A retrospective study to assess the influence of anaesthetic type on incomplete excision rate for non-melanoma skin cancers

Background: Australia has the highest incidence of non-melanoma skin cancers (NMSC) in the world estimated to be 2448/100,000 population with the state of Queensland carrying the highest burden of disease. Surgical excision is the primary treatment and makes up a large proportion of general surgical lists in regional Queensland where they are typically removed using either local anaesthetic (LA) alone, local anaesthetic and sedation (LAS), or general anaesthesia (GA). There is little in the literature to suggest if anaesthetic type effects the rate of incomplete excision. The purpose of this study is to establish if anaesthetic type impacts the rate of incomplete excision of NMSC.Methods: A retrospective audit was performed, incorporating a total of 194 squamous and basal cell carcinoma lesions excised between October 2019 and October 2020 at two hospitals in regional Queensland, Australia. Data was recorded for the type of anaesthetic used and the histopathology of the lesions including type of lesion and clearance of microscopic margins.Results: Of the 194 excised lesions 39 of them had involved margins (20.1%). The rate of involved margins under LA, GA and LAS were found to be 19.79, 18.52 and 22.73% respectively. When comparing these modalities with each other: LA vs. GA, LAS vs. GA and LA vs. LAS no significant difference was found in the rate of incomplete excision of NMSC with p values (<0.05) of 1, 0.62 and 0.82 respectively.Conclusions: Modality of anaesthetic used for excision of NMSC does not affect the outcome of incomplete excision of NMSC.

Download Full-text

309 Does Anaesthetic Type Effect Positive Excision Margin Rate for Non-Melanoma Skin Cancers?

British Journal of Surgery ◽

10.1093/bjs/znab259.813 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

D Page

Keyword(s):

Local Anaesthetic ◽

Surgical Excision ◽

Primary Treatment ◽

Margin Involvement ◽

Retrospective Audit ◽

Skin Cancers ◽

Significant Difference ◽

Excision Margins ◽

Regional Australia ◽

Melanoma Skin

Abstract Aim Australia has the highest incidence of Non-melanoma skin cancers (NMSC) in the world estimated to be 2448/100,000 population with the state of Queensland carrying the highest burden. Surgical excision is the primary treatment and makes up a large proportion of general surgical lists in regional Queensland where they are typically removed using either local anaesthetic (LA) alone, local anaesthetic and sedation (LAS), or general anaesthesia (GA). There is little in the literature to suggest if anaesthetic type effects the rate of involved margins. The purpose of this study is to establish if anaesthetic type impacts the rate of positive excision margins in regional hospitals in Queensland. Method A retrospective audit was performed, incorporating a total of 194 squamous and basal cell carcinoma lesions excised between October 2019 and October 2020 at two hospitals in regional Australia. Data was recorded for the type of anaesthetic used and the histopathology of the lesions including type of lesion and microscopic margin involvement. Results Of the 194 excised lesions 39 of them had involved margins (20.1%). The rate of involved margins under LA, GA and LAS were found to be 19.79%, 18.52% and 22.73% respectively. When comparing these modalities with each other: LA vs GA, LAS vs GA and LA vs LAS no significant difference was found in involved margins for excision of NMSC with p-values (<0.05) of 1, 0.624 and 0.8225 respectively. Conclusions Modality of anaesthetic used for excision of NMSC does not affect the outcome of margin involvement.

Download Full-text

33% hydrogen peroxide as a Neoadjuvant treatment in the surgical excision of non-melanoma skin cancers: a case series

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00433-6 ◽

2020 ◽

Vol 49 (1) ◽

Author(s):

N. Mundi ◽

K. Jordan ◽

P. Doyle ◽

C. Moore

Keyword(s):

Hydrogen Peroxide ◽

Neoadjuvant Treatment ◽

Case Series ◽

Surgical Excision ◽

Skin Cancers ◽

Melanoma Skin

Download Full-text

Dermal Pleomorphic Sarcoma of the Scalp – Report of Two Cases

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.274 ◽

2019 ◽

Vol 7 (18) ◽

pp. 2982-2984

Author(s):

Uwe Wollina ◽

Jacqueline Schönlebe ◽

Violetta Bujok ◽

Torello Lotti ◽

Georgi Tchernev ◽

...

