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J A Zitelli - One of the best experts on this subject based on the ideXlab platform.
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cutaneous head and neck melanoma treated with Mohs Micrographic Surgery
Journal of The American Academy of Dermatology, 2005Co-Authors: Gregory M Bricca, David G Brodland, J A ZitelliAbstract:Background Previous studies show that Mohs Micrographic Surgery is a viable treatment option for cutaneous melanoma. The head and neck region represents an anatomic location of historically high recurrence/metastasis rates and poor survival rates. Objective Our purpose was to determine the safety and efficacy of Mohs Micrographic Surgery for the treatment of primary cutaneous melanoma of the head and neck. Methods A consecutive sample of 625 patients referred for treatment of primary cutaneous melanoma of the head and neck comprised the study group. Mean follow-up for the group was 58.0 months. All melanomas were excised using Mohs Micrographic Surgery and surgical margin examination was performed using frozen section tissue in all cases. After stratification using updated American Joint Commission for Cancer (AJCC) Breslow thickness criteria, the Kaplan-Meier method was used to calculate 5-year local recurrence rates, metastasis rates, and disease specific survival rates. Tumors were then re-stratified by earlier Breslow thickness criteria for comparison to historical controls for local recurrence rates, metastasis rates, and disease-specific survival rates. Recommendations for predetermined excision margins were proposed and were based on the surgical margin widths that achieved complete melanoma removal in 97% of the cases in this study. Results Mohs Micrographic Surgery for the treatment of head and neck melanoma achieved five-year local recurrence rates, metastasis rates, and disease specific survival rates comparable to or better than historical controls after Breslow thickness stratification. The size of the surgical margin required for complete excision was significantly related to tumor thickness but not tumor size or specific location. Conclusion Mohs Micrographic Surgery is an effective treatment modality for primary cutaneous melanoma, and may contribute to favorable outcomes especially on the head and neck where extensive sub-clinical spread is relatively common.
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Mohs Micrographic Surgery a cost analysis
Journal of The American Academy of Dermatology, 1998Co-Authors: J Cook, J A ZitelliAbstract:Abstract Background: The incidence of skin cancer is increasing significantly, and many people have declared the increase an epidemic. It was estimated that 900,000 to 1.2 million cases of nonmelanoma skin cancer occurred in the United States in 1994. With increasing pressure to deliver cost-effective medical care, physicians must understand the cost and value of the various methods to treat skin cancer. Objective: Our purpose was to define the true cost of treating a series of skin cancers with the Mohs Micrographic technique and compare our costs with calculated estimates of the costs to treat the same cancers with traditional methods of surgical excision. Methods: A group of 400 consecutive tumors was selected. The cost of treatment in the reference group included diagnosis, Mohs Micrographic Surgery, reconstruction (if applicable), follow-up, and the cost to treat disease recurrence. These costs were then compared with traditional methods of surgical excision: excision with permanent section margin control, excision with frozen section margin control, and excision with frozen section margin control in an ambulatory surgical facility. For cost comparisons, it was assumed that all tumors in the comparison groups would be excised with standard surgical margins and the resultant surgical defects would be reconstructed with the simplest method possible. The costs of diagnosis, excision, pathology, reconstruction, and the cost to treat disease recurrence were then calculated and compared with the costs of treating the lesions with Mohs Micrographic Surgery. Results: Our calculation of costs documents that Mohs Micrographic Surgery is similar in cost to office-based traditional surgical excision and less expensive than ambulatory surgical facility–based surgical excision. The average cost of Mohs Micrographic Surgery was $1243 versus $1167 for excision with permanent section margin control, $1400 for excision in the office with frozen section margin control, and $1973 for excision with frozen section margin control in an ambulatory surgical facility. Analysis based on anatomic location yielded similar results. Conclusion: Mohs Micrographic Surgery is a method of surgical excision with high intrinsic value that is cost-effective in comparison to traditional surgical excision. (J Am Acad Dermatol 1998;39:698-703.)
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Mohs Micrographic Surgery: a cost analysis.
