Surgical Management Of Skin Cancer Research Articles

Skin procedures in general practice.

Most skin cancers diagnosed in Australia, including melanomas, are identified and managed in a primary care setting. Most skin cancers have the diagnosis confirmed by histopathology, and surgical excision is the most common form of treatment. Therefore, it is important that all primary care doctors in Australia are competent and confident in the diagnostic sampling and surgical management of skin cancers. This article considers the process of performing biopsies and excisions from the skin to diagnose or treat skin cancers. Primary care is the appropriate setting for the management of most skin cancers in Australia. Small simple lesions can be sampled for diagnosis and excised as definitive treatment of the tumour. This can be simpler, cheaper and more efficient for the patient compared to the hospital setting, allows the resources of speciality care to be used for more difficult scenarios and be quite a satisfying part of providing primary care.

Issues in the surgical management of skin squamous cell cancers in albinos—experience of two surgical oncology units in Burkina Faso

Background and objectivesSkin cancers in albinos are frequent in sunny countries. The surgeon plays a crucial role in their treatment. The objective was to describe the challenges of surgical management of skin cancer in albinos.MethodsRetrospective, descriptive, and multicenter study on skin cancer surgery in albinos performed over the past 14 years in Ouagadougou. We were interested in surgery indications, techniques, and results. Survival was assessed using the Kaplan–Meier method. Comparisons of proportions were made by Student’s t-test.ResultsThe cancers were multiple synchronous in 41.3%. We identified 46 albinos with 71 skin cancers. Surgery was performed in 93%. Lesions were located on the back, upper limbs, and head and face in 40.9%, 30.3%, and 16.7%, respectively. Precancerous lesions were treated concomitantly in 23.6%. The surgery consisted of a lumpectomy. Direct suturing and mobilization of flaps allowed skin coverage in 17.9% and 34.3%, respectively. Lymph node dissection was associated with the limbs in 73.1% of localizations. The average number of lymph nodes removed was 11, with extremes of 7 and 14. Node invasion was noted in 16 out of 19 cases. The resection margins were invaded in 7.5% and required surgical revision. Recurrences were noted in 8.9% of cases. Overall 2-year survival rate was 55.8%.ConclusionsSurgery must meet the triple challenge of treating single or multiple synchronous cancers, precancerous lesions, and allowing good healing. Early diagnosis would reduce the rate of secondary healing and improve survival. The absence of extemporaneous histology and the large size of the tumors associated with the delay in diagnosis meant that surgery, whenever possible, was limited to wide and deep resection, to ensure healthy margins.

The effect of COVID-19 on surgical management of skin cancers of the head, face and neck in elderly patients.

The Corona Virus (COVID-19) has had a profound impact on healthcare systems worldwide, with interruptions to medical practices including the delivery of cancer treatment. Skin cancer is one of the leading causes of malignancy worldwide, with later stages of disease correlating to poorer prognosis. Immunocompromized and elderly patients represent populations that are at higher risk for adverse outcomes related to skin cancer, treatment delay and COVID-19 infection. Patients aged 65 and above who underwent surgical management of skin cancers from 31 January 2020 to 31 January 2021 were included in this study then compared with samples pre- and post-pandemic. Retrospective analysis was performed regarding: date of referral to date of surgery, skin cancer type, location of cancer, surgery performed, anaesthesia used, sutures used and outcomes. Data was compared to national guidelines. Five hundred and twenty skin cancers were included in this analysis, of which 340 were treated during the COVID-19 pandemic. Of the cohort treated during the pandemic, 44.2% (n=111) received excision and direct closure, 13.1% (n=33) underwent reconstruction by integra dermal substitute, 3.2% (n=8) by split thickness skin graft, 6.4% (n=16) by full thickness skin grafts and 33.1% (n=83) by local flaps. Complete excision was achieved in 88.5% of cases (n=301). The mean time from referral to surgery was 119days. There were no deaths associated with COVID-19. Safe and prompt treatment of head and neck skin cancers is achievable despite the COVID-19 pandemic. Measures to minimize infection risk include the use of teledermatology, reliable COVID-19 testing, Green Pathways and a reduction in the mean referral to surgery time.

32622 Imaging technologies for presurgical margin assessment of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Mohs micrographic surgery is a highly used BCC treatment, involving staged resection of the tumor with complete histologic evaluation of the peripheral margins. A reduction in the number of Mohs stages would significantly improve care and could result in substantial economic benefits, estimated at $36 million USD in savings per annum. Noninvasive imaging modalities can potentially streamline the surgical management of skin cancers by refining presurgical assessments of tumor size.

Broadening the Differential for Complicated Hemostasis in the Surgical Management of Skin Cancer.

Broadening the Differential for Complicated Hemostasis in the Surgical Management of Skin Cancer.

