Removal Of Basal Cell Carcinoma Research Articles

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

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

Septic Cervicofacial Phlegmon Following Basal Cell Carcinoma Excision: Life-threatening Complication of Routine Operation in Maxillofacial Surgery?

Basal cell carcinoma (BCC) is a frequent tumor entity, especially in the facial region. The standard therapy for BCC is surgical tumor excision which is generally a low-risk procedure. One of the life-threatening surgical risks and complications when removing BCC in the facial area is infection with the possibility to spread across the deep neck spaces as well as systemic inflammation (sepsis). A 73-year-old patient presented to the emergency department with a swelling of the right cheek, extended towards the neck. Based on his medical history, an outpatient BCC excision of the cheek had been performed the day before. Laboratory tests showed a fulminant inflammatory process of sepsis. Computed tomography (CT) revealed a buccal phlegmon on the right extended towards the deep neck. A diagnosis of septic cervicofacial phlegmon following BCC excision was made. The therapy consisted of intensive care sepsis treatment, surgical relief, and drainage of the phlegmon and a calculated antibiotic treatment (piperacillin/tazobactam, clindamycin). Removal of BCC in the facial region is generally a low-risk procedure. A possible complication is postoperative wound infection. In rare cases the clinical picture of a septic cervicofacial phlegmon can develop. Surgical focus sanitation, broad-based antibiotic therapy and intensive care sepsis management are the key therapeutic pillars of this postoperative complication.

Excellent Closure of Postauricular Defect Using Type-1 Keystone Perforator Island Flap: An Alternative Facial Reconstruction Technique

The use of local flaps is a common and effective method for reconstructing various post-surgical defects. Some advantages of local flaps compared to other methods such as skin grafts are the relatively high success rate and lower complication rates such as infections and wound dehiscence. There are various methods of flaps available and choosing the proper method is based on various factors such as the size of the defect, anatomical location of the defect, and operator capabilities. Therefore, an effective but simple local flap method with a high success rate is needed especially when dealing with defects located on prominent cosmetic areas such as the face. We report the successful use of the keystone perforator island flap for closure of a facial defect caused by basal cell carcinoma removal in a 76-year-old female patient. Although not commonly used for facial reconstruction, this paper reports successful use of this relatively simple and effective method prompting the potential for increased usage in treating small-moderate sized defects on the face.

Design and Validation of a Handheld Optical Polarization Imager for Preoperative Delineation of Basal Cell Carcinoma.

Simple SummarySkin cancer is the most common malignancy in humans. The goal of this study was to design, implement, and clinically test a novel handheld optical polarization imaging (OPI) system for rapid and noninvasive detection of basal cell carcinoma (BCC) margins. The device is compact, lightweight, and can be operated with minimal training. To validate the handheld imager, 10 subjects with biopsy-confirmed BCC were imaged prior to Mohs surgery. The optical images were processed using a spectral encoding method to increase the accuracy of the tumor boundary delineation. Preoperative margin assessment results from the OPI were compared to the surgeon’s clinical evaluation and to the gold standard of histopathology. Our findings indicate that OPI may be a valuable tool for optimizing surgical treatment of skin cancer.Background: Accurate removal of basal cell carcinoma (BCC) is challenging due to the subtle contrast between cancerous and normal skin. A method aiding with preoperative delineation of BCC margins would be valuable. The aim of this study was to implement and clinically validate a novel handheld optical polarization imaging (OPI) device for rapid, noninvasive, in vivo assessment of skin cancer margins. Methods: The handheld imager was designed, built, and tested. For clinical validation, 10 subjects with biopsy-confirmed BCC were imaged. Presumable cancer margins were marked by the study surgeon. The optical images were spectrally encoded to mitigate the impact of endogenous skin chromophores. The results of OPI and of the surgeon’s preoperative visual assessment were compared to clinical intraoperative histopathology. Results: As compared to the previous prototype, the handheld imager incorporates automated image processing and has 10-times shorter acquisition times. It is twice as light and provides twice as large a field of view. Clinical validation demonstrated that margin assessments using OPI were more accurate than visual assessment by the surgeon. The images were in good correlation with histology in 9 out of 10 cases. Conclusions: Handheld OPI could improve the outcomes of skin cancer treatments without impairing clinical workflows.

