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Zhou, Xiaobo; Sun, Di; Liu, Yang; Sun, Qilin; Yuan, Zhaoqi; Luo, Xusong; Yang, Jun; Chen, Jun
doi: 10.1080/09546634.2019.1622629pmid: 31116621
AbstractBackground: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma. Its high recurrence rate is a clinical challenge.Objective: To analyze DFSP clinicopathologic factors and review our experience of treatments.Materials and methods: A total of 80 patients who were treated between 2007 and 2017 in Shanghai Ninth People’s Hospital were evaluated. Outcomes were compared focusing on recurrence following different treatment methods. Classical DFSP and transformed DFSP were classified as the two subtypes.Results: The recurrence rate after local excision was significantly higher than that after wide margin excision. Patients undergoing wide margin excision (margins over 3 cm) were found to have lower recurrence rate compared with those margins less than 3 cm, while 10 underwent Mohs surgery were not found recurrence. Transformed DFSP had a greater tendency to recur.Conclusions: Clean margin of excision should be achieved to prevent recurrence of DFSP. Slow Mohs surgery is recommended to treat DFSP.
Phan, Kevin; Onggo, James; Loya, Asad
doi: 10.1080/09546634.2019.1639605pmid: 31264932
AbstractBackground: Various surgical options can be used to remove melanoma in situ (MIS). These include wide local excision (WLE), staged excision, and Mohs micrographic surgery (MMS). For MIS lesions located in the head and neck regions, the WLE approach may not always be a technically feasible option if both cosmesis and anatomical function is to be preserved.Methods: We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEERs) cancer registry. A total of 7933 cases of MIS in the head and neck region were included in this study, of which 5353 cases were treated by WLE and the remaining 2580 cases by MMS.Results: Comparing between the WLE and MMS group, cancer-specific survival rates at 5 (99% vs. 99%) and 10 years (98% vs. 98%) as well as the 5 year overall survival rate (85% vs. 86%) were similar. After adjusting for confounders, there was no significant difference in cancer-specific survival (HR: 0.902, 95% confidence interval (CI): 0.539–1.511, p = .695) and overall-survival (HR: 0.943, 0.813–1.093, p = .435).Conclusions: For cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MIS due to its tissue-preserving nature particularly in the head and neck region.Key PointsOur adjusted analysis demonstrates similar overall and cancer-specific survival for Mohs surgery vs wide local excision for head and neck melanoma-in-situFor cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MISThis is due to its tissue-preserving nature particularly in the head and neck region
Barnes, Elizabeth A.; Sinclair, Emily; Assaad, Dalal; Fialkov, Jeffrey; Antonyshyn, Oleh; Tsao, May N.
doi: 10.1080/09546634.2019.1641582pmid: 31294616
AbstractBackground: Historically, radiation to skin cancers for the lower legs has been avoided due to the perceived increased risk of radiation toxicity (poor wound healing, radiation necrosis). However, there is a paucity of published data regarding this perceived risk.Purpose: The objective was to review the risk of poor wound healing/radiation necrosis occurring post radiation and to determine rates of complete response (CR), partial response (PR), and progressive disease after radiation therapyMaterials and methods: A retrospective review of patients treated with radiation for skin cancer below the knee was undertaken from January 1, 2013 to May 31, 2018.Results: A total of 25 patients with 39 below the knee skin sites were treated with radiation. Mean follow-up time was 19 months (range 3 months–7.2 years). Crude CR, PR and progression rates for the treated lesions were 65%, 19%, and 16% respectively. Four out of 23 (17%) patients developed Grade 3 skin toxicity. There were no grades 4 or 5 toxicities.Conclusions: For patients not eligible for surgery, radiation therapy is an option with a moderate chance of complete response (65%) and a 17% risk of poor wound healing/radiation necrosis.
Puyana, Carolina; Zimmerman, Lacey; Tsoukas, Maria M.
doi: 10.1080/09546634.2019.1654074pmid: 31474170
AbstractBackground: Skin cancer has the highest incidence of all cancers in the United States. Conventional surgical excision (CSE) and Mohs micrographic surgery (MMS) are among the most common surgical treatment options for skin cancer.Objective: The purpose of this study was to examine utilization patterns of MMS compared to CSE in the United States for non-basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) skin cancers.Methods: Data from the NCI SEER program, collected from 1973 to 2015, were retrospectively analyzed. Cases were separated into MMS and CSE. Patient characteristics were analyzed. Multivariate models were fitted to evaluate significant predictors for MMS.Results: Of the total procedures performed during the years 1988–2015, a total of 12,654 MMS cases and 267,291 CSE were considered for analysis. Females, white, and non-Hispanic patients of increasing age were more likely to undergo MMS compared to CSE. Cases diagnosed in the pacific coast, east, and southwest regions were more likely to be treated with MMS compared to those in the northern plains Additionally, in situ cases and of the face had the highest likelihood of being treated with MMS.Conclusions: Studying demographics and tumor characteristics aid in understanding the utilization patterns of MMS.
