A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location

Theroux, Zachary A.; Blechman, Adam B.; Russell, Mark

doi:10.1097/dss.0000000000001571

Cited by 2 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Primary closure of the post-excisional defects is done for smaller lesions with surrounding skin laxity. [ 4 ] Optimum method of reconstruction for facial defects is selected based on anatomic location, size of lesion, patient age (skin laxity), patient gender (hair-bearing skin), number of lesions, recurrent lesions, surgical skills as well as patient’s preference [ Figure 1 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of defects following excision of basal cell carcinoma of face: A subunit-based algorithm

Mohapatra

Friji

Kumar

et al. 2023

J Cutan Aesthet Surg

View full text Add to dashboard Cite

Introduction: Basal cell carcinoma (BCC) is a locally invasive, slowly spreading tumor arising in the basal layer of epidermis and rarely metastasizes. Surgical excision with adequate margins is curative. Reconstruction of post-excisional defects on the face is both essential and challenging. Clinical Cases and Methods: A retrospective review of hospital records for patients operated for BCC of the face excluding the pinna at our institute in the last 3 years was done and a review of the literature was carried out to identify the most common principles governing the optimal reconstruction of post-excisional defects on the face. Literature search was made in Embase, Medline, and Cochrane databases in the last two decades with the filters placed for human and English language studies with the search terms (Facial Basal cell carcinoma) AND reconstruction AND (Humans[Mesh]). Results: Records of 32 patients with facial BCC who underwent excision and reconstruction at our hospital were identified and details were recorded. Our literature search with the terms and filters mentioned above revealed 244 studies with duplicates removed. After further hand-searching, 218 journal articles were identified, reviewed, and a reconstruction algorithm was designed based on the findings. Discussion: Reconstruction of post-BCC excisional defects of the face relies on an adequate understanding of the general principles of reconstruction, subunit principle of facial esthetics, flap anatomy and vascularity as well as operator experience. Complex defects need innovative solutions, multidisciplinary approaches, and newer methods of reconstruction like perforator flaps and newer techniques like supermicrosurgery. Conclusion: Multiple reconstructive options for post-excisional defects of the BCC over the face are available and most defects can be approached in an algorithmic manner. Further well-designed prospective research studies are needed to compare outcomes of different reconstructive options for a given defect and identify the most suitable options.

show abstract

Section: Discussionmentioning

confidence: 99%

Reconstruction of defects following excision of basal cell carcinoma of face: A subunit-based algorithm

Mohapatra

Friji

Kumar

et al. 2023

J Cutan Aesthet Surg

View full text Add to dashboard Cite

show abstract

“…A greater defect will also require a more complex closure 12 . Tumours located in risk areas are also bigger and frequently needing a flap or a graft to be closed 20,21 . BCCs with aggressive histology are more likely to display subclinical extension and require more stages to achieve clear margins 22,23 and wider and deeper surgical defects with complex repair 23 …”

Section: Discussionmentioning

confidence: 99%

“…12 Tumours located in risk areas are also bigger and frequently needing a f lap or a graft to be closed. 20,21 BCCs with aggressive histology are more likely to display subclinical extension and require more stages to achieve clear margins 22,23 and wider and deeper surgical defects with complex repair. 23 Immunosuppression is a risk factor for recurrence and even for death in different types of cutaneous carcinomas.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a model to predict complex Mohs micrographic surgery in clinical practice: REGESMOSH scale

Montero‐Vílchez

Rodríguez-Prieto

Ruiz‐Salas

et al. 2023

Acad Dermatol Venereol

View full text Add to dashboard Cite

Introduction There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs micrographic surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure. Materials and Methods A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to three or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale. Results A total of 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. A total of 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required three or more stages. A model to predict the need for three or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non‐complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location. Conclusion We present a model to predict MMS needing ≥3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration.

show abstract

A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location

Cited by 2 publications

References 11 publications

Reconstruction of defects following excision of basal cell carcinoma of face: A subunit-based algorithm

Reconstruction of defects following excision of basal cell carcinoma of face: A subunit-based algorithm

Development and validation of a model to predict complex Mohs micrographic surgery in clinical practice: REGESMOSH scale

Contact Info

Product

Resources

About