hazard tests were done for potential risk factors. Survival analysis was done using Kaplan–Meier plots and the log rank test. The median age was 59 with a range of 27–82 years. Most common (90%) histological type was squamous cell carcinoma. Most (66.7%) patients had early stage disease, while stage III was seen in 23.3% and stage IV in 10%. Primary surgery was done in 27/30 (90%) patients while three with stage IV had surgery following neoadjuvant therapy. Complications included wound dehiscence in 6/30 (20%), lymphocysts in 11/30 (36.7%), urinary infections in 3/30 (10%) and one death within 30 days. There were 6 recurrences (20%) and 10 deaths (33.3%). Mean recurrence-free survival was 84.6 (95% CI 67.6–101.6) months. Mean overall survival time was 70 (95% CI 53.1–86.9) months. Radical wide local excision with groin node dissection is possible in most early cases. Flaps can reduce wound breakdown. A multidisciplinary approach can ensure long-term survival with good quality of life.

Aesthetic reconstruction of localized periurethral cancer defects: a case report

Although several techniques of vulvar reconstruction have been reported, the aesthetic repair of localized periurethral defects has not been investigated yet. A 60-year-old woman presented with a neoplasm located on the right side 1–2 mm from the urethral meatus. A radical wide local excision was performed with the resection of the distal part of the urethra. The urethral meatus was reconstructed by the mobilization of the anterior and lateral vaginal mucosa. The vulvar defect was repaired by the advancement of the two bilateral V-shaped local flaps harvested at the level of labia majora. The present case emphasizes the importance of tailoring reconstructive options for vulvar reconstruction to provide aesthetically appealing results, to prevent or restore organ function and to reduce disease and treatment-related morbidity. Level of evidence: Level V, therapeutic study.

Mohs micrographic surgery versus wide local excision for head and neck melanoma-in-situ

Background: Various surgical options can be used to remove melanoma in situ (MIS). These include wide local excision (WLE), staged excision, and Mohs micrographic surgery (MMS). For MIS lesions located in the head and neck regions, the WLE approach may not always be a technically feasible option if both cosmesis and anatomical function is to be preserved.Methods: We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEERs) cancer registry. A total of 7933 cases of MIS in the head and neck region were included in this study, of which 5353 cases were treated by WLE and the remaining 2580 cases by MMS.Results: Comparing between the WLE and MMS group, cancer-specific survival rates at 5 (99% vs. 99%) and 10 years (98% vs. 98%) as well as the 5 year overall survival rate (85% vs. 86%) were similar. After adjusting for confounders, there was no significant difference in cancer-specific survival (HR: 0.902, 95% confidence interval (CI): 0.539–1.511, p = .695) and overall-survival (HR: 0.943, 0.813–1.093, p = .435).Conclusions: For cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MIS due to its tissue-preserving nature particularly in the head and neck region.Key PointsOur adjusted analysis demonstrates similar overall and cancer-specific survival for Mohs surgery vs wide local excision for head and neck melanoma-in-situFor cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MISThis is due to its tissue-preserving nature particularly in the head and neck region

Surgical treatment of low-grade chondrosarcoma involving the appendicular skeleton: long-term functional and oncological outcomes.

The traditional treatment for chondrosarcoma is wide local excision (WLE), as these tumors are resistant to chemotherapy and radiation treatment. While achieving negative margins has traditionally been the goal of chondrosarcoma resection, multiple studies have demonstrated good short-term results after intralesional procedures for low-grade chondrosarcomas (LGCS) with curettage and adjuvant treatments (phenol application, cauterization or cryotherapy) followed by either cementation or bone grafting. Due to the rarity of this diagnosis and the recent application of this surgical treatment modality to chondrosarcoma, most of the information regarding treatment outcomes is retrospective, with short or intermediate-term follow-up. The aim of this study was to assess the long-term results of patients with LGCS of bone treated with intralesional curettage (IC) treatment versus WLE. This retrospective analysis aims to characterize the oncologic outcomes (local recurrence, metastases) and functional outcomes in these two treatment groups at a single institution. Using an institutional musculoskeletal oncologic database, we retrospectively reviewed medical records of all patients with LGCS of the appendicular skeleton that underwent surgical treatment between 1985 and 2007. Thirty-two patients (33 tumors) were identified with LGCS; 17 treated with IC and 15 with WLE. Seventeen patients (18 tumors) with a minimum clinical and radiologic follow-up of 10years were included. Nine patients were treated with IC (four with no adjuvant, three with additional phenol, one with liquid nitrogen and one with H2O2) with either bone graft or cement augmentation, and nine others were treated with WLE and reconstruction with intercalary/osteoarticular allograft or megaprosthesis. The mean age at surgery was 41years (range 14-66years) with no difference (p = 0.51) between treatment cohorts. There was a mean follow-up of 13.5years in the intralesional cohort (range 10-19years) and 15.9years in the WLE cohort (range 10-28years, p = 0.36). Tumor size varied significantly between groups and was larger in patients treated with WLE (8.2 ± 3.1cm versus 5.4 ± 1.2cm, at the greatest dimension, p = 0.021). There were two local recurrences (LR), one in the intralesional group and one in the wide local excision group, occurring at 3.5months and 2.9years, respectively, and both required revision. No further LR could be detected with long-term follow-up. The MSTS score at final follow-up was significantly higher for patients managed with intralesional procedures (28.7 ± 1.7 versus 25.7 ± 3.4, p = 0.033). There were less complications requiring reoperation in the intralesional group compared with the wide local excision group, although this difference was not found to be statistically significant (one versus four patients, respectively; p = 0.3). This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Complications were infrequent and minor and MSTS functional scores were excellent. Wide resection of LGCS was associated with lower MSTS score and more complications. In our series, the LR in both groups were detected within the first 3.5years following the index procedure, and none were detected in the late surveillance period.