Keyword(s):

Surgical Excision ◽

The Elderly ◽

Histopathologic Examination ◽

Split Skin Graft ◽

Pleomorphic Sarcoma ◽

Skin Cancers ◽

Split Skin ◽

Margin Control ◽

Aggressive Variant ◽

Melanoma Skin

BACKGROUND: Neoplasias of the UV-exposed head-and-neck area of the elderly include non-melanoma skin cancers of various origin. CASE REPORT: We report two cases of rapid growing exophytic scalp tumors on chronic sun-damaged skin, in one case with a tendency of bleeding. The tumours were removed by wide surgical excision with 3D margin control, and the resulting defect was covered by a meshed split skin graft. Histopathologic examination disclosed a dermal pleomorphic sarcoma in both cases. The staging was unremarkable in both patients. CONCLUSIONS: Sarcomatous tumours of the scalp should be completely excised with a 3D margin control. Dermal pleomorphic sarcoma is a more aggressive variant compared to atypical fibroxanthoma despite some similarities.

Download Full-text

A Peculiar Way of Reconstruction for Surgical Defects of the Upper Lip: A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.04.03 ◽

2020 ◽

pp. 1-3

Author(s):

Roberto D'Astolto ◽

Alfredo Zucchi ◽

Claudio Feliciani ◽

Elena Pierobon ◽

Michele Maria Dominici ◽

...

Keyword(s):

Surgical Excision ◽

Vascular Supply ◽

Surgical Reconstruction ◽

Surgical Wound ◽

Upper Lip ◽

Skin Cancers ◽

Inner Surface ◽

And Function ◽

Surrounding Skin ◽

Melanoma Skin

Cutaneous neoformations of the upper lip, especially non melanoma skin cancers (NMSC), are very common. The upper lip is composed of multiple cosmetic subunits and it is divided into a philtral subunit and two lateral ones. For what concerns philtral subunit, Cupid’s bow can be particularly difficult to be recreated after a surgical excision. The vermillion border, that has the function to separate the inner surface of the lip (oral mucosa) from the surrounding skin, lies directly on a circumoral band of orbicularis oris. This is a circumferential muscle with a rich vascular supply that gives the lips their shape, definition and function. Any surgical wound of the lip can be repaired successfully in a variety of ways and the goal is always to maintain the integrity of the philtrum and the Cupid’s bow. We present the case of a 63 year-old woman with a pinkish nodule of the central portion of the upper lip, focusing on surgical reconstruction.

Download Full-text

Non-Melanoma Skin Cancer in People Living With HIV: From Epidemiology to Clinical Management

Frontiers in Oncology ◽

10.3389/fonc.2021.689789 ◽

2021 ◽

Vol 11 ◽

Author(s):

Emmanuele Venanzi Rullo ◽

Maria Grazia Maimone ◽

Francesco Fiorica ◽

Manuela Ceccarelli ◽

Claudio Guarneri ◽

...

Keyword(s):

Skin Cancer ◽

Early Stage ◽

Treatment Options ◽

Case Series ◽

Surgical Excision ◽

People Living With Hiv ◽

Skin Cancers ◽

Ablative Techniques ◽

Living With Hiv ◽

Melanoma Skin

Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.

Download Full-text

Topical hydrogen peroxide as a neoadjuvant treatment in the surgical excision of non-melanoma skin cancers

17th International Photodynamic Association World Congress ◽

10.1117/12.2528241 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kevin J. Jordan ◽

Neil Mundi ◽

Corey Moore

Keyword(s):

Hydrogen Peroxide ◽

Neoadjuvant Treatment ◽

Surgical Excision ◽

Skin Cancers ◽

Melanoma Skin

Download Full-text

Evaluation of the treatment of non-melanoma skin cancers by surgical excision

Australasian Journal of Dermatology ◽

10.1111/j.1440-0960.2009.00531.x ◽

2009 ◽

Vol 50 (3) ◽

pp. 171-175 ◽

Cited By ~ 20

Author(s):

Vernon SC Pua ◽

Shyamala Huilgol ◽

Dudley Hill

Keyword(s):

Surgical Excision ◽

Skin Cancers ◽

Melanoma Skin

Download Full-text

Melanoma and Non-Melanoma Skin Cancer in Patients with Chronic Lymphocytic Leukemia.

Blood ◽

10.1182/blood.v114.22.1268.1268 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1268-1268

Author(s):

Timothy G Call ◽

Kari G Rabe ◽

Brewer D Jerry ◽

Neil E. Kay ◽

Clive S. Zent ◽

...

