Traditional Surgical Excision Research Articles

Progress of EGFR targeted therapy for oral cancer

Because of some uncertain factors such as eating habits and smoking, oral cancer has become one of the serious diseases of the oral and maxillofacial region. Especially in some Chinese cities where betel nut chewing is customary, the incidence of oral cancer has been high. Today, the main treatment methods are still traditional surgical excision, radiation and chemotherapy. However, with the development of medical technology, gene-targeted therapy has become the most important research object. Gene targeting technology is mainly targets the treatment of cancer organ cells, reducing the damage of traditional treatment methods on other areas without lesions. At present, the epidermal cytokine EGFR has been the most studied, and some research results have been put into clinical application. However, in terms of targeted therapy, the development of technology is still incomplete and immature. This article mainly discusses the pathogenic mechanism of EGFR in oral cancer, the synergistic effect of EGFR and other factors on the development of oral cancer, and the research results of EGFR-targeted therapy and combination therapy for oral cancer. The significance of this study is that based on these discussions, it provides reference opinions for treatment that can achieve a good prognosis for oral cancer patients and alleviate the pain of oral cancer patients, and evaluate the current development status of clinical application of EGFR targeted therapy for oral cancer. At present, the targeted therapy technology of oral cancer is still immature. In the future, the role of other factors in the development of oral cancer can be studied, and the influence of the combination of targeted therapy and other therapeutic methods on the treatment results of oral cancer can be studied.

Mohs surgery for female genital Paget’s disease: a prospective observational trial

Extramammary Paget's disease recurs often after traditional surgical excision. Margin-controlled surgery improves the recurrence rate for male genital disease but is less studied for female anatomy. This study aimed to compare surgical and oncologic outcomes of margin-controlled surgery vs traditional surgical excision for female genital Paget's disease. We conducted a prospective observational trial of patients with vulvar or perianal Paget's disease treated with surgical excision guided by Mohs micrographic surgery between 2018 and 2022. The multidisciplinary protocol consisted of office-based scouting biopsies and modified Mohs surgery followed by surgical excision with wound closure under general anesthesia. Modified Mohs surgery cleared peripheral disease margins using a moat technique with cytokeratin 7 staining. Medial disease margins (the clitoris, urethra, vagina, and anus) were assessed using a hybrid of Mohs surgery and intraoperative frozen sections. Surgical and oncologic outcomes were compared with the outcomes of a retrospective cohort of patients who underwent traditional surgical excision. The primary outcome was 3-year recurrence-free survival. Three-year recurrence-free survival was 93.3% for Mohs-guided excision (n=24; 95% confidence interval, 81.5%-100.0%) compared to 65.9% for traditional excision (n=63; 95% confidence interval, 54.2%-80.0%) (P=.04). The maximum diameter of the excisional specimen was similar between groups (median, 11.3 vs 9.5 cm; P=.17), but complex reconstructive procedures were more common with the Mohs-guided approach (66.7% vs 30.2%; P<.01). Peripheral margin clearance was universally achieved with modified Mohs surgery, but positive medial margins were noted in 9 patients. Reasons included intentional organ sparing and poor performance of intraoperative hematoxylin and eosin frozen sections without cytokeratin 7. Grade 3 or higher postoperative complications were rare (0.0% for Mohs-guided excision vs 2.4% for traditional excision; P=.99). Margin control with modified Mohs surgery significantly improved short-term recurrence-free survival after surgical excision for female genital Paget's disease. Use on medial anatomic structures (the clitoris, urethra, vagina, and anus) is challenging, and further optimization is needed for margin control in these areas. Mohs-guided surgical excision requires specialized, collaborative care and may be best accomplished at designated referral centers.

Management of lentiginous melanoma with imiquimod assessed by reflectance confocal microscopy.

Management of lentiginous melanoma with imiquimod assessed by reflectance confocal microscopy.

The Feasibility of Computer Simulations and 3-Dimensional-Printed Resection Guides for Skin Cancer Resection.