Mohs micrographic surgery for eyelid sebaceous carcinoma: A multicenter cohort of 360 patients

The decision toperform Mohsmicrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial. To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE. A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders. Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P=.002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P=.453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P=.329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P=.488). Retrospective nature of the study. MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis ortumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.

Primary small cell neuroendocrine carcinoma of the Bartholin's gland: A case report.

Primary carcinoma of the Bartholin's gland (BG) is a rare malignancy. There are extremely rare cases of small cell neuroendocrine carcinoma (SCNC) of the BG reported in the English literature. A postmenopausal female presented with a 1-month history of increasing pain and swelling on the left vulva consistent with spontaneously bleeding. Pathology identified SCNC that arose in BG. The patient was treated with a radical wide local excision and bilateral inguinal lymph node dissection followed by six courses of chemotherapy. One month after primary treatment, without any pelvic recurrence or abnormal tumor markers indications, distant metastasis of the liver was diagnosed and VI hepatic lobectomy was performed. The patient maintained regular adjuvant chemotherapy every month under outpatient surveillance and has no local recurrence or distant metastasis.

Anorectal Malignant Melanoma-Defining the Optimal Surgical Treatment and Prognostic Factors.

Patients with anorectal malignant melanoma (ARMM) have a poor prognosis. Optimal surgical treatment is not defined. The aim of the study was to define the surgical treatment for ARMM, to compare the overall survival (OS) of abdomino-perineal resection (APR) and wide local excision (WLE) and to study various prognostic factors. Thirty patients of ARMM were managed, 20 with locoregional disease, 10 metastatic. Of the 20 patients with locoregional disease, 15 underwent APR and 5 WLE. The 1-, 2-, 3-, and 4-year overall survival rates (by Kaplan-Meier survival analysis) in the APR group were 67, 40, 40, and 32%, and in WLE group were 100, 100, 67, and 67% respectively. Median survival for APR and WLE groups were 13 and 36months and were not significant (p 0.48). Node-negative patients had better survival than node positive in the APR group (56 vs. 13months) (p 0.017). Patients with tumor size < 2cm, lymphovascular invasion and perineural invasion negative, and margin-negative and with superficial infiltration had a trend toward better survival than their counterparts. WLE gives an equivalent oncological outcome and can be offered for patients with smaller ARMM and APR for locally advanced, larger tumors or as a salvage following recurrence after WLE.

Outcomes of Melanoma In Situ Treated With Mohs Micrographic Surgery Compared With Wide Local Excision

Melanoma in situ (MIS) is increasing in incidence, and expert consensus opinion recommends surgical excision for therapeutic management. Currently, wide local excision (WLE) is the standard of care. However, Mohs micrographic surgery (MMS) is now used to treat a growing subset of individuals with MIS. During MMS, unlike WLE, the entire cutaneous surgical margin is evaluated intraoperatively for tumor cells. To assess the outcomes of patients with MIS treated with MMS compared with those treated with WLE. Retrospective review of a prospective database. The study cohort consisted of 662 patients with MIS treated with MMS or WLE per standard of care in dermatology and surgery (general surgery, otolaryngology, plastics, oculoplastics, surgical oncology) at an academic tertiary care referral center from January 1, 1978, to December 31, 2013, with follow-up through 2015. Mohs micrographic surgery or WLE. Recurrence, overall survival, and melanoma-specific survival. There were 277 patients treated with MMS (mean [SD] age, 64.0 [13.1] years; 62.1% male) and 385 treated with WLE (mean [SD] age, 58.5 [15.6] years; P < .001 for age; 54.8% male). Median follow-up was 8.6 (range, 0.2-37) years. Compared with WLE, MMS was used more frequently on the face (222 [80.2%] vs 141 [36.7%]) and scalp and neck (23 [8.3%] vs 26 [6.8%]; P < .001). The median (range) year of diagnosis was 2008 (1986-2013) for the MMS group vs 2003 (1978-2013) for the WLE group (P < .001). Overall recurrence rates were 5 (1.8%) in the MMS group and 22 (5.7%) in the WLE group (P = .07). Mean (SD) time to recurrence after MMS was 3.91 (4.4) years, and after WLE, 4.45 (2.7) years (P = .73). The 5-year recurrence rate was 1.1% in the MMS group and 4.1% in the WLE group (P = .07). For WLE-treated tumors, the surgical margin taken was greater for tumors that recurred compared with tumors that did not recur (P = .003). Five-year overall survival for MMS was 92% and for WLE was 94% (P = .28). Melanoma-specific mortality for the MMS group was 2 vs 13 patients for the WLE group, with mean (SD) survival of 6.5 (4.8) and 6.1 (0.8) years, respectively (P = .77). No significant differences were found in the recurrence rate, overall survival, or melanoma-specific survival of patients with MIS treated with MMS compared with WLE.

