Frozen Section Mohs: A Hybrid Technique and One Plastic Surgeon's Experience With 1714 Consecutive Skin Cancer Removals.

IF 1.4 4区 医学 Q3 SURGERY
Michael L Chang, Steven L Chang, Fady Gerges, Matthew M Delancy, Amanda C Yang, Lawrence D Chang
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引用次数: 0

Abstract

Abstract: While US nonmelanoma skin cancer (NMSC) mortality rate has decreased in the past decade, its incidence is rising. Traditional surgical treatments include wide local excision, intraoperative frozen section analysis (IFSA), and Mohs micrographic surgery (MMS). IFSA and MMS are techniques that provide intraoperative analysis allowing the surgeon to confirm margins clear of malignancy and minimize tissue damage, especially in cosmetically sensitive subunits. MMS, with cure rates up to 99%-100%, is considered the gold standard but is limited geographically and financially because of specialized training. We report a hybrid surgical technique that effectively excises cutaneous malignancy but can be utilized by plastic surgeons. This hybrid technique is called frozen section Mohs (FSM), which combines both techniques utilized in IFSA and MMS. FSM is similar to IFSA in that the middle breadloaf visualizes the central deep margin but is similar to MMS in that the entire periphery is also analyzed. This paper is a retrospective review of all patients who have undergone the FSM procedure by one plastic surgeon from September 2017 to June 2023. The primary outcomes were 1) recurrence, determined by excision of skin cancer demonstrated to be arising from postexcision scar tissue, and 2) concordance between intraoperative and final pathology. There were 1714 FSM procedures performed with a cohort averaging 73.8 years old and 57% male. Zero recurrences were identified (100% cure rate). Two cases (0.11%) were false negatives and the patients returned for re-excision. About 48.2% of cases were basal cell carcinoma while 40.7% were squamous cell carcinoma. The average number of stages per FSM procedure was 1.17. The mean defect size was 1.83 cm.2 Complication rate was 2.28% (n = 39), with the most common issue being bleeding that required suturing or cautery. Our proposed FSM technique's results demonstrate effective carcinoma removal comparable to MMS. Plastic surgeons may therefore utilize this technique to meet the growing demands of skin cancer surgery in the United States with equally effective outcomes.

冷冻莫氏切片:一种混合技术和一位整形外科医生连续切除1714例皮肤癌的经验。
摘要:虽然美国非黑色素瘤皮肤癌(NMSC)的死亡率在过去十年中有所下降,但其发病率却在上升。传统的手术治疗包括广泛的局部切除,术中冷冻切片分析(IFSA)和Mohs显微摄影手术(MMS)。IFSA和MMS是提供术中分析的技术,允许外科医生确认边缘清除恶性肿瘤,并尽量减少组织损伤,特别是对美容敏感的亚单位。MMS治愈率高达99%-100%,被认为是黄金标准,但由于专业培训,在地理和经济上受到限制。我们报告一种混合手术技术,有效地切除皮肤恶性肿瘤,但可用于整形外科医生。这种杂交技术被称为冷冻切片Mohs (FSM),它结合了IFSA和MMS中使用的两种技术。FSM与IFSA的相似之处在于,中间的面包块显示了中央深边缘,但与MMS的相似之处在于,整个外围也被分析。本文回顾性分析了2017年9月至2023年6月期间由一名整形外科医生进行FSM手术的所有患者。主要结果为:1)复发,由切除后瘢痕组织引起的皮肤癌决定;2)术中病理与最终病理的一致性。共进行了1714例FSM手术,平均年龄为73.8岁,其中57%为男性。无复发(治愈率100%)。假阴性2例(0.11%),术后复诊。基底细胞癌占48.2%,鳞状细胞癌占40.7%。每个FSM过程的平均阶段数为1.17。平均缺陷尺寸为1.83 cm.2并发症发生率为2.28% (n = 39),最常见的问题是出血,需要缝合或烧灼。我们提出的FSM技术的结果表明,有效的肿瘤切除与MMS相当。因此,整形外科医生可以利用这项技术来满足美国日益增长的皮肤癌手术需求,并取得同样有效的效果。
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
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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