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3.
An Bras Dermatol ; 97(3): 291-297, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35379511

RESUMO

BACKGROUND: Mohs Micrographic Surgery (MMS) is commonly used to treat high-risk basal cell carcinoma (BCC). OBJECTIVES: Correlate clinicopathologic preoperative features with the number of MMS stages (primary endpoint) and margins (secondary endpoint) required for BCC complete excision. METHODS: We retrospectively analyzed BCCs treated by MMS in a 2-year period at the study's institution. Variables studied included the patient gender, age, immune status, lesion size, location, if it was a primary, recurrent, or persistent tumor, histopathologic characteristics, number of surgical stages, and amount of tissue excised. RESULTS: 116 BCCs were included. The majority (61.2%, n = 71) required a single-stage surgery for complete clearance, requiring a final margins of 3.11 ± 2.35 mm. Statistically significant differences between locations in different high-risk areas (periocular, perioral, nose, ear) and the number of MMS stages required for complete excision (p = 0.025) were found, with periocular tumours requiring the highest mean of stages (2.29 ± 0.95). An aggressive histopathology significantly influenced the number of MMS stages (p = 0.012). Any significant relation between clinicopathological features and variation in the final surgical margins was found, just certain tendencies (male patients, persistent tumor, periocular location, and high-risk histopathological tumors required larger margins). Neither patient age or tumor dimension correlated significantly with both number of MMS stages and final surgical margins. STUDY LIMITATIONS: Limitations of this study include its single-center nature with a small sample size, which limits the value of conclusions. CONCLUSION: Main factors related to a greater number of MMS stages were periocular location and high-risk histopathological subtype of the tumor.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Humanos , Masculino , Margens de Excisão , Cirurgia de Mohs , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
4.
An. bras. dermatol ; 97(3): 291-297, 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1383575

RESUMO

Abstract Background Mohs Micrographic Surgery (MMS) is commonly used to treat high-risk basal cell carcinoma (BCC). Objectives Correlate clinicopathologic preoperative features with the number of MMS stages (primary endpoint) and margins (secondary endpoint) required for BCC complete excision. Methods We retrospectively analyzed BCCs treated by MMS in a 2-year period at the study's institution. Variables studied included the patient gender, age, immune status, lesion size, location, if it was a primary, recurrent, or persistent tumor, histopathologic characteristics, number of surgical stages, and amount of tissue excised. Results 116 BCCs were included. The majority (61.2%, n = 71) required a single-stage surgery for complete clearance, requiring a final margins of 3.11 ± 2.35 mm. Statistically significant differences between locations in different high-risk areas (periocular, perioral, nose, ear) and the number of MMS stages required for complete excision (p = 0.025) were found, with periocular tumours requiring the highest mean of stages (2.29 ± 0.95). An aggressive histopathology significantly influenced the number of MMS stages (p = 0.012). Any significant relation between clinicopathological features and variation in the final surgical margins was found, just certain tendencies (male patients, persistent tumor, periocular location, and high-risk histopathological tumors required larger margins). Neither patient age or tumor dimension correlated significantly with both number of MMS stages and final surgical margins. Study limitations Limitations of this study include its single-center nature with a small sample size, which limits the value of conclusions. Conclusion Main factors related to a greater number of MMS stages were periocular location and high-risk histopathological subtype of the tumor.

5.
An. bras. dermatol ; 96(6): 693-699, Nov.-Dec. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1355635

RESUMO

Abstract Background: There are conflicting data regarding the prognostic value of the lymphatic basin drainage pattern in melanoma patients and the evidence is scant in the setting of negative sentinel lymph node biopsy. Objective: To investigate whether the pattern of lymphatic basin drainage influences the risk of nodal disease in patients with melanoma of the trunk and negative sentinel lymph node biopsy. Methods: A case series of patients with trunk melanoma and negative sentinel lymph node biopsy was retrospectively evaluated. Clinicopathological features, the pattern of lymphatic drainage and nodal, metastatic, and overall recurrence-free survival were reviewed. Results: Of the 135 patients included, multiple lymphatic basin drainage was identified in 61 (45.2%). Ten of the 74 (13.5%) patients with single drainage developed nodal recurrence, compared with 2 of the 61 (3.6%) patients with multiple drainages (p = 0.04). Nodal recurrence-free survival was significantly longer in the group with multiple drainages than in the group with single drainage (175.6 vs. 138.7 months; p = 0.04). In multivariate analysis, single drainage was associated with a higher risk of nodal recurrence (HR = 4.54; p = 0.05). No significant differences in metastatic and overall recurrence-free survival were found between groups. Study limitations: Retrospective analysis, single-center study, small sample, detailed histopathologic information not always present. Conclusions: In patients with trunk melanoma and negative sentinel lymph node biopsy, multiple lymphatic basin drainage may be an independent risk factor for nodal disease recurrence. This factor may help to identify patients with negative sentinel lymph node biopsy with a higher risk of nodal recurrence.