Non-surgical Removal of Basal Cell Carcinoma by Apis Mellifera L Venom

Background: Honeybee’s venom is potent anticancer drug without exhibiting any side effects. Skin Basal Cell Carcinoma (SBCC) is a common malignancy. It can cause significant local destructions depending on affected site. The diagnosis of SBCC can be suspected from clinical findings and confirmation of diagnosis histopathology. The present SBCC is recurrent and aggressive in the skin of head [upper right, in front of the right ear]; the patient was 65 years old in time of first intervention. Materials & Methods: Following the lesions primarily surgically excised, the malignant growths recurrent and visual recognition occurred after 1 year from first operation, then another (the second) surgical removal of SBCC from affected skin with removal of all skin layers near the affected site but another recurrence visually occurs after about 4 months, in the form of malignant growth in the skin of right ear. Dry honeybee’s venom 1 mg was dissolved in 1 ml dist. water as injectable solution. Moreover, ointment contains 2% bee venom was prepared to be used topically inside affected ear as injection is not possible. Results: Before this novel intervention, the desperate patient situation seems very dangerous; as the new growths appear as continuous spread near the removed skin, so that patient’s family decided to apply more noninvasive and non-surgical intervention. The only precaution was testing the patients to assure she is not hypersensitive to honeybees’ venom. The treatment performed by subcutaneous injection of 0.3 ml from prepared Honeybees venom (0.1 % conc.) in the skin of affected part of the ear. Subcutaneous infiltration was applied around the lesions of about 0.5 ml as well, topical application of the ointment inside inner part of affected ear. This process repeated daily with cleaning of the ear every time by suitable safe and sterile saline solutions. Management of healing process was enhanced by ascorbic acid solution as topical application on dead cancer cells and to help in exudates debris removal. The complete removal of malignant growths and recovery obtained after 1 month from first bee venom injections. No recurrence of SBCC seen for 3 yrs. Conclusions: Honeybees venom is highly effective and safe anticancer drug that can be used for all patients’ categories of all ages. Regarding the present case invasive surgical intervention was not the good choice from the beginnings, as recurrence and giving chance for spreading following the time lapse between every surgery.

Metabolic signature of eyelid basal cell carcinoma

PurposeEyelid basal cell carcinoma (BCC) is the most common eyelid malignancy. Metabolic reprogramming is critical in tumorigenesis, but the metabolic feature of eyelid BCC remains elusive. In this study, we aim to reveal the metabolic profile in eyelid BCC using targeted metabolomics. Eyelid samples were collected from patients who had removal of BCC and from control patients who underwent blepharoplasty. Multivariate analysis of metabolomics data distinguished the two groups, indicating that eyelid BCC has significantly different metabolome than the healthy tissue. We found 16 increased and 11 decreased metabolites in the BCC tissues. These metabolites were highly enriched in the metabolism of nicotinamide adenine dinucleotide (NAD), glutathione metabolism, polyamine metabolism, and the metabolism of glycine, serine, threonine, arginine and proline. amino acid metabolism. Metabolites from NAD metabolism (Nicotinamide; Nicotinamide riboside; N1-Methylnicotinamide) had the highest sensitivity, specificity, and prediction accuracy in a prediction model for eyelid BCC. In conclusion, eyelid BCC has a signature change of cell metabolome. Metabolites in NAD metabolic pathways could potentially be biomarkers or therapeutic targets for eyelid BCC.

Perioperative margin detection in basal cell carcinoma using a deep learning framework: a feasibility study.

Basal cell carcinoma (BCC) is the most commonly diagnosed cancer and the number of diagnosis is growing worldwide due to increased exposure to solar radiation and the aging population.Reduction of positive margin rates when removing BCC leads to fewer revision surgeries and consequently lower health care costs, improved cosmetic outcomes and better patient care.In this study, we propose the first use of a perioperative mass spectrometry technology (iKnife) along with a deep learning framework for detection of BCC signatures from tissue burns. Resected surgical specimen were collected and inspected by a pathologist. With their guidance, data were collected by burning regions of the specimen labeled as BCC or normal, with the iKnife. Data included 190 scans of which 127 were normal and 63 were BCC. A data augmentation approach was proposed bymodifying the location and intensity of the peaks of the original spectra, through noise addition in the time and frequency domains.A symmetric autoencoder was built by simultaneously optimizing the spectral reconstruction error and the classification accuracy. Using t-SNE, the latent space was visualized. The autoencoder achieved an accuracy (standard deviation) of 96.62 (1.35%) when classifying BCC and normal scans, a statistically significant improvement over the baseline state-of-the-art approach used in the literature. The t-SNE plot of the latent space distinctly showed the separability between BCC and normal data, not visible with the original data. Augmented data resulted in significant improvements to the classification accuracy of the baseline model. We demonstrate the utility of a deep learning framework applied to mass spectrometry data for surgical margin detection. We apply the proposed framework to an application with light surgical overhead and high incidence, the removal of BCC. The learnt models can accurately separate BCC from normal tissue.

