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Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
Patients with a history of SCC of skin are more likely to develop similar lesions. In a follow-up study of 101 SCC patients, 52% subsequently developed NMSC within 5 years of therapy for the first lesion,172 and 95% of local recurrences and metastases are detected within 5 years.157 It is recommended that patients should be followed up every 3 months for the first year and every 6 months thereafter, for a minimum of 5 years after initial treatment. Patients should be examined for local recurrence, metastatic spread, and new tumors. Recurrent lesions are treated where possible by surgical excision.157 Mohs’ surgery is particularly suitable to ensure complete clearance of recurrent tumor. Patients with recurrent lesions should be followed up indefinitely. All patients should be taught to self-examine regularly for local and regional recurrence.
Treatment of Cancer
Published in Prakash Srinivasan Timiri Shanmugam, Understanding Cancer Therapies, 2018
Known also as Mohs micrographic surgery, Mohs surgery is mainly used in skin cancers. The dermatologist performs both surgical excision of skin cancer and microscopic examination of the surgical margin to confirm that all the skin cancer cells are removed.
Surgery
Published in John Melford, Pocket Guide to Cancer, 2017
A local anesthetic is injected into the skin before surgery. Following removal, each layer of tumor is immediately prepared and examined under a microscope to ascertain if the sample is cancer-free. A minimal amount of normal tissue may be removed with each layer to make sure all tumor cells are excised. Surgery is complete when no more cancer cells are observed, otherwise a further layer of tissue is removed. By this means, Mohs surgery eliminates the guesswork in skin cancer removal. Mohs surgery is routinely used to excise basal cell carcinomas and squamous cell carcinomas, the two most common forms of skin cancer, for which cure rates of 98% have been reported.
Basal cell carcinoma arising within a longstanding hemangioma
Published in Baylor University Medical Center Proceedings, 2022
Dylan Maldonado, Ashley Sturgeon, Michelle Babb Tarbox
A 75-year-old man presented to the dermatology clinic for a full-body skin examination. Upon examination, the provider noted a well-circumscribed, 5 mm red papule on the left lower eyelid (Figure 1a). The patient reported that the lesion had been present for over 10 years, which was confirmed by chart review showing diagnosis as a benign angioma. Upon closer inspection utilizing dermoscopy, the lesion was composed of a central lobular vascular proliferation consistent with a benign angioma. However, on the periphery, arborizing telangiectasias in a milky pink stroma were noted, raising suspicion for basal cell carcinoma (Figure 1b). Following a shave biopsy, histopathology showed nested aggregates of basaloid cells with peripheral palisading within the dermis consistent with basal cell carcinoma. Of note, dilated ectatic lobular collections of blood vessels were also noted consistent with an angioma, leading to the diagnosis of a basal cell carcinoma arising within a benign angioma (Figure 2). The tumor was removed after one stage of Mohs surgery.
Porcine dermal matrix sandwich graft for lower eyelid reconstruction
Published in Orbit, 2021
Philip L. Custer, Robi N. Maamari
During the 5-year study period, 13 procedures were performed on 12 patients following Mohs surgery. One patient underwent repair of bilateral lower eyelid defects in two separate operations. Average age of the seven male and five female patients was 65.4 years (range: 42.3–90.5 years). The width of the marginal eyelid defect ranged from 6 to 16 mm (mean: 11.7 mm), while the width of the dermal matrix graft varied from 5 to 9 mm (mean: 7.7 mm). The vertical height of the grafts ranged from 4 to 7 mm (mean: 5.2 mm). In the seven cases with a small amount of remaining tarsus at the top of the conjunctival flap, the graft was positioned just inferior to the tarsal edge. The graft was covered anteriorly with a rhomboid transposition skin flap in 12 procedures. An advancement skin flap was used in one individual.
Modified second stage Hughes tarsoconjunctival reconstruction for lower eyelid defects
Published in Orbit, 2018
Shruti Aggarwal, Christopher T. Shah, Maria Kirzhner
In our patient series (n = 30), the indication for Mohs surgery was for treatment of basal cell carcinoma (n = 29) and squamous cell carcinoma in situ (n = 1) of the lower eyelid. The lesions were located in the right lower eyelid in 14 (46.67%) and left lower eyelid in 16 (53.33%) cases. The mean size of the post Mohs defect was 23.75 ± 6.6 mm2 horizontally and 9.1 ± 5.4 mm2 vertically, respectively, involving (79.53 ± 16.8%) of the lower eyelid margin. The canaliculus was involved in 14 patients (46.67%). The average time to flap division was 4.24 ± 0.8 weeks. The mean follow-up time after the second stage of the surgery with addition of AMT was 4.41 ± 2.91 months. Twenty one patients had 8 weeks or more of follow-up while only nine patients had 6 weeks of follow-up after flap division. There was no evidence of recurrence of the hyperemic margin following revision (n = 1) and no evidence of a hyperemic margin following a primary addition of AMT (n = 29) at follow-up (Figure 3). One patient (3.3%) developed a small pyogenic granuloma and one patient (3.3%) developed a mild ectropion not needing any surgical intervention. No complications of the donor site for the skin graft or the tarso-conjunctival flap were noted.