Surgical Technique For Excision Research Articles

Antrolith: radiological diagnosis and surgical treatment – presentation of clinical cases

Introduction: Antrolith is a pathological calcified mass located in the paranasal sinuses, commonly in the maxillary sinus. When it is found in the vicinity or into the nasal cavity, it is also called rhinolith. In most of the cases, antroliths are incidentally identified through dental patients’ radiological examination. This fact underlines the need of antroliths’ detection in radiographs even by the general dentist. Objective: This paper aims to discuss the clinical and radiological diagnosis of antrolith, as well as its therapeutic methods, through the presentation of two clinical cases. Materials – Methods: Clinical cases, diagnosed with dental panoramic radiographs, radiographs of paranasal sinuses (Water’s view) and cone beam computed tomography (CBCT), are presented. Moreover, there has been conducted a review of the recent literature with scientific papers published in databases PubMed and Google Scholar. Results: Antrolith is usually an asymptomatic clinical feature, but painful symptomatology is rarely observed. Radiologically, it is mainly diagnosed with accuracy using orthopantomography and CBCT. As a pathological mass, antrolith should be differentiated from dental dysplasias, inflammatory calcifications, foreign bodies, even neoplasms in case of sizeable antroliths. The treatment choices of antroliths, depending on the severity of every clinical case, include frequent medical observation without any intervention or surgical excision techniques, most commonly the endoscopic sinus surgery or the removal through intraoral access. This article refers to two clinical cases of antroliths, one asymptomatic and one painful case, with all the diagnostic and management methodology being discussed. Conclusions: The radiological diagnosis of antroliths in conjunction with the endoscopic sinus surgery for its removal provide with the opportunity to treat and relieve patients with painful symptomatology. It is important not to be missed by the general dentist, as it may appear incidentally when evaluating panoramic radiographs. The assessment of antroliths is crucial for the differential diagnosis and its therapeutic management requires cooperation with a specialist.

DIFFERENT CONJUNCTIVAL AUTOGRAFT TECHNIQUES FOR PTERYGIUM SURGICAL EXCISION, A CASE SERIES

Abstract
 Introduction : Pterygium is a wing shaped fibrovascular growth that extends from the conjunctiva onto the cornea. There are many techniques available for pterygium removal, from simple excision to excision and repair of the defect with modified techniques.
 Case Illustration : 1. A 50-year-old woman presented with a grade II pterygium in both of her eyes. She was undergone sliding flap pterygium excision for her right eye. Case 2. A 32-year-old man presented with a grade II pterygium in his left eye. He was then undergone rotational flap pterygium excision for his left eye. Case 3 A-55-year-old woman presented with a grade II-III double head pterygium. She was later undergone modified conjunctival autograft double head pterygium excision for his left eye.
 Discussion : Surgical management is the gold standard for pterygium treatment. Indications for pterygium excision include decreased visual acuity due to astigmatism, obstruction of visual axis, repeated irritation and cosmetics. Surgical techniques for excision of the pterygium include bare sclera excision, tissue grafting using conjunctival graft, membrane transplantation amnion and limbal- conjunctival autograft. There are several choices of conjunctival graft techniques after pterygium excision, such as conjunctival sliding flap, conjunctival rotational flap, and modified conjunctival autograft. Modified conjunctival autograft technique was performed for double head pterygium management. The technique consisting of horizontally modified conjunctival autograft and vertically modified conjunctival autograft.
 Conclusion : The choices of surgical excision techniques for pterygium depends on the grades of the pterygium and operator’s preference.

Cervical Chondrocutaneous Branchial Remnants: A Rare Congenital Anomaly of The Neck. A Case Series, Literature Review and Associated Anomalies.

Cervical chondrocutaneous branchial remnants (CCBR) are rare anomalies found in the neck. These remnants can be easily misdiagnosed due to their relatively low incidence, and they are often associated with other anomalies. Previous studies have reported associations with other anomalies in up to 76% of cases. In this article, the authors present a case series of two patients with bilateral CCBR and investigate associated anomalies through a literature review. Patients diagnosed CCBRs who presented with cervical masses were included. Records were reviewed to investigate factors such as sex, location of CCBRs, associated anomalies, timing of operations, and cartilage pathology. A surgical excision technique was employed, and the study also includes a literature review focusing on reports related to CCBRs and associated anomalies. Two patients, a 3-year-old boy and a 17-year-old girl, with bilateral CCBRs underwent successful surgical excision without complications or recurrence at the 1-year follow-up. Patient demographics, prevalence and characteristics of associated anomalies in CCBR cases were documented in the literature review. This case series presented two successful surgical excisions of CCBR without complications or recurrence at one-year follow-up. The study emphasized the importance of thorough evaluation and assessment for associated anomalies in various body systems due to the potential co-occurrence of CCBRs with other anomalies.

