Incomplete Excised Skin Cancers Referred from Other Clinics: Problems & Managements

초록

강의명: Incomplete Excised Skin Cancers Referred from Other Clinics: Problems & Managements: Clinical & Diagnostic Problems Incomplete excision of non-melanoma skin cancer(NMSC) is a frequently encountered clinical scenario especially cases referred from other clinics. The biopsy reports often have the following readings; atypical basal cell proliferation, atypical squamous cell proliferation, squamous cell carcinoma with clear resection margin, and very close to resection margin. It is rare to do excision only without biopsy. Diagnostic problems: For example, a nodular lesion of the patient’s nose was excised and clinically removed at the local clinic, the biopsy results were atypical basic cell carcinoma. We have to carefully consider how to diagnosis the patient’s lesion and explain the treatment plan. The lesion might be a benign trichoblastoma or a malignant basal cell carcinoma. Clinically, NMSC are barely seen after excisional biopsy when the patient appears for consultation before Mohs surgery. We Mohs surgeon is sometimes faced with two potentially embarrassing situations: first, when the patient asks why surgery is needed as the tumor seems to be gone, and secondly, when after surgery no tumor has been found and the patient asks why surgery was performed if there was no tumor present. Recent reports investigate the incidence of histologic and clinical evidence of residual BCC at Mohs micrographic surgery (MMS) for the treatment of incompletely excised BCC. A report shows 69% of incompletely excised BCCs had residual tumor at MMS re-excision. Recurrence rates after incomplete regular excision, including excisional biopsies, have been widely discussed in the literature and vary from 4.7 to 50%. Some recent guidelines proposed that supervision of incompletely excised (positive margin) BCCs showing nonaggressive histological patterns would be the most appropriate management. Nonaggressive incompletely excised BCCs probably do not require re-excision.