Journal of the American Academy of Dermatology, 1998Co-Authors: J Cook, J A ZitelliAbstract:The incidence of skin cancer is increasing significantly, and many people have declared the increase an epidemic. It was estimated that 900,000 to 1.2 million cases of nonmelanoma skin cancer occurred in the United States in 1994. With increasing pressure to deliver cost-effective medical care, physicians must understand the cost and value of the various methods to treat skin cancer. Our purpose was to define the true cost of treating a series of skin cancers with the Mohs Micrographic technique and compare our costs with calculated estimates of the costs to treat the same cancers with traditional methods of surgical excision. A group of 400 consecutive tumors was selected. The cost of treatment in the reference group included diagnosis, Mohs Micrographic Surgery, reconstruction (if applicable), follow-up, and the cost to treat disease recurrence. These costs were then compared with traditional methods of surgical excision: excision with permanent section margin control, excision with frozen section margin control, and excision with frozen section margin control in an ambulatory surgical facility. For cost comparisons, it was assumed that all tumors in the comparison groups would be excised with standard surgical margins and the resultant surgical defects would be reconstructed with the simplest method possible. The costs of diagnosis, excision, pathology, reconstruction, and the cost to treat disease recurrence were then calculated and compared with the costs of treating the lesions with Mohs Micrographic Surgery. Our calculation of costs documents that Mohs Micrographic Surgery is similar in cost to office-based traditional surgical excision and less expensive than ambulatory surgical facility-based surgical excision. The average cost of Mohs Micrographic Surgery was $1243 versus $1167 for excision with permanent section margin control, $1400 for excision in the office with frozen section margin control, and $1973 for excision with frozen section margin control in an ambulatory surgical facility. Analysis based on anatomic location yielded similar results. Mohs Micrographic Surgery is a method of surgical excision with high intrinsic value that is cost-effective in comparison to traditional surgical excision.
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Mohs Micrographic Surgery for the treatment of primary cutaneous melanoma
Journal of The American Academy of Dermatology, 1997Co-Authors: J A Zitelli, Christine D Brown, B H HanusaAbstract:Abstract Background: Mohs Micrographic Surgery is thought to be a useful therapy for cutaneous melanoma. Controversy persists, however, because there are few published reports that document its safety and efficacy. Objective: Our purpose was to determine the safety and efficacy of Mohs Micrographic Surgery for the treatment of cutaneous melanoma. Methods: A consecutive sample of 535 patients referred for treatment of 553 primary cutaneous melanomas was entered into the study. Of this sample, 99.5% of patients completed their first 5 years of follow-up. All melanomas were excised by means of fresh-tissue Mohs Micrographic Surgery with frozen-section examination of the margin. The 5-year Kaplan-Meier melanoma mortality, metastasis, and local recurrence rates were compared with historical control cases. Results: Mohs Micrographic Surgery provided 5-year survival and metastatic rates equivalent to or better than historical controls that were treated by standard wide-margin Surgery. Satellite metastases were not more common with the narrow margins used with Mohs Micrographic Surgery. Local recurrences from inadequate excision of the primary tumor were infrequent (0.5%). The majority of melanomas were successfully excised with a narrow margin (83% were excised with a 6 mm margin). Conclusion: Mohs Micrographic Surgery is an effective therapy for primary cutaneous melanoma. It may be particularly useful to conserve tissue for melanomas on the head, neck, hands, or feet or for melanomas with indistinct clinical margins. (J Am Acad Dermatol 1997;37:236-45.)
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Mohs Micrographic Surgery for the treatment of primary cutaneous melanoma.
