A retrospective study of outcome of Mohs’ micrographic surgery for cutaneous squamous cell carcinoma using formalin fixed sections

Abstract

The surgical management of recurrent or large squamous cell carcinoma (SCC) can be challenging as tumours often extend beyond visible margins. Micrographic surgery is a potentially effective method of ensuring complete clearance of tumour. A retrospective study of all cases of SCC treated by micrographic surgery in this department between 1986 and 1996 has been done. Sixty-one patients were treated using a formalin-fixed paraffin-embedded tissue technique with a median follow-up of 4 years. In two cases there was local recurrence and in three others metastasis to local lymph nodes. The overall cure rate was 92% (56 of 61), which compares favourably with published series using chemosurgery and frozen tissue techniques. The results show that this technique of micrographic surgery is a satisfactory and cost-effective alternative to conventional frozen section techniques in the treatment of SCC. The formalin-fixed tissue method has the advantage of providing high-quality permanent histological sections using existing conventional pathology services.

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…568 In a case series of 87 auricular SCCs, no distant metastases were reported during a mean follow-up period of 34.6 months. 571 One smaller series of 48 SCCs treated by MMS observed one patient with distant metastasis during a mean follow-up of 3.4 years, 567 and a further series including eight patients with periocular SCC also noted one patient with metastases to the lung; 564 however, the authors presumed that this patient had subclinical spread of tumour prior to treatment with MMS as there was no evidence of local recurrence.…”

“…568,572 Six studies reported recurrence in the regional lymph nodes after treatment with MMS. 545,564,565,567,569,573 On pooled analysis (comprising 1162 patients) the average regional recurrence was 4.2% (95% CI 2.3% to 6.6%; I 2 = 56%) ( Figure 37). There was no significant impact on regional recurrence in the sensitivity analysis, which included only four studies meeting the criteria, 545,565,567,569 with average recurrence of 3.2% (95% CI 1.9% to 5.0%, I 2 = 29%).…”

“…545,558,[564][565][566][567][568][569][570][571][572][573][574][575][576][577] In a seminal series of papers, Mohs reported 5-year cure rates for previously untreated SCCs of 95.7% for SCC of the trunk and extremities; 578 96.6% for the ear; 579 97.8% for facial, scalp and neck SCCs; 578 98.5% for eyelid SCCs; 580 and 98.8% for SCCs of the nose. 578 These rates translated to a pooled 5-year cure rate 97.4% for the 2133 SCCs at all sites (95% CI 96.2% to 98.3%; I 2 = 48%).…”

“…Specified mean follow-up was between 2 and 5 years in five studies, 545,564,565,567,569 with pooled regional recurrence of 3.4% (95% CI 1.8% to 5.3%; I 2 = 34%). None of the studies had mean follow-up of > 5 years.…”

Fatores preditivos do maior número de estádios na cirurgia micrográfica de Mohs para o tratamento do carcinoma espinocelular da cabeça

“…Permite a remoção completa do tumor com máxima preservação do tecido sadio peritumoral. [1][2][3][4][5][6][7][8][9][10] Na CMM são examinadas 100% das margens do tecido removido através da análise histopatológica por congelação. Código de cores e mapa são confeccionados para determinar a exata localização de um possível tumor residual.…”