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Файл:Ординатура / Офтальмология / Английские материалы / Mohs Micrographic Surgery_Nouri_2012.pdf
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- •Foreword
- •Preface
- •Acknowledgements
- •Contents
- •Contributors
- •Summary: An Introduction to Mohs Micrographic Surgery
- •1.1 Introduction
- •Summary: Conclusion
- •1.2 Conclusion
- •References
- •Summary: Introduction
- •2.1 Introduction
- •Summary: Common Indications
- •2.2 Common Indications
- •2.2.1 Basal Cell Carcinoma (BCC)
- •2.2.2 Squamous Cell Carcinoma (SCC)
- •Summary: Uncommon Indications
- •2.3 Uncommon Indications
- •2.3.2 Microcystic Adnexal Carcinoma (MAC)
- •2.3.3 Atypical Fibroxanthoma (AFX)
- •2.3.5 Malignant Fibrous Histiocytoma (MFH)
- •2.3.6 Sebaceous Carcinoma (SC)
- •2.3.7 Melanoma
- •2.3.8 Merkel Cell Carcinoma (MCC)
- •Summary: Conclusion
- •2.4 Conclusion
- •References
- •3: Preoperative Evaluation
- •Summary: Introduction
- •3.1 Introduction
- •3.3 History of Present Illness and Physical Examination
- •Summary: Past Medical History
- •3.4 Past Medical History
- •Summary: Medications and Allergies
- •3.5 Medications and Allergies
- •Summary: Assessing the Need for Infection Prophylaxis
- •Summary: Discussion of Postoperative Care
- •3.7 Discussion of Postoperative Care
- •Summary: Conclusion
- •3.8 Conclusion
- •References
- •Summary: Introduction
- •4.1 Introduction
- •Summary: Mohs Surgery Waiting Room
- •4.2 Mohs Surgery Waiting Room
- •4.3 Mohs Surgery Operative Room Planning
- •4.3.1 Photography
- •4.3.2 Laser Safety
- •4.4 Mohs Surgery Operative Room Equipment
- •4.4.1 Surgical Table
- •4.4.3 Surgical Lights
- •4.4.4 Surgical Sink
- •4.4.5 Electrosurgical Equipment
- •4.4.6 Suction
- •4.4.7 Mayo Stand/Kick Bucket
- •4.4.8 Waste Disposal
- •Summary: Personal Protective Equipment
- •4.5 Personal Protective Equipment
- •4.5.1 Masks and Eye Protection
- •4.5.2 Gowns
- •4.5.3 Scrubs
- •4.5.4 Gloves
- •Summary: Instrumentation and Setup
- •4.6 Instrumentation and Setup
- •4.6.1 Scalpels
- •4.6.2 Blades
- •4.6.3 Standard Mohs Surgery Setup
- •4.6.4 Mohs Surgery Eye Tray
- •4.6.5 Excision/Closure Tray for Face
- •4.6.6 Excision/Closure Tray for Trunk
- •4.6.7 Nail Surgery Instruments
- •Summary: Wound Care Dressing Materials
- •4.7 Wound Care Dressing Materials
- •Summary: Equipment Sterilization
- •4.8 Equipment Sterilization
- •Summary: Monitoring and Emergency Equipment
- •4.9 Monitoring and Emergency Equipment
- •Summary: Conclusion
- •4.10 Conclusion
- •References
- •Summary: Introduction
- •5.1 Introduction
- •Summary: History
- •5.2 History
- •Summary: Pharmacology
- •5.3 Pharmacology
- •Summary: Pharmacokinetics
- •5.4 Pharmacokinetics
- •Summary: Regional Anesthesia
- •5.5 Regional Anesthesia
- •Summary: Peripheral Nerve Fibers
- •5.6 Peripheral Nerve Fibers
- •Summary: Metabolism
- •5.7 Metabolism
- •Summary: Toxicity
