Mohs surgery

Um dos sinais do envelhecimento perioral é o alongamento do lábio superior seguido de flacidez perioral que ocasiona a queda do ângulo da boca. São descritas várias técnicas de rejuvenescimento perioral, tais como preenchimentos e técnicas ablativas, observando, porém, que a inversão labial não costuma melhorar totalmente com essas modalidades de tratamento. Relatam-se três casos de queda do ângulo da boca corrigidos cirurgicamente por técnica simples, mas pouco utilizada, que apresenta resultados estéticos satisfatórios. Palavras-chave: boca; envelhecimento; cirurgia plástica.

BACKGROUND. Trichilemmal carcinoma is a rare cutaneous malignancy that usually occurs on the sun-exposed areas of older individuals. The lesion is usually solitary and may present as an exophytic or polypoid nodule that maybe hyperkeratotic with ulceration. OBJECTIVE. To present two cases of trichilemmal carcinoma, one occurring in a kidney transplantation patient. METHODS. Two case reports and a discussion of the rare carcinoma are presented. RESULTS. Both lesions were treated with Mohs micrographic surgery without sign of recurrence after several years. CONCLUSION. Trichilemmal carcinoma is a rare cutaneous malignancy that can be seen in both immunocompetent and immunosuppressed hosts. Mohs micrographic surgery should be considered among the surgical options to avoid a wide surgical excision in these patients.

This article discusses the often unique patient presentations and management challenges of the post Mohs resection surgical patient. This includes social, economic, and health issues. Anesthesia considerations and pre-and postoperative care are also discussed in this article.

Introduction: Defects of the chin after Mohs resection of skin cancer are relatively uncommon yet technically challenging. This is due in part from the numerous topographic features and multiple soft-tissue components such as the underlying muscle layers, the well-defined submental crease, and the bony gonion, all of which contribute to the intricacy of the reconstruction. We review our results over an 11-year period to assess the most commonly used closure techniques and to provide a simplified algorithm for closure of chin defects. Materials and Methods: Retrospective chart review. Approval was obtained by the Institutional Review Board of the University of Texas Southwestern Medical Center for this retrospective medical chart review. All patients undergoing reconstruction of chin defects by the senior author (J.T.) following Mohs excisional chemosurgery from 2005–2013 were included. Pre- and postoperative photographs were reviewed in addition to defect size, location, operative t...

Background: Artificial Intelligence (AI) is increasingly being integrated into facial plastic surgery, offering novel applications in early lesion detection, surgical planning, and aesthetic analysis. The use of AI in this field holds significant potential for improving diagnostic accuracy, optimizing surgical outcomes, and enhancing patient care.

Objective: This study explores the current and future applications of AI in facial plastic surgery, focusing on its role in skin cancer detection and the development of algorithms that assess facial aesthetics.

Methods: A literature review was conducted to evaluate AI’s role in facial plastic surgery, including its use in dermatology, automated facial beauty assessments, and preoperative surgical planning. Recent advancements in AI-driven image analysis, machine learning algorithms, and deep learning-based models were examined.

Results: AI has demonstrated high accuracy in detecting and classifying skin cancer, often outperforming traditional diagnostic methods. In cosmetic surgery, machine learning models have been developed to analyze facial proportions and predict post-operative outcomes. Automated classifiers trained on facial attractiveness criteria have shown capabilities comparable to human evaluators, offering a data-driven approach to surgical planning.

Conclusion: While AI in facial plastic surgery is still in its early stages, its applications in skin cancer detection, facial feature analysis, and outcome prediction are promising. Further research and clinical validation are necessary to refine AI algorithms and integrate them into routine surgical practice, ensuring both safety and efficacy.

Background: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging. Objectives: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour. Methods: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used. Results: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05). Study limitations: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice.

Facial reconstruction is one of the most challenging problems faced by a reconstructive surgeon. We present a case of complex facial reconstruction with a composite trauma to the nose resulting in near total loss of skin and lining along with complete loss of left eyebrow with exposed frontal bone and partial loss of the left eyelid. We combined a temporoparietal fascial flap for reconstruction of the eyebrows and covering the exposed frontal bone and prefabricated forehead flap with skin graft for nasal reconstruction. Proper planning and staging of the surgical procedures and use of local flaps gave us good aesthetic and functional outcome with a satisfied patient.