Journal of the American Academy of Dermatology, 1997Co-Authors: J A Zitelli, C Brown, B H HanusaAbstract:Mohs Micrographic Surgery is thought to be a useful therapy for cutaneous melanoma. Controversy persists, however, because there are few published reports that document its safety and efficacy. Our purpose was to determine the safety and efficacy of Mohs Micrographic Surgery for the treatment of cutaneous melanoma. A consecutive sample of 535 patients referred for treatment of 553 primary cutaneous melanomas was entered into the study. Of this sample, 99.5% of patients completed their first 5 years of follow-up. All melanomas were excised by means of fresh-tissue Mohs Micrographic Surgery with frozen-section examination of the margin. The 5-year Kaplan-Meier melanoma mortality, metastasis, and local recurrence rates were compared with historical control cases. Mohs Micrographic Surgery provided 5-year survival and metastatic rates equivalent to or better than historical controls that were treated by standard wide-margin Surgery. Satellite metastases were not more common with the narrow margins used with Mohs Micrographic Surgery. Local recurrences from inadequate excision of the primary tumor were infrequent (0.5%). The majority of melanomas were successfully excised with a narrow margin (83% were excised with a 6 mm margin). Mohs Micrographic Surgery is an effective therapy for primary cutaneous melanoma. It may be particularly useful to conserve tissue for melanomas on the head, neck, hands, or feet or for melanomas with indistinct clinical margins.
B H Hanusa - One of the best experts on this subject based on the ideXlab platform.
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Mohs Micrographic Surgery for the treatment of primary cutaneous melanoma
Journal of The American Academy of Dermatology, 1997Co-Authors: J A Zitelli, Christine D Brown, B H HanusaAbstract:Abstract Background: Mohs Micrographic Surgery is thought to be a useful therapy for cutaneous melanoma. Controversy persists, however, because there are few published reports that document its safety and efficacy. Objective: Our purpose was to determine the safety and efficacy of Mohs Micrographic Surgery for the treatment of cutaneous melanoma. Methods: A consecutive sample of 535 patients referred for treatment of 553 primary cutaneous melanomas was entered into the study. Of this sample, 99.5% of patients completed their first 5 years of follow-up. All melanomas were excised by means of fresh-tissue Mohs Micrographic Surgery with frozen-section examination of the margin. The 5-year Kaplan-Meier melanoma mortality, metastasis, and local recurrence rates were compared with historical control cases. Results: Mohs Micrographic Surgery provided 5-year survival and metastatic rates equivalent to or better than historical controls that were treated by standard wide-margin Surgery. Satellite metastases were not more common with the narrow margins used with Mohs Micrographic Surgery. Local recurrences from inadequate excision of the primary tumor were infrequent (0.5%). The majority of melanomas were successfully excised with a narrow margin (83% were excised with a 6 mm margin). Conclusion: Mohs Micrographic Surgery is an effective therapy for primary cutaneous melanoma. It may be particularly useful to conserve tissue for melanomas on the head, neck, hands, or feet or for melanomas with indistinct clinical margins. (J Am Acad Dermatol 1997;37:236-45.)
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Mohs Micrographic Surgery for the treatment of primary cutaneous melanoma.
Journal of the American Academy of Dermatology, 1997Co-Authors: J A Zitelli, C Brown, B H HanusaAbstract:Mohs Micrographic Surgery is thought to be a useful therapy for cutaneous melanoma. Controversy persists, however, because there are few published reports that document its safety and efficacy. Our purpose was to determine the safety and efficacy of Mohs Micrographic Surgery for the treatment of cutaneous melanoma. A consecutive sample of 535 patients referred for treatment of 553 primary cutaneous melanomas was entered into the study. Of this sample, 99.5% of patients completed their first 5 years of follow-up. All melanomas were excised by means of fresh-tissue Mohs Micrographic Surgery with frozen-section examination of the margin. The 5-year Kaplan-Meier melanoma mortality, metastasis, and local recurrence rates were compared with historical control cases. Mohs Micrographic Surgery provided 5-year survival and metastatic rates equivalent to or better than historical controls that were treated by standard wide-margin Surgery. Satellite metastases were not more common with the narrow margins used with Mohs Micrographic Surgery. Local recurrences from inadequate excision of the primary tumor were infrequent (0.5%). The majority of melanomas were successfully excised with a narrow margin (83% were excised with a 6 mm margin). Mohs Micrographic Surgery is an effective therapy for primary cutaneous melanoma. It may be particularly useful to conserve tissue for melanomas on the head, neck, hands, or feet or for melanomas with indistinct clinical margins.