- •5.8 Toxicity
- •Summary: Method of Injection
- •5.9 Method of Injection
- •Summary: Amino-Esters
- •5.10 Amino-Esters
- •Summary: Amino-Amides
- •5.11 Amino-Amides
- •5.11.1 Topical Anesthesia
- •Summary: Conclusion
- •5.12 Conclusion
- •References
- •Summary: Introduction
- •6.1 Introduction
- •Summary: Scalp and Forehead
- •6.2 Scalp and Forehead
- •6.2.1 Vasculature
- •6.2.2 Nerves
- •6.2.3 Lymphatic Drainage
- •Summary: Midface
- •6.3 Midface
- •6.3.1 Nasal Subunit
- •6.3.1.1 Vasculature
- •6.3.1.2 Nerves
- •6.3.1.3 Lymphatic Drainage
- •6.3.2 Perioral
- •6.3.2.1 Vasculature
- •6.3.2.2 Nerves
- •6.3.2.3 Lymphatic Drainage
- •6.3.3 Chin
- •6.3.3.1 Vasculature
- •6.3.3.2 Nerves
- •6.3.3.3 Lymphatic Drainage
- •Summary: Periorbital
- •6.4 Periorbital
- •6.4.1 Vasculature
- •6.4.2 Nerves
- •6.4.3 Lymphatic Drainage
- •Summary: Cheeks
- •6.5 Cheeks
- •6.5.1 Vasculature
- •6.5.2 Nerves
- •6.5.3 Lymphatic Drainage
- •Summary: Auricular
- •6.6 Auricular
- •6.6.1 Vasculature
- •6.6.2 Nerves
- •6.6.3 Lymphatic Drainage
- •Summary: Neck
- •6.7 Neck
- •6.7.1 Nerves
- •6.7.2 Lymphatic Drainage
- •6.8 Special Anatomic Considerations in Mohs Micrographic Surgery
- •6.8.1 Danger Zones
- •6.8.2 Other Considerations
- •References
- •7: Mohs Surgery: Fixed Tissue Technique
- •Summary
- •Summary: Conclusion
- •7.2 Conclusion
- •References
- •8: Fresh Tissue Technique
- •Summary: Introduction
- •8.1 Introduction
- •Summary: The Technique
- •8.2 The Technique
- •Summary: Histologic Preparation of the Tissue
- •8.3 Histologic Preparation of the Tissue
- •Summary: Conclusion
- •8.4 Conclusion
- •References
- •Summary: Introduction
- •9.1 Introduction
- •Summary: Solid Organ Transplant Recipients
- •9.2 Solid Organ Transplant Recipients
- •Summary: HIV/AIDS
- •9.3 HIV/AIDS
- •Summary: Cutaneous Neoplasms
- •9.4 Cutaneous Neoplasms
- •9.4.1 Actinic Keratoses and Squamous Cell Carcinoma
- •9.4.2 Basal Cell Carcinoma
- •9.4.3 Melanoma
- •9.4.4 Merkel Cell Carcinoma
- •9.4.5 Kaposi Sarcoma
- •9.5.1 Preoperative Evaluation
- •9.5.2 Antibiotic Prophylaxis
- •9.5.3 Wound Healing
- •9.5.4 Selection of Therapeutic Modality
- •9.5.5 Follow-Up
- •Summary: Conclusion
- •9.6 Conclusion
- •References
- •10: Mohs Micrographic Surgery in Ethnic Skin
- •10.1 Introduction
- •Summary: Histologic Differences in Skin of Color
- •Summary: Basal Cell Carcinoma (BCC)
- •10.3 Basal Cell Carcinoma (BCC)
- •Summary: Squamous Cell Carcinoma (SCC)
- •10.4 Squamous Cell Carcinoma (SCC)
- •Summary: Malignant Melanoma (MM)
- •10.5 Malignant Melanoma (MM)
- •Summary: Conclusion
- •10.7 Conclusion
- •References
- •Summary: The Operating Room (OR)
- •11.2 The Operating Room (OR)
- •Summary: Surgical Waiting Room
- •11.3 Surgical Waiting Room
- •Summary: The Histopathology Laboratory
- •11.4 The Histopathology Laboratory
- •Summary: Grossing and Inking
- •11.5 Grossing and Inking