Surgical management and practices in pregnancy and lactation: A survey of United States dermatologic surgeons

To the Editor: Treatment of skin cancers in pregnant and lactating women poses a challenge for dermatologic surgeons because the welfare of both mother and fetus must be considered. A standardized approached is especially important because melanoma is a significant cause of cancer-related deaths in women of reproductive age. While guidelines advocate for the immediate surgical management of skin cancers in pregnancy, whether this is applied in practice is unclear.1,2 To address this knowledge gap, we surveyed members of the American College of Mohs Surgery (ACMS) to describe current practice patterns in the management of malignant lesions in pregnant and lactating women.

Mohs Surgery versus Standard Local Excision for Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Skin Cancer.

Basal cell carcinoma, squamous cell carcinoma, and melanoma represent the three most common skin cancers that occur on the face. The most common surgical treatments for facial skin cancers are Mohs' surgery and standard local excision. The effective utilization of either of these techniques is based on tumor and patient risk stratification incorporating known risk factors for occult invasion and local recurrence, combined with patient comorbidities, expectations, and desires. Best available evidence highlights multiple and consistent risk factors for each specific skin cancer type, and dictate local control rates reported in the literature. Recognizing gaps in the literature, we compare and review surgical treatment guidelines and data for standard local excision versus Mohs' surgery for cutaneous nonmelanoma and melanoma skin cancer. This article serves as a resource for optimal therapeutic decision making for surgical management of skin cancer on the face.

Surgical Management of Skin Cancer

Surgical Management of Skin Cancer

Clinicopathological and surgical management of skin cancer: Experience from high altitude region of Ladakh

Clinicopathological and surgical management of skin cancer: Experience from high altitude region of Ladakh

Surgical management of skin cancer and trauma involving the middle third of the auricle.

The main causes of acquired auricular defects are surgical treatment of skin tumors and trauma. Due to the complex anatomy of the external ear, surgical reconstruction of defects in this area is challenging for surgeons, especially in case of midhelix-antihelix involvement with significant loss of soft tissue and cartilage. Our purpose is to illustrate the main reconstructive techniques of large midhelix and antihelix defects, as well as the advantages or disadvantages associated with each surgical procedure. Primary closure/wedge technique is mainly used in elderly, multimorbid subjects where single-stage procedures are desirable, but several complex chondrocutaneous, retroauricular, temporoparietal full-thickness flap procedures can also be used to recreate an ear with normal appearance. Auricular reconstruction of large midhelix-antihelix defects requires a good knowledge of auricular anatomy and the various surgical procedures available for such defects.

Surgical Considerations in Advance Basal Cell Carcinoma, Cutaneous Squamous Cell Carcinoma, and Cutaneous Melanoma: a Head and Neck Perspective

Skin cancers, including basal cell carcinoma, cutaneous squamous cell carcinoma, and cutaneous melanoma, are the most common cancer worldwide. The treatment of these cancers is primarily surgical, and when treated early and correctly, the prognosis is excellent. In this review, we aim to discuss the appropriate surgical management of skin cancers and associated controversies as it pertains to the head and neck. Evidences guiding treatment have expanded enormously over the past decade. Studies have drastically improved our understanding of skin cancer including risk factors for tumor recurrence and metastasis, indicated margin size of surgical excision, the role of sentinel lymph node biopsy, and the management of occult and gross regional neck metastasis. Management of skin cancer poses a unique challenge in the head and neck region due to its proximity to anatomic sensitive areas and complex lymphatic drainage. Understanding how to efficiently manage the primary tumor site and the regional lymph nodes is paramount in minimizing locoregional recurrence and improving overall survival.

Imaging in cutaneous surgery.

Skin cancer is the most commonly diagnosed cancer in the USA. Mohs micrographic surgery is a microscopically controlled surgical technique that excises lateral and deep surgical margins while also sparing function and achieving a good cosmetic outcome. Given the increasing incidence in skin cancer worldwide and its associated treatment costs, techniques are being developed to improve the time and cost efficacy of this procedure. The use of noninvasive imaging, both in vivo and ex vivo, has the potential to increase efficiency of diagnosis and surgical management of skin cancers. These devices are useful in delineating lateral and deep tumor margins prior to surgery in vivo as well as to detect residual tumor ex vivo virtually in real time.

Surgical Management of Skin Cancers - Is Slow MOHS an utilitarian approach?

Surgical Management of Skin Cancers - Is Slow MOHS an utilitarian approach?

Interdisciplinary Surgical Management of Skin Cancer: the Saint Louis University Experience

While the vast majority of skin cancers can be managed by a single practitioner in the outpatient setting, there is a subset of complex skin cancers that benefit from multidisciplinary care. At our institution, we have built strong collegial relationships with allied specialties such as surgical oncology, otolaryngology-head and neck surgery, plastic surgery, facial plastic surgery, and oculoplastic surgery. It is common for patients with high-risk or complex tumors to be seen pre-operatively by several allied specialties. This allows for care coordination and more seamless care in addition to fostering skin cancer expertise within our collaborators in allied specialties.