James F. Thornton - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery.
Plastic and reconstructive surgery. Global open, 2020Co-Authors: Andrew M Ferry, Shayan M Sarrami, Pierce C. Hollier, Caitlin F Gerich, James F. ThorntonAbstract:Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs Micrographic Surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs Micrographic Surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs Micrographic Surgery is not readily available.
Richard G. Bennett - One of the best experts on this subject based on the ideXlab platform.
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dermatofibrosarcoma protuberans growing around plantar aponeurosis excision by Mohs Micrographic Surgery
Dermatologic Surgery, 2000Co-Authors: Gregory J Kricorian, Richard G. Bennett, Carl F Schanbacher, Paul A KellyAbstract:Background. Dermatofibrosarcoma protuberans (DFSP) is a spindle cell malignancy that has a high local recurrence rate after excision with minimal or no immediate tissue margin assessment. DFSP is exceedingly rare on the palms and soles. Objective. To report a case of a locally aggressive DFSP on the sole excised using Mohs Micrographic Surgery. Methods. Case report and review of the literature. Results. Mohs Micrographic Surgery unmasked tumor infiltration that extended around plantar aponeurosis and into underlying plantar muscle fascia. Conclusion. Mohs Micrographic Surgery should be considered the treatment of choice for DFSP, especially in acral locations. This technique allows the surgeon to trace out deep tumor extensions that may wrap around underlying tendon, a finding that may not be appreciated clinically.
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Success of delayed full-thickness skin grafts after Mohs Micrographic Surgery
Journal of The American Academy of Dermatology, 1995Co-Authors: Marie-josee Thibault, Richard G. BennettAbstract:Abstract Background: Specific factors affect the outcome of full-thickness skin grafts after Mohs Micrographic Surgery. No recent clinical studies have systematically investigated the clinical factors that may affect the success of full-thickness skin grafts. Objective: Our objective was to analyze patient data to define factors that may influence the success of full-thickness skin grafts. Methods: We reviewed the clinical course of 117 patients who had full-thickness skin grafts after Mohs Micrographic Surgery. We analyzed these cases using patient variables, tumor variables, and skin graft variables and then correlated these variables to skin graft success. Results: Delay of skin graft placement (>1 day) was significantly correlated with subsequent skin graft success ( p = 0.015). Skin graft necrosis was more likely to develop in men than in women ( p = 0.021). Conclusion: A delay of 2 to 8 days between Mohs Micrographic Surgery and full-thickness skin graft placement resulted in a lower incidence of skin graft necrosis than no delay or a delay of 1 day.
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Mohs Micrographic Surgery of the nail unit.
The Journal of dermatologic surgery and oncology, 1992Co-Authors: David Goldminz, Richard G. BennettAbstract:Malignancies of the nail unit are relatively uncommon, with squamous cell carcinoma (SCC) representing most of the reported cases. Squamous cell carcinoma of the nail unit, although commonly considered to be a curable malignancy, can and does kill. Review of the literature as well as a personal series confirm that Mohs Micrographic Surgery is an ideal treatment for periungual and subungual SCCs without osseous involvement. In addition, the anatomy and histology of nail unit SCC, as well as prognostic factors and perioperative evaluation as they relate to performing Mohs Micrographic Surgery, are reviewed.
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Current concepts in Mohs Micrographic Surgery.
Dermatologic clinics, 1991Co-Authors: Richard G. BennettAbstract:The evolution of fresh-tissue Mohs Micrographic Surgery is presented in this article. Special emphasis is given to accepted indications for Mohs Micrographic Surgery. Reconstructive techniques and certification in Mohs Micrographic Surgery are discussed.
Andrew M Ferry - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery.
Plastic and reconstructive surgery. Global open, 2020Co-Authors: Andrew M Ferry, Shayan M Sarrami, Pierce C. Hollier, Caitlin F Gerich, James F. ThorntonAbstract:Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs Micrographic Surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs Micrographic Surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs Micrographic Surgery is not readily available.