- •11.6 Embedding and Mounting Tissue and the Cryostat
- •Summary: Staining Frozen Sections
- •11.7 Staining Frozen Sections
- •Summary: Slide Reading
- •11.8 Slide Reading
- •Summary: Conclusion
- •11.10 Conclusion
- •References
- •Summary: Tissue Transport
- •12.1 Tissue Transport
- •Summary: Initial Processing
- •12.2 Initial Processing
- •Summary: Conclusion
- •12.3 Conclusion
- •Reference
- •Summary: Introduction
- •13.1 Introduction
- •13.2 Histopathologic Scanning of Mohs Slides
- •13.3 Histopathologic Recognition of Cutaneous Structures
- •13.3.1 Recognition of Epidermal and Epithelial Components and Their Neoplasia
- •13.3.1.1 The Epidermis
- •13.3.1.2 Melanocytes and the Melanocytic Lesions
- •13.3.1.4 The Pilosebaceous Unit
- •13.3.1.5 The Bulge
- •13.3.1.6 The Mantle and Sebaceous Glands
- •13.3.1.7 The Folliculocentric Basaloid Proliferations (FBP)
- •13.3.2 Histopathologic Recognition of Dermal Components
- •13.3.2.1 Fibrous Tissue, Desmoplasia, and Nerves
- •13.3.2.2 The Dermal Microvascular Unit
- •13.3.2.3 Dermal Muscles, Cartilage, and Subcutaneous Adipose Tissue
- •Summary: Conclusion
- •13.4 Conclusion
- •References
- •Summary: History
- •14.1 History
- •Summary: Preexamination Process
- •14.4 Preexamination Process
- •Summary: Examination Process
- •14.5 Examination Process
- •Summary: Postexamination Process
- •14.6 Postexamination Process
- •Summary: Conclusion
- •14.7 Conclusion
- •References
- •15: Immunostains
- •Summary: Introduction
- •15.1 Introduction
- •Summary: Melanoma
- •15.3 Melanoma
- •15.4 Basal Cell and Squamous Cell Carcinoma
- •Summary: Other Rare Tumors
- •15.7 Other Rare Tumors
- •15.7.1 Granular Cell Tumor
- •15.7.2 Primary Mucinous Carcinoma
- •15.7.3 Trichilemmal Carcinoma
- •Summary: Conclusions
- •15.8 Conclusions
- •References
- •16: Basal Cell Carcinoma
- •Summary: Introduction
- •16.1 Introduction
- •Summary: Etiology
- •16.2 Etiology
- •16.3 Histological Findings Using Horizontal Frozen Sections
- •Summary: Non-cancerous Conditions That May Be Histologically Similar to BCC
- •Summary: Cancerous Conditions That May Be Histologically Similar to BCC
- •16.6 Adnexal Differentiation Observed in BCC
- •Summary: Basosquamous Differentiation
- •16.7 Basosquamous Differentiation
- •Summary: Therapeutic Options
- •16.8 Therapeutic Options
- •Summary: Mohs Micrographic Surgery
- •16.9 Mohs Micrographic Surgery
- •Summary: Conclusions
- •16.10 Conclusion
- •References
- •17: Squamous Cell Carcinoma
- •Summary: Introduction
- •17.1 Introduction
- •Summary: Pathophysiology (Risk Factors for SCC Development)
- •17.2 Pathophysiology (Risk Factors for SCC Development)
- •17.2.1 Ultraviolet Light
- •17.2.2 Human Papilloma Virus
- •17.2.3 Molecular and Genetic Factors Impacting SCC Development
- •Summary: Clinical Disease Spectrum
- •17.3 Clinical Disease Spectrum
- •17.3.1 Actinic Keratosis
- •17.3.2 Squamous Cell Carcinoma In Situ
