Locally advanced breast cancer made amenable to radical surgery after a combination of systemic therapy and Mohs paste: two case reports

Abstract

IntroductionChemotherapy and other systemic therapies are the primary treatments for patients with unresectable, locally advanced breast cancer. The clinical application of supportive care using Mohs paste has become widespread for the purpose of improving patients’ quality of life. Here, we report two cases of locally advanced breast cancer, for which the patients underwent radical surgery after a combination of systemic therapy and Mohs chemosurgery.Case presentationsPatient 1 was a 90-year-old Japanese woman with right breast cancer diagnosed as stage IIIB (T4bN1M0). The treatment included Mohs paste application and hormonal therapies. Patient 2 was a 60-year-old Japanese woman with right breast cancer diagnosed as stage IIIB (T4cN2aM0). Her treatment included Mohs paste application, together with chemotherapy (four cycles of 5-fluorouracil, epirubicin, and cyclophosphamide, and four cycles of docetaxel). In both cases, a reduction in the primary tumor volume was observed, and radical mastectomy and axillary lymph node dissection were possible without relaxation incision or skin flap.ConclusionWe report patients with no distant metastases who were able to undergo radical resection after a combination of systemic therapy and Mohs chemosurgery. For locally advanced breast cancer, Mohs chemosurgery, in addition to multidisciplinary treatment, is useful.

The palliative efficacy of modified Mohs paste for controlling canine and feline malignant skin wounds

“…In particular, two cases (Cases 2 and 6) with open skin wounds occurred due to the presence of mammary gland tumors experienced the closure of their wounds with MPT. The same result has been reported in humans (Tsukada et al 2012). A decrease in pressure from the tumor mass to the skin surface may allow reepithelialization.…”

“…MPT has been proven effective in terminally ill animals with unresectable skin tumors and tumors that surgical excision is not desired by the animals' owners. In humans, MPT has been documented as an effective treatment to decrease bleeding, decrease frequency of wound dressing changes, decrease odor and degree of pain experienced, and increase patient QOL (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012;Komine et al 2014;Nakai et al 2015). Similarly, its efficacy has been demonstrated in this study through significant decreases in tumor size and the number of dressing changes required.…”

“…In human medicine, pain control in MPT was achieved by the administration of analgesics, the topical use of petroleum jelly to the surrounding healthy skin to protect it from the paste, and a reduction in the contact time of the Mohs paste to the skin (Shigeyama et al 2005;Kakimoto et al 2010;Tsukada et al 2012). With subsequent pain monitoring, prescription analgesics may be used for management and control of ongoing pain at the wound site.…”

“…Malignant skin wounds which are likely to appear in these patients are an issue which worsens the QOL of the patients. The modified Mohs paste has been applied in patients with malignant skin wounds whose skin tumors are considered unresectable (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012;Komine et al 2014;Nakai et al 2015). The application of the Mohs paste had positive effects on the fixed-necrotic tissues, alleviated the signs and symptoms of malignant wounds, and decreased tumor volumes, allowing their subsequent excision (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012;Komine et al 2014;Nakai et al 2015).…”

“…The modified Mohs paste has been applied in patients with malignant skin wounds whose skin tumors are considered unresectable (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012;Komine et al 2014;Nakai et al 2015). The application of the Mohs paste had positive effects on the fixed-necrotic tissues, alleviated the signs and symptoms of malignant wounds, and decreased tumor volumes, allowing their subsequent excision (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012;Komine et al 2014;Nakai et al 2015). The efficacy of modified Mohs paste has been reported in pleomorphic adenoma (Shigeyama et al 2005), adenoid cystic carcinoma (Shigeyama et al 2005), malignant melanoma (Shigeyama et al 2005), and squamous cell carcinoma (SCC) (Komine et al 2014;Nakai et al 2015), and for those with non-cutaneous skin tumors such as angiosarcoma and advanced breast cancer (Shigeyama et al 2005;Kakimoto et al 2010;Uno et al 2010;Tsukada et al 2012).…”