Non-communicating rudimentary uterine horn: overview and surgical excision technique

To present principles and techniques for safe and efficient laparoscopic excision of a rudimentary non-communicating rudimentary horn. Laparoscopic surgery of a non-communicating rudimentary uterine horn is effective in treating patients with this anomaly. This video will give an overview of a rudimentary uterine horn and review fundamental principles for safe and effective surgical removal of the defect. A 34-year-old female presents with a history of pelvic pain and endometriosis. She was previously diagnosed with a unicornuate uterus with a non-communicating rudimentary horn. The fundamental principles for safe and effective excision of a non-communicating rudimentary horn include: Accurate diagnosis of rudimentary horn via imaging, hysteroscopy, and laparoscopy. Understanding that Mullerian anomalies have a propensity for pelvic pain and endometriosis, therefore a pelvic survey should be completed. Methylene blue can be helpful to surgeons during rudimentary horn excision because it guides surgeons during the surgery and can notify the surgeon when the uterine cavity has been entered. Methylene blue also helps assess the anatomy and functionality of the fallopian tubes during a Mullerian horn resection. Vasopressin should be considered during uterine horn resection to help minimize blood loss. Identifying the location of the uterine vessels in relation to the uterine horn dissection is essential. Preservation of the uterine vessels is optimal, when possible, especially in women who desire future fertility. Reapproximation of anatomy should be attempted to stabilize anatomy and reduce the risk of ovarian torsion. When performing an excision of a rudimentary horn, a surgeon should remember these operative techniques for a safe and efficient procedure. A rudimentary horn is a lateral fusion defect and can be safely excised if one understands the surgical methods.

A novel technique for surgical excision of a symptomatic lumbar spine facet joint synovial cyst using a cyst dyeing method: a report of two cases and a literature review

The aim of this study was to investigate the efficacy of a cyst dyeing technique that was used during the surgical excision of facet joint cysts in 2 cases. We evaluated the patients’ clinical outcomes and perioperative complications after decompression of lumbar spinal stenosis caused by the cysts. Two patients, who underwent surgical decompression for symptomatic lumbar spinal stenosis caused by facet cysts in August and October 2020, were reviewed. Their main complaints were severe low back pain and sciatica 1 or 2 months ago, for which they visited Wooridul Spine Hospital, Daegu, Korea. Under general anesthesia, the cysts were removed with the cyst dyeing method, using indigo carmine. Clinical outcomes were assessed by preoperative and postoperative visual analog scale (VAS) scores. Perioperative complications were observed.Favorable clinical outcomes and no perioperative complications were reported. Low back pain and sciatica improved, as shown by changes of the VAS score from 9 or 8 to 1, and no dural defects were observed. The cyst dyeing method is an effective technique for the surgical removal of symptomatic lumbar spine facet joint cysts.

Paediatric nasal dermoid: evaluation and management.

The aim of this study was to present the evaluation and current management of congenital paediatric nasal dermoid. There has been a trend towards less invasive surgical excision techniques, including purely endoscopic excision, endoscopic-assisted approaches and midline excision with nasal bone osteotomies and bone flap. These approaches allow adequate access for both total resection and nasal contour and skull base reconstruction. Following resection, if nasal bone osteotomies are insufficient for restoring nasal appearance, free temporoparietal fascial graft and/or conchal cartilage can be considered. For nasal tip deformities, interdomal sutures and free fat grafting are a suitable option. Complete surgical excision remains the treatment of choice for nasal dermoid lesions. The surgical approach taken and reconstruction depends on the type of lesion (cyst versus sinus or fistula), location (intranasal versus extranasal), whether or not there is intracranial extension, and experience of the surgical team.

Surgical Excision of Endometriosis in the Setting of a Congenital Pelvic Kidney

Study Objective To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Design Video of case-presentation. Setting Academic hospital. Patients or Participants Single surgical patient. Interventions Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. Measurements and Main Results A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. Conclusion A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement. To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Video of case-presentation. Academic hospital. Single surgical patient. Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement.