doi: 10.1080/09546634.2019.1657223pmid: 31418320
AbstractObjective: To assess the prognostic impact of socioeconomic status (SES) on the outcome of cases with cutaneous melanoma.Methods: Novel SEER socioeconomic database has been accessed and patients with malignant melanoma of the skin (2000–2015) were reviewed. SES was evaluated through a specialized multi-dimension index and patients were classified into three groups (group 1/2/3) where group 1 has the lowest SES and group 3 has the highest SES. Kaplan–Meier survival estimates were used to evaluate the impact of SES on overall survival and multivariable Cox regression analysis was used to assess the impact of SES on melanoma-specific survival.Results: A total of 261,076 patients with malignant melanoma of the skin were included in the current study. Among which, 44,804 patients were within group 1 SES, 84,168 patients were within group 2 SES and 132,104 patients were within group 3 SES. Kaplan–Meier survival analysis was performed, and it showed that patients with lower SES have worse overall survival (p < .001). Multivariable Cox regression analysis was subsequently performed, and it showed also that lower SES is associated with worse melanoma-specific survival (hazard ratio for group 1 versus group 3 SES: 1.361; 95% CI: 1.315–1.409; p < .001).Conclusion: Patients with cutaneous melanoma and lower SES have worse overall and melanoma-specific survival compared to patients with higher SES. This finding was consistent among different clinical subsets of patients according to stage, race/ethnicity, and year of diagnosis.
Philipp-Dormston, Wolfgang G.; Battistella, Maxime; Boussemart, Lise; Di Stefani, Alessandro; Broganelli, Paolo; Thoms, Kai-Martin
doi: 10.1080/09546634.2019.1679335pmid: 31625770
AbstractIntroduction: Actinic keratosis (AK) is a chronic skin condition that can be a precursor to cutaneous squamous cell carcinoma. AK can recur and patients are likely to undergo multiple treatments. It is important that AK lesions are managed appropriately, and that patients are involved in treatment decisions.Materials and methods: The Supporting Professional Expertise in AK (SPEAK) program aims to facilitate this patient-centered care by identifying patient needs and aiding healthcare practitioners (HCPs) in selecting optimal treatment and communication strategies for different types of patients. Twenty-two dermato-oncologists with established expertise in the treatment of AK collaborated to describe commonly encountered psychosocial patient profiles, and to develop respective communication and treatment strategies.Results and conclusion: Six patient profiles were defined based on different psychosocial characteristics and were used to develop appropriate management approaches. We provide a systematic way of identifying these patient profiles in clinical practice and we outline communication strategies tailored to the primary needs of each type of patient. In addition, we provide recommendations for potential field-treatments that may be best suited for each profile. The recommendations provided here may help improve the communication and relationship between patients and HCPs, resulting in higher treatment adherence and improved patient outcomes.
Duarte, B.; Vieira, L.; Pessoa e Costa, T.; Ribeiro, L.; João, A.; Cabete, J.; Varanda, A.
doi: 10.1080/09546634.2019.1687815pmid: 31689139
AbstractIntroduction: Surgical treatment of basal cell carcinomas is often performed by physicians with different surgical backgrounds. Collecting data from different surgical departments would better reflect their real-life surgical management.Objectives: To identify the rate, recurrence risk, and predictive factors accordingly to their relative contribution for an incomplete basal cell carcinoma excision in a large multidisciplinary real-life settingMethods: Retrospective cohort study of 2305 surgically treated lesions in different departments of a tertiary center.Results: There was a rate of incomplete excisions (15%) and a recurrence rate (35.5% vs. 6.8% in incomplete vs. complete excisions (p < .001)). A third of incompletely excised basal cell carcinoma (BCC) will recur over time. Stratified by relevancy, high-risk histological subtypes (micronodular (OR 5.10 – p < .001) and morpheaform (OR 5.42 – p < .001), smaller specimen sizes ( <0.5 cm or 0.5–1 cm, OR 3.99 and 2.49, respectively, p < .001) high-risk locations (OR 3.06 on the nose, OR 2.77 on the eyelids, p < .001), and recurrent BCCs (OR 1.72, p < .001). are the best predictors of an incomplete excision.Conclusions: Acknowledging the rate, recurrence risk and predictive factors for incomplete excisions may be beneficial for optimal preoperative planning and to prevent unwarranted re-interventions, morbidity, and healthcare costs.
Filho, Roberto Bueno; de Carvalho Fantini, Bruno; dos Santos, Cecília Anatriello; Melo, Rafael V. G.; Rosan, Isadora; Chahud, Fernando; da Silva Souza, Cacilda
doi: 10.1080/09546634.2019.1695724pmid: 31751157
AbstractBackground: Residual tumors increase the likelihood of recurrence of basal cell carcinoma (BCC).Objective: We determined the attributes and risk factors for positive surgical margins (+SM) of excised BCC in a university hospital.Methods: In this cross-sectional retrospective study, we reviewed the histologic reports of BCC removed via conventional surgical excision (CSE) by specialists from different fields.Results: Among excised BCCs (n = 864), there was a predominance of nodular BCC (82.64%) in the facial H-area (72.81%; average diameter = 9.12 mm), which had the highest + SM rate (20.17%). Most cephalic (ce-BCC; 69.01%) and non-cephalic (91.11%) BCCs were excised by dermatologists, with low rates of + SM (4.53%; 1.46%, respectively); the overall + SM rate was 12.73%. Men had larger (p < .001) and more ulcerated (p = .04) BCC. An aggressive histologic pattern (Ag-P) (p < .04) and ulceration (p < .001) were correlated with tumor size on multivariate analysis. The risk for + SM increased in ulcerated ce-BCC (p = .02), BCC with Ag-P (p = .02), and in the H-area (p < .001), nasal (p = .007), and labial (p = .05) regions. ce-BCC excised by head-neck surgeons had a high chance of ulceration (p < .001) and Ag-P (p = .002).Conclusions: Ag-P and H-zone remain critical risk factors for + SM. Accordingly appropriate treatment protocols should be used to ensure low + SM rates via CSE.
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