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Skin cancer can be broadly categorized into melanoma and nonmelanoma skin cancer (NMSC). Squamous cell carcinoma and basal cell carcinoma are the most common subtypes of NMSC. When a patient presents with a skin finding suspect for NMSC, a confirming skin biopsy is performed. On the basis of the biopsy results, patient factors, and clinical characteristics of the cancer, an appropriate form of treatment is selected. Mohs micrographic surgery (or Mohs) is a tissue-sparing surgical approach, utilizing frozen section margin control. Once removal of the NMSC has been assured by Mohs surgery, the resultant skin defect is evaluated for repair. The choice of repair should maintain or restore function and aesthetic form while minimizing skin tension. Using a skin flap may be the best choice of repair to achieve these goals. Here, we describe both rotation and advancement flaps. Rotation flaps are constructed using an arciform incision adjacent to the original wound. Advancement flaps describe the movement of skin and tissue directly forward to close the wound, employing no rotational movement. There are three main subtypes of advancement flaps: unidirectional, bidirectional, and island pedicle or V-to-Y flaps.
Skin cancer can be broadly categorized into melanoma and nonmelanoma skin cancer (NMSC). Squamous cell carcinoma and basal cell carcinoma are the most common subtypes of NMSC. When a patient presents with a skin finding suspect for NMSC, a confirming skin biopsy is performed. On the basis of the biopsy results, patient factors, and clinical characteristics of the cancer, an appropriate form of treatment is selected. Mohs micrographic surgery (or Mohs) is a tissue-sparing surgical approach, utilizing frozen section margin control. Once removal of the NMSC has been assured by Mohs surgery, the resultant skin defect is evaluated for repair. The choice of repair should maintain or restore function and aesthetic form while minimizing skin tension. Using a skin flap may be the best choice of repair to achieve these goals. Here, we describe both rotation and advancement flaps. Rotation flaps are constructed using an arciform incision adjacent to the original wound. Advancement flaps describe the movement of skin and tissue directly forward to close the wound, employing no rotational movement. There are three main subtypes of advancement flaps: unidirectional, bidirectional, and island pedicle or V-to-Y flaps.
SummaryBackgroundDue to rising skin cancer incidence rates there is an urgent need for a quick, reliable and cost‐effective therapy. Previous studies showed that fresh tumor tissue and margins could be directly examined microscopically with high sensitivity and specificity.ObjectiveComparing the accuracy of rapid lump examination (RLE) for the detection of basal cell carcinoma (BCC) during micrographic surgery with formalin‐fixed paraffin‐embedded hematoxylin and eosin (HE)‐stained sections.Methods and Materials382 specimens of 118 excised samples with suspected BCC were examined with RLE and compared with formalin‐fixed paraffin‐embedded HE‐stained sections. For RLE, following a standardized 60 sec staining protocol, the fresh tissue samples were observed directly with a stereomicroscope.ResultsFor BCC, RLE had a high but insufficient diagnostic accuracy compared to the gold standard of formalin‐fixed paraffin‐embedded HE‐stained sections. The sensitivity was 76 % (95 % CI = [66.18 %; 84.5 %]) and specificity was 91 % (95 % CI = [86.73 %; 93.75 %]).ConclusionsRLE is a fast and simple technique for microscopically controlled surgery (MCS) of basal cell carcinomas that requires training. The experience of the examiner has a major influence on the results. RLE has great potential to speed up the workflow in Mohs surgery but should be improved in the future.
ZusammenfassungHintergrundAufgrund der steigenden Inzidenz von Hautkrebs besteht ein dringender Bedarf an einer schnellen, zuverlässigen und kostengünstigen Therapie. Frühere Studien zeigten, dass natives Tumorgewebe und Schnittränder direkt mikroskopisch mit hoher Sensitivität und Spezifität untersucht werden können.ZielVergleich der Rapid Lump Examination (RLE) im Rahmen der mikrographischen Chirurgie mit formalinfixierten, paraffineingebetteten Hämatoxylin‐ und Eosin (HE)‐gefärbten Schnitten beim Nachweis von Basalzellkarzinomen (BZK).Material und Methodik382 Proben von 118 Exzidaten mit Verdacht auf BZK wurden mit RLE im Vergleich zu formalinfixierten, paraffineingebetteten HE‐gefärbten Schnitten untersucht. Für die RLE wurden die Frischgewebeproben nach einem standardisierten 60‐Sekunden‐Färbeprotokoll direkt mit einem Stereomikroskop untersucht.ErgebnisseDie RLE erreichte eine hohe, aber unzureichende diagnostische Genauigkeit im Vergleich zum Goldstandard den formalinfixierten, paraffineingebetteten, HE‐gefärbten Schnitten. Die Sensitivität betrug 76 % (95 %‐KI = [66,18 %; 84,5 %]) und die Spezifität 91 % (95 %‐KI = [86,73 %; 93,75 %]).SchlussfolgerungenDie RLE ist eine schnelle und einfache Technik für die mikroskopisch kontrollierte Chirurgie (MKC) von Basalzellkarzinomen, die jedoch Übung erfordert. Die Erfahrung des Untersuchers hatte großen Einfluss auf die Ergebnisse. Die RLE verfügt über großes Potenzial, den Arbeitsablauf in der Mohs‐Chirurgie zu beschleunigen, bedarf aber weiteren Verbesserungen.
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