The surgical resection margin in skin cancer is traditionally determined by the lesion's surface boundary without 3-dimensional information. Computed tomography (CT) can offer additional information, such as tumor invasion and the exact cancer extent. This study aimed to demonstrate the clinical application of and to evaluate the safety and accuracy of resection guides for skin cancer treatment. This prospective randomized comparison of skin cancer resection with (guide group; n=34) or without (control group; n=28) resection guide use was conducted between February 2020 and November 2021. Patients with squamous cell carcinoma or basal cell carcinoma were included. In the guide group, based on CT images, the surgical margin was defined, and a 3-dimensional-printed resection guide was fabricated. The intraoperative frozen biopsy results and distance from tumor boundary to resection margin were measured. The margin involvement rates were 8.8% and 17.9% in the guide and control groups, respectively. The margin involvement rate was nonsignificantly higher in the control group as compared with the guide group ( P =0.393). The margin distances of squamous cell carcinoma were 2.3±0.8 and 3.4±1.6mm ( P =0.01) and those of basal cell carcinoma were 2.8±1.0 and 4.7±3.2mm in the guide and control groups, respectively ( P =0.015). Margin distance was significantly lower in the guide group than the control group. The resection guide demonstrated similar safety to traditional surgical excision but enabled the minimal removal of normal tissue by precisely estimating the tumor border on CT scans.

Risk factors for complicated Mohs surgery in the South Sweden Mohs Cohort.

BackgroundMohs micrographic surgery (MMS) is a precise, tissue‐sparing surgical technique that offers superior cure rates compared to traditional surgical excision. However, the degree of difficulty of MMS depends on many variables, and consequently, the number of surgical stages required for each case is quite unpredictable.ObjectivesTo identify risk factors for complicated MMS, defined as MMS requiring ≥3 stages.MethodsIn a cohort study design, data were prospectively collected from 612 patients that underwent MMS for basal cell carcinoma (BCC) at the Department of Dermatology, Skåne University Hospital, Lund, between 2009 and 2020. Univariate and multivariate logistic regression were used to estimate the risk of MMS requiring ≥3 stages. Due to the risk of multicollinearity between recurrent or incompletely excised BCC and previous treatments, a partially and a fully adjusted multivariate logistic regression model were constructed.ResultsIn fully adjusted multivariate analyses, age (odds ratio (OR) 1.02; confidence interval (CI) 95% 1.00–1.04), previous cryotherapy (OR 2.3; CI 95% 1.1–4.8), and >1 previous surgery (OR 3.4; CI 95% 1.5–7.7) were significantly associated with risk of complicated MMS. Recurrent BCC was associated with the risk of complicated MMS in partially adjusted multivariate analyses, but not in the fully adjusted analyses. In this highly selected cohort, histopathological subtype, and tumour localization were not associated with the risk of complicated MMS.ConclusionsOlder age and tumours previously treated with cryotherapy or multiple prior surgeries increased the risk of MMS requiring ≥3 stages. Whether recurrent BCC is an independent risk factor for complicated MMS needs further evaluation. Knowledge of these risk factors may ameliorate the planning of Mohs surgeries.

Recent Advances in Nanoplatforms for the Treatment of Osteosarcoma.

Osteosarcoma (OS) is the most common primary bone tumor in children and young people. Traditional surgical excision combined with chemotherapy presents many limitations, such as resistance and systemic side effects of chemotherapy drugs, postoperative recurrence, and bone defects. Given these limitations, novel therapeutic modalities for OS treatment using nanometer-sized platform-based chemotherapeutic delivery have emerged as a promising alternative therapy. This form of therapy offers multiple advantages, such as accurate delivery of the drug to the tumor site and repair of limited bone defects after tumor resection. In this review, we briefly summarize nanoplatforms, including liposomes, polymeric nanoparticles, inorganic nanoparticles, nanomicelles, dendrimers, nanocapsules, and exosomes. The essential shortcomings involved in these nanoplatforms, such as poor stability, immunogenicity, insufficient circulation, and drug leakage are also discussed, and related solutions are briefly proposed. Finally, the application prospects of nanoplatforms in the treatment of OS are discussed.

