Mohs Micrographic Surgery Local Recurrences

Hruza, George J.

doi:10.1111/j.1524-4725.1994.tb00149.x

Cited by 93 publications

(74 citation statements)

References 18 publications

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“…It is closer to that obtained with Mohs surgery, which is often below 2% (Tromovitch and Stegman, 1978;Robins, 1981;Robins et al, 1985;Roenigk et al, 1986;Rowe et al, 1989;Lawrence, 1993;Hruza, 1994). In contrast to radiotherapy, a histological appraisal of the efficiency of the treatment is possible with surgery.…”

Section: Failure Ratesupporting

confidence: 56%

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

Avril

Aupérin²,

Margulis³

et al. 1997

Br J Cancer

291

175

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Summary Basal cell carcinomas (BCCs) are very frequent cutaneous cancers, often located on the face. Cure rates with surgery and radiotherapy are high, but these treatments have never been compared prospectively. A randomized trial was initiated in 1982 to compare surgery and radiotherapy in the treatment of primary BCC of the face measuring less than 4 cm. The primary end point was the failure rate (persistent or recurrent disease) after 4 years of follow-up. The secondary end point was the cosmetic results assessed by the patient, the dermatologist and three persons not involved in the trial. In the course of the trial, 347 patients were treated. Of the 174 patients in the surgery group, 71% had local anaesthesia and 91% frozen section examination. Of the 173 patients in the radiotherapy group, 55% were treated with interstitial brachytherapy, 33% with contactherapy and 12% with conventional radiotherapy. The 4-year actuarial failure rate (95% Cl) was 0.7% (0.1-3.9%) in the surgery group compared with 7.5% (4.2-13.1%) in the radiotherapy group (log-rank P= 0.003). The cosmetic results assessed by four of the five judges were significantly better after surgery than after radiotherapy. Eighty-seven per cent of the surgery-treated patients and 69% of the radiation-treated patients considered the cosmetic result as good (P < 0.01). Thus, in the treatment of BCC of the face of less than 4 cm in diameter, surgery should be preferred to radiotherapy.

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Section: Failure Ratesupporting

confidence: 56%

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

Avril

Aupérin²,

Margulis³

et al. 1997

Br J Cancer

291

175

View full text Add to dashboard Cite

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“…9,10 Because of its accuracy in determining tumor-free margins, patients referred for MMS typically present with tumors that have a relatively higher statistical likelihood of local recurrence. Indications for MMS have been formulated based on studies [12][13][14] that tended to focus on a subset of risk factors for subclinical spread. Tumors were compared on the basis of one variable alone, for example, histologic type or anatomic location.…”

Section: Methodsmentioning

confidence: 99%

“…15 Mohs micrographic surgery was performed on an outpatient basis under local anesthesia using the standard technique. 12,13,16 An average of 3-mm margins were taken for each layer.…”

Section: Participants and Methodsmentioning

confidence: 99%

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Batra¹

2002

Arch Dermatol

158

130

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Background: In nonmelanoma skin cancer, the clinically visible portion may represent a small fraction of microscopic tumor spread. Previous studies have examined individual risk factors for subclinical spread based on patient and tumor characteristics. However, these risk factors have not been prioritized or studied in combination.Objective: To identify the most predictive risk factors for extensive subclinical tumor spread.Design: Retrospective analysis of 1131 Mohs micrographic surgical cases. Variables analyzed included patient age, sex, and immune status and lesion size, location, histologic subtype, and recurrence. Logistic regression was applied to identify important combinations of tumor characteristics and to quantify relative odds of spread.Setting: Academic referral center.Patients: Consecutive sample of all referred patients treated by a single Mohs micrographic surgeon in a 3-year period.Main Outcome Measure: Number of Mohs micrographic surgical layers required to clear a tumor, with 3 or more layers defined as extensive subclinical spread.Results: The highest-risk tumors, with odds ratios greater than 6.0, were basosquamous and morpheaform basal cell carcinoma (BCC) on the nose, morpheaform BCC on the cheek, and those with a preoperative size greater than 25 mm. Other important risk factors were recurrent and nodular BCC on the nose; location on the eyelid, temple, or ear helix; neck tumors and recurrent BCC in men; and tumor size greater than 10 mm. Patients younger than 35 years were at lower risk. Increasing age and immunocompromise were not significant predictors. Conclusion:Identification of lesions likely to exhibit extensive subclinical spread can help guide management to ensure complete tumor eradication and thereby reduce the risk of recurrence and its associated morbidity and cost.

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“…Slight technical problems are likely to greatly interfere in the accuracy of microscopic control of margins, and not always does a technician really understand the difficulty of the problem. [5][6][7][8][9][10][11] In the specific case of "disappearance of residual malignant cells" one of the alternatives below is likely to have happened: a) False positivity of the examination of surgical piece's margins. This depends on the multiple slicing incidences, incorrect inclusion of part of the surgical material -which might have detached from the main piece in this stage of specimen preparation -and also an initial wearing of the block until the technician collects the best slice to be put in the slide.…”

Section: Figurementioning

confidence: 99%

Margem de segurança: um conceito antigo e relativo

Kopke¹,

Bastos²,

Filho

et al. 2005

An. Bras. Dermatol.

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Safety margin and surgical margin are terms frequently used as synonyms, although they have different meanings. Safety margin is pre-determined and is a part of the surgical planning. Surgical margin is subsequently verified by the pathologist when he or she examines the surgical piece. There is no consensus in the literature regarding the extension of the safety margin, which is based on a series of variables which are not always easy to analyze. On the other hand, the microscopically controlled surgery does not use the concept of safety margin and is the most rational treatment of skin cancer. This article discusses the determinant factors of safety margin and surgical margin, from a both clinical and laboratorial point of view, making a parallel with microscopically controlled surgeries and raising some important reflections about the relativity of the concept of safety margin. Keywords: Mohs surgery; Skin neoplasms/surgery; Pathology, surgical; Reoperation Resumo: As expressões margem de segurança e margem cirúrgica são usadas freqüentemen-te como sinônimas, embora tenham significados distintos. A margem de segurança é preestabelecida e faz parte do planejamento cirúrgico. A margem cirúrgica é verificada posteriormente pelo patologista ao exame da peça cirúrgica. Na literatura não existe consenso a res-

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Mohs Micrographic Surgery Local Recurrences

Abstract: MMS local recurrences are rare with procedural errors representing a majority of them. Five-year cure rates for basal cell carcinoma may somewhat overestimate the ultimate cure rate.

Cited by 93 publications

References 18 publications

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery

Margem de segurança: um conceito antigo e relativo

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