Indication guidelines for Mohs micrographic surgery in skin tumors

Cernea, Selma Schuartz; Gontijo, G.; Pimentel, Eugênio Raul de Almeida; Tarlé, Roberto Gomes; Tassara, Glaysson; Ferreira, Juliana Arêas de Souza Lima Beltrame; Fernandes, Victor Miguel Coutinho; Bernardo, Wanderley Marques

doi:10.1590/abd1806-4841.20164808

Cited by 16 publications

(24 citation statements)

References 38 publications

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“…That examination aides the surgeon decides if further tissue removal is necessary. Mohs surgery is one of the few surgical methods of obtaining complete margin control during skin cancer removal (a complete circumferential peripheral and deep margin assessment) using frozen section histology technique [79,80]. Minton, 2008.…”

Section: Current Status Of Knowledgementioning

confidence: 99%

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

2019

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Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.

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Section: Current Status Of Knowledgementioning

confidence: 99%

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

2019

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“…This aggressive biological behavior is characterized by sclerodermiform, infiltrative, micronodular or basosquamous histology. MMS technique for these tumors can achieve higher cure rates when compared to standard excision [7].…”

Section: Basal Cell Carcinomas (Bcc)mentioning

confidence: 98%

3 Mohs Micrographic Surgery

2018

Facial Reconstruction After Mohs Surgery

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Mohs micrographic surgery (MMS) is used to obtain clear margins in skin cancer treatment. MMS involves staged excisions and complete margin assessment of the specimen from fresh tissue frozen sectioning. It has been shown to achieve higher cure rates with malignancies, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), lentigo maligna, melanoma in situ and dermatofibrosarcoma protuberans. This technique is especially useful in face, feet and hand regions to avoid cosmetic deformities.

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“…Mohs micrographic surgery (MMS) is the treatment of choice for HRBCCs, but this method requires special instruments and both surgical and pathologic experts; it is also expensive. 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Outcome of staged excision with pathologic margin control in high-risk basal cell carcinoma of the head region

Kavoussi

Ebrahimi

et al. 2020

Anais Brasileiros de Dermatologia

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Background High-risk basal cell carcinoma involves a significant rate of basal cell carcinoma that requires Mohs micrographic surgery for definitive treatment. Staged excision with pathologic margin control is a simple, accessible, and curative procedure suggested for the treatment of high-risk basal cell carcinoma. Objective To evaluate the results of staged excision of high-risk basal cell carcinoma in the head region. Methods This interventional study was performed on patients with high-risk basal cell carcinoma, who underwent staged excision until the margins were free of tumor. Results A total of 122 patients (47 females and 75 males) with mean age of 57.66 ± 9.13 years were recruited in this study. Nasal and nodular types were the most common of both clinical and pathologic forms, respectively. Further, 89.3 % of cases were cured by staged excision after four years of follow-up. There was a significant relationship between treatment outcomes and recurrent lesions, multiplicity of risk factors, long-standing disease, and pathologic type. There was also a significant association between the number of surgical excisions and multiplicity of risk factors, as well as recurrence, location, and size of basal cell carcinoma. Study limitations Lack of magnetic resonance imaging assessment in cases of suspected perineural invasion. Conclusions High-risk basal cell carcinoma had a high cure rate by staged excision. Patients with more risk factors and those with nasal and recurrent basal cell carcinoma required more staged excisions. Failure of treatment is more probable in patients with more risk factors, long-standing lesions, and high-risk pathologic and recurrent basal cell carcinomas.

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Indication guidelines for Mohs micrographic surgery in skin tumors

Cited by 16 publications

References 38 publications

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

3 Mohs Micrographic Surgery

Outcome of staged excision with pathologic margin control in high-risk basal cell carcinoma of the head region

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