Surgery For Basal Cell Carcinoma Research Articles

Recidivas e recorrências de carcinomas basocelulares da face

To evaluate factors related to oncological follow-up of basal cell face carcinomas it was carried out the analysis of a series of cases. Four hundred sixty-five patients with 834 basal cell face carcinomas were evaluated; 3,1% presented recurrences. There was 14.7% of recurrence in incompletely excised tumors against 2.3% of the tumors with clear margins. Recurrences were more prevalent on the nose. Relapse rates showed a cumulative risk. These findings reinforce the importance of oncological follow-up after surgery of basal cell carcinoma.

An Overview of Mohs Micrographic Surgery for the Treatment of Basal Cell Carcinoma

This article reviews Mohs micrographic surgery for basal cell carcinoma. Its evolution to the present day technique, indications, and limitations are discussed, along with future expectations for the procedure.

Quantification of melanocytes in sun-damaged skin

The density of melanocytes varies by anatomic site and degree of sun damage. To determine the density of melanocytes and frequency of confluence in specimens adjacent to nonmelanoma skin cancers. Two hundred final layer specimens from Mohs surgery for basal cell carcinomas were analyzed by using MART-1. Data for 162 skin specimens from the head demonstrated an average keratinocyte to melanocyte ratio of 7.12 and 8.19 for epidermis and adnexal structures, respectively. The 23 specimens from the trunk demonstrated respective ratios of 7.54 and 7.46, and 13 specimens from extremities demonstrated ratios of 8.69 and 12.38. Margins from Mohs micrographic surgery for nonmelanoma skin cancers were utilized as a proxy for chronically sun-damaged skin. Our results suggest that chronically sun-exposed skin demonstrates increased melanocytic density, but confluence of melanocytes is rare. Occasionally intraepidermal pagetoid scatter and isolated melanocytic nests were rarely noted. These findings alone should not support an unequivocal diagnosis of melanoma in situ.

Secondary Intention Healing following Mohs Micrographic Surgery for Basal Cell Carcinoma of the Nipple and Areola*

Basal cell carcinoma (BCC) is the most common malignancy occurring in white Caucasians worldwide and the incidence of BCC is rising. The majority of BCCs occur sporadically on sun-exposed areas of the head and neck, with ultraviolet radiation (UVR) considered an important aetiological factor (1). However, BCCs also occur on covered and non-sun-exposed sites, including the nipple and areola, axilla, hands, feet, inguinal and genital areas. These are often referred to as being unusual sites for BCC and occur in the absence of immunosuppression, exposure to carcinogens or a hereditary predisposition (2). BCC has been postulated to originate from pilosebaceous units. It is, however, more generally accepted that pluripotent epithelial cells in the epidermis or adnexal structures can mature into any epithelial structure (3).

Basal Cell Carcinoma: 10 Years of Experience

Introduction. Basal cell carcinoma (BCC) is a locally invasive malignant epidermal tumour. Incidence is increasing by 10% per year; incidence of metastases is minimal, but relapses are frequent (40%–50%). The complete excision of the BCC allows reduction of relapse. Materials and Methods. The study cohort consists of 1123 patients underwent surgery for basal cell carcinoma between 1999 and 2009. Patient and tumor characteristics recorded are: age; gender; localization (head and neck, trunk, and upper and lower extremities), tumor size, excisional margins adopted, and relapses. Results. The study considered a group of 1123 patients affected by basal cell carcinoma. Relapses occurred in 30 cases (2,67%), 27 out of 30 relapses occurred in noble areas, where peripheral margin was <3 mm. Incompletely excised basal cell carcinoma occurred in 21 patients (1,87%) and were treated with an additional excision. Discussion. Although guidelines indicate 3 mm peripheral margin of excision in BCC <2 cm, in our experience, a margin of less than 5 mm results in a high risk of incomplete excisions.

Does incomplete excision of basal cell carcinoma of the eyelid mean tumor recurrence?