1291 COVID-19 And Skin Cancer Mohs Service: Are We on The Line?

Abstract Introduction Mohs surgery is a technique of surgical excision indicated for high-risk basal cell carcinomas involving contemporaneous histopathological assessment to ensure clear margins at the time of excision. Post-Mohs excision, patients should undergo reconstruction by plastic surgeons. Aim To explore the impact of the COVID-19 pandemic on a post-Mohs plastic surgery reconstructive service. Method A single-centre, retrospective analysis of patient undergoing post-Mohs reconstruction between March and September 2020 – including the first national lockdown period. This was compared with the same period in 2019. Key outcome measures included: Results In 2019, between March and September, 12 patients were referred for Mohs surgery and reconstruction versus 23 in 2020. In 2019, patients referred for Mohs waited a mean of 101 days between their clinic appointment and surgery, versus 97 days in 2020. No Mohs surgery was performed during the first lockdown and patients referred during this period waited a mean of 150 days for surgery versus 81 days in this period in 2019. The proportion of patient undergoing direct closure or full thickness skin grafting to post-Mohs defects increased by 20% while the number undergoing local flap reconstruction decreased by 12% in 2020 compared to 2019. Conclusions While overall waiting times improved in 2020, those patients referred during the lockdown experienced longer waits for Mohs surgery. The increased proportion of patients undergoing simpler reconstructive techniques in 2020 may reflect pressure on operating time due to the period of inactivity during the lockdown.

Uveal melanoma diagnosis and current treatment options (Review).

Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris. There is a consistent difference in incidence between different regions with individuals of northern European descent having a significantly higher risk as compared to Hispanics, Asians, and Blacks. Among the many risk factors, mutations in the G protein subunit alpha Q (GNAQ) or G protein subunit alpha 11 (GNA11) genes and different receptors are highly suggestive. While iris melanoma can easily be noticed by the patient itself or diagnosed at a routine slit-lamp evaluation, a consistent percentage of posterior uveal tumors are incidentally diagnosed at funduscopic evaluation as they can evolve silently for years, especially if located in the periphery. Uveal melanoma classifications rely on the tumor size (thickness and basal diameter) and also on intraocular and extraocular extension. The differential diagnosis with pseudomelanomas is carried out according to the tumor aspect and position. Iris melanoma has a better prognosis and a lower mortality rate as compared to choroidal melanoma that has a much higher rate of metastasis (50% of the patients) and a subsequent limited life expectancy from 6 to 12 months. While conservative therapeutic options for the primary tumor, relying on different surgical excision techniques and/or irradiation therapies, offer good local tumor control, the treatment options for metastatic disease, although numerous, are still inadequate in preventing a fatal outcome.

Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy

To describe techniques for resection of a cornual heterotopic pregnancy. This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. Laparoscopic resection of the cornual ectopic pregnancy. Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

Pleomorphic Adenoma of Palate – A Case Report and Review of Literature

10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so definite diagnostic evaluation should be executed. A case of 26-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetia We discuss the appropriate preoperative investigations, operative technique for surgical excision, histopathologic interpretation for this patient and brief review of literature for pleomorphic adenoma.

In situ implantable three-dimensional extracellular matrix bioactive composite scaffold for postoperative skin cancer therapy

Despite drastic improvements in surgical excision techniques, tumor recurrence has remained a significant problem over the past decades. In particular, there are unavoidable factors that include intraoperative tissue defects and trauma-related bacterial infections that can persistently induce tumor recurrence after surgical excision. Here, a novel platform was established with an extracellular matrix (ECM) scaffold that innovatively incorporated photothermal (PTT)/chemodynamic therapy (CDT). A decellularized small intestinal submucosa extracellular matrix (dSIS-ECM) was extracted from porcine small intestine and used to generate a polyporous tissue engineering scaffold. In addition, black phosphorus nanosheets (BPNs) were synchronously assembled by polydopamine (PDA) and Ag nanoparticles (Ag NPs) to fabricate a BPNs-PDA@Ag nanosystem. The as-prepared BPNs-PDA@Ag nanosystem was incorporated into the polyporous dSIS-ECM to establish a three-dimensional bioactive composite scaffold (dSIS-BPNs-PDA@Ag) that exhibited broad-spectrum bactericidal effects (over 99.6%) toward the E. coli and S. aureus. Additionally, the dSIS-BPNs-PDA@Ag composite scaffold not only accelerated the regeneration of infected wounds due to the intrinsic bioactive elements of dSIS but also effectively inhibited tumor recurrence by generating hyperthermia and hydroxyl radicals (•OH), which kill local residual tumor cells at the sites of excised tumors. In brief, this work designed an ingenious “all in one” strategy to achieve the integration of regeneration and therapy for future clinical applications. This strategy aims to simultaneously cause effective damage to residual tumor cells and bacterial infections and accelerate the regeneration of tissue defects for postoperative therapy.