Vulval extra-mammary Paget's disease: the master of disguise revealed.

Extra-mammary Paget's disease is a rare cancer affecting the anogenital region and can present with a myriad of symptoms. In women, the diagnosis of Paget's disease can be challenging as it mimics several other vulval conditions. It is important to promptly recognise this disease because of its potential association with synchronous tumours, such as colorectal adenocarcinoma. The mainstay of treatment is with immunomodulating therapies or surgery, but unfortunately the risk of recurrence is high and appears to be independent of treatment choice and tissue margin status. There is growing evidence to move away from traditional surgical excision to using topical therapy, such as imiquimod, as surgery can often be extensive and disfiguring with a prolonged recovery time. There is considerable psychosexual and physical morbidity associated with Paget's disease, largely owing to multiple surgical recurrences. As recurrences can occur several years after the initial presentation, long-term follow up of patients is recommended.

Acute soft head syndrome in sickle anemia: The first case report in Kano

Sickle cell anemia is an autosomal recessive disorder resulting from insertion of the valine codon at position sixth of beta-hemoglobin gene instead of glutamate leading to the production of insoluble beta-hemoglobin chain. Although sickle anemia is mostly associated with bone pain and anemia, other manifestations also occur. Acute head syndrome is an uncommon complication resulting from skull bone infarction, cortical osteopenia, and rupture of tortuous periosteal blood vessels leading to extravasation of blood into the subgaleal space. This report therefore intends to create awareness that nontraumatic scalp swelling is an uncommon complication in sickle cell disease and no traditional practice or surgical excision should be employed in managing it.

Enzymatic debridement in critically injured burn patients — Our experience in the intensive care setting and during burn resuscitation

BackgroundMuch of the recent literature on bromelain based enzymatic debridement of burn injury has focused on its use in smaller burn injury and specialist areas such as the hands or genitals (Krieger et al., 2012; Schulz et al., 2017a,b,c,d). This is despite the original papers describing its use in larger burn injury (Rosenberg et al., 2004, 2014).The current EMA license for Nexobrid™ advises that it should not be used for burn injuries of more than 15% TBSA and should be used with caution in patients with pulmonary burn trauma and suspected pulmonary burn trauma. The original safety and efficacy trial of NexoBrid™ limited its use to 15% TBSA aliquots with concern regarding the effect of bromelain on coagulation. In a European consensus paper of experienced burns clinicians, now on its second iteration, 100% of respondents agreed that “up to 30% BSA can be treated by enzymatic debridement based on individual decision” (Hirche et al., 2017). Hofmaenner et al.’s recent study on the safety of enzymatic debridement in extensive burns larger than 15% provides some further evidence that “bromelain based enzymatic debridement can be carried out safely in large-area burns” (Hofmaenner et al., 2020) but the literature is scant in these larger debridement areas.In our centre we have been using enzymatic debridement for resuscitation level burn injury since 2016. We have gained significant learning in this time; this article aims to describe our current protocol for enzymatic debridement in this patient population and highlight specific learning points that might aid other centres in using enzymatic debridement for larger burn injury. MethodWe performed a search of the IBID database to identify all adult patients who satisfied the inclusion criteria of resuscitation level burn injury (defined as total burn surface area (TBSA) ≥15% in patients aged >16 years), or level 3 admission following burn injury and who underwent Enzymatic Debridement. A case note review was completed, and details comprising patient demographics, TBSA, mechanism of burn, presence of inhalation injury, sequencing of debridement, length of ICU and hospital stay, blood product utilisation and the need for autografting were recorded. No ethical approval has been sought for this retrospective review. ResultsWe identified 29 patients satisfying the inclusion criteria (Table 1). Between June 2016 and June 2020 the average total burn size of patients who had at least some of their burn treated by enzymatic debridement increased from 21.4% in 2016/17 to 34.7% in 2019/20. In these patients the actual area treated by enzymatic debridement also increased from 11.9% TBSA to 20.3% TBSA. 19 patients (66%) had enzymatic debridement performed within 24 h of injury, a further 2 patients (7%) within 48 h after injury. Patients were more likely to have enzymatic debridement commenced in the first 24 h after injury if they had circumferential limb injury (39% vs 9%) or were planned for enzyme only debridement (78% vs 28%). Those who were planned for combination enzyme and surgical debridement were more likely to have enzymatic debridement commenced after the first 48 h (75%). We have performed enzymatic debridement overnight on one occasion, for a patient who presented with circumferential limb injury and was determined to undergo urgent debridement. ConclusionMuch of the literature has described the use of enzymatic debridement in smaller burns, and specialist areas. However, it is our opinion that the advantages of enzymatic debridement appear to be greater in larger burns with a facility for whole burn excision on the day of admission in the ICU cubicle. We have demonstrated significantly reduced blood loss, improved dermal preservation, reduced need for autografting, and a reduction in the number of trips to theatre. We would advocate that both the team and the patient need to be as prepared as they would be for a traditional surgical excision. The early part of our learning curve for enzymatic debridement in resuscitation level injuries was steep, and we were able to build on experience from managing smaller injuries. We recommend any team wishing to using enzymatic debridement gain experience in the same way and develop robust local pathways prior to attempting use in larger burn injuries.