Basal cell carcinoma is the most common tumor of the eyelid. In this region, reconstruction is complex and damage to healthy tissue should be minimal. To define the relationship between margin clearance at excision and the recurrence rate of basal cell carcinoma of the eyelid. This prospective study was conducted with 111 patients submitted to surgery for basal cell carcinoma of the eyelid between 2001 and 2003 and followed up for a period of five years. The patients were evaluated according to age, tumor site, recurrence rate and margin clearance at excision. No significant association was found between incomplete tumor excision and recurrence except in patients under 56 years of age, female patients and in the case of tumors of the medial canthus. A risk of recurrence in incompletely excised basal cell carcinomas of the eyelid was only confirmed in younger patients, females and for tumors of the medial canthus.

Dermoscopy‐guided surgery in basal cell carcinoma

In basal cell carcinoma (BCC), excision margins between 3 and 10 mm, according to site, size, borders, previous treatment and histology, can allow for radical excision in at least 95% of cases. The objective was to ascertain whether dermoscopy can detect more accurately the lateral borders in BCCs than clinical examination alone, and allow us to obtain radical excision in more than 95% of cases with only 2-mm excision margins. A prospective study was performed of 200 consecutive BCCs of the head and neck removed with 2-mm dermoscopically detected excision margins. Morpheaform BCC, deeply recurrent BCC, BCC in Gorlin-Goltz syndrome, BCC located in sites not accessible through dermoscopy and superficial multifocal BCC were excluded. All cases of excised BCC were submitted to a uniform method of histological examination of the whole specimen with serial parallel sections at 2-mm intervals. In only three cases did surgical excision with 2-mm margins prove to be inadequate; in the remaining 197 cases, the excision margins were tumour-free. The comparison of clinical and dermoscopic extension measurement showed concordance in 131 cases (65.5%). In 69 cases (34.5%), dermoscopic evaluation showed a larger peripheral extension. These results indicate that 2-mm dermoscopically detected excision margins can achieve histologically confirmed complete excisions in 98.5% of cases.

Mohs Micrographic Surgery for Basal Cell Carcinoma of the Face

Mohs Micrographic Surgery for Basal Cell Carcinoma of the Face

Mohs Surgery for Basal Cell Carcinoma Assisted by Dermoscopy

*Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York Address correspondence and reprint requests to: Steven Q. Wang, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd St. New York, NY 10022, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters.

Anatomic Location of Hyaluronic Acid Filler Material Injected into Nasolabial Fold: A Histologic Study

BACKGROUND Products instilled within or beneath the skin to improve its physical features are known as fillers. The position of the filler within the skin is one determinant of the end cosmetic result. OBJECTIVE The objective was to histologically determine the anatomic location of injected hyaluronic acid (HA) filler within nasolabial fold (NLF) skin. METHODS AND MATERIALS Sixteen patients (12 females, 4 males; median age, 59 years) undergoing Mohs micrographic surgery for basal cell carcinoma of the NLF area consented to injection of Burow's triangle or dog-ear redundant skin with HA gel (Juvederm), ex vivo, in vivo, or in vivo with delayed (1-4 weeks) removal. Sections of alcohol-fixed, paraffin-embedded tissue specimens were stained with hematoxylin and eosin and with Hale's colloidal iron for detection of acid mucins. Dermal thickness was measured and HA distribution assessed. RESULTS NLF dermal thickness was 1.37+/-0.27 mm (mean+/-SD), with a range of 1.04 to 1.86 mm. All 16 patients showed HA filler localized to the subcutis. In 9/16 tissue samples, some HA was present in the deep dermis, but filler was only observed in more superficial dermis in 1 patient. The thickness of injected filler was 2.11+/-0.63 mm, but filler was often transected at the specimen base. CONCLUSION The predominant localization of injected HA filler is within the subcutis. A relatively thin NLF dermal thickness, typically <1.50 mm, likely precludes accurate injection of filler into dermal collagen. The results suggest that dermal localization of HA filler products is not required for an excellent cosmetic result.