- •17.3.3 Invasive Squamous Cell Carcinoma
- •17.3.4 Differential Diagnosis
- •17.4 Management of Invasive Cutaneous SCC
- •17.4.1 Surgical Options
- •17.4.2 Radiation Therapy as Primary Therapy
- •17.5.4 Surgical Management
- •17.5.5 Radiation as Primary Therapy
- •17.5.6 Adjuvant Therapy
- •17.5.7 Assessment of Immune Status
- •17.5.8 Follow-Up for High-Risk SCC Patients
- •Summary: Treatment of Field Cancerization
- •17.6 Treatment of Field Cancerization
- •Summary: Conclusions
- •17.7 Conclusions
- •References
- •Summary: Introduction
- •18.1 Introduction
- •Summary: Surgical Treatment of Melanoma
- •18.2 Surgical Treatment of Melanoma
- •Summary: MMS for Cutaneous Melanoma
- •18.3 MMS for Cutaneous Melanoma
- •Summary: Application of MMS for the Treatment of Cutaneous Melanoma: IHC Stains
- •18.4 Application of MMS for the Treatment of Cutaneous Melanoma
- •18.4.1 IHC Stains
- •18.4.2 Technical Application of MMS and Interpretation of IHC Stains
- •Summary: Conclusion
- •18.5 Conclusion
- •References
- •19.1 Introduction
- •Summary: Epidemiology
- •19.2 Epidemiology
- •Summary: Pathogenesis
- •19.3 Pathogenesis
- •Summary: Clinical Features
- •19.4 Clinical Features
- •Summary: Pathology
- •19.5 Pathology
- •Summary: Differential Diagnose
- •19.6 Differential Diagnoses
- •Summary: Management
- •19.7 Management
- •19.7.1 Surgery
- •19.7.1.1 Wide Local Excision
- •19.7.1.2 Mohs Micrographic Surgery
- •19.7.2 Radiotherapy
- •19.7.3 Molecularly Targeted Therapy
- •19.7.4 Imaging Studies
- •Summary: Prognosis
- •19.8 Prognosis
- •Summary: Conclusion
- •19.9 Conclusion
- •20: Microcystic Adnexal Carcinoma
- •Summary: Introduction
- •20.1 Introduction
- •Summary: Epidemiology
- •20.2 Epidemiology
- •Summary: Pathogenesis
- •20.3 Pathogenesis
- •Summary: Clinical Features and Diagnosis
- •20.4 Clinical Features and Diagnosis
- •Summary: Histopathological Features
- •20.5 Histopathological Features
- •Summary: Treatment
- •20.6 Treatment
- •Summary: Prognosis and Follow-Up
- •References
- •21: Atypical Fibroxanthoma
- •Summary: History
- •21.1 History
- •Summary: Pathogenesis
- •21.2 Pathogenesis
- •Summary: Clinical Features
- •21.3 Clinical Features
- •Summary: Pathology
- •21.4 Pathology
- •Summary: Treatment
- •21.5 Treatment
- •Summary: Conclusion
- •21.6 Conclusion
- •References
- •22: Extramammary Paget Disease
- •Summary: Introduction
- •22.1 Introduction
- •Summary: History of EMPD and Epidemiology
- •22.2 History of EMPD and Epidemiology
- •22.2.1 History of EMPD
- •22.2.2 Epidemiology
- •22.2.3 Associated Malignancies
- •22.2.4 Affected Areas: Sites with Apocrine Glands
- •22.3 Clinical Presentation and Natural History
- •22.3.1 Clinical Presentation
- •22.3.2 Prognosis
- •Summary: Clinical Subtypes
- •22.4 Clinical Subtypes
- •22.4.1 Vulvar EMPD
- •22.4.2 Perianal EMPD
- •22.4.3 Penoscrotal EMPD
- •22.4.4 Triple EMPD
- •22.4.5 Unifocal or Multifocal Disease?