The Zitelli’s bilobed flap in ala and nasal tip reconstruction

Background: The Zitelli’sbilobed flap is one of the most useful local flaps for reconstruction of skin and soft tissue defects of the nose. Its main indications are small and circular wounds located on the distal third of the nose (tip and ala). Aims and Objectives: To describe our experience with the use of ZBF for reconstruction of small skin and soft tissue defects of the alar lobules and nasal tip following removal of skin tumors. Materials and Methods: In this paper, we report on our experience with a retrospective study of 23 cases with small defect located in ala and nasal tip between January 2009 and December 2015. Results: The study included 14 men and 9 women with a mean age of 48.08±14.13 years and sex ratio of 1.55, basal cell carcinoma removal was the most cause of defects in 82.6%. All patients underwent reconstruction by using Zitelli’sbilobed flap.Aside from a few complications, the postoperative results were satisfactory for the majority of our patients. Conclusion: This flap is versatile, reliable and easy to implement especially when the principles of technique, patient and wound selection are carefully applied.

浅側頭動脈－中大脳動脈吻合術後頭皮創トラブルに対する高気圧酸素療法の効果

Hyperbaric oxygen therapy (HBO) was used to treat 9 patients who had delayed wound healing, among 30 patients who underwent a superficial temporal artery-middle cerebral artery bypass from 2014 to 2015. Of these 9 patients, 1 patient was treated after irradiation for intracranial tumor, 1 patient underwent surgical removal of basal cell carcinoma from the contralateral head skin, and 4 patients were undergoing treatment for diabetes mellitus. HBO was performed at an absolute pressure of 2 atmospheres for 75 minutes, with 100% oxygen inhalation. The wounds of all patients successfully healed after 5 to 20 sessions of HBO. Therefore, HBO might be useful for treatment of wounds that fail to heal.

Confocal imaging of carbon dioxide laser-ablated basal cell carcinomas: An ex-vivo study on the uptake of contrast agent and ablation parameters.

Laser ablation can be an effective treatment for the minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histological confirmation after ablation results in high variability of recurrence rates and has been a limitation. Reflectance confocal microscopy (RCM) imaging, combined with a contrast agent, may detect the presence (or absence) of residual BCC tumors directly on the patient and thus provide noninvasive histology-like feedback to guide ablation. The goal of this ex vivo bench-top study was to determine affective ablation parameters (fluence, number of passes) for a CO2 laser that will allow both removal of BCCs and control of the underlying thermal coagulation zone in post-ablated tissue to enable uptake of contrast agent and RCM imaging. We used 72 discarded fresh normal skin specimens and frozen BCC tumor specimens to characterize the depth of ablation and to evaluate uptake of contrast agent and image quality. Acetic acid was used to enhance nuclear brightness ("acetowhitening") during imaging pre- and post-ablation. Histology sections of the post-ablated imaged surface were visually examined for the appearance of nuclear and dermal morphology and compared to the RCM images. Results for 1-3 passes of 5.5 J/cm(2), 6.5 and 7.5 J/cm(2), and 1-2 passes of 8.5 J/cm(2) showed the uptake of acetic acid for contrast and RCM imaging of the presence and absence of residual BCC tumors in post-ablated tissue. Morphologic details in the images were validated by the histology. The use of effective ablation parameters may enable RCM imaging to guide ablation.

Lumbar BCC removal and reconstruction with a perforator plus flap

The lower back still remains a challenging area for a reconstructive surgeon, especially when it comes to a big defect. A 78-year-old man presented with a neglected basal cell carcinoma (BCC). He underwent excision of the lesion and reconstruction of the 18 × 10-cm defect with a lumbar perforator plus flap. His operation and final outcome are presented, and the possible options for reconstruction are discussed. The advantages of the rotational design, the axial blood supply, and the skin island preservation are reported, giving the lumbar perforator plus flap a definite role in a difficult area such as the lower back.