Surgical defects located within 5 mm of the nasal alar margin are at risk for alar elevation or collapse of the external nasal valve during wound healing. To reduce the chance of such complications, free cartilage grafts may be used as part of the reconstruction. However, if the defect is large enough so that the free cartilage graft does not fill most of the defect, wound contraction can still lead to alar displacement. In these situations, skin may need to be recruited from either the forehead or cheek in the form of an interpolation flap to cover both the free cartilage graft and the residual cutaneous defect. Typically, such reconstructions require multiple procedures at separate time periods and pose prolonged wound care and an inconvenience to the patient. We describe a case of a 94-year-old male who desired an aesthetic reconstruction of a large nasal alar defect that required only a single operative visit. To simplify the repair into a one-stage procedure, a tunneled cheek i...

A 79-year-old man with a biopsy-proven melanoma in situ on the left apical triangle of the lip underwent slow Mohs surgery for definitive treatment. After 5 layers, no residual tumor was seen but a portion of the epidermis was missing. At that time, the defect involved his left nasal sidewall, medial cheek, and upper lip. The patient departed for his native Australia with the resulting defect unrepaired. His plan

In 2005 methylisothiazolinone (MI) was allowed in cosmetics as a preservative at the maximum level of 100 ppm (Cosmetic Directive 2005/42/EC). In four to five years several cases of allergic contact dermatitis (ACD) were published, mainly due to wet wipes for personal hygiene, hair and facial cosmetics, deodorants and sunscreens. In a few years a real epidemic of ACD from MI was installed in Europe 1 and all over the world. In some contact dermatitis clinics more than 10% of patients tested were allergic to MI, mostly with relevant reactions. Young children were also frequently affected. 4 Although there were several alerts from dermatologists and the European Society of Contact Dermatitis, 1 the European regulatory authorities that should protect European citizens have not yet agreed on a final decision to prohibit this potent sensitizer in cosmetic products. As leave-on cosmetics with such high concentrations of MI are known to elicit ACD and, eventually, also sensitize individuals, some in the cosmetic industry have been slowly removing MI from their leave-on products. Until now, apart from clinical data, there was no proof that rinse-off products with MI could also elicit ACD and they are still frequently found in the market. The work elegantly developed by Yazar et al. 5 produced definitive proof that rinse-off products containing MI, even at half the maximum accepted level (50 ppm), elicit ACD in MI-sensitized individuals. Therefore, MI at 50 ppm is not safe and further studies should be done to determine a 'safe' level, if any, of MI in rinse-off cosmetics. Yazar et al. 5 developed a modified repeated open application test (ROAT), with several daily applications of a soap on the forearm, followed by washing, which mimics the daily life exposure to rinse-off products. It is a real-use test that is feasible and can be further used to study other chemicals in rinse-off products. As previously shown for another preservative that had to be removed from cosmetics, methyldibromoglutaronitrile, 6 the documentation of ACD from repeated exposure to MI in rinse-off products suggests that even after very short repeated exposures some chemicals penetrate the stratum corneum, bind skin proteins and accumulate in the skin, reaching the threshold epidermal concentration to initiate the innate and adaptive immune responses responsible for ACD. This may be particularly significant in products containing detergents, like liquid soaps used repeatedly for hand washing, as they enhance skin penetration of sensitizing chemicals and additionally cause minor irritation, thus enhancing both sensitization and elicitation of ACD.

Background The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. Methods Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. Results Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.

BackgroundThe elderly population is increasing and more patients in this group undergo Mohs micrographic surgery (MMS). The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single‐centre studies without a comparison group.ObjectiveTo compare the characteristics of patients, tumours, MMS and 1‐year follow‐up in patients younger than 80 years, with patients older than 80 years at the time of surgery.MethodsData was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour and surgery were recorded. Follow‐up data were collected from two visits; the first within 1 month postsurgery and the second within the first year.ResultsFrom July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75.4%) were aged &lt;80 ye...

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for ...

