Mohs micrographic technique in high-risk basal cell carcinoma: a 3D prediction of safety margins.

IF 1.5 4区医学 Q3 DERMATOLOGY

Journal of wound care Pub Date : 2024-08-01 DOI:10.12968/jowc.2020.0322

Edoardo Cammarata, Elia Esposto, Chiara Airoldi, Roberto Giorgione, Paolo Boggio, Paola Savoia

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Abstract

Objective: Compared with standard excision with a two-dimensional histological examination, Mohs micrographic surgery offers a lower recurrence rate and a greater extent of healthy tissue sparing for the treatment of high-risk basal cell carcinoma (BCC). The aims of this study were to first quantify the healthy tissue spared through the micrographic technique compared to traditional surgery for high-risk tumours. Then, to speculate, through the analysis of the distal micrographic resection margin, the adequate width of safety margins for standard excision.

Method: A cohort of patients with high-risk BCC was treated with Mohs surgery. Safety margins, tumours residual final breach and hypothetical standard excision safety margins areas were recorded.

Results: A total of 96 patients were included. A reduction of 27.96% (95% Confidence Interval (CI): 17.90-38.02) of healthy skin removed was observed using a micrographic method compared to the standard approach. Standard excision with a 6mm safety margin was associated with 86.46% (95% CI: 79.62-93.30) of complete excision. Greater margins were not associated with a statistically significant improvement of complete excision.

Conclusion: Mohs surgery should be considered the gold standard operative treatment for high-risk BCC. However, if micrographic techniques are not feasible, the standard excision with a predetermined margin of 6 mm, should be considered as the best option.

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莫氏显微放射技术在高风险基底细胞癌中的应用：安全系数的三维预测。

目的：在治疗高危基底细胞癌（BCC）时，与二维组织学检查的标准切除术相比，莫氏显微外科手术的复发率更低，且能更大程度地保留健康组织。本研究的目的是首先量化莫氏显微摄影技术与传统手术相比在治疗高危肿瘤时所保留的健康组织。然后，通过对显微放射学远端切除边缘的分析，推测标准切除术安全边缘的适当宽度：方法：对一组高危 BCC 患者进行莫氏手术治疗。结果：共纳入96名患者：结果：共纳入 96 名患者。与标准方法相比，采用显微外科方法切除的健康皮肤减少了 27.96%（95% 置信区间（CI）：17.90-38.02）。标准切除术的安全边缘为 6 毫米，完全切除率为 86.46%（95% 置信区间：79.62-93.30）。结论：莫氏手术应被视为 "金标准"：结论：莫氏手术应被视为高风险 BCC 的金标准手术治疗方法。结论：Mohs 手术应被视为高危 BCC 的金标准手术治疗方法，但如果显微技术不可行，则应考虑将预定边缘为 6 毫米的标准切除术作为最佳选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of wound care DERMATOLOGY-

CiteScore

2.90

自引率

10.50%

发文量

215

期刊介绍： Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.