Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up

Mosterd, Klara; Krekels, Gertruud A. M.; Nieman, Fred; Ostertag, J.U.; Essers, Brigitte; Dirksen, Carmen D.; Steijlen, P.M.; Vermeulen, Anton H. M.; Neumann, H. A. M.; Kelleners‐Smeets, Nicole W.J.

doi:10.1016/s1470-2045(08)70260-2

Cited by 399 publications

(331 citation statements)

References 21 publications

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“…The first RCT for MMS comparing MMS with standard excision of primary and recurrent facial BCC was conducted in the Netherlands. 32,33,49 In the final analysis, a 10-year recurrence rate of 4.4% was reported for primary facial BCC treated with MMS, compared with 12.2% (P = .100) following standard excision. For recurrent BCC, the 10-year recurrence rates were 3.9% and 13.5% (P = .023) after MMS and standard excision, respectively.…”

Section: Standard Excisionmentioning

confidence: 95%

“…32 Cox regression analysis identified an aggressive histologic growth pattern as a significant risk factor for recurrence. 49 These findings cannot necessarily be extrapolated beyond the scope of the study population with facial BCC. However, the results strongly support the use of MMS for both primary and recurrent BCC at increased risk for recurrence on the basis of factors such as anatomic location and histologic growth pattern.…”

Section: Standard Excisionmentioning

confidence: 98%

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Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

311

219

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Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed. ( J Am Acad Dermatol

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Section: Standard Excisionmentioning

confidence: 95%

Section: Standard Excisionmentioning

confidence: 98%

Guidelines of care for the management of basal cell carcinoma

Baum¹,

Bordeaux²,

Brown³

et al. 2018

Journal of the American Academy of Dermatology

311

219

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“…However, ensuring the complete excision of the tumor remains one of the key challenges in tissue-conserving surgery. Failure to remove all tumor cells increases the risk of tumor recurrence and the need for secondary surgery (6,7).…”

mentioning

confidence: 99%

Diagnosis of tumors during tissue-conserving surgery with integrated autofluorescence and Raman scattering microscopy

Kong

Rowlands

Varma

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

221

223

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Tissue-conserving surgery is used increasingly in cancer treatment. However, one of the main challenges in this type of surgery is the detection of tumor margins. Histopathology based on tissue sectioning and staining has been the gold standard for cancer diagnosis for more than a century. However, its use during tissue-conserving surgery is limited by time-consuming tissue preparation steps (1-2 h) and the diagnostic variability inherent in subjective image interpretation. Here, we demonstrate an integrated optical technique based on tissue autofluorescence imaging (high sensitivity and high speed but low specificity) and Raman scattering (high sensitivity and high specificity but low speed) that can overcome these limitations. Automated segmentation of autofluorescence images was used to select and prioritize the sampling points for Raman spectroscopy, which then was used to establish the diagnosis based on a spectral classification model (100% sensitivity, 92% specificity per spectrum). This automated sampling strategy allowed objective diagnosis of basal cell carcinoma in skin tissue samples excised during Mohs micrographic surgery faster than frozen section histopathology, and one or two orders of magnitude faster than previous techniques based on infrared or Raman microscopy. We also show that this technique can diagnose the presence or absence of tumors in unsectioned tissue layers, thus eliminating the need for tissue sectioning. This study demonstrates the potential of this technique to provide a rapid and objective intraoperative method to spare healthy tissue and reduce unnecessary surgery by determining whether tumor cells have been removed.

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“…Positive margins on dura mater and the mastoid bone required adjuvant radiotherapy. [16,17]. Exceeding the advantages, it is timeconsuming and costs are greatly higher than classic excision [6].…”

Section: Discussionmentioning

confidence: 99%

Invasive basosquamous cell carcinoma of the head treated with wide excision and reconstruction with fascia lata graft and two muscle flaps. Case report

Chelmuș¹,

Dobreanu²,

Tripa³

et al. 2015

Arch Clin Cases

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Background: Basosquamous carcinoma (BSC) is a variant of basal cell carcinoma subtype that is locally aggressive with high tendency for recurrence and metastasis and a poor prognosis. Up to 95% are located in head and neck area. Treatment for invasive BSC with aggressive growth pattern is wide excision and reconstruction. Complex defects require free tissue transfer to protect underlying structures and to sustain the adjuvant radiotherapy.Case report: A 57 year-old male presented with ulcerated, bleeding tumors in frontal and periauricular area, identified as BSC on biopsy. CT-scan revealed contact to dura mater. Wide excision included frontal bone and dura mater, frontal sinus, lateral orbital wall and exenteration, ear en-bloc with parotid gland. Dura mater was replaced with fascia lata graft, frontal sinus was filled with pedicled temporalis muscle and 20/25 cm soft tissue defect was covered with free Latissimus dorsi muscle anastomosed to superior thyroid artery and internal jugular vein branch, respectively. The muscle was skin grafted 14 days later.Results: Postoperative recovery was complicated: cerebrospinal fluid leak, extradural hematoma, posthemorrhagic anemia, pneumonia, and withdrawal syndrome, remitted under specific treatment. Muscle flap survived entirely with skin graft fully integrated. Positive margins on dura mater and mastoid bone required radiotherapy.Conclusions: Wide excision of head invasive BSC resulted in complex defect reconstructed with fascia lata graft, temporalis muscle and Latissimus dorsi free flap grafted secondarily. Short-term evaluation showed no recurrence and good life-quality; follow-up is needed to evaluate long-term results. Interdisciplinary approach is the key for patient's successful treatment.

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Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up

Cited by 399 publications

References 21 publications

Guidelines of care for the management of basal cell carcinoma

Guidelines of care for the management of basal cell carcinoma

Diagnosis of tumors during tissue-conserving surgery with integrated autofluorescence and Raman scattering microscopy

Invasive basosquamous cell carcinoma of the head treated with wide excision and reconstruction with fascia lata graft and two muscle flaps. Case report

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