Lower Eyelid Reconstruction after Basal Cell Carcinoma Removal - A Decision Management Tool

Purpose: To describe the clinical features in patients presenting with a primary basal cell carcinoma (BCC) involving the lower lid and/or adjacent inferior periocular area, and present simple surgical guidelines for reconstruction based on the lesion location and size. Design: Retrospective observational case series. Methods: This is an institutional, observational study involving 64 patients with a single primary BCC affecting the lower eyelid +/- adjacent periocular area. We included only adults who underwent primary surgical excision of the tumor with margin control. We excluded all patients with prior history of an eyelid malignancy, recurrent tumors, and invasive disease beyond the orbital septum. Results: Small-moderate full-thickness defects ( 25mm) had a complex reconstruction, and all used a Mustarde cheek rotational flap for the anterior lamella. The posterior lamella was reconstructed with: a tarso-conjunctival graft from the upper lid +/- a chondro-mucosal graft from nasal septum +/- a periosteal flap. Lesions in the medial periocular area (not involving the full-thickness eyelid) were repaired with a bilobed or rhomboid myocutaneous flap +/- an island advancement flap from the nasojugal area. Conclusions: Our goal is to provide a basic framework for pre and intra-operative decision making that leads to successful functional and aesthetic appearance after lower eyelid reconstruction after basal cell carcinoma removal.

Comparison of Tissue-Engineered and Artificial Dermis Grafts after Removal of Basal Cell Carcinoma on Face—A Pilot Study

Planning reconstruction for facial defects should include the safest and least-invasive methods, with a goal of achieving optimal functional and cosmetic outcomes. To compare tissue-engineered dermis grafts with artificial dermis grafts after removal of basal cell carcinoma (BCC) on the face. A tissue-engineered dermis composed of autologous cultured dermal fibroblasts seeded on a hyaluronic acid sheet was applied to 16 patients. Grafting of hyaluronic acid sheets that did not contain fibroblasts (artificial dermis group) was performed in 13 patients. Healing time, scar condition, and patient satisfaction were compared. The wounds of the tissue-engineered dermis group reepithelialized after 31.4 ± 5.3 days and those of the artificial dermis group after 34.2 ± 4.9 days. The tissue-engineered dermis graft was superior in scar quality. In particular, statistically significant differences were detected in the height and contracture of scars, although there were no significant differences in terms of scar texture or color match. Patient satisfaction in the tissue-engineered dermis graft group (8.3 ± 1.0) was also statistically superior to that in the artificial dermis group (6.9 ± 1.4). The tissue-engineered dermis graft is superior to the artificial dermis graft for covering defects after removal of BCC on the face.

Response to Letter on Tangential Shave Removal of Basal Cell Carcinoma

Response to Letter on Tangential Shave Removal of Basal Cell Carcinoma

Tangential Shave Removal of Basal Cell Carcinoma

Tangential Shave Removal of Basal Cell Carcinoma

Tangential Shave Removal of Basal Cell Carcinoma

To determine the outcome of tangential shave removal (TS) of basal cell carcinoma (BCC) on the trunk and extremities. Cohort study of patients with multiple truncal BCC treated using TS in an academic dermatologic surgery practice. Academic institution referral practice. Individuals with BCC referred to the dermatologic surgery unit for ongoing therapy of multiple lesions. TS of amenable superficial and nodular BCCs with twice-annual follow-up. Lesions were removed using a scalpel as a uniform-depth mid-to-upper dermal shave and sent for routine pathology. Basic wound care was applied. Apparent cure rate and outcome of scars. One hundred eighty-two BCCs were treated in 19 individuals. Patients were followed for an average of 5.2years. One lesion recurred. Three specimens had positive margins requiring further surgery. Scarring was acceptable and similar to what is observed with curettage and electrocoagulation. TS is a reasonable treatment for primary superficial and nodular BCC on the trunk and extremities.