Background Subungual squamous cell carcinoma (SSCC) is the most common malignancy of the nail unit. Mohs micrographic surgery (MMS) is a microscopically controlled surgical technique that has a high cure rate for skin cancers despite allowing narrow surgical margins. Objective To evaluate the long-term effectiveness of MMS in the treatment of SSCC, and in particular its ability to reduce the number of digital amputations. Methods Fifteen patients diagnosed with SSCC were treated with MMS as the firstline surgical approach, and were followed up for between 2 and 5 years. Results SSCC was completely excised in 13 patients, while two patients required amputation of the distal phalanx. For tumours with predominantly exophytic growth, clinical and radiological findings were found not to be reliable indicators of bone invasion. No recurrences were detected on follow-up. Conclusion Our results show that MMS provides a high cure rate for SSCC and reduces the number of amputations needed. MMS should become the first-line surgical approach for SSCC.

Lentigo maligna (LM) is a relatively common tumour, with increasing prevalence and substantial morbidity. Cases of LM treated with Mohs micrographic surgery (MMS) have been previously reported as single-centre experiences. This retrospective study included patients with a histological diagnosis of LM located on the head and neck area, referred for a surgical procedure to the Skin Cancer Unit, Dermatology, University of Bologna between September 2005 and September 2010. Only cases with at least 5 years of follow-up were included. Patients were divided in three groups: Group A) Patients treated with MMS: tissue was excised at a bevelled angle (generally 45°), to subcutis with a 3 to 4 mm initial margin around the clinically apparent tumour and followed by tissue orientation and precise mapping. Immunostains were not used. For areas with positive margins (defined as nested or confluent single melanocytes with cytologic atypia in any section), an additional 2 mm to 3 mm of tissue was excised from the involved site(s), until clear margins were obtained. Group B) Patients treated with videodermoscopy-assisted MMS (VDS-MMS): after the first MMS step, videodermatoscopy with a 409 magnification (FotoFinderR Dermoscope-Medicam 800 HD) was applied to evaluate the main specimens perimeter (360 degree control); (Fig. ). No gels, but only liquid solutions, were applied in the fresh tissue during the procedure in order to avoid artifacts during frozen sections preparation. When VDS evaluation showed tumour residuals on the perimeter of the lesion, a second surgical step was performed with an additional 2 to 3 mm tissue excision from the involved margin (Fig. ). VDS evaluation of the second excised tissue followed (Fig. ), and a further excision was performed where a residual tumour was suspected, until complete clearing. Group C) Patients treated with conventional surgical excision: the tumour was excised perpendicularly (at a 90°angle), with 5-10 mm distance from the clinical border. 6 Follow-up was performed every 6 months for the first 5 years.

Background Subungual squamous cell carcinoma (SSCC) is the most common malignancy of the nail unit. Mohs micrographic surgery (MMS) is a microscopically controlled surgical technique that has a high cure rate for skin cancers despite allowing narrow surgical margins. Objective To evaluate the long-term effectiveness of MMS in the treatment of SSCC, and in particular its ability to reduce the number of digital amputations. Methods Fifteen patients diagnosed with SSCC were treated with MMS as the firstline surgical approach, and were followed up for between 2 and 5 years. Results SSCC was completely excised in 13 patients, while two patients required amputation of the distal phalanx. For tumours with predominantly exophytic growth, clinical and radiological findings were found not to be reliable indicators of bone invasion. No recurrences were detected on follow-up. Conclusion Our results show that MMS provides a high cure rate for SSCC and reduces the number of amputations needed. MMS should become the first-line surgical approach for SSCC.

The panel's recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario. SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation. References: The citation number and PMID for the reference(s) associated with the recommendation. • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference. • RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure. Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds. Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds. Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.). Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.

Background: The risk of squamous cell carcinoma (SCC) is increased in solid organ transplant recipients (OTRs), and preferential treatment modalities vary among clinicians. Objectives: The purpose of this study was to survey dermatologists regarding practice patterns for electrodesiccation and curettage (EDC) of SCC in OTRs and nontransplant patients. Methods: An 18-question survey was sent to dermatologist members of the International Transplant Skin Cancer Collaborative, Association of Professors of Dermatology, and American College of Mohs Surgery. Differences in EDC practice patterns for treatment of SCC in OTRs and nontransplant patients were evaluated. Results: Dermatologists in this study (N = 227) were more likely to treat SCC with EDC in nontransplant patients (67.4%) than in OTRs (48.0%; P = .0003). Dermatologists who perform EDC in both groups (n = 108) were unlikely to use EDC on the H-zone of the face; they were more likely to EDC tumors on non-H-zone areas of the face and neck in nontransplant patients compared to OTRs (P = .0007). Dermatologists were more likely to use EDC over surgery in nontransplant patients compared to OTRs with the following demographics: dementia or psychiatric disease (P = .04), multiple medical comorbidities (P = .03), or anticoagulation medications (P = .02). Conclusions: In OTRs with SCC, 48% of clinicians would consider EDC. The main factors that affect the decision to perform EDC include tumor location and patient comorbidities.