The Outcome of Combined Electro-fulguration and Surgical Excision Techniques in the Management of Anogenital Condylomas

The Outcome of Combined Electro-fulguration and Surgical Excision Techniques in the Management of Anogenital Condylomas

Nasolabial cyst: Transnasal Marsupialization versus Sublabial Technique

Background: nasolabial cyst is relatively rare soft tissue lesion of nasal alar region. It is nonodontogenic in origin. Surgical sublabial excision is the treatment of choice for nasolabial cyst (NLC). However, it is associated with high complication rate. The transnasal marsupialization was introduced as an alternative modality of surgery. Aim of the work: to compare between both approaches to assess the intra-and post-operative outcome. Patients and Methods: twenty two patients presented by unilateral nasolabial cyst were included in the study and divided into two equal groups: endoscopic transnasal marsupialization (TM group; 11 patients) and sublabial surgical excision technique (SL group; 11 patients). For all patients, operative time, postoperative pain, postoperative complications and recurrence of the NLC were documented. Results: the operative time was significantly shorter in TM when compared to SL group (18.54±3.01 vs. 44.63±5.4 minutes respectively). Postoperative VAS was lower in TM when compared to SL group (3.09±0.83 vs. 6.09±1.13 respectively). The overall complications were significantly lower in TM group (18.2%) when compared to SL group (72.7%). Conclusion: the transnasal endoscopic marsupialization is preferred than conventional sublabial approach as it had shorter operative time, less postoperative pain and lower overall complications rate.

Nasolabial cyst: Transnasal Marsupialization versus Sublabial Technique

Background: nasolabial cyst is relatively rare soft tissue lesion of nasal alar region. It is nonodontogenic in origin. Surgical sublabial excision is the treatment of choice for nasolabial cyst (NLC). However, it is associated with high complication rate. The transnasal marsupialization was introduced as an alternative modality of surgery. Aim of the work: to compare between both approaches to assess the intra-and post-operative outcome. Patients and Methods: twenty two patients presented by unilateral nasolabial cyst were included in the study and divided into two equal groups: endoscopic transnasal marsupialization (TM group; 11 patients) and sublabial surgical excision technique (SL group; 11 patients). For all patients, operative time, postoperative pain, postoperative complications and recurrence of the NLC were documented. Results: the operative time was significantly shorter in TM when compared to SL group (18.54±3.01 vs. 44.63±5.4 minutes respectively). Postoperative VAS was lower in TM when compared to SL group (3.09±0.83 vs. 6.09±1.13 respectively). The overall complications were significantly lower in TM group (18.2%) when compared to SL group (72.7%). Conclusion: the transnasal endoscopic marsupialization is preferred than conventional sublabial approach as it had shorter operative time, less postoperative pain and lower overall complications rate.

EP20 INTRACARDIAC MASSES: PROTOCOL EVOLUTION OVER 15 YEARS IN A HIGH VOLUME REFERRAL CENTER

Abstract Background: Intracardiac masses are not such uncommon findings in daily clinical routine. They can be essentially subdivided into tumors, thrombi, anatomical variation and infective vegetations. The 75 % of Primary cardiac tumors are benign and are mainly represented by myxomas; while the 25% remnants are subdivided between sarcomas (95%) and lymphomas (5%). Clinical presentation is often non-specific leading to delay in diagnosis. This study aims to analyze outcomes and evolution of the protocol management of tertiary high volume referral center over the last 15yrs. Methods: We retrospectively analyzed 83 consecutive patients who underwent surgical removal of intracardiac mass from January 2004 to January 2018. All the patients underwent preoperative transthoracic echocardiography. Cardiac CTscan, endomyocardial biopsy, and MRI were performed in selected cases. Symptoms presentation, Implantation site, macroscopic description and histological classification was collected. Preoperative Multidisciplinary team discussion was carried out for all elective cases. Different surgical techniques have been used according to type and localization of the lesions. Follow-up was performed by phone calls +/- TT-Echo and clinical visits. Results: Perioperative mortality was 0%. The percentage of the different type of masses, origins, and aspect are reported in the figure. Conclusion: TTE remains the first-line diagnosis method. In the modern era, intracardiac masses can benefit from multi-imaging preoperative assessment to maximize diagnosis accuracy and to choose the most appropriate surgical technique and approach. Optimal surgical excision technique is crucial. To achieve excellent outcomes dedicated referrals centers are needed. An interdisciplinary approach is essential: oncologists, echocardiographists, and surgeons must cooperate closely.

