【开放获取】局部皮瓣联合修复鼻及鼻周Mohs显微外科手术后较大缺损11例效果分析

【摘要】 目的 探讨局部皮瓣联合应用修复鼻及鼻周非黑素瘤皮肤癌Mohs显微外科手术后较大缺损的效果及优势。方法 2018年3月至2020年11月,于河北医科大学第二医院皮肤科收集行Mohs显微外科切除术后应用局部皮瓣联合修复的11例鼻及鼻周非黑素瘤皮肤癌患者。 根据术后缺损部位及大小,遵循鼻亚单位美学原则设计皮瓣进行修复,对于直接缝合或单个局部皮瓣无法覆盖的较大缺损,联合应用风筝皮瓣、改良菱形皮瓣、鼻唇沟皮瓣、双叶皮瓣等局部皮瓣中2 ~ 3种皮瓣修复创面。结果 11例患者中,基底细胞癌10例,鳞状细胞癌1例,缺损面积2.0 cm × 2.3 cm～2.7 cm × 3.6 cm。经Mohs显微外科手术联合局部皮瓣修复后皮瓣均存活良好,未出现血运障碍,修复皮瓣质地、颜色、轮廓等与周围正常皮肤相近,缺损未见明显瘢痕。术后随访4 ~ 32个月,肿瘤无复发,患者对外观满意。结论 联合应用2 ~ 3种皮瓣修复鼻及鼻周非黑素瘤皮肤癌Mohs手术后的较大缺损,可保持鼻及鼻周正常形态结构和美学效果,达到满意的美容修复效果。     

Mohs外科手术治疗颜面皮肤恶性肿瘤31例疗效观察

目的：探讨颜面部皮肤恶性肿瘤的皮肤外科手术治疗方法。方法：应用Mohs外科手术切除25例颜面皮肤基底细胞癌和6例皮肤鳞状细胞癌。结果：31例患者切口均Ⅰ期愈合，其中采用局部转移皮瓣者16例，全厚皮片移植者10例，其余患者采用直接缝合。术后随访4—26个月，患者均对手术后的外形满意，美容效果好，眼、耳、鼻未见损害，肿瘤无复发。结论：Mohs外科手术治疗颜面部皮肤恶性肿瘤具有损伤小、美容效果好、复发率低和安全性好的优点。     

Mohs显微描记手术治疗皮肤恶性肿瘤56例临床分析

目的探讨Mohs显微外科手术治疗皮肤恶性肿瘤的临床效果。方法对56例皮肤恶性肿瘤沿皮损周围行扩大切除术,将切除的边缘组织染色,按Mohs显微描记手术法冰冻切片,观察残余肿瘤细胞情况。结果 56例患者随访1～5年,其中53例患者伤口愈合良好,美容效果佳,无复发现象,56例中仅复发3例。结论 Mohs显微外科手术治疗皮肤恶性肿瘤具有损伤小、美容效果好、复发率低和安全性好的优点。     

改良Mohs显微描记手术治疗Merkel细胞癌二例

【摘要】 Mohs显微描记手术是切除皮肤肿瘤的理想术式。本文2例Merkel细胞癌患者行改良Mohs显微描记手术切除肿瘤,随访1年余,肿瘤未复发。与传统扩大切除术相比,改良Mohs手术是Merkel 细胞癌患者更好的选择。     

改良Mohs显微描记手术26例分析

目的　观察改良Mohs显微描记手术治疗皮肤癌的临床疗效。方法　沿皮损外约2mm～4mm切除病灶,用数码相机拍下切除组织的位置及形状,并即时打印,将送检的组织在打印图纸上及病人身上相对应的位置作相同的记号。然后按Mohs显微描记手术其他步骤进行。结果　26例患者经改良Mohs显微描记手术治疗,所有切口均Ⅰ期愈合,皮片或皮瓣均成活,随访1个月～2年,除一例头皮复发性鳞状细胞癌术后一月复发外,余患者均治愈,肿瘤无复发。结论　改良Mohs显微描记手术可指导手术医生更精确地控制扩大切除的范围,在根治肿瘤的同时最大限度的保留正常组织,为下一步的成形修复创造最佳条件。     