A study of patients treated for primary squamous cell carcinoma of the vulva in the regional cancer centre in Cardiff, UK

Objective: Review of patients operated for primary squamous cell carcinoma (SCC) of the vulva in the Department of Gynaecological Oncology, University Hospital of Wales in Cardiff, to determine factors related to recurrence as well as survival of disease. Material/Methods: A retrospective review using details obtained from patients' records. Hazard ratio estimation was carried out with Cox Regression analysis and survival plots were determined using Kaplan-Meier plots. Results: 144 women with primary vulval SCC were operated from 2002-2010. Commonly, radical wide local excision (49.3%) and radical vulvectomy (46.5%) were carried out, apart from ano-vulvectomy (1.4%) and local excision biopsies (2.8%). In 77.1% lympnode dissection was performed and inguinal metastasis was diagnosed in 28.8%, bilaterally in 68.8%. Histologically, 64.4% were moderate/poor differentiation and 30.9% were advanced disease (FIGO III and IVA). The 5-year survival rate (OS) was 61.1%. Stratified by FIGO classification, the 5-year OS for stages IA, IB, II, III and IVA were 72.7%, 86.0%, 50%, 34.4% and 45.5% respectively. Age >70 years was an important prognostic factor (51.9% OS) compared to 71.6% in patients 70 years. Patients with grade 1 disease survived in 72.5%, grade 2 in 58.8% and poorly differentiated cancer in 41.7%. Presence of inguinal metastasis was associated with a 40.6% 5-year OS, absence with 74.7%. Conclusions: Cox regression analysis confirms that age, presence/bilaterality of inguinal lymphnode metastasis, high-grade tumour differentiation, tumour size, FIGO stage and adjuvant therapy are important prognostic factors for 5-year survival.

Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results?

We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer. We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square. Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004). WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

P035. Reaching a national consensus on the surgical management of multiple ipsilateral breast cancers (MIBCs): Perceptions by patients, healthy volunteers, surgeons and breast cancer associations

P035. Reaching a national consensus on the surgical management of multiple ipsilateral breast cancers (MIBCs): Perceptions by patients, healthy volunteers, surgeons and breast cancer associations

Vulvar cancer: epidemiology, clinical presentation, and management options.

EpidemiologyVulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders.HistologySquamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%).Clinical featuresPruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain.TherapyThe gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1). A sentinel lymph node (SLN) biopsy may be performed to reduce wound complications and lymphedema.PrognosisThe survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival.

Breast cancer surgery without suction drainage: The impact of adopting a ‘no drains’ policy on symptomatic seroma formation rates

AimTo determine the effect of a ‘no drains’ policy on seroma formation and other complications in women undergoing breast cancer surgery. Materials and methodsBefore May 2010 drains were routinely used in our unit following mastectomy ± axillary surgery and axillary lymph node dissection (ALND) ± wide local excision (WLE). Since then, a ‘no drains’ policy has been adopted. Data was collected prospectively between 01/12/06 and 30/11/11 to compare symptomatic seroma, wound infection, re-admission and re-operation rates in women treated with a drain and those without. Results596 women were included in the study. 247 women underwent modified radical mastectomy (MRM) and ALND (Group 1), 184 MRM ± sentinel lymph node biopsy (SLNB)/axillary node sampling (ANS) (Group 2) and 165 ALND ± WLE (Group 3).In group 1, 149 had a drain, in group 2, 62, and in group 3, 50.Within each group, the presence or absence of a drain did not significantly affect the rate of symptomatic seroma, number of aspirations performed, wound infection rates or the incidence of complications requiring re-admission. Having a drain was associated with lower volumes of seroma aspirated. In all three groups, the presence of a drain was associated with a longer hospital stay (p < 0.001). ConclusionThis study suggests that MRM ± ALND/SLNB/ANS and ALND ± WLE can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a ‘no-drains’ policy may also contribute to earlier hospital discharge.