Multiple cylindroma of the scalp

Cylindroma is a rare benign tumor derived from the skin appendages, its typical localization is head and neck. The histogenesis of the disease is unknown, cylindromas are thought to develop from the epithelial ducts of the eccrine or apocrine glands, or represent a neoplastic proliferation of epithelial stem cells.&#x0D; The clinical presentation of the disease includes single or multiple smooth nodules and nodes of a pale pink color. Branching vessels are often visualized on their surface.&#x0D; There are two types of this tumor: sporadic genetically not determined сylindroma and inherited in an autosomal dominant manner multiple сylindroma.&#x0D; Multiple cylindroma may cause a lesion on the scalp that looks like a turban, due to the fusion and an increasing size of the nodules. Therefore, cylindroma are sometimes called a turban tumor.&#x0D; The treatment of multiple cylindroma is a serious interdisciplinary problem due to the large area of the lesion, abundant blood supply to the scalp and the tendency of the disease to recur. The treatment methods described in the literature include traditional surgical excision, electrocoagulation, laser, Mohs micrographic surgery.&#x0D; In this article we present a rare clinical case of a young male diagnosed with multiple cylindroma.

Engineered Protein Photo-Thermal Hydrogels for Outstanding In Situ Tongue Cancer Therapy.

Surgical excision is the main choice for tongue cancer treatment. However, the physiological functions of oral and maxillofacial regions might be severely impaired and high risk of tongue tumor recurrence cannot be avoided. It is thus becoming urgently important to develop alternative strategies for tongue cancer therapy. In this regard, a new class of near-infrared (NIR) light-responsive and peritumoral injectable hydrogel is fabricated with extraordinary photothermal therapy (PTT) for in situ tongue tumors. The as-prepared soft material exhibits good biocompatibility and ultra-strong photothermal effect due to the formed network by negatively charged proteins, chitosan molecules, and Ag3 AuS2 nanoparticles (NPs). In a well-constructed in situ tongue tumor model, tumors can be efficiently eradicated by one-time PTT treatment. Importantly, there are no side effects on surrounding normal tissues and potential tumor recurrence is inhibited. In stark contrast to traditional surgical excision, such biomaterials hold great potential for clinical treatment of oral cancers.

A pilot study of minimal invasion combined PDL/Nd:YAG laser in treating facial epidermoid cyst.

