Description of patients excluded for Mohs surgery after pre-surgical evaluation: data from the Regesmohs Spanish registry
| Autor: | Ignacio García-Doval, J.L. Artola Igarza, T. Alonso-Alonso, P. Redondo Bellón, E. Vilarasa, Raquel Navarro, Veronica Ruiz-Salas, P. Lázaro Ochaita, M. Alonso, E. Eusebio Murillo, J.R. Garcés, C. Guillén Barona, C. Ciudad Blanco, A. Alfaro Rubio, R. Miñano, O. Sanmartín-Jiménez, Miguel Ángel Descalzo, Y. Delgado Jiménez, Manuel Ángel Rodríguez-Prieto, I. Allende Markixana, Hugo Vázquez-Veiga, L. Barchino Ortiz, A. Toll-Abelló, José L. López-Estebaranz |
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| Rok vydání: | 2017 |
| Předmět: |
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medicine.medical_specialty Histology Palliative care Skin Neoplasms medicine.medical_treatment Evaluation data Vismodegib Dermatology Comorbidity Pathology and Forensic Medicine Contraindications Procedure 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine medicine Mohs surgery Humans Basal cell carcinoma Hedgehog Proteins Prospective Studies Registries Lymph node Contraindication Aged Aged 80 and over business.industry Patient Selection Palliative Care medicine.disease Mohs Surgery Surgery Neoplasm Proteins Radiation therapy medicine.anatomical_structure Withholding Treatment Carcinoma Basal Cell Spain 030220 oncology & carcinogenesis Carcinoma Squamous Cell Female business medicine.drug |
| Zdroj: | Actas dermo-sifiliograficas. 109(4) |
| ISSN: | 2173-5778 |
| Popis: | Background Regesmohs registry is a nationwide registry including patients evaluated for Mohs surgery in 17 Spanish centres since July 2013. Given that Mohs surgery is the therapy with best results for high risk basal cell carcinoma (BCC) and other skin tumours, we wanted to describe the reasons that lead to some patients being excluded from this therapy and the alternative treatments that they received. These data may be useful to avoid excluding patients for Mohs surgery use, to estimate the healthcare demand of these patients and the demand for Hedgehog inhibitors therapy in this group. Objective To describe patients excluded for Mohs surgery after pre-surgical assessment, and the treatments that they received. Methods Regesmohs includes all consecutive patients assessed for Mohs surgery in the participating centres, collecting data on patient characteristics, intervention, and short and long-term results. Patients excluded for Mohs surgery after pre-surgical evaluation were described. Results 3011 patients were included in Regesmohs from July 2013 to October 2016. In 85, Mohs surgery was not performed as they were considered inadequate candidates. 67 had BCC. Reasons for exclusion were: medical contraindication (27.1%, n = 23) low-risk tumour in (18.8%, n = 16) and giant tumour and bone invasion (15.3%, n = 13). Only 1 patient (1.2%) showed lymph node involvement and no patients had visceral metastases. Of the 85 excluded patients, 29 (34.1%) were treated with conventional surgery, 24 (28.3%) with radiotherapy, 4 (4.7%) with inhibitors of the Hedgehog pathway (only indicated for BCC), and 2 (2.4%) received palliative care. We had no follow-up data on 14 patients (16.5%). Conclusion Medical comorbidities were the most common reason for withholding Mohs surgery. Withholding therapy on the basis of distant extension is uncommon. Most excluded patients received simpler therapies: conventional surgery or radiotherapy, with hedgehog inhibitors being a new option. |
| Databáze: | OpenAIRE |
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