- •22.5 Diagnosing EMPD/Disease Pathophysiology
- •22.5.1 Histology
- •22.5.2 Histologic Differential Diagnosis
- •22.5.3 Evaluation for Internal Malignancy
- •22.5.4 Sentinel Lymph Node Biopsy
- •22.5.5 Pathophysiology
- •22.5.6 Cell of Origin
- •Summary: EMPD Treatment
- •22.6 EMPD Treatment
- •22.6.1 Wide Local Excision and Recommended Margin
- •22.6.2 Time to Recurrence
- •22.6.2.1 Mohs Surgery for EMPD
- •22.6.3 Mohs Surgery with CK7 Immunostaining
- •22.6.4 Peripheral Mohs Surgery
- •22.6.5 Scouting Biopsies
- •Summary: Alternative Treatment Options
- •22.7 Alternative Treatment Options
- •22.7.2 Photodynamic Therapy
- •22.7.3 Laser Vaporization
- •22.7.4 Radiation Therapy
- •22.7.5 Chemotherapy for EMPD: Local and Systemic
- •Summary: Conclusion
- •22.8 Conclusion
- •References
- •23: Leiomyosarcoma
- •Summary: Introduction
- •23.1 Introduction
- •Summary: Clinical Features
- •23.2 Clinical Features
- •Summary: Histologic Features
- •23.3 Histologic Features
- •Summary: Prognosis
- •23.4 Prognosis
- •23.4.1 Treatment
- •23.4.2 Mohs Micrographic Surgery (MMS)
- •Summary: Conclusion
- •23.5 Conclusion
- •References
- •24: Merkel Cell Carcinoma
- •Summary: Overview of Merkel Cell Carcinoma
- •24.1 Overview of Merkel Cell Carcinoma
- •Summary: Diagnosis of Merkel Cell Carcinoma
- •24.2 Diagnosis of Merkel Cell Carcinoma
- •24.2.1 Clinical Features
- •24.2.2 Pathology
- •24.2.3 Differential Diagnosis
- •Summary: Management of Merkel Cell Carcinoma
- •24.3 Management of Merkel Cell Carcinoma
- •24.3.1 Patient Evaluation and Staging
- •24.3.1.1 No Clinical Nodal Involvement
- •24.3.1.2 Clinical Nodal Involvement
- •24.3.1.3 Metastatic Disease
- •24.3.2 Treatment
- •24.3.3 Prognosis
- •24.4 Mohs Micrographic Surgery and Merkel Cell Carcinoma
- •Summary: Conclusion
- •24.5 Conclusion
- •References
- •25: Selected Sweat Gland Carcinomas
- •Summary: Porocarcinoma
- •25.1 Porocarcinoma
- •Summary: Hidradenocarcinoma
- •25.2 Hidradenocarcinoma
- •Summary: Cutaneous Adenoid Cystic Carcinoma
- •25.3 Cutaneous Adenoid Cystic Carcinoma
- •Summary: Malignant Cylindroma
- •25.5 Malignant Cylindroma
- •Summary: Mucinous Carcinoma of the Skin
- •25.6 Mucinous Carcinoma of the Skin
- •Summary: Conclusion
- •25.7 Conclusion
- •References
- •Porocarcinoma
- •Hidradenocarcinoma
- •Cutaneous Adenoid Cystic Carcinoma
- •Spiradenocarcinoma
- •Malignant Cylindroma
- •Mucinous Carcinoma of the Skin
- •26: Sebaceous Carcinoma
- •Summary: Introduction
- •26.1 Introduction
- •26.1.1 Origin
- •26.1.2 History
- •26.1.3 Extraorbital Sites
- •26.1.4 Incidence
- •Summary: Demographics
- •26.2 Demographics
- •26.2.1 Age, Sex, Irradiation, Race
- •26.2.3 Human Papillomavirus (HPV)
- •26.2.4 Other Risk Factors
- •Summary: Clinical Presentation
- •26.3 Clinical Presentation
- •Summary: Histopathology
- •26.4 Histopathology
- •26.4.1 Pattern of Differentiation
- •26.4.2 Degree of Differentiation
- •26.4.3 Mechanisms of Invasion
- •26.4.3.1 Direct Invasion
- •26.4.3.2 Pagetoid Spread
- •26.4.3.3 Multicentric Origin
- •26.4.4 Clinicopathologic Features of Poor Outcomes
- •Summary: Treatment
- •26.5 Treatment
- •26.5.1 Biopsy Procedure
- •26.5.2 Conjunctiva Mapped Biopsies
- •26.5.3 Oil Red O and Sudan Black Stains
- •26.5.4 Traditional Wide Local Excision (WLE)
- •26.5.5 Mohs Micrographic Surgery
- •26.5.6 Surgical and Tissue Processing Issues
- •26.5.7 Frozen Sections