BACKGROUND. Trichilemmal carcinoma (TLC) is a rare cutaneous neoplasm that occurs in the sun-exposed skin of the elderly. Although the clinical behavior of TLC appears to be relatively indolent, wide excision or Mohs micrographic surgery is the recommended treatment owing to its locally aggressive growth. Recently, imiquimod has become an important part of the armamentarium in the treatment of nonmelanoma skin cancer. OBJECTIVE. This article serves to remind dermatologists that in addition to Mohs micrographic surgery and surgical excision, imiquimod 5% cream may have a role in the treatment of TLC. METHODS. In addition to a review of the literature, we present a case of TLC successfully treated with 5% imiquimod cream. CONCLUSION. Its nonsurgical approach and excellent cosmetic result make imiquimod 5% cream another promising therapeutic option for TLC, even though it is histologically infiltrative.

Introduction: Malignant skin tumors in the majority of cases arise from the squamous epithelium, although they may occur in other accompanying skin structures, such as skin adnexa (hair follicle, sweat and sebaceous glands), as well as soft tissues participating in the building of skin structure, such as muscles, fibrous, fatty tissue and cartilagå. Those tumors may also have a neuroendocrine origin or may arise from a premalignant lesion (solar keratosis and lentigo maligna). Regardless of their origin, they usually present as a nodule or longstanding, non-healing ulceration. Their early recognition enhances the treatment results and decreases the possibility of complications (invasion of deeper tissue structures and occurrence of regional and distant metastases). Material and methods: Our retrospective study included 100 patients of both sexes surgically treated for skin malignancy in the Department for Otorhinolaryngology and Maxillofacial surgery of the Clinical Hospital Centre ...

Background: Dermatologists are at risk of body-fluid contamination during procedures. Objective: We sought to determine the frequency of blood splash during procedural dermatology. Methods: In all, 500 consecutive excisions were performed. Postoperatively, blood droplets on face shields and surgical gowns were counted. A survey regarding universal precautions during procedures was also conducted with members of the American College of Mohs Surgery (ACMS). Results: Contamination from blood splashes during dermatologic procedures (Mohs micrographic surgery, excision, repair) occurred in 66.4%. Reconstruction type, anticoagulation use, wound location, and wound size correlated with a higher blood splash rate. Our survey showed that face shields and goggles are used inconsistently. Limitations: The 4 participating dermatologists do not represent all practicing dermatologists. It may be possible to generalize the survey results directed at physicians in the ACMS. Physician body-fluid contamination risk with procedural dermatology is clinically significant. Dermatologists and their assistants should wear preventive barriers during procedures to minimize the risk of viral transmission. (

In the routine handling of Mohs specimens the curetted first layer is integral to the process of tumor identification. Small specimens may be smeared inadvertently on filter paper or gauze or even lost between the operating room and laboratory. An efficient method for processing small curetted specimens has been devised that bypasses the use of a tissue tray. This method improves tissue morphology and saves time.

The department of Dermatology of the University hospital Maastricht performed a randomised trial to compare the cost-effectiveness of surgical excision (SE) and Mohs Micrographic surgery (MMS) in a group of patients with primary and recurrent facial Basal Cell Carcinoma (BCC). METHODS: Hospital costs, recurrence rates and quality of life data (NHP and STAI) were collected during a time period of 18 months. The Incremental Cost Effectiveness Ratio's were calculated based on incremental costs per recurrence avoided, both for primary and recurrent BCC. The reliability of the ICER was estimated by means of bootstrap simulations. RESULTS: In total 408 primary BCC and 204 recurrent BCC were randomised to either SE or MMS. The ICER for primary BCC amounted to €25.200. Seventy-four percent of all ratio's were within the quadrant where MMS is more effective but also more costly. Twenty-four percent of all ratio's were in the quadrant where SE dominates. The ICER for recurrent BCC amounted to €7.733. All ratios were within the quadrant where MMS is more effective but also more costly. For both primary and recurrent BCC group, quality of life was not statistically significant different between SE and MMS. CONCLUSIONS: Based on costs and the recurrence rates, it is not cost-effective to introduce MMS for primary BCC on a large scale. However, other aspects like the patient perspective have not been examined in this study. It is possible that patients have a specific preference for either one of the two treatment modalities. For the recurrent BCC both ICER and bootstrap results should be treated with caution since only fifty percent of the patients with recurrent BCC have completed their 18-month follow-up. Possible changes in the recurrence rate may have a considerable effect on the final cost-effectiveness ratio of this group.

