Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Radiation therapy
Radiation therapy may be useful for primary treatment of low-risk non melanoma skin cancers. In experienced hands, primary radiation therapy may also be useful for higher risk tumors with high cure rates. For cutaneous SCC with many high-risk factors and for those with extensive neurotropism, adjuvant prophylactic radiation therapy to the primary site and the primary draining lymph nodes may decrease the risks of local recurrence and regional nodal metastasis. Prophylactic adjuvant radiation therapy should also be considered for highly aggressive, deeply invasive BCCs that exhibit extensive neurotropism.
Monday, December 3, 2007
Sunday, December 2, 2007
Treating BCC and SCC (Skin Cancer #6)
Skin cancer awareness ---> skin cancer videos ---> Non melanoma skin cancer ---> treatment of Non melanoma skin cancer
Basal cell carcinoma and squamous cell carcinoma are the two types of non-melanoma skin cancers. Luckily, there are many options for treating them.
Basal cell carcinoma and squamous cell carcinoma are the two types of non-melanoma skin cancers. Luckily, there are many options for treating them.
Surgical Treatment of Nonmelanoma Skin Cancers
Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Non melanoma skin cancer Surgery
A skin biopsy for diagnosis is important before treatment of any skin cancer. Fortunately, most non melanoma skin cancers are small, low-risk lesions that respond with 90% to 95% cure rates to standard treatment techniques, including curettage and electrodesiccation, cryosurgery, radiation therapy, and surgical resection. Many skin cancers can be removed with elliptical excisions. Margins for low-risk SCC range from 0.5 to 1 cm. Margins for low-risk BCC range from 0.3 to 0.5 cm. Mohs surgery should be considered for BCCs and SCCs that exhibit the higher-risk factors. If Mohs surgery is not available, excision with careful frozen-section control (with permanent section confirmation) is indicated. The fundamental oncologic principle of tumor clearance first, reconstruction second should be followed.
A skin biopsy for diagnosis is important before treatment of any skin cancer. Fortunately, most non melanoma skin cancers are small, low-risk lesions that respond with 90% to 95% cure rates to standard treatment techniques, including curettage and electrodesiccation, cryosurgery, radiation therapy, and surgical resection. Many skin cancers can be removed with elliptical excisions. Margins for low-risk SCC range from 0.5 to 1 cm. Margins for low-risk BCC range from 0.3 to 0.5 cm. Mohs surgery should be considered for BCCs and SCCs that exhibit the higher-risk factors. If Mohs surgery is not available, excision with careful frozen-section control (with permanent section confirmation) is indicated. The fundamental oncologic principle of tumor clearance first, reconstruction second should be followed.
Saturday, December 1, 2007
Understanding Basal Cell Carcinoma (Skin Cancer #4)
Skin cancer awareness ---> skin cancer videos ---> Non melanoma skin cancer ---> Basal Cell Carcinoma
Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.
Basal cell carcinoma is the most common form of all cancers. Learn more about BCC.
Mohs Surgery
Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Non melanoma skin cancer Surgery ---> Mohs Surgery
Mohs surgery was developed by Frederick E. Mohs, a general surgeon from the University of Wisconsin, in the 1940s. Initially, a chemical fixative paste was applied to the skin to fix the tissue in situ; hence, the now outdated term Mohs chemosurgery. The fresh tissue technique, which omitted the chemical paste, was developed and refined in the 1970s. Mohs micrographic surgery is most useful for the treatment of higher risk NMSC. Mohs surgery is usually performed under local anesthesia in an outpatient Mohs surgical unit. After removal of all gross tumor, the surgeon excises a thin layer of tissue with 2- to 3-mm margins. The tissue is mapped, color-coded for orientation, and sent to the technician for frozen-section processing. The specimen is flexible and flattened, with the beveled peripheral skin edge placed in the same horizontal plane with the deep margin. In this plane, both the deep and peripheral margins are examined in one horizontal cut by frozen-section analysis with total (theoretically 100%) margin control. Good-quality frozen sections may be achieved only by a skilled and experienced Mohs histotechnician. The Mohs surgeon functions as both surgeon and pathologist. After histologic interpretation of the frozen-section specimens, the precise anatomic location of any residual tumor can be identified and re-excised until all margins are tumor free. The Mohs surgeon's ability microscopically to track subclinical tumor extensions results in the highest cure rate with maximal preservation of normal tissue. Soft tissue reconstruction can then be performed on the same day, after completion of Mohs surgical excision of the tumor. A multidisciplinary approach involving Mohs, plastic, head and neck, and oculo-plastic surgeons and radiation oncologists may be needed for extensive tumors. Mastering the Mohs technique is based on a steep learning curve. The American College of Mohs Micrographic Surgery and Cutaneous Oncology requires 1 to 2 years of fellowship training with a minimum of 500 to 600 cases before certification.
Mohs surgery was developed by Frederick E. Mohs, a general surgeon from the University of Wisconsin, in the 1940s. Initially, a chemical fixative paste was applied to the skin to fix the tissue in situ; hence, the now outdated term Mohs chemosurgery. The fresh tissue technique, which omitted the chemical paste, was developed and refined in the 1970s. Mohs micrographic surgery is most useful for the treatment of higher risk NMSC. Mohs surgery is usually performed under local anesthesia in an outpatient Mohs surgical unit. After removal of all gross tumor, the surgeon excises a thin layer of tissue with 2- to 3-mm margins. The tissue is mapped, color-coded for orientation, and sent to the technician for frozen-section processing. The specimen is flexible and flattened, with the beveled peripheral skin edge placed in the same horizontal plane with the deep margin. In this plane, both the deep and peripheral margins are examined in one horizontal cut by frozen-section analysis with total (theoretically 100%) margin control. Good-quality frozen sections may be achieved only by a skilled and experienced Mohs histotechnician. The Mohs surgeon functions as both surgeon and pathologist. After histologic interpretation of the frozen-section specimens, the precise anatomic location of any residual tumor can be identified and re-excised until all margins are tumor free. The Mohs surgeon's ability microscopically to track subclinical tumor extensions results in the highest cure rate with maximal preservation of normal tissue. Soft tissue reconstruction can then be performed on the same day, after completion of Mohs surgical excision of the tumor. A multidisciplinary approach involving Mohs, plastic, head and neck, and oculo-plastic surgeons and radiation oncologists may be needed for extensive tumors. Mastering the Mohs technique is based on a steep learning curve. The American College of Mohs Micrographic Surgery and Cutaneous Oncology requires 1 to 2 years of fellowship training with a minimum of 500 to 600 cases before certification.
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