- •26.5.9 Exenteration
- •26.5.10 Mohs Surgery, Practical Points
- •26.5.11 Corneal Protection Measures
- •Summary: Follow-Up Considerations
- •26.6.1 Local Recurrence
- •26.6.2 Metastasis
- •26.6.3 Distant Metastasis
- •26.6.4 Sentinel Lymph Node (SLN)
- •Summary: Conclusion
- •26.7 Conclusion
- •References
- •Summary: Introduction
- •27.1 Introduction
- •Summary: Review of the Relevant Anatomy
- •27.2 Review of the Relevant Anatomy
- •27.3 Anatomical Considerations When Using Mohs Micrographic Surgery in the Periorbital Region
- •Summary: Periorbital BCC
- •27.4 Periorbital BCC
- •Summary: Periorbital SCC
- •27.5 Periorbital SCC
- •Summary: Other Tumors
- •27.6 Other Tumors
- •Summary: Conclusion
- •27.7 Conclusion
- •References
- •28.1 Introduction
- •Summary: Introduction
- •Summary: Anatomy
- •28.2 Anatomy
- •28.2.1 Nail Matrix
- •28.2.2 Nail Plate
- •28.2.3 Supporting Portion: Nail Bed and Phalangeal Bone
- •28.2.4 Nail Folds
- •28.2.5 Cuticle
- •28.2.6 Hyponychium
- •28.2.7 Arteries and Nerves of the Digit
- •28.2.8 Extensor Tendon
- •Summary: Tumors
- •28.3 Tumors
- •28.3.1 Squamous Cell Carcinoma
- •28.3.3 Melanoma
- •28.3.4 Basal Cell Carcinoma
- •28.3.5 Warts
- •Summary: Mohs Technique
- •28.4 Mohs Technique
- •28.4.1 Preoperative Evaluation
- •28.4.2 Anesthesia
- •28.4.3 Instruments
- •28.4.4 Preoperative Preparation
- •28.4.5 Mohs Technique
- •28.4.6 Dressings and Postoperative Care
- •Summary: Complications
- •28.5 Complications
- •Summary: Conclusions
- •28.6 Conclusions
- •References
- •29: Genitalia
- •Summary: Introduction
- •29.1 Introduction
- •Summary: Surgical Technique
- •29.2 Surgical Technique
- •Summary: Reconstruction
- •29.3 Reconstruction
- •Summary: Common Genital Lesions Treated with Mohs Micrographic Surgery
- •29.4.1 Basal Cell Carcinoma
- •29.4.3 In Situ and Invasive Malignant Melanomas
- •29.4.6 Granular Cell Tumor
- •29.4.8 Leukemias and Lymphoblastomas
- •29.4.9 Langerhans Cell Histiocytosis
- •29.4.10 Haemolymphangioma
- •Summary: Conclusions
- •29.5 Conclusions
- •References
- •Summary: Introduction
- •30.1 Introduction
- •Summary: Innervation of the Face and Scalp
- •30.2 Innervation of the Face and Scalp
- •30.2.2 Sensory Innervation of the Face and Scalp
- •30.2.3 Innervation of the Ear
- •Summary: Muscles of Facial Expression
- •30.3 Muscles of Facial Expression
- •30.3.1 Muscles of the Forehead
- •30.3.2 Muscles of the Periorbital Region
- •30.3.3 Muscles of the Nose
- •30.3.4 Muscles of the Cheek and Perioral Region
- •30.4 Soft Tissue Components of the Scalp and Face
- •30.4.1 Scalp
- •30.4.2 Face
- •30.5 Bony and Cartilaginous Structures of the Face and Scalp
- •30.5.1 Bony Landmarks
- •30.5.2 Cartilaginous Structures
- •30.6 Muscosa of the Lip, Nose, and Conjunctiva
- •Summary: Conclusion
- •30.8 Conclusion
- •References
- •Summary: Bleeding Complications
- •31.1 Bleeding Complications
- •Summary: Infectious Complications
- •31.2 Infectious Complications
- •Summary: Nerve Injury
- •31.3 Nerve Injury
- •Summary: Tumor Recurrence
- •31.4 Tumor Recurrence
- •Summary: Medication Complications
- •31.5 Medication Complications
- •Summary: Recently Described Complications
- •31.6 Recently Described Complications
- •Summary: Conclusion
- •31.7 Conclusion
- •References
- •32.1.1 Upper Eyelid
- •32.1.1.1 Primary Closure
- •32.1.1.2 Myocutaneous Advancement Flap
