Mohs micrographic surgery: a study of 83 cases

Abstract

BACKGROUND: Mohs micrographic surgery can achieve high cure rates in the treatment of skin cancer and remove a minimum of healthy tissue. OBJECTIVES: To characterize patients undergoing Mohs micrographic surgery and study issues related to the number of surgical stages. METHODS: A descriptive, retrospective, cross-sectional study was conducted in a micrographic surgery reference center for the period of 2004 to 2010. Data was collected from medical records of 79 patients (83 surgeries). RESULTS: We studied 43 women and 36 men. The mean age was 57.5 ± 14,6 years. Skin types II and III were the most frequent, accounting for 41% and 36.1%, respectively. The most frequent tumor was the basal cell carcinoma (89.1%), and the solid subtype was the most common (44.6%), followed by sclerodermiform histological subtype (32%).The most frequent location was the nasal region (44.6%). The large majority of the operated tumors were recurrent lesions (72.7%). Half of the tumors measured 2 cm or more. In 68.7% of the cases two or more surgical stages were necessary for the removal of the tumors. The observation period was 2 or more years in 75% of the tumors. There was 01 post-Mohs recurrence and 02 patients had metastases during the observation period (both with squamous cell carcinoma). CONCLUSIONS: The findings coincide with those of the literature, recurrent tumors and tumors larger than 2cm needed more surgical stages for their removal, although there was no statistic difference (p=0,12 and 0,44 respectively). Keywords: Carcinoma, basal cell; Carcinoma, squamous cell; Mohs surgery; Skin neoplasms Resumo: FUNDAMENTOS: A cirurgia micrográfica de Mohs é capaz de alcançar altas taxas de cura no tratamento do câncer de pele e remover o mínimo possível de tecido saudável. OBJETIVOS: caracterizar os pacientes submetidos à cirurgia micrográgica de Mohs e estudar aspectos relacionados ao número de fases cirúrgicas. Métodos: trata-se de estudo observacional, transversal e descritivo realizado em serviço de referência para cirurgia micrográfica no período de 2004 a 2010. Foram revisados os prontuários de 79 pacientes (83 cirurgias). RESULTADOS: Foram avaliados 43 mulheres e 36 homens. A média de idade foi 57,5 ± 14,6 anos. Os fototipos II e III foram os mais frequentes, respondendo por 41% e 36,1% respectivamente. O tumor mais freqüente foi o carcinoma basocelular (89,1%), sendo o subtipo sólido o mais frequente (44,6%), seguido pelo esclerodermiforme (32%). A localização mais freqüente foi a nasal (44,6%). A grande maioria dos tumores operados eram recidivados (72,7%). Metade dos tumores mediam 2 cm ou mais. Foram necessárias duas ou mais fases cirúrgicas em 68,7% dos tumores para sua remoção. O tempo de acompanhamento foi igual ou superior a 2 anos em 75%. Houve 01 recidiva pós-Mohs e 02 pacientes apresentaram metástases durante o estudo (ambos carcinomas espinocelulares). CONCLUSÕES: Os achados coincidem com os da literatura, sendo que tumores recidivados e maiores que 2cm necessitaram de mais fases cirúrgicas para sua co...

Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery

“…The possibility of performing surgery, such as MMS, with a high cure rate, under local anesthesia, constitutes a significant advance in terms of the prevention of intra-and postoperative complications in elderly patients, as observed in our studied cohort, in which 57% of patients were aged 61-80 years, in whom comorbidities occurred more frequently and the use of multiple medications was also common. In the Northeast Brazil, Aracaju, the predominant skin phototypes (Fitzpatrick's classification), were types II (41%) and III (36%); these values are similar to those observed in our cohort of patients from Southeast Brazil (15). Differences in the BCC incidence rate illustrate the effect of skin phototype on the disease's geographical distribution and incidence, worldwide.…”

“…MMS enables the surgeon to map the location of all tissue removed and microscopically examine the entire deep and lateral margins of a horizontally sectioned specimen (18). This is useful for tumors located in the peripheral areas of orifices, tumors with a high risk of relapse, and tumors that are macroscopically indistinguishable border or of diffuse type (15,18), in addition to those with a micronodular and infiltrative histopathologic type (10), which accounted for 46% of the BCCs excised in this study. In our study, there was a strong association between tumors ≤30 mm in size that were predominant in H zone, and the nodular, infiltrative or micronodular histopathological patterns;…”

Squamous cell carcinoma of the skin: clinical presentation, diagnosis, treatment, and prevention

“…Хирургическая операция по Мохсу (Mohs) явля-ется эффективным методом лечения ПКРК [19]. При операции по Мохсу проводится послойное уда-ление ПКРК, параллельно проводится гистологиче-ское исследование криостатных срезов каждого уда-ленного слоя, благодаря чему удаление опухолевых клеток производится полностью при максимальном сохранении окружающей здоровой ткани.…”

“…При операции по Мохсу проводится послойное уда-ление ПКРК, параллельно проводится гистологиче-ское исследование криостатных срезов каждого уда-ленного слоя, благодаря чему удаление опухолевых клеток производится полностью при максимальном сохранении окружающей здоровой ткани. Показа-тель эффективности достигает 97,9% [19,20].…”

Value of Changes of the Curtailing System of Blood in Pathogenesis of Development of Planocellular Cancer of Skin

“…Опасно для жизни больного расположение опухоли в окружности наружного слухового прохода, периорбитальной области, а также в носогубных складках и заушной области. В этих случаях плоскоклеточный рак может прорастать в мышцы, кости и возникает возможность разви- [2][3][4]. В патогенезе заболевания немаловажная роль отводится расстройствам реологических свойств крови [5].…”