Mohs显微描记手术联合光动力疗法治疗会阴部乳房9bPaget病1例

目的报道Mohs显微描记手术联合5．氨基酮戊酸光动力疗法（ALA—PDT）治疗会阴部乳房外Paget病1例。方法于阴茎前段包皮水肿机化所致瘢痕挛缩狭窄处行“Z皮瓣”成形术,松解瘢痕;Mohs显微描记手术切除阴茎根部及阴囊上部的乳房外Paget病变组织,阴囊皮瓣修复创面;创面愈合拆线后5～7d开始对手术区域及周边范围进行ALA-PDT治疗,10d1次,4次为1个疗程。结果术后患者创面愈合良好,外观功能无异常,排尿障碍明显改善。术后随访2年,未见肿瘤复发和转移。结论Mohs显微描记手术是治疗乳房外Paget病的重要手段,ALA-PDT对于彻底清除肿瘤组织和降低复发率有一定作用。     

Mohs显微手术治疗乳房外Paget病42例

目的:评价Mohs治疗乳房外Paget病的疗效。方法:42例乳房外Paget病患者沿皮损周围2 cm行Mohs手术切除,确认边缘结果阴性之后行皮瓣或植皮闭合。术后31例患者使用光动力,每周1次,共4次。11例外用咪喹莫特乳膏,每日1次,共半年,随访8~36个月。结果:6例患者复发,复发率14.3%,其中4例为术后光动力治疗患者,2例为术后外用咪喹莫特乳膏。结论:EMPD进行Mohs显微描记手术结合光动力治疗或外用咪喹莫特乳膏有效。     

影像学检查在辅助确定皮肤肿瘤手术切缘中的应用进展

目前对于皮肤肿瘤的治疗仍首选手术切除,手术中在尽量做到切净肿瘤的同时,最大限度的保留正常皮肤,因此对准确界定肿瘤边缘提出了更高的要求.尽管Mohs显微描记手术可以准确界定肿瘤边缘,但Mohs显微描记手术因其耗时多,费用高,过程繁琐等缺点限制了在临床的推广.近年来荧光染色、皮肤CT以及皮肤镜等影像学检查的快速发展,恰好解决了这一难题.研究证实,这些影像学检查在皮肤肿瘤切除术中可以起到辅助确定肿瘤边缘的作用,临床上有助于确定术前及术中肿瘤边界,最终使得手术结果可以同时达到治疗和美观的要求.尤其是皮肤镜、光动力荧光染色和皮肤CT技术相比于Mohs显微描记手术有着创伤小、操作简单、费用低等优点,因此在临床上更容易普及,具有广泛的应用前景.     

周围组织的 Mohs 显微描记外科手术治疗乳房外 Paget 病

目的：探讨周围组织的 Mohs 显微描记外科手术治疗乳房外 Paget 病（EMPD）的有效性。方法对28例 EMPD 患者术前肿瘤侵犯的深度和范围进行判断,术前1 d 外敷20%盐酸氨酮戊酸,伍德灯下观察并标记手术切缘。切取荧光定位后的边缘皮肤组织,按 Mohs 显微描记外科技术方法仅对周围组织进行冰冻切片检查,同时进行肿瘤切除。术后3～6个月随访1次,观察局部复发和转移情况。结果28例患者中,男25例,女3例。6例患者需要3次冰冻切片,12例患者要2次冰冻切片,平均1.86次。随访5～72个月,局部复发者3例,1例尿毒症患者随访2年因肝转移死亡。结论周围组织的 Mohs 显微描记外科手术是一省时和有效的治疗EMPD 的方法。     

皮肤恶性肿瘤的Mohs显微外科切除与缺损的修复

皮肤恶性肿瘤以基底细胞癌、鳞状细胞癌为多见，我科于2004年8～12月采用Mohs显微外科切除、即期行缺损整形修复手术8例，取得了满意的疗效，现报告如下。     

Synoptic reporting in Mohs micrographic surgery

There is currently no standardised reporting format for Mohs surgery with its operation reports mostly written in a narrative form making them prone to unintentional errors and omission of necessary data. Synoptic histology reporting is used to describe excised skin cancers such as melanomas and, more recently, squamous cell and basal cell carcinomas. Since Mohs surgery is utilised as the gold standard treatment for locally invasive squamous and basal cell carcinomas, we propose the use of our model of synoptic reporting to ensure the completeness and consistency of Mohs surgery operation reports.     