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.

Inferiorly Based Crescentic Sliding Cheek Flaps for the Reconstruction of Paranasal Surgical Defects

Doctors involved in the surgical management of skin cancer frequently encounter the repair of paranasal surgical defects. Similar to other reconstructions, these defects present surgeons with a variety of options, depending on the site, size, depth, and available tissue laxity. In the paranasal region, mobilizing the cheek skin reservoir for flap repairs allows the reconstructive surgeon to optimize tissue match and often to conceal resultant scar lines at the junction of cosmetic units or within naturally occurring rhytides. Another important consideration in this region is to avoid distortion of free margins such as the lower eyelid, ala, and upper lip caused by flap movement.

Surgical management of skin cancers: Experience from a regional cancer centre in North India

To review the disease profile and treatment outcome of patients with primary skin malignancies treated at a regional cancer centre. Surgical oncology unit of a tertiary care regional cancer centre. Evaluation of treatment outcome of patients with skin cancer from Surgical Oncology database was done. Retrospective analysis of records of 77 patients with skin cancers treated between 1995 and 2002 was conducted. Profile of patients with skin cancer, surgical details including the management of primary tumour, regional lymph nodes and reconstructive procedures performed and survivals were analysed. All computations were done using the Statistical Package for Social Sciences (SPSS-9). Descriptive statistics were calculated in a standard fashion and survival analysis was performed using Kaplan-Meier method. Skin cancers constituted 2.4% (77/3154) of patients with cancer treated in the surgical oncology department. Squamous cell carcinoma (SCC) was the most common histological type (55.8%) followed by melanoma (26.1%) and basal cell carcinoma (BCC, 18.1%). Forty one percent of patients had undergone some form of intervention elsewhere before being referred. Reconstruction was required in 55.8% patients with large postresection defects. Regional lymph nodal dissection was required in 32.4% of total patients. Five-year median disease-free survival for the entire study population was 75%. Skin cancers constitute a small but significant proportion of patients with cancer. Unlike in the Western countries, SCC is the commonest histologic variety. Primary level inadequate intervention is very common. Optimal results can be obtained with radical surgery and optimal surgical margins along with a reconstructive procedure when needed.

Regarding Appropriate Delays in Reconstructing Large, Deep, or Extensive Midfacial Defects Following Surgical Management of Skin Cancer

Inaugural Traveling Chair of Dermatologic Surgery (International Society for Dermatologic Surgery) University of California, San Francisco Stanford University, Stanford, California Foster City, California

ISSUES IN THE DELIVERY OF DERMATOLOGIC SURGERY FOR SKIN CANCER

Significant financial resources need to be dedicated to treating the large numbers of skin cancers in the United States. The goal of the surgical treatment of skin cancer is to provide a high cure rate in a manner that is minimally morbid, convenient, and inherently of high value. Cost-effective delivery of this skin cancer care is critical given the prevalence of cutaneous neoplasia. Dermatologists are the best-trained physicians in the identification and management of melanoma and NMSCs. They are the most highly skilled judges of when intervention is indicated, of which lesions warrant biopsy, and of which treatment techniques are applicable for each individual tumor. These skills take years to develop and are necessary to provide the highest standard of medical and surgical management of skin cancer. As dermatologic surgery continues to evolve and dermatologists in residency receive even more surgical training, the dermatologist will prove to be the surgical skin cancer specialist well into the new millennium.

Frozen Section Analysis in the Management of Skin Cancers

Frozen section analysis is used routinely to ensure complete removal of basal cell and squamous cell carcinomas of the skin, but the current emphasis on controlling costs raises the question as to which lesions should be evaluated with frozen section histology. A retrospective study of the clinical records and pathological reports of 51 patients selected randomly from a total of 225 patients was undertaken to determine the overall impact of frozen section analysis on the surgical management of skin cancers at this institution. The results indicate that frozen section analysis was performed on 76% of the 277 lesions evaluated, and that the results of frozen section examination were 91.1% accurate in detecting the presence or absence of tumor involvement at the surgical margins. The data also showed that the surgeons were able to estimate the margin of the skin tumor clinically and remove it entirely during the first excision 91.1% of the time. The lesions that had not been removed completely with the initial excision were those located on the periorbital region, forehead, and cheeks; were recurrent lesions; or were lesions that required more involved reconstruction than primary closure. This study shows that frozen section analysis is a valuable tool in selected situations, but routine use is not indicated for the majority of basal and squamous cell carcinomas of the skin.