Anatomic Location of Hyaluronic Acid Filler Material Injected into Nasolabial Fold

BACKGROUND Products instilled within or beneath the skin to improve its physical features are known as fillers. The position of the filler within the skin is one determinant of the end cosmetic result. OBJECTIVE The objective was to histologically determine the anatomic location of injected hyaluronic acid (HA) filler within nasolabial fold (NLF) skin. METHODS AND MATERIALS Sixteen patients (12 females, 4 males; median age, 59 years) undergoing Mohs micrographic surgery for basal cell carcinoma of the NLF area consented to injection of Burow's triangle or dog-ear redundant skin with HA gel (Juvederm), ex vivo, in vivo, or in vivo with delayed (1–4 weeks) removal. Sections of alcohol-fixed, paraffin-embedded tissue specimens were stained with hematoxylin and eosin and with Hale's colloidal iron for detection of acid mucins. Dermal thickness was measured and HA distribution assessed. RESULTS NLF dermal thickness was 1.37±0.27 mm (mean±SD), with a range of 1.04 to 1.86 mm. All 16 patients showed HA filler localized to the subcutis. In 9/16 tissue samples, some HA was present in the deep dermis, but filler was only observed in more superficial dermis in 1 patient. The thickness of injected filler was 2.11±0.63 mm, but filler was often transected at the specimen base. CONCLUSION The predominant localization of injected HA filler is within the subcutis. A relatively thin NLF dermal thickness, typically <1.50 mm, likely precludes accurate injection of filler into dermal collagen. The results suggest that dermal localization of HA filler products is not required for an excellent cosmetic result.

Surgery of basal cell carcinoma around the lacrimal canaliculus can be necessary after primary treatment with intralesional interferon alpha 2b

Surgery of basal cell carcinoma around the lacrimal canaliculus can be necessary after primary treatment with intralesional interferon alpha 2b

Economic Impact of Preoperative Curettage before Mohs Micrographic Surgery for Basal Cell Carcinoma

The role of curettage before Mohs micrographic surgery for basal cell carcinoma (BCC) remains controversial. Preoperative curettage may allow the surgeon to better delineate the subclinical extensions of high-risk BCCs, thereby enabling a more precise first-stage excision around tumor-containing tissue. To assess the economic impact of preoperative curettage for high-risk BCCs treated with Mohs micrographic surgery on patients, providers, and insurers. Given the enormous variability in practice styles, it was estimated that the time required to complete a second stage of Mohs surgery was 25, 50, or 75% of that required to complete the first stage. New York City Medicare and Standard reimbursement rates were used to approximate the cost of an additional stage of Mohs surgery for high-risk BCCs. Assuming that preoperative curettage increases operative efficiency by reducing the number of required Mohs stages from 2 to 1, the time saved can be quantified. Thus, if the Mohs surgeon estimates that the time required to remove a second stage is 75% of that of the first stage, the time savings with preoperative curettage equals 75% of the duration of a one-stage Mohs surgery. Similarly, when a second stage requires 50 or 25% of the time needed to complete the first stage, the time saved equals 50 or 25% of the duration of a one-stage Mohs surgery. Reducing the number of stages from 2 to 1 saves insurers and privately paying patients approximately $250 and $500, respectively. Whether preoperative curettage can offer a more precise first-stage excision without compromising tissue conservation remains a subject of debate. Preoperative curettage may reduce the number of Mohs surgical stages required for tumor clearance, potentially shortening patient encounters and allowing surgeons to treat additional patients, while decreasing costs for patients and insurers.

