Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer
| Autor: | Michael A. Henderson, Albert Tiong, Emma L Hiscutt, Angela Webb, Michelle Sy Goh, Phillip Tran, Vanessa Estall, William K. Murray, Edmund Wee, Catherine Mitchell, Christopher McCormack |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Neoplasm Residual Skin Neoplasms medicine.medical_treatment Dermatology Documentation 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine medicine Mohs surgery Operative report Carcinoma Photography Humans Basal cell carcinoma Referral and Consultation Aged Retrospective Studies Aged 80 and over Medical Audit business.industry General surgery fungi Margins of Excision Retrospective cohort study Pathology Report Middle Aged medicine.disease Mohs Surgery Radiation therapy Treatment Outcome Carcinoma Basal Cell Head and Neck Neoplasms 030220 oncology & carcinogenesis Retreatment Carcinoma Squamous Cell Female Radiotherapy Adjuvant Skin cancer Neoplasm Recurrence Local business |
| Zdroj: | The Australasian journal of dermatology. 59(4) |
| ISSN: | 1440-0960 |
| Popis: | Background/objectives To describe the characteristics, subsequent management and outcomes of patients referred for further management following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods Retrospective analysis of patients referred to a quaternary cancer centre from 2000 to 2015. Results In total, 83 lesions in 82 patients were referred for further management; 52 (62%) were SCC and 80 (96%) were located in the head and neck. Reasons for referral included high-risk disease for consideration for adjuvant radiotherapy (37/83, 45%), inadequate resection (28/83, 34%) or recurrence following previous MMS (15/83, 17%). Fewer than 40% of the 69 referrals received from MMS surgeons included photos or an operative report and diagram. There was discordance in pathology opinion in 11 (13%) of cases. Histopathology from MMS was reviewed in eight cases and there was discordance with the in-hospital pathology opinion in six of these. In-hospital re-excision was performed in 19 cases and in five of these the pathology report on the paraffin-sectioned re-excised tissue was discordant with prior MMS assessment. Significantly, two cases were associated with a misinterpretation of lymphocytic infiltrate as residual disease in patients with chronic lymphocytic leukaemia (CLL). Conclusion This study highlights some of the challenges and limitations of MMS. Early referral for multidisciplinary management is recommended when MMS resection margins are inadequate or uncertain, especially for high-risk SCC. We recommend that referrals be accompanied by histological material, as well as a detailed report with operative photos and diagrams. CLL can pose an intraoperative diagnostic challenge. Discrepancies in the interpretation of MMS slides present an opportunity for improvement, and our findings support the role of ongoing quality assurance programs. |
| Databáze: | OpenAIRE |
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