- •32.1.1.3 Full-Thickness Skin Graft
- •32.1.2 Lower Eyelid
- •32.1.2.1 Primary Closure
- •32.1.2.2 Myocutaneous Advancement Flap
- •32.1.2.3 Ellipse Sliding Flap
- •32.1.2.4 Unipedicle Flap
- •32.1.2.5 Skin Graft
- •Summary: Full-Thickness Eyelid Defects
- •32.2.1 Upper Eyelid
- •32.2.1.1 Primary Closure
- •32.2.2 Lower Eyelid
- •32.2.2.1 Primary Closure
- •Summary: Special Circumstances
- •32.3 Special Circumstances
- •32.3.1 Medial Canthal Defect
- •32.3.1.1 Glabellar Flap
- •Summary: Postoperative Care and Follow-up
- •Summary: Conclusion
- •32.5 Conclusion
- •References
- •33: Flaps
- •Summary: Introduction
- •33.1 Introduction
- •Summary: Risks and Precautions
- •33.2 Risks and Precautions
- •Summary: Flap Design and Execution
- •33.3 Flap Design and Execution
- •Summary: Advancement Flaps
- •33.4 Advancement Flaps
- •33.4.1 Single Advancement
- •33.4.2 Bilateral Advancement
- •33.4.3 Crescentic Advancement
- •33.4.4 Island Pedicle
- •Summary: Rotation Flaps
- •33.5 Rotation Flaps
- •33.5.1 Dorsal Nasal Rotation
- •33.5.2 Bilateral Rotation
- •Summary: Transposition Flaps
- •33.6 Transposition Flaps
- •33.6.1 Rhombic
- •33.6.1.1 Dufourmental
- •33.6.1.2 Thirty-Degree Angle Webster Flap
- •33.6.2 The Banner Flap
- •33.6.3 Bilobed Flap
- •Summary: Interpolation Flaps
- •33.7 Interpolation Flaps
- •33.7.1 Paramedian Forehead
- •33.7.2 Nasolabial Interpolation
- •33.7.4 Retroauricular
- •Summary: Postoperative Care
- •33.8 Postoperative Care
- •Summary: Complications
- •33.9 Complications
- •Summary: Monitoring and Follow-Up
- •33.10 Monitoring and Follow-Up
- •Summary: Conclusion
- •33.11 Conclusion
- •References
- •34: Skin Grafting
- •Summary: Introduction
- •34.1 Introduction
- •Summary: Physiology
- •34.2 Physiology
- •Summary: Indications
- •34.3 Indications
- •Summary: Preoperative Assessment
- •34.4 Preoperative Assessment
- •Summary: Site Selection
- •34.5 Site Selection
- •Summary: Full-Thickness Skin Grafts
- •34.6.1 Graft Harvesting
- •34.6.2 Graft Fixation
- •Summary: Split-Thickness Skin Grafts
- •34.7.1 Graft Harvest
- •34.7.2 Graft Fixation
- •Summary: Composite Grafts
- •34.8 Composite Grafts
- •Summary: Postoperative Instructions
- •34.9 Postoperative Instructions
- •34.9.1 FTSG
- •34.9.2 STSG
- •Summary: Cultured Skin Substitutes
- •34.10 Cultured Skin Substitutes
- •34.10.1 Epidermal
- •34.10.2 Dermal
- •34.10.3 Bilayered
- •34.10.4 Graft Fixation
- •34.10.5 Postoperative Instructions
- •Summary: Graft Failure
- •34.11 Graft Failure
- •Summary: Conclusion
- •34.12 Conclusion
- •References
- •Summary: Introduction
- •35.1 Introduction
- •Summary: Side to Side Closures
- •35.2 Side to Side Closures
- •Summary: Suturing of the Wounds
- •35.3 Suturing of the Wounds
- •Summary: Cosmetic Subunits
- •35.4 Cosmetic Subunits
- •Summary: Complex Facial Defects
- •35.5 Complex Facial Defects
- •Summary: General Considerations
- •35.6 General Considerations
- •Summary: Complications
- •35.7 Complications
- •Summary: Conclusion
- •35.8 Conclusion
- •References
- •36: Prosthetic Rehabilitation
- •Summary: Introduction
- •36.1 Introduction
- •Summary: Moulage Impression Procedure
- •36.2 Moulage Impression Procedure
- •Summary: Adhesive Retained Nasal Prosthesis
- •36.3 Adhesive Retained Nasal Prosthesis
- •Summary: Adhesive Retained Auricular Prosthesis
- •36.4 Adhesive Retained Auricular Prosthesis