Economic Impact of Preoperative Curettage before Mohs Micrographic Surgery for Basal Cell Carcinoma

Economic Impact of Preoperative Curettage before Mohs Micrographic Surgery for Basal Cell Carcinoma

Surgery for basal cell carcinoma: study biases: reply from authors

Surgery for basal cell carcinoma: study biases: reply from authors

Determinants of satisfaction with the health state of the facial skin in patients undergoing surgery for facial basal cell carcinoma

Objective The main objective of the study was to assess which health beliefs predict and explain satisfaction with the facial health state of patients undergoing surgery for basal cell carcinoma. Methods Data were collected by administering a newly developed questionnaire pre-operatively and 6 months post-operatively ( n = 222). Results Results show that satisfaction as measured by post-operative worrying, susceptibility and fear of developing a new BCC at other facial sites can be predicted by pre-operative health beliefs. In addition, some patients an increase in perceived susceptibility, fear of recurrence of BCC on the same site or fear of developing a new BCC at other facial sites. Conclusion Our findings indicate that both pre- and post-operative perceptions predict and explain for a substantial part the extent to which patients are satisfied with their facial health state 6 months after surgery. Practice implications Administering a short questionnaire at the start of the treatment period will give physicians a better understanding of how patients experience this skin disease. It will also help them to adjust information about BCC and its consequences to the needs of the patient.

Multiple Subclinical Syringomatous Proliferations Encountered during Mohs Surgery for Basal Cell Carcinoma

Examination of Mohs surgery frozen sections may lead to discovery of incidental benign neoplasms such as syringomas. An unusual occurrence of numerous subclinical syringomatous proliferations discovered during Mohs surgery for a basal cell carcinoma that posed a diagnostic and management dilemma is reported. Clinical records and histologic sections are examined. Multiple syringomatous proliferations were noted around a basal cell carcinoma during Mohs surgery. A few foci were atypical appearing and focally extending into the deep dermis causing a diagnostic dilemma. All atypical syringomatous proliferations were excised. Evaluation of final Mohs margins by permanent sections and biopsies of normal-appearing facial skin showed multiple benign syringomas. Although solitary subclinical syringomas have been described in association with basal cell carcinomas, the occurrence of multiple syringomas and syringomatous proliferations has not been previously reported. Dermatologists should be aware of the existence of this phenomenon and consider permanent section evaluation to better determine nature of unusual incidental tumors identified in frozen sections during Mohs surgery.

Multiple Subclinical Syringomatous Proliferations Encountered during Mohs Surgery for Basal Cell Carcinoma

BACKGROUND Examination of Mohs surgery frozen sections may lead to discovery of incidental benign neoplasms such as syringomas. OBJECTIVE An unusual occurrence of numerous subclinical syringomatous proliferations discovered during Mohs surgery for a basal cell carcinoma that posed a diagnostic and management dilemma is reported. METHODS Clinical records and histologic sections are examined. RESULT Multiple syringomatous proliferations were noted around a basal cell carcinoma during Mohs surgery. A few foci were atypical appearing and focally extending into the deep dermis causing a diagnostic dilemma. All atypical syringomatous proliferations were excised. Evaluation of final Mohs margins by permanent sections and biopsies of normal-appearing facial skin showed multiple benign syringomas. CONCLUSION Although solitary subclinical syringomas have been described in association with basal cell carcinomas, the occurrence of multiple syringomas and syringomatous proliferations has not been previously reported. Dermatologists should be aware of the existence of this phenomenon and consider permanent section evaluation to better determine nature of unusual incidental tumors identified in frozen sections during Mohs surgery.

Surgery for basal-cell carcinoma of the face

Surgery for basal-cell carcinoma of the face

Munich method of micrographic surgery for basal cell carcinomas: 5-year recurrence rates with life-table analysis.

The aim of this study was to find the recurrence rates of basal cell carcinomas treated with micrographic surgery in the Department of Dermatology, University of Regensburg. From 1992 to 1997, 261 basal cell carcinomas (178 primary and 83 recurrent) have been treated. The mean duration of follow-up was 5 years (range 1-9). Data were analysed by life-table analysis. Eleven basal cell carcinomas (6 primary and 5 recurrent) recurred. The 5-year recurrence rates were 3.3% for primary and 7.3% for recurrent basal cell carcinomas. Our results are comparable with previously published data from Europe but seem higher than those reported in the USA. Use of different statistical methods to report the recurrence rates mainly accounts for the discrepancy among studies. For a better comparison among studies on recurrence rates, a standard statistical method should be used, and we support the idea that life-table analysis provides the best approximation of the true recurrence rates.