To compare the efficacy and complication of minimal invasion and combined pulsed dye laser/Nd:YAG laser and traditional surgical excision in the treatment of facial epidermoid cyst. A total of 100 patients with facial epidermoid cyst aged from 16 to 65years and cyst diameter ranged from 0.3 to 3.0cm were treated and followed up. Patients were divided into the minimal invasion and combined pulsed dye laser/Nd:YAG laser treatment group and traditional surgical excision group. All patients were followed up for 12months including scar size, recurrence rate, incidence of complications, and patient global satisfaction. The mean operative time in the minimal invasion and combined pulsed dye laser/Nd:YAG laser treatment was 15.23±7.02minutes, which is significantly shorter than that of surgical excision (27.26±10.12minutes, P<.05). After 12months, the average scar size in minimal invasion and combined pulsed dye laser/Nd:YAG laser group was 0.54±0.35cm, while that of traditional surgical excision group was 1.77±0.81cm (P<.05). No statistical difference was found between two groups in the wounds split, hematoma, early and late recurrence rates (P>.05), while the patients' global satisfaction in the pulsed dye laser/Nd:YAG laser group is much higher than that of the traditional surgical excision group. The treatment of minimal invasion and combined pulsed dye laser/Nd:YAG laser is effective and safe for medium-size facial epidermoid cysts. For facial epidermoid cyst ranging for 0.3cm to 3.0cm, considering the cosmetic factors, minimal invasion and combined pulsed dye laser/Nd:YAG laser should be particularly recommended.

Electrochemotherapy and basal cell carcinomas: First-time appraisal of the efficacy of electrochemotherapy on survivorship using FACE-Q

SummaryIntroductionThe establishment and success of new treatments are significantly influenced by patient satisfaction. Post-operative scarring is an important outcome for patients, and subsequently influences overall satisfaction with treatment. The objective was to measure post-treatment scarring satisfaction using a novel scale, the FACE-Q Skin Cancer Module, to compare electrochemotherapy (ECT) to traditional surgical excision (SE) to demonstrate equivalence of ECT and SE regarding outcome and survivorship.Methods and materialsThis was a multicentre first-time appraisal study of the efficacy of ECT. All patients with facial BCCs treated with either ECT or SE were deemed eligible and subsequently recruited from either a previous clinical trial or outpatient clinics, respectively. Of the 40 participants invited, 25 responses were received. Patient information recorded included age, gender, location and size of BCCs, and time since treatment. Patient outcomes were measured using the FACE-Q Skin Cancer Module.ResultsThe ECT and SE groups consisted of 14 and 11 patients, respectively. Mean age was 68 years (M:F = 16:9), while mean time since treatment was 4.98 years (range 0.3–9.58 years). Appraisal of scars was significantly higher in the ECT cohort versus SE (p = 0.034). Cancer worry was equivalent across both cohorts (p = 0.804). According to treatment type, no correlation was detected between time since treatment and both appraisal of scars (ECT p = 0.466 and SE p = 0.214) and adverse effects (ECT p = 0.924 and SE p = 0.139).ConclusionBased on this study, ECT has superior scar outcomes and overall equivalence to SE. This demonstrates high patient satisfaction for those treated with ECT without any additional cancer worry.

17847 A critical appraisal of the history of Mohs micrographic surgery and its evolution in the management of primary mucinous adenocarcinoma

Primary mucinous carcinoma (PMC) of the skin is a rare head and neck malignancy. It is resistant to chemotherapy and radiation; therefore, standard treatment includes surgical excision with 1–2-cm margins. Mohs micrographic surgery (MMS) is fast becoming the criterion standard for management of cutaneous carcinomas, offering maximal tissue conservation and high cure rates. We present a brief review of the evolution of MMS, highlight changing practice patterns and introduce a new therapeutic option for PMC. MMS was developed in the 1930s by Frederic E. Mohs. Initially referred to as “chemosurgery,” Dr. Mohs implemented fixed tissue techniques using a chemical cauterant, zinc chloride (ZnCl). He discovered that tissue injected with ZnCl remained histologically preserved. He microscopically examined horizontal sections of fixed tissue from various tumors thereby developing the basic premise of MMS. In 1936, he successfully treated the first squamous cell carcinoma of the lower lip using MMS. The technique has since evolved and is currently applied to various cutaneous malignancies. Our extensive PubMed literature review revealed that the majority of PMC cases are treated with traditional surgical excision (85.5%) and only few with MMS (9.4%). The first case of PMC treated with MMS was published in 1988 with only 20 cases reported in total. Published data reveals lower recurrence rates of PMC treated with MMS (0%-7%) versus excision (30%-40%). In conclusion, MMS appears to be superior to standard excision for PMC and should be considered as first line therapy for primary and recurrent lesions especially in cosmetically sensitive areas.