- •Summary: Adhesive and/or Mechanically Retained Orbital Prosthesis
- •36.5 Adhesive and/or Mechanically Retained Orbital Prosthesis
- •36.6 Midface/Multisite Craniofacial Prosthesis
- •36.7 Considerations Regarding Implant Retained Craniofacial Prosthesis
- •Summary: Implant Retained Nasal Prosthesis
- •36.8 Implant Retained Nasal Prosthesis
- •Summary: Implant Retained Auricular Prosthesis
- •Summary: Implant Retained Orbital Prosthesis
- •36.10 Implant Retained Orbital Prosthesis
- •36.11 Multisite Implant Retained Craniofacial Prosthesis
- •Summary: Conclusion
- •36.12 Conclusion
- •References
- •Summary: Adjuvant Treatment with Imiquimod
- •37.1 Adjuvant Treatment with Imiquimod
- •Summary: Adjuvant Treatment with Radiation
- •37.2 Adjuvant Treatment with Radiation
- •37.3 Nonsurgical Treatment of Aggressive Basal Cell Carcinoma
- •Summary: Photodynamic Therapy
- •37.5 Photodynamic Therapy
- •Summary: Off-Label Intraoperative PDT with Topical and Intralesional Aminolevulinic Acid on SCC of the Penis
- •Summary: Conclusion
- •37.7 Conclusion
- •References
- •References
- •39: Establishing a Mohs Practice
- •Summary: General Considerations
- •39.1 General Considerations
- •Summary: The Electronic Medical Record
- •39.2 The Electronic Medical Record
- •39.3 Credentials, Licensure, and Malpractice Insurance
- •Summary: Quality Assurance
- •39.4 Quality Assurance
- •Summary: Cameras
- •39.5 Cameras
- •Summary: Care of Instruments
- •39.6 Care of Instruments
- •Summary: Work Rooms
- •39.7 Work Rooms
- •Summary: Microscopes
- •39.8 Microscopes
- •Summary: Instrumentation
- •39.9 Instrumentation
- •Summary: Regulations
- •39.10 Regulations
- •Summary: Reception Area
- •39.11 Reception Area
- •Summary: Waiting Area
- •39.12 Waiting Area
- •Summary: Exam/Surgery Rooms
- •39.13 Exam/Surgery Rooms
- •Summary: Nurses Work Station
- •39.15 Nurses Work Station
- •Summary: Personnel
- •39.16 Personnel
- •Summary: The Laboratory
- •39.17 The Laboratory
- •Summary: Space
- •39.18 Space
- •Summary: Personal Protective Equipment
- •39.19 Personal Protective Equipment
- •Summary: Mapping and Grossing the Tissue
- •39.20 Mapping and Grossing the Tissue
- •Summary: Devices to Aid Embedding
- •39.22 Devices to Aid Embedding
- •Summary: Cryosectioning Tissue
- •39.23 Cryosectioning Tissue
- •Summary: Staining
- •39.24 Staining
- •Summary: Coverslipping
- •39.25 Coverslipping
- •Summary: At the End of the Day
- •Summary: Permanent Sections and Immunostains
- •39.27 Permanent Sections and Immunostains
- •39.27.1 Immunostains
- •Summary: Training of Laboratory Technicians
- •39.28 Training of Laboratory Technicians
- •Summary: Inspections and Regulations
- •39.29 Inspections and Regulations
- •Summary: Marketing
- •39.30 Marketing
- •Summary: Preoperative Consultation
- •39.31 Preoperative Consultation
- •Summary: Brochures and Handouts
- •39.32 Brochures and Handouts
- •Summary: Operative Consents
- •39.33 Operative Consents
- •Summary: Conclusion
- •39.34 Conclusion
- •Reference
- •Summary: The Brazilian Perspective
- •40.1 The Brazilian Perspective
- •Summary: The Argentinean Perspective
- •40.2 The Argentinean Perspective
- •Summary: Conclusion
- •40.3 Conclusion
- •References
- •References
- •42.1 Characteristics of Skin Cancers in East Asia
- •Summary: Treatment of Skin Cancers in East Asia
- •42.2 Treatment of Skin Cancers in East Asia
- •42.2.1 Standard Treatment of