Aim With the rapidly increasing number of basal cell carcinomas in Europe, a close look at Mohs Micrographic Surgery (MMS) is timely. Subject We report the results of MMS in the Netherlands, as treatment for extensive basal cell carcinomas. Metbods Patients {n = 198) with extensive basal cell carcinoma (n = 208) were treated with MMS. The mean follow up period was 6.4 years. Results Four of 208 BCCs recurred. Conclusions Considering a recurrence rate of only 2% for the treatment of extensive and mainly recurrent basal cell carcinomas, we suggest that MMS provides the best prospect for total tumour removal.

Background The incidence of skin cancer and especially basal cell carcinoma (BCC) has increased in the last decade and is still increasing. Many treatment modalities can be used to treat BCC; surgical excision is the most frequently used. Mohs' micrographic surgery (MMS) is an advanced excision technique which is often used to treat BCC in the U.S.A. In Europe it is practised less frequently. Objective The aim of this article was to evaluate the efficiency of MMS for the treatment of facial BCC. Methods In a retrospective study recurrence rates after the treatment of facial BCC by MMS were estimated by reviewing the records of all patients with BCCs (620 patients with 720 BCCs) treated by MMS in our department from April 1992 until December 1999. Results The 5-year recurrence rates estimated from this study were 3AE2% for primary BCC and 6AE7% for recurrent BCC. Prognostic factors for recurrence are: an aggressive histopathological subtype, more than four Mohs' stages, a large defect size and a recurrent BCC. Conclusion Based on the fact that MMS provides the lowest recurrence rates, it is the treatment of first choice for primary facial BCCs with an aggressive histopathological subtype and for recurrent BCCs in the face.

the study. Of these, 102 were in the SE group and 102 in the MMS group. The mean age was 67.9 (+/-11.7) years and 58% were male. Patients with more than one BCC were included multiple times. Study design This was a prospective, randomised clinical trial that was carried out at a single centre, the dermatology outpatient clinic of the University Hospital Maastricht. Separate randomisation procedures were performed for both primary and recurrent BCC. The length of follow-up was 30 months for the primary BCC sample and 18 months for the recurrent BCC sample. In the group of primary BCC, 33 patients (16%) in the SE group and 44 patients (22%) in the MMS group were lost to follow-up. In the group of recurrent BCC, 9 patients (9%) in the SE group and 7 patients (7%) in the MMS group were lost to follow-up. Blinding does not appear to have been performed.