Mohs micrographic surgery pearls

Mohs micrographic surgery has evolved over the last 60 years from fixed-tissue chemosurgery with secondary intention healing to fresh-tissue surgical excision utilizing advanced histotechnology and reconstructive techniques. This evolution has occurred while preserving the fundamental characteristics of Mohs surgery: microscopically controlled tumor excision by one surgeon acting as pathologists to ensure complete tumor extirpation while maximally conserving tissue. Refinements, modifications, and clinical pearls will be outlined that uphold these tenets and enhance the quality of patient care.     

Mohs micrographic surgery technique

This article provides a protocol for the systematic approach to the technique of Mohs micrographic surgery. Each step, from tumor excision and tissue mapping, to specimen processing and histologic interpretation, through wound closure and postoperative management, is covered. The advantages of Mohs surgery over other treatment modalities are observed histologic margin control, superior cure rates, and maximal tissue-sparing potential. The increased preservation of normal tissue leads to smaller surgical defects, optimal reconstructive results, and diminished risk of poor surgical outcomes. Overall, the risks of the procedure are few, the benefits numerous, and the outcomes worth the time and effort spent in learning the technique.     

Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases

BackgroundThe ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact.ObjectiveTo describe the authors’ experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods.MethodsRetrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years.ResultsOne hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection).Study limitationsRetrospective design and the absence of long-term follow-up of some cases.ConclusionsThe dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.     

Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

BackgroundMohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique.ObjectiveTo study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors.MethodsThis was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021.ResultsDuring the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up.Study limitationsThis is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service.ConclusionThis retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.     

Current procedural terminology coding for Mohs micrographic surgery

Accurate surgical current procedural terminology (CPT) coding allows for proper reimbursement, decreases the possibility of being audited, and decreases the likelihood of inadvertently misrepresenting a claim. The CPT codes describe the type of services provided to a patient. CPT modifiers provide information to insurance payers to assure that the provider is reimbursed correctly. When coding for reconstruction of a surgical defect, the appropriate code is determined by the type of reconstruction performed. Reconstructive procedures that are performed because of underlying tumors are reimbursed. Adequate documentation is essential, because this substantiates claims and promotes their timely processing.     

Second intention healing after Mohs micrographic surgery

BACKGROUND: Although second intention healing has been used for many years in Mohs micrographic surgery, it has lost popularity. This is due to the long process and functional alteration of important anatomical units if certain wound healing factors are not carefully taken into consideration. OBJECTIVE: To review indications, contraindications, complications, advantages, disadvantages, as well as basic concepts of the wound healing process, wound care and antibiotic prophylaxis in the management of open wounds after Mohs surgery. METHODS: A short but comprehensive review of studies published in the literature dealing with second intention healing as a reconstruction alternative option in certain situations. CONCLUSIONS: Second intention healing is a simple and cost-effective method for reconstruction after Mohs micrographic surgery in well-defined cases. It allows adequate tumoral control with good to excellent functional and cosmetic results.     

改良Mohs显微描记手术治疗小汗腺汗孔癌5例

目的探讨改良Mohs显微描记手术治疗小汗腺汗孔癌的效果。方法回顾2016—2020年武汉市第一医院皮肤科治疗的5例小汗腺汗孔癌患者临床资料, 采用改良Mohs显微描记手术治疗。结果 5例年龄52 ～ 80岁, 男2例, 女3例, 病史1 ～ 50年。皮疹分别位于头皮、面部、腹部、大腿、足部, 直径1 ～ 6 cm。沿皮疹周围1 cm切除, 深度至筋膜浅层, 切缘组织病理阴性行皮瓣或植皮闭合缺损面, 阳性则继续扩切, 切净为止。5例患者随访1 ～ 5年未见复发, 1例因肝癌转移术后2年死亡。结论改良Mohs显微描记手术治疗小汗腺汗孔癌可确保肿瘤切净, 并减少正常组织的损失。