Evaluación de los márgenes quirúrgicos del carcinoma basocelular según la especialidad del cirujano

Bassas, P.; Hilari, H.; Bodet, D.; Serra, Magdalena; Kennedy, Francisco; García‐Patos, Vicente

doi:10.1016/j.ad.2012.06.001

Cited by 23 publications

(5 citation statements)

References 23 publications

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“…However, this difference did not remain significant in the multivariate analysis [10]. Other studies on the successful management of keratinocyte cancers, especially those focusing on BCC, showed similar trends [9,[22][23][24]. In our study, the surgeons' experience seemed to be of greater importance than their medical specialty.…”

Section: Discussionsupporting

confidence: 49%

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Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Fougelberg

Claeson

et al. 2021

Dermatol Pract Concept

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Background: One common treatment for Bowen’s disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins. Objectives: This study examined what factors affect the rate of incomplete excision of BD. Methods: Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin). Results: In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition. Conclusions: When removing BD surgically, an elliptical excision with surgical margins ≥3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.

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Section: Discussionsupporting

confidence: 49%

“…When surgery is considered to be the best treatment alternative, we must provide the surgeon with the right conditions, such as knowledge of optimal safety margins and information about potential risk factors for incomplete excision. Such factors could include lesion size, body site and excisional method [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Fougelberg

Claeson

et al. 2021

Dermatol Pract Concept

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“…Outras opções dependem de fatores relevantes como número de lesões, dimensões do tumor, localização anatômica, tipo histológico, estado geral e comorbidades do paciente, além da própria experiência do médico. 2,4,5 Alternativas no tratamento dos tumores cutâneos são a eletrocauterização, crioterapia, terapia fotodinâmica, laser, ablação química, radioterapia e cirurgia microscópica ou de Möhs. 2,6 A excisão cirúrgica consiste em ressecção tumoral com margens de segurança que medem de 3 a 10 mm da borda do tumor dependendo da localização.…”

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“…12 O CEC, por outro lado, é responsável por aproximadamente 25% dos tumores cutâneos malignos não melanoma³ e detém um poder metastático maior, podendo acometer, conforme o tempo de evolução, linfonodos regionais e até mesmo produzir metástases à distância envolvendo ossos, cérebro e pulmões. 2,4 Os fatores de risco conhecidos para o desenvolvimento de CBC e CEC envolvem dados como raça, idade, gênero e fototipo, relevantes na classificação e estratificação desses pacientes. 4 No presente trabalho, não foi possível a coleta de informações como fototipo e raça, visto que não constavam nos prontuários.…”

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Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Simoneti

Cunha

Gomes

et al. 2016

Rev. Fac. Ciênc. Méd. Sorocaba

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RESUMOIntrodução: O tumor de pele não melanoma é o de maior prevalência e incidência no Brasil, englobando o carcinoma espinocelular (CEC) e o basocelular (CBC). O principal fator de risco para o desenvolvimento desses tumores é a exposição crônica aos raios solares, justificando a faixa etária e as localizações anatômicas mais acometidas. O tratamento objetiva extirpar a lesão com deformidade mínima. A excisão cirúrgica com margens seguras é a principal opção terapêutica; outras dependem do número de lesões, localização, tipo histológico, estado geral e comorbidades clínicas. Objetivos: Descrever o perfil epidemiológico dos pacientes com tumores cutâneos malignos; identificar a prevalência dos não melanoma; e avaliar a margem cirúrgica. Métodos: Estudo observacional, longitudinal e retrospectivo de pacientes submetidos à ressecção de lesões suspeitas em serviço secundário. Resultados: Foram identificadas 140 lesões em 67 pacientes, sendo 59% do sexo masculino e 71,6% maiores de 60 anos. O segmento mais acometido foi cabeça/pescoço (72,1%); 69,1% eram CBC, 29,2% CEC e 1,6% melanoma; 80,4% informavam margens livres, 7,3% indicavam comprometimento; esses pacientes apresentavam média de 75,2 anos e 8,7 lesões concomitantes. A associação foi significante entre gênero feminino e presença de lesões <5 mm. Conclusões: O predomínio de lesões em indivíduos do sexo masculino acima de 60 anos é compatível com o padrão já descrito na literatura. As margens livres, obtidas em grande parte do presente estudo, indicam eficácia terapêutica da excisão cirúrgica simples. As margens macroscópicas adotadas na marcação pré-operatória favorecem a eficácia, reservando a cirurgia de Möhs para recidivas ou comprometimento de margem. Palavras-chave: neoplasias cutâneas; procedimentos cirúrgicos operatórios; carcinoma de células escamosas; carcinoma basocelular. ABSTRACT Introduction: Non-melanoma skin tumor is the one with highest prevalence and incidence in Brazil, comprising squamous cell carcinoma (SCC) and basal cell carcinoma (CBC). The main risk factor for the development of these tumors is chronic exposure to sunlight, justifying the most affected age group and anatomical locations. Treatment aims to excise the lesion with minimal deformity. Surgical excision with safe margins is the main therapeutic option; others depend on the number of lesions, location, histological type, general health and medical comorbidity. Objectives: To describe the epidemiological profile of patients with skin tumors; to identify the prevalence of non-melanoma; and to evaluate surgical margin. Methods: Observational, longitudinal and retrospective study of patients undergoing resection of suspicious lesions in secondary service. Results: We identified 140 lesions in 67 patients, 59% were male and 71.6% over 60 years of age. The most affected regions were head and neck (72.1%); 69.1% were CBC, 29.2% CBC, and 1.6% melanoma; 80.4% informed free margins, 7.3% indicated affected margins; the mean age of these patients was 75.2 years and the mean number of co...

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Basal cell carcinoma with compromised margins: retrospective study of management, evolution, and prognosis

Fidelis

Stelini

Staffa

et al. 2021

Anais Brasileiros de Dermatologia

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Background Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations Mean follow-up time of less than five years and sample size. Conclusions The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

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Evaluación de los márgenes quirúrgicos del carcinoma basocelular según la especialidad del cirujano

Cited by 23 publications

References 23 publications

Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision

Perfil epidemiológico de pacientes com tumores cutâneos malignos atendidos em ambulatório de cirurgia plástica de serviço secundário no interior de São Paulo

Basal cell carcinoma with compromised margins: retrospective study of management, evolution, and prognosis

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