Surgical Treatment Of Skin Cancer Research Articles

Patient Anxiety Related to Patient-Perceived Delays in Surgical Treatment of Skin Cancer.

Patients undergoing dermatologic surgery report higher anxiety levels than those undergoing nonsurgical treatments. However, little is known about the association between patient-perceived delays in skin cancer surgery and patient-reported anxiety. To examine the relationship between patient-perceived delays in surgery and patient-reported anxiety. Patients undergoing wide local excision or Mohs micrographic surgery were recruited to complete a survey to assess perception of surgical delay and anxiety related to skin cancer surgery using the validated Psychosocial Screen for Cancer-Revised. Demographic and surgical characteristics were collected through chart review. Chi-square and Student t -tests were used to compare demographic and surgical information between patients who did and did not perceive a surgical delay. Differences in anxiety and depression scores for patients who did and did not report a delay were assessed using univariate and multivariate regressions. Twenty-seven percent ( N = 33) of patients perceived a surgical delay. Perception of surgical delay was associated with increased time between biopsy and surgery ( p = .0001) and increased self-reported anxiety scores after controlling for various demographic and surgical factors ( p = .038). Patient-perceived delays in dermatologic surgery are associated with increased time to surgery and patient-reported anxiety.

Outcomes of Surgical Treatment of Skin Cancer at Surgical Oncology Unit of Donka, Conakry University Hospital

Aim: The main aim of this study was to evaluate outcomes after surgical treatment of skin cancer. Methods: This retrospective cohort study concerned 46 patients who presented 43 skin cancers lesions surgically treated at surgical oncology unit, Conakry University Hospital. There were 29 (61.7%) squamous cell carcinoma, 12 (25.5%) melanoma, 4 (8.5%) sarcomas and 1 (2.1%) porocarcinoma. Surgical indications and prognosis factors were analyzed. Results: Surgical treatment included simple excision in 2 cases (3.8%), wide excision in 38 cases (71.7%) and amputation/disarticulation in 13 cases (24.5%). Inguinal lymph node dissection was performed in 16 patients (34.3%). Postoperative complications were wound suppuration (5 cases), lower limb lymphedema (4 cases), seroma (2 cases) and skin flap necrosis (1 case). Surgical margins were free in 28 (60.9%) patients, infiltrated in 3 patients (6.5%) and unspecified in 15 patients (32.6%). The median follow-up after surgery was 29 months. During the follow-up, 13 patients (28.3%) had a relapse. The relapse was influenced by surgical margins (p = 0.012) and iterative resection (p = 0.04). Overall survival was 65.2%. Factors related to survival in univariate analysis were: iterative resection (p = 0.008), fungated tumor (p = 0.037), the status of surgical margins (p = 0.002) and the occurrence of relapse (p = 0.0000). In multivariate analysis, the status of surgical margins was the only independent prognostic factor. Conclusion: The prognosis after surgical treatment of cutaneous cancers depends on the resection margins.

Surgical treatment of skin cancer by the plastic surgeon

Surgical treatment of skin cancer by the plastic surgeon

Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: Results of a combined approach

PurposeMalposition of the lower lid, including rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, and ectropion, is a relatively frequent complication in the surgical treatment of skin cancer of the cheek and zygomatic areas. The tarsal strip technique, in association with a vertical vector cheek lift, is a reliable method for correcting lower lid malposition. Materials and patientsFrom January 2008 to January 2010, we treated 19 patients with lower eyelid malposition after skin cancer surgery of the cheek and zygomatic areas. To correct lower eyelid malposition, we used the tarsal strip technique and a vertical vector cheek lift in all patients. ResultsEleven patients had scleral show and eight patients had ectropion. Sixteen patients obtained satisfactory correction of the eyelid malposition in a single surgical procedure, while three patients required a second surgical step to correct the remaining scleral show. Good esthetic and functional results were achieved in all cases. ConclusionsThe surgical treatment of skin cancer of the cheek and zygomatic areas has the potential for postoperative sequelae. The tarsal strip technique, in association with a vertical vector cheek lift, is a relatively simple technique for correcting scleral show and ectropion.

Surgical excision of skin cancer: the importance of training

Background Skin cancers are the most common malignancy in New Zealand and their treatment imparts a huge burden on the healthcare system both in terms of the cost of surgical intervention and in treatment delivery (estimates are in excess of NZ$33 million per annum for the year 2000). Currently in New Zealand, skin cancers are excised by dermatologists, general practitioners (GPs), GPs with a special interest in skin surgery (GPSIs) and specialist surgeons with diverse training backgrounds including ear, nose and throat, ophthalmic and general surgeons. To date there is scant literature evaluating complete excision rates following surgical treatment of skin cancer between these vocational groups. Objectives To review retrospectively pathology reports from all skin excisions sent to one private pathology laboratory over three consecutive months. The aim was to investigate the margins of excision and completeness of skin cancer surgery performed by each vocational group. Methods A retrospective analysis of skin pathology reports was undertaken for a 3-month period between April and June 2007. Raw data obtained from the pathology reports included diagnosis, completeness of excision, size of specimens, body site and vocational group of the medical practitioner performing the surgery. Results In total, 1532 lesions were excised: 432 benign and 1100 malignant. Six hundred and seven were from the head and neck. Dermatologists excised 276 lesions of which 93% were malignant, 55% were from the head and neck, and 0% were incompletely excised. GPs excised 633 lesions: 63% malignant, 30% head and neck, 23% incomplete excision of malignant lesions. GPSIs excised 368 lesions: 71% malignant, 35% head and neck, 21.5% incomplete malignant excision. Specialist surgeons excised 255 lesions: 72% malignant, 53% head and neck, 20% incomplete malignant excision. Conclusion GPs and GPSIs excised more benign lesions and had higher incomplete excision rates of skin cancer surgery than dermatologists. Incomplete excision rates for the vocational groups ranged from 0% to 45% depending on site and pathology.

皮膚悪性腫瘍切除後の一時的閉鎖法としての人工真皮の応用

皮膚悪性腫瘍切除後に植皮や皮弁移植を用いて再建を行った後に，拡大切除が必要となると，植皮や皮弁が犠牲となる。そのため一期的再建は行わず，人工真皮を貼付して，確定診断が付いてから再建を行う場合がある。本法の適応は①乳房外Paget病などで辺縁が明瞭でない腫瘍，②悪性黒色腫などで腫瘍の深さや浸潤が術中迅速診断では確定できない場合，③血管系腫瘍などで腫瘍の悪性度の判定が付きにくい場合である。また，④腫瘍切除後の皮膚軟部組織欠損が深い場合も人工真皮の適応となる。また，本法においては，確実な病理診断がついてから，再建方法について患者や家族と充分に相談できる時間があり，インフォームド・コンセントを得るためにも有効である。ただし，本法では最低2回の手術が必要であり，治療期間は長くなることが欠点である。

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.

The application of laser Nd-Yag in the surgical treatment of skin cancer

1Polyclinic No. 1 of Health and Rehabilitation Department under the Cabinet of Ministers of Ukraine, and 2Medical Academy of Postgraduate Education, Kiev, Ukraine.

Surgical treatment of skin cancer of the nose

Principles to be observed in the treatment of cancer of the nasal skin are outlined and discussed. The primary and dual aims include eradication of the disease with careful histologic control, and restoration of the nasal appearance and architecture (with free full thickness skin grafts for superficial lesions, and regional pedicle flaps when the loss is more extensive). In selected alar lesions, auricular composite grafts give a satisfactory result. Pedicle flaps from a distant part of the body are used only when other methods of reconstruction are not feasible.