RESUMO-Introdução: A cirurgia micrográfica de Mohs é um método cirúrgico de tratamento dos tumores cutâneos que consiste no controlo histológico das margens do tumor usando cortes horizontais em camadas finas congeladas a fresco. Esta técnica é uma indicação preferencial para tumores cutâneos da face (carcinoma basocelular e espinocelular, entre outros) associados a maior risco de recidiva, tumores recidivados, com margens clínicas indefinidas, quando existe envolvimento perivascular e perineural ou com subtipos histológicos agressivos. Métodos: Os autores realizaram um estudo retrospetivo de um período de 6 anos (de julho 2012 até junho 2018) num hospital Português-Hospital de Egas Moniz, para definir as características dos doentes submetidos a cirurgia micrográfica de Mohs e avaliar as vantagens desta técnica. Foram analisados os fatores: idade, género, proveniência, diagnóstico, localização do tumor, número de estádios da cirurgia micrográfica de Mohs, tipo de reconstrução do defeito cirúrgico, seguimento e recidiva. Resultados: Foram operados 835 tumores no total, 459 em doentes do sexo masculino e 376 em doentes do sexo feminino. A média de idades foi de 71 anos (intervalo entre 23-95 anos). A maioria dos tumores submetidos a cirurgia micrográfica de Mohs foram carcinomas basocelulares (87%) localizados na pirâmide nasal (43%). Em 44% dos casos, houve necessidade de realizar mais de um estadio micrográfico. Metade dos encerramentos do defeito cirúrgico foram realizados por enxerto ou retalho cutâneo. Em doentes com seguimento igual ou superior a 3 anos, a taxa de recidiva foi de 4,9%. Discussão: O diagnóstico mais frequente foi o de carcinoma basocelular, o que reflete a importância da cirurgia micrográfica de Mohs, neste tipo de neoplasia cutânea, quer em lesões primárias como persistente/recorrentes. Salientamos que comparativamente a outras revisões europeias de cirurgia de Mohs, a taxa de recidiva dos tumores se encontra dentro dos parâmetros normais. Este dado é particularmente relevante, se considerarmos que o nosso serviço recebe doentes enviados de hospitais e dermatologistas de todo o país, especialmente selecionados quanto à agressividade tumoral ou já recidivados. O intervalo médio de recorrência para MMS foi de 27,9 meses, o que demonstra a necessidade de um seguimento a longo prazo destes doentes. Conclusão: A cirurgia micrográfica de Mohs permite menores taxas de recidiva comparativamente á excisão cirúrgica simples pelo que a sua prática deve ser encorajada em tumores devidamente selecionados. O controlo cirúrgico das margens em vez das "margens cegas" é uma mais-valia tanto na poupança de tecido são como na garantia da excisão completa do tumor num mesmo tempo cirúrgico. PALAVRAS-CHAVE-Cirurgia de Mohs; Neoplasias da Pele; Portugal.

Expert diagnosis of cutaneous pathology requires precise anatomic description. This brief report will review the clinically relevant surface anatomy of the ear. Bien connaître l'anatomie de l'oreille a des incidences sur le plan clinique en ce qui concerne l'é volution des cancers de la peau sié geant en des points particuliers et la complexité de la reconstruction chirurgicale. Le cas pré senté ici et l'examen de l'anatomie de la surface de l'oreille aideront les cliniciens à repé rer ces points particuliers.

Expert diagnosis of cutaneous pathology requires precise anatomic description. This brief report will review the clinically relevant surface anatomy of the ear. Bien connaı̂tre l’anatomie de l’oreille a des incidences sur le plan clinique en ce qui concerne l’évolution des cancers de la peau siégeant en des points particuliers et la complexite ́ de la reconstruction chirurgicale. Le cas présente ́ ici et l’examen de l’anatomie de la surface de l’oreille aideront les cliniciens a ̀ repérer ces points particuliers. N ONMELANOMA SKIN CANCER (NMSC) is themost common type of human cancer.1,2 It accounts for over 1 million new cases in the United States every year3,4 and over 80,000 new cases in Canada, more than cancers of the lung, colorectum, and breast combined.2 Although NMSC generally carries an excellent prognosis, with a very low mortality rate,5 several factors have important prognostic implications. These include the tumor size and type, immune status of the patient, and ana...

Background: Surgical excision is the treatment of choice for basal cell carcinoma. Complete removal is the key to cure. Objective: To determine the utility of intraoperative frozen section in basal cell carcinoma surgery of high risk cases on the head and neck to achieve margin clearance.

Dermatofibrosarcoma protuberans (DFSP) and giant cell fibroblastoma (GCF) are recurrent, infiltrative skin tumors that presently are treated with surgery. DFSP and GCF tumors are genetically characterized by chromosomal rearrangements fusing the collagen type Ialpha1 (COLIA1) gene to the platelet-derived growth factor B-chain (PDGFB) gene. It has been shown that the resulting COL1A1/PDGF-B fusion protein is processed to mature PDGF-BB. Autocrine PDGF receptor stimulation has therefore been predicted to contribute to DFSP and GCF tumor development and growth. Here we demonstrate presence of activated PDGF receptors in primary cultures derived from six different DFSP and GCF tumors. Three of the primary cultures were further characterized; their in vitro growth displayed an increased sensitivity to treatment with the PDGF receptor tyrosine kinase inhibitor STI571, as compared with normal fibroblasts. Transplantable tumors, displaying a DFSP-like histology, were established from one of...