Slow Mohs surgery for the treatment of periocular basal cell carcinomas, three and five year follow‐up

AbstractPurposeBasal cell carcinoma (BCC) is the most common skin malignancy, disproportionately occurring in sun exposed areas, such as the eyelids. Whilst surgical excision is considered the most effective method for treating periocular BCCs, there is a paucity of evidence as to which surgical technique is the most appropriate. Mohs micrographic surgery is likely superior to traditional surgical excision in achieving clear excision margins and sparing tissues, but requires immediate access to histology. Slow Mohs surgery offers an alternative when immediate histology is unavailable, as tumour excision and reconstruction are performed in two separate procedures. In this retrospective case series is reported the 3 and 5 year outcomes following Slow Mohs surgery.Methods193 consecutive patients who had undergone Slow Mohs surgery, between January 2009 and December 2015 at a large district general hospital were identified retrospectively using electronic theatre records. Electronic lab reports and patient records were then utilised and the data analysed using EXCEL and SPSS.Results160 patients had a diagnosis of BCC or basosquamous carcinoma. Following exclusions, 141 survived to be included in the 3 year recurrence cohort. Of these, 2.83% had recurred at 3 years. A smaller group of 72 patients survived and had follow‐up lasting 5 years, within this group there was a recurrence rate of 4.16%.ConclusionSlow Mohs potentially achieves recurrence rates comparable to Mohs micrographic surgery, offering an alternative should immediate histological examination not be available. There currently exists little evidence comparing the techniques prospectively, nor is there cost comparison between them.

Xanthelasma: An update on treatment modalities

Xanthelasmas are localized accumulation of lipid deposits on the eyelids. Lesions are typically asymptomatic and treatment is often sought for cosmetic purposes. Unfortunately, there is paucity of strong evidence in the literature for the effective treatment of normolipidemic xanthelasmas. A literature search using the term “xanthelasma” was carried out in PubMed and Medline databases. Only articles related to treatment were considered and analyzed for their data. Commonly cited treatments include topical trichloroacetic acid, liquid nitrogen cryotherapy, and various lasers including carbon dioxide, Er:YAG, Q-switched Nd:YAG, and pulse dye laser. However, traditional surgical excision has also been used. This article reviews these currently accepted modalities of treatment.

Liquid nitrogen cryosurgery for a chromatophoroma in a captive largemouth bass (Micropterus salmoides)

Chromatophoromas are a common, pigmented malignant tumor that originates from dermochromatophores normally found in the skin of amphibians, reptiles, and fish. Chromatophoromas are typically locally aggressive and can appear as unsightly exudative masses. Effective treatment options in fish are limited mostly to surgical excision. An alternative approach to traditional surgical excision is liquid nitrogen cryosurgery. An adult (3.63kg) largemouth bass (Micropterus salmoides), housed in a mixed teleost species tank, presented with a history of inappetence of 14 days duration and 2 visible cutaneous skin lesions. Histopathology revealed the cutaneous skin lesions to be consistent with a chromatophoroma. Cryosurgery was successfully used to remove the diseased tissue, and no evidence of the tumor was identified on follow-up histopathologic examination.

