Intraoperative use of Mohs' surgery for the resection of major cutaneous head and neck cancer under general anaesthetic: Initial experiences, efficiency and outcomes
| Autor: | Eunice K. Tan, Martin Heaton, Hyder Ridha, Jennifer Garioch, Marc Moncrieff, Laszlo Igali |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Skin Neoplasms medicine.medical_treatment Simultaneous resection Anesthesia General Surgical Flaps Resection medicine Mohs surgery Humans Prospective Studies General anaesthetic Prospective cohort study Aged Aged 80 and over Intraoperative Care business.industry Head and neck cancer Middle Aged Plastic Surgery Procedures medicine.disease Mohs Surgery Surgery Treatment Outcome Head and Neck Neoplasms Female Skin cancer business |
| Zdroj: | Journal of plastic, reconstructiveaesthetic surgery : JPRAS. 68(12) |
| ISSN: | 1878-0539 |
| Popis: | Summary Background Complete excision of high-risk extensive non-melanoma skin cancers in the head and neck is paramount to achieving loco-regional control. However, achieving clear margins still remains a significant challenge. Mohs' micrographic surgery (MMS) provides the most accurate method of intraoperative mapping and histological assessment of tumour margins. We have developed a technique combining MMS with reconstruction as a single-stage procedure performed under general anaesthetic. We present our experience and results. Materials and methods Following regional skin cancer multidisciplinary team (MDT) discussion, patients considered appropriate for management as a single-stage combined procedure were referred for assessment. At surgery, a two-team approach was employed consisting of an MMS resection team and a reconstructive team, allowing simultaneous resection and elevation of any free tissue required for reconstruction. Outcome data were retrieved from a prospectively collated MMS database. Results Twenty-six cases were performed between January 2010 and January 2013. Fifty-eight percent of cases were basal cell carcinomas. Clear margins were achieved in 50% of cases following the first Mohs' layer. Free tissue reconstruction was required in 13 cases. Mean anaesthetic time was 445 min. Loco-regional control was achieved in 96% of patients, at a mean follow-up period of 29 months (range 11–50 months). Conclusions This study shows that the combined single-stage MMS and reconstruction surgical model is safe, results in a low recurrence rate and improved patient care. It is a model that can be replicated in other tertiary skin cancer units. |
| Databáze: | OpenAIRE |
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