Keyword(s):

Skin Cancer ◽

Cell Carcinoma ◽

Gene Mutation ◽

Research Funding ◽

Age At Diagnosis ◽

Mutation Status ◽

Non Melanoma Skin Cancer ◽

Skin Cancers ◽

Significant Difference ◽

Melanoma Skin

Abstract Abstract 1268 Poster Board I-290 Purpose There are reports of an increased risk of skin cancers in patients with B-Chronic Lymphocytic Leukemia (CLL). These skin cancers include basal cell and squamous cell carcinoma. This analysis was performed to more completely define the prevalence of skin cancers in patients in the Mayo Clinic Rochester CLL database and to look for contributing factors. Methods The Mayo Clinic Rochester CLL Database includes all patients with a diagnosis of CLL since January 1995 seen in the Division of Hematology and who have signed institutional review board approved consents for research. For this study, 2240 patients were analyzed to compare differences in characteristics between CLL patients with and without skin cancer. Chi-square statistics were used to compare qualitative variables (age categories, gender, referral status, ALC categories, CD38, ZAP-70, IgVH gene mutation status, FISH categories, Rai stage), and t-tests were used for quantitative variables (age at diagnosis, ALC values). Overall survival (OS) and time to first treatment (TFT) analyses were performed with results being displayed using Kaplan-Meier curves and p-values calculated using a log-rank test. Prevalence of melanoma among CLL patients was compared to the age-adjusted prevalence of melanoma in individuals in the Iowa SEER registry. Results Median follow-up for the 2240 patients diagnosed between 1/1/1995 and 8/11/2009 was 4.6 years. In aggregate, 293 (13.1%) patients were found to have non-melanoma skin cancer (squamous cell carcinoma or basal cell carcinoma) cancer. The diagnosis of non-melanoma skin cancer occurred before the CLL diagnosis in 39% and at or after the diagnosis of CLL in 61%. There were 57 (2.5%) cases of melanoma in association with CLL. The diagnosis of melanoma occurred before the CLL diagnosis in 38% and at or after the diagnosis of CLL in 62%.The prevalence of non-melanoma skin cancer and melanoma skin cancer were both higher in non-referred (geographically regional) CLL patients than referred CLL patients (16.6% vs. 11.4%, p<0.001 for non melanoma; 2.0% vs. 3.6%, p=0.03 for melanoma). The prevalence of melanoma in CLL patients was higher than that of age-adjusted prevalence for individuals in the Iowa SEER registry (2.5% vs. 0.03%; p<0.001). We next evaluated the relationship between CLL patients with skin cancer and demographic characteristics, prognostic parameters, and CLL related treatment. The risk of non-melanoma skin cancer in CLL was found to be associated with age (median age at diagnosis with skin cancer 67.6 vs. without skin cancer 63.3, p<0.001) and with sex (males 15.1% vs females 8.9%, p <0.001). There was no statistical significant difference in frequency of non-melanoma skin cancer associated with absolute lymphocyte count (ALC), Rai stage, CD 38, Zap 70, IgVH gene mutation status, FISH, or treatment history. The risk of melanoma in CLL was found to be associated with age at diagnosis (median age with melanoma 69.9 vs. without melanoma 63.8, p=0.002) and CD38 (positive 1.3% vs negative 3.1%, p=0.03). There was no statistically significant difference associated with gender, ALC, Rai stage, Zap 70, IgVH gene mutation status, FISH, or treatment history. Since the presence of skin cancer could be a marker of immune dysregulation we hypothesized skin cancer may be associated with clinical outcome of CLL. Accordingly, we evaluated the relationship between non-melanoma skin cancer and melanoma skin cancer and TFT and OS. Contrary to our hypothesis, TFT (median 6.0 years vs. 4.9; p=0.04) and OS (median 10.8 years vs. 9.7; p=0.02) of patients with non-melanoma skin cancer were both longer than those without non-melanoma skin cancer. No differences in TFT (p=0.06) or OS (p=0.66) were observed among patients with melanoma compared to those without melanoma. Conclusions We find in our cohort of CLL patients a higher prevalence of melanoma than the general population. Risk of melanoma and non-melanoma skin cancer among patients with CLL does not appear to be related to CLL characteristics, with the exception of CD 38, or CLL outcome. The diagnosis of melanoma and non-melanoma skin cancer in patients with CLL does not appear to be a risk factor for either CLL specific outcomes (TFT) or shorter survival. Disclosures Kay: Biogenc-Idec, Celgene, Genentech, genmab: Membership on an entity's Board of Directors or advisory committees; Genentech, Celgene, Hospira, Polyphenon Pharma, Sanofi-Aventis: Research Funding. Zent:Genentech, Bayer, Genzyme, Novartis: Research Funding. Shanafelt:Genentech: Research Funding; Hospira: Membership on an entity's Board of Directors or advisory committees, Research Funding; Polyphenon E International: Research Funding; Celgene: Research Funding; Cephalon: Research Funding; Bayer Health Care Pharmaceuticals: Research Funding.

Download Full-text