Assuntos
Neoplasias Cutâneas/cirurgia , Melanoma/cirurgia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Excisão de Linfonodo , Linfonodos , Recidiva Local de Neoplasia
6.
An Bras Dermatol ; 96(6): 693-699, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34620526

RESUMO

BACKGROUND: There are conflicting data regarding the prognostic value of the lymphatic basin drainage pattern in melanoma patients and the evidence is scant in the setting of negative sentinel lymph node biopsy. OBJECTIVE: To investigate whether the pattern of lymphatic basin drainage influences the risk of nodal disease in patients with melanoma of the trunk and negative sentinel lymph node biopsy. METHODS: A case series of patients with trunk melanoma and negative sentinel lymph node biopsy was retrospectively evaluated. Clinicopathological features, the pattern of lymphatic drainage and nodal, metastatic, and overall recurrence-free survival were reviewed. RESULTS: Of the 135 patients included, multiple lymphatic basin drainage was identified in 61 (45.2%). Ten of the 74 (13.5%) patients with single drainage developed nodal recurrence, compared with 2 of the 61 (3.6%) patients with multiple drainages (p = 0.04). Nodal recurrence-free survival was significantly longer in the group with multiple drainages than in the group with single drainage (175.6 vs. 138.7 months; p = 0.04). In multivariate analysis, single drainage was associated with a higher risk of nodal recurrence (HR = 4.54; p = 0.05). No significant differences in metastatic and overall recurrence-free survival were found between groups. STUDY LIMITATIONS: Retrospective analysis, single-center study, small sample, detailed histopathologic information not always present. CONCLUSIONS: In patients with trunk melanoma and negative sentinel lymph node biopsy, multiple lymphatic basin drainage may be an independent risk factor for nodal disease recurrence. This factor may help to identify patients with negative sentinel lymph node biopsy with a higher risk of nodal recurrence.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Excisão de Linfonodo , Linfonodos , Melanoma/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
7.
Surg. cosmet. dermatol. (Impr.) ; 11(2): 156-159, Abr.-Jun. 2019. ilus.
Artigo em Inglês, Português | LILACS | ID: biblio-1008533

RESUMO

A reconstrução de defeitos que envolvam até 2/3 da extensão dos lábios é desafiadora, levando-se em consideração a importância funcional e estética desta estrutura. Existem diversas técnicas cirúrgicas descritas para esta finalidade, salientando-se o retalho de Abbe- Estlander, o retalho de Karapandzic e o retalho de Bernard-Burrow-Webster. A escolha da melhor abordagem deve levar em conta a dimensão e localização do defeito e as comorbidades do doente. O retalho de Yu constitui uma alternativa a ser considerada em relação a outros métodos, permitindo obter geralmente excelentes resultados cosmético- -funcionais.


The reconstruction of defects involving up to 2/3 of the lip extension is challenging, considering the functional and aesthetic importance of this structure. There are several surgical techniques described for this purpose, highlighting the Abbé-Estlander flap, the Karapandzic flap, and the Bernard-Burrow- Webster flap. The choice of the best approach should consider the size and location of the defect as well as the comorbidities of the patient. The reverse Yu flap is an alternative to be considered in relation to other methods, allowing obtaining excellent cosmetic-functional results in general.


Assuntos
Retalhos Cirúrgicos
8.
Surg. cosmet. dermatol. (Impr.) ; 10(4): 346-348, Out.-Dez. 2018. ilus.
Artigo em Inglês, Português | LILACS | ID: biblio-1007948

RESUMO

Os defeitos cutâneos da pálpebra inferior frequentemente requerem reconstruções com enxertos ou retalhos para evitar-se o ectrópio. A retirada de um carcinoma basocelular da pálpebra inferior de uma paciente de 39 anos resultou em um defeito exclusivamente cutâneo, com diâmetros transversal e vertical de 32 e 13mm, respectivamente. Apesar da grande dimensão do defeito, a elevação da fáscia suborbicular dos olhos para o periósteo da borda orbital lateral permitiu o fechamento primário. A posição da pálpebra inferior também foi reforçada com uma cantopexia lateral, com excelentes resultados estético e funcional.


Cutaneous defects of the lower eyelid frequently require reconstructions with grafts or flaps to avoid ectropion. Removal of a basal cell carcinoma from the lower eyelid of a 39-year-old patient resulted in an exclusively cutaneous defect, with transversal and vertical diameters of 32 and 13mm, respectively. Despite the large size of the defect, the elevation of the suborbicularis oculi fascia to the periosteum of the lateral orbital border made primary closure possible. The position of the lower was also reinforced with a lateral canthopexy, with excellent aesthetic and functional results.


Assuntos
Carcinoma Basocelular , Ectrópio , Pálpebras
9.
An Bras Dermatol ; 92(5 Suppl 1): 151-153, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29267477

RESUMO

The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/cirurgia , Neoplasias Nasais/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia , Carcinoma Basocelular/cirurgia , Feminino , Humanos , Masculino , Tela Subcutânea/transplante , Resultado do Tratamento
10.
An. bras. dermatol ; 92(5,supl.1): 151-153, 2017. graf
Artigo em Inglês | LILACS | ID: biblio-887067

RESUMO

Abstract The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.


Assuntos
Humanos , Masculino , Feminino , Retalhos Cirúrgicos/cirurgia , Neoplasias Faciais/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Nasais/cirurgia , Transplante de Pele/métodos , Carcinoma Basocelular/cirurgia , Resultado do Tratamento , Tela Subcutânea/transplante
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