Facial Dermis Grafts After Removal of Basal Cell Carcinomas

Selecting a proper reconstruction method is the key to success in skin cancer management, especially for lesions involving the face. Using a skin graft is usually straightforward when covering a skin defect; however, major concerns in skin grafting include a poor color match in the recipient-site and donor-site morbidity. To overcome these limitations, the authors have developed a dermis graft, which utilizes a de-epithelialized split-thickness skin graft method. The purpose of this retrospective study was to report reliability of dermis grafts after removal of basal cell carcinomas (BCCs) on the face by presenting our clinical experience with them. This study included 38 patients who were treated for facial defects created by resection of BCCs. The locations of the defects were as follows: nose (n = 17), orbital area (n = 14), cheek (n = 4), temple area (n = 2), and forehead (n = 1). The defects ranged in size from 3.3 to 6.5 cm. Functional and cosmetic outcomes, postoperative complications, and patient satisfaction were assessed. The patients were followed up for 12 to 36 months. The entire dermis graft re-epithelialized after grafting within 17 to 27 days. Most of the patients had satisfactory results in both functional and cosmetic matters with high-quality skin characteristics. There were no significant complications and no recurrences were observed during the follow-up period. Patient satisfaction with the dermis graft was also excellent. The dermis graft may be used reliably for covering defects after removal of BCCs on the face.

Incomplete removal of basal cell carcinoma: what is the value of further surgery?

IntroductionSurgical management of skin cancer is an important part of modern maxillofacial surgery. The common tumours treated are squamous cell carcinoma, malignant melanoma and some benign lesions, but the largest group of tumours are the basal cell carcinomas. Although only locally aggressive, if they are not completely removed, recurrence may occur and be troublesome, especially in the head and neck. Even in this region, incomplete excision is uncommon, less than 20 %, but management of positive margins remains controversial. This review evaluates the effectiveness of a further surgical intervention after a positive margin.Materials and methodsA retrospective audit was undertaken to determine the rate of positive margins within the unit and subsequently the percentage of residual tumour found in any secondary excisions.ResultsThe results show that in a sample of 247 patients, 11 % had positive peripheral margins. A second excision only showed that 36 % had any evidence of residual tumour.DiscussionThe study raises the question of the value of further surgery. Finally, the authors suggest a more focused approach to the finding of a positive margin before the patient is offered more treatment.

Horizontal V-Y Advancement Lower Eyelid Flap

Sir: We have read the article by Dr. Marchac et al. entitled “A Horizontal V-Y Advancement Lower Eyelid Flap” published in Plastic and Reconstructive Surgery (2009;124:1133–1141). We congratulate the authors for this wonderful idea that helps many patients. Previously in this Journal, we published a communication entitled “The V-Y Advancement for Lower Eyelid Defect in Preventing Ectropion” (Plast Reconstr Surg. 2006:118:557–558), also for a basal cell carcinoma. Obviously, it is the same flap, also with nice results. Our concern is, why is it that if our contribution was published in the same Journal, there is no reference to it? In the background of their article, it is mentioned that “The authors were surprised to realize that the horizontal V-Y advancement flap of the lower eyelid is not even mentioned in the textbooks about eyelid repair, and they wanted to report their very positive experience with this subcutaneous pedicle flap.” However, this idea has been published by us before their article in Plastic and Reconstructive Surgery. When we are going to publish in Plastic and Reconstructive Surgery, our first investigation is in the references of this Journal. Wilfredo Calderón, M.D. Patricio Leniz, M.D., Ph.D. Plastic Surgery Service Hospital del Trabajador Santiago, Chile

Risk and outcome analysis of 1832 consecutively excised basal cell carcinoma's in a tertiary referral plastic surgery unit

Basal cell carcinomas are the most prevalent of all skin cancers worldwide and form the majority of the surgical workload for most modern cutaneous malignancy centres. Primary surgical removal of basal cell carcinomas remains the gold standard of treatment but, despite almost two centuries of surgical experience, rates of incomplete surgical excision of up to 50% are still reported. The aim of this study was to assess, quantify and perform comparative analysis of the outcomes and predictive factors of consecutive primarily-excised basal cell carcinomas in a tertiary centre over a six-year period. Retrospective audit was conducted on all patients who underwent surgical excision of basal cell carcinomas from January 2000 to December 2005. Assessment parameters included patient biographics, tumour management differences and detailed histopathological analysis of tumour margins and subtypes. One thousand eight hundred and thirty two basal cell carcinomas were excised from 1329 patients over the designated time period. Two hundred and fifty one (14%) lesions were incompletely excised with 135 (7.4%) involving the peripheral margin only, 48 (2.6%) the deep margin only and 41 (2.2%) involving both. Nasal location was the most common predictor of incomplete excision. Overall basal cell carcinomas excision rates compared favourably with international reported standards but attention to a variety of surgical and histological risk factors may improve this further.