Complication and recurrence rate in laser CO2 versus traditional surgery in the treatment of Bartholin’s gland cyst

The treatment of Bartholin's gland cysts by traditional surgery is characterized by some disadvantages and complications such as hemorrhage, postoperative dyspareunia, infections, necessity for a general anesthesia. Contrarily, CO2 laser surgery might be less invasive and more effective as it solves many problems of traditional surgery. The aim of our study is to describe CO2 laser technique evaluating its feasibility, complication rate and results vs traditional surgery. Among patients treated for Bartholin's gland cyst, we enrolled 62 patients comparing traditional surgical excision vs CO2 laser surgery of whom 27 patients underwent traditional surgery, whereas 35 patients underwent CO2 laser surgery. Mean operative time, complication rate, recurrence rate and short- and long-term outcomes were assessed. The procedures required a mean operative time of 9±5.3min for CO2 laser surgery and 42.2±13.8 for traditional surgery. Two patients (5.7%) needed an hemostatic suture for intraoperative bleeding in the laser CO2 laser technique against 14.8% for traditional surgery. Carbon dioxide allows a complete healing in a mean time of 22days without scarring, hematomas or wound infections and a return to daily living in a mean time of 2days. Instead, patients undergone traditional surgery required a mean time of 14days to return to daily life with a healing mean time completed in 28days. The minimum rate of intra- and post-operative complications, the ability to perform it under local anesthesia in an outpatient setting make CO2 laser surgery more cost-effective than traditional surgery.

A Strategy for the Successful Management of Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive soft tissue sarcoma with extensive subclinical involvement. The National Comprehensive Cancer Network guidelines recommend immediate reconstruction in most cases. Our study reviewed the methods of treatment of DFSP at our institution, examined the types of closure used after surgical excision, and analyzed the prevalence of positive margins on permanent pathology after immediate closure after conventional non-Mohs excision of DFSP. The charts of 25 patients treated with surgical excision and 16 with Mohs surgery from 1990 to 2009 for lesions consistent with DFSP were reviewed for clinical variables including disease state, tumor site, closure type, permanent pathology margin status, disease recurrence/persistence, and excisional margin size. The trunk, followed by the head and neck, were the most common sites for DFSP. No patients had distant metastasis at diagnosis or experienced recurrence in either the surgical excision or the Mohs surgery group. Twelve (48%) patients were found to have positive margins after initial surgical resection. All lesions treated with Mohs surgery had clear histological margins at completion. Average margin size for surgical excision patients was 2.33 cm (range, 0.75-4.5 cm), and 1.36 cm (range, 0.74-2.55 cm) for Mohs excision. The average duration of follow-up was 107.9 months. The extent of DFSP is difficult to determine intraoperatively with traditional surgical excision, which leads to a higher rate of positive margins. Considering this difficulty and the complications of reconstruction with positive margins, we believe that reconstruction after tumor resection should be dependent on definitive pathologic clearance of the tumor.

Intralesional bleomycin injection in management of low flow vascular malformations in children

Low flow vascular malformations are challenging to manage, particularly with their propensity to grow, and can lead to severe disfigurement and dysfunction. Traditional surgical excision is fraught with tedious dissection and complications, particularly in the head and neck region. Trends toward less invasive techniques, such as intralesional sclerotherapy, are proving to be successful independent treatments or adjuncts in management in low flow vascular malformations. This study was a retrospective case note review, over an 8-year period, reporting the outcomes of 32 children (mean = 5.8 years, range = 5 months–11.5 years) with radiologically confirmed low flow vascular malformations, treated with serial intralesional bleomycin injection (IBI) therapy. Patient demographics, lesion characteristics, imaging findings, treatment course, radiological and clinical response to treatment were recorded. An overall 91% (n = 29) response rate was achieved, with 28% obtaining complete resolution for low flow vascular malformations. Lesions were sub-categorized into venous malformation, including mixed venous-capillary (n = 27) or lymphatic malformation (LM) (n = 5). Twenty-seven of 32 children experienced no complications. Local complications included superficial skin infection (n = 2), skin necrosis (n = 1), hyperpigmentation, and minor contour deformity. There was no recurrence and no systemic side-effects to bleomycin. Mean follow-up was 38 months (range = 6–95 months). In conclusion, serial intralesional bleomycin injections can be effective and also safe in a paediatric population for the successful management of symptomatic or disfiguring low flow vascular malformations.