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      Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery*

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          Abstract

          BACKGROUND

          Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness.

          OBJECTIVE

          The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost.

          METHODS AND MATERIALS

          The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy.

          RESULTS

          There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399).

          CONCLUSION

          Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique.

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          Vascular structures in skin tumors: a dermoscopy study.

          H. Soyer, Gianluca Petrillo, R Corona … (2004)
          To describe the different vascular structures seen by dermoscopy and to evaluate their association with various melanocytic and nonmelanocytic skin tumors in a large series of cases. Digital dermoscopic images of the lesions were evaluated for the presence of various morphologic types of vessels. Specialized university clinic. From a larger database, 531 excised lesions (from 517 patients) dermoscopically showing any type of vascular structures were included. The frequency and positive predictive value of the different vascular structures seen in various tumors were calculated, and the differences were evaluated by the chi2 or Fisher exact test. Arborizing vessels were seen in 82.1% of basal cell carcinomas, with a 94.1% positive predictive value (P<.001). Dotted vessels were generally predictive for a melanocytic lesion (90.0%, P<.001), and were especially seen in Spitz nevi (77.8% of lesions). In melanoma, linear-irregular, dotted, and polymorphous/atypical vessels were the most frequent vascular structures, whereas milky-red globules/areas were the most predictive ones (77.8%, P = .003). The presence of erythema was most predictive for Clark nevus, whereas comma, glomerular, crown, and hairpin vessels were significantly associated with dermal/congenital nevi, Bowen disease, sebaceous hyperplasia, and seborrheic keratosis, respectively (P<.001 for all). Different morphologic types of vessels are associated with different melanocytic or nonmelanocytic skin tumors. Therefore, the recognition of distinctive vascular structures may be helpful for diagnostic purposes, especially when the classic pigmented dermoscopic structures are lacking.
          Article 0 comments Cited 75 times – based on 0 reviews     Review now
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            Dermatoscopy of basal cell carcinoma: morphologic variability of global and local features and accuracy of diagnosis.

            Davide Altamura, Scott Menzies, Giuseppe Argenziano … (2010)
            Early detection of basal cell carcinoma (BCC) is crucial to reduce the morbidity of this tumor. We sought to investigate the variability and diagnostic significance of dermatoscopic features of BCCs. We conducted retrospective dermatoscopic analysis of 609 BCCs and 200 melanocytic and nonmelanocytic lesions, and assessment of interrater reliability of dermatoscopic BCC criteria. Lesions included nonpigmented (15.1%), lightly pigmented (33.2%), pigmented (42.7%), and heavily pigmented (9%) BCCs. Classic BCC patterns including arborizing telangiectasia (57.1%), blue/gray ovoid nests (47.5%), ulceration (39.2%), multiple blue/gray globules (26.1%), leaflike areas (15.9%), and spoke-wheel areas (9%) were significantly increased in pigmented BCCs compared with nonpigmented and heavily pigmented BCCs (P = .0001). Among nonclassic BCC patterns, we detected short fine superficial telangiectasia (10%) and multiple small erosions (8.5%), and described two new patterns named "concentric structures" (7.6%) and "multiple in-focus blue/gray dots" (5.1%). Dermatoscopic features suggestive of melanocytic lesions (eg, multiple brown to black dots/globules, blue/white veillike structures, and nonarborizing vessels) were observed in 40.6% BCCs and significantly increased in heavily pigmented BCCs (P < .0001). Expert observers provided an accurate (sensitivity: 97%) and reliable (K: 87%) dermatoscopic diagnosis of BCC, although a significant difference in terms of specificity (P = .0002) and positive predictive value (P = .0004) was found. Arborizing telangiectasia, leaflike areas, and large blue/gray ovoid nests represented reliable and robust diagnostic parameters. The study was retrospective. BCCs show a large spectrum of global and local dermatoscopic features; heavily pigmented BCCs show the most challenging combinations of dermatoscopic features.
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              Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature.

              Judith U Ostertag, Heinrich Neumann, P Nelemans … (2004)
              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. The aim of this article was to evaluate the efficiency of MMS for the treatment of facial BCC. 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. The 5-year recurrence rates estimated from this study were 3.2% for primary BCC and 6.7% 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. 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.
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): An Bras Dermatol
                Journal ID (iso-abbrev): An Bras Dermatol
                Journal ID (publisher-id): An Bras Dermatol
                Title: Anais Brasileiros de Dermatologia
                Publisher: Sociedade Brasileira de Dermatologia
                ISSN (Print): 0365-0596
                ISSN (Electronic): 1806-4841
                Publication date (Print): Jan-Feb 2014
                Volume: 89
                Issue: 1
                Pages: 38-43
                Affiliations
                [1 ] Board-certified dermatologist, Brazilian Society of Dermatology, Physician in private practice, Curitiba (PR), Brazil.
                [2 ] Board-certified dermatologist, Brazilian Society of Dermatology - Professor, Department of Dermatology, Hospital de Clínicas - Universidade Federal do Paraná (HC UFPR) - Curitiba (PR), Brazil.
                [3 ] Board-certified dermatologist, Brazilian Society of Dermatology - Staff physician, Outpatient Mohs Surgery Clinic - Hospital de Clínicas - Universidade Federal do Paraná (HC UFPR) - Curitiba (PR), Brazil.
                Author notes
                MAILING ADDRESS: Heliane Sanae Suzuki. Rua General Carneiro, 181 SAM. 4 80060-900 - Curitiba -PR. Brazil. E-mail: helianesuzuki@ 123456yahoo.com.br
                Article
                DOI: 10.1590/abd1806-4841.20142400
                PMC ID: 3938352
                PubMed ID: 24626646
                SO-VID: d161ef9d-34d9-475d-a870-c58102486758
                Copyright © ®2013 by Anais Brasileiros de Dermatologia
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 January 2013
                Date accepted : 18 February 2013
                Categories
                Subject: Investigation

                Keywords: dermoscopy,mohs surgery,skin neoplasms
                Data availability:
                Keywords: dermoscopy, mohs surgery, skin neoplasms

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