Fabella Syndrome Following De-Rotation Surgery to Correct a Femoral Malunion

Background:The fabella is a sesamoid bone situated within the lateral head of the gastrocnemius tendon, close to the lateral femoral condyle, and adjoined to the fabellofibular ligament. It is a normal variant, found in up to 87% of patients. Fabella Syndrome describes traditionally posterolateral knee pain, occurring due to biomechanical pressure of the fabella against the lateral femoral condyle. Given its rarity, its diagnosis is often overlooked. We present a case of Fabella Syndrome with a modified surgical excision technique and review of the literature.Methods and Results:A thirty-four-year-old man presented with posterolateral knee pain following de-rotation surgery to correct a femoral malunion, from a previous femoral shaft fracture. Due to the patient’s complex orthopaedic history, Fabella Syndrome was not initially diagnosed. Fabellectomy eliminated all symptoms of knee pain, with no limitations in knee function.Conclusion:Review of the literature identified ten publications (evidence level IV) describing Fabella Syndrome. This is the first reported case of Fabella Syndrome secondary to femoral de-rotation surgery. The authors recommend fabellectomy as a definitive treatment for Fabella Syndrome, in keeping with published literature.

Current perspectives on Mohs micrographic surgery for melanoma.

Mohs micrographic surgery (MMS), a specialized surgical excision technique used primarily in the treatment of skin cancers, is tissue sparing and provides optimal margin control through evaluation of 100% of both the peripheral and deep margin. The use of MMS for the treatment of malignant melanoma (MM) and melanoma in situ (MIS) has been slow in gaining the same widespread acceptance that it has for keratinocyte carcinomas despite its cost-effectiveness and the growing body of evidence demonstrating similar or improved cure rates to standard wide local excision. However, modern advances in immunohistochemical staining have continued to greatly enhance the ability of Mohs surgeons to interpret MMS frozen sections of melanoma specimens – the primary concern of most opponents of MMS for melanoma. These advances, coupled with an increased recognition by professional organizations of the utility of MMS in treating MM and MIS, have led to a rise in the use of MMS for melanoma in recent years. Given the expanding role of MMS in the treatment of cutaneous melanoma, this manuscript will describe how MMS is performed, discuss the rationale and current evidence regarding the use of MMS for MM and MIS, review the immunohistochemical stains currently available for use in MMS, and consider special situations and future directions in this area of growing interest.

A new surgical technique for excision of orbital cavernous hemangioma: a 15-year experience

ABSTRACTPurpose: To present a new surgical technique for excision of orbital cavernous hemangiomas (CHs).Methods: This retrospective case series study included patients with orbital CH who were operated from 2001 to 2016 at our referral center. Epidemiologic data, symptoms, signs, and images were reviewed from patients’ files with at least one year of follow-up. Surgical results and complications were documented. We used the “index finger dissection” technique without grasping the tumor for release of adhesions and its removal.Results: We included 60 patients with orbital CH consisting of 36 (60%) female and 24 (40%) male patients with mean age of 40 ± 12.1 (range 9–66) years.The main complaint was proptosis with average size of 5.3 ± 2 millimeters. The surgical approach was lateral orbitotomy in 49 (81.7%) patients, medial transcutaneous in seven (11.7%) patients, inferior transconjunctival in three (5%) patients, and simultaneous lateral and medial orbitotomy in one (1.6%) patient. All tumors were removed intact; complications included ptosis in one subject, lower lid retraction in one case, and diplopia in two patients, all of which improved before 2 months. No optic nerve damage occurred.Conclusion: The “index finger dissection” technique without grasping the tumor for excision of orbital CH, via any external approach to the tumor, is a safe technique with minimal complications.

Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians.

IntroductionDermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition.MethodsOver 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate.ResultsOf 191 soft tissue sarcomas, a total of 28 cases were diagnosed as DFSP (14.7%). Facial types occurred in 3 cases (1.6%). Tumour had age and site predilections for the 4th decade and trunk respectively. There was an equal gender distribution among cases. Most common clinical presentation was in form of painless protruding nodular mass. General histologic presentation revealed cellular lesions composed of spindle to oval neoplastic cells arranged in a storiform pattern. Mitotic figures were rare. All cases showed positive expressions to CD34.ConclusionFacial DFSP is rare among Nigerians. Its clinical appearance may mimic other common benign lesions of the head and neck region often resulting in misdiagnoses. A comprehensive knowledge of its clinical and histologic presentations and biologic behavior, combined with its identification with the aid of advanced histologic and radiographic techniques results in prompt confirmatory diagnosis. Appropriate treatment should include adequate surgical excision techniques combined with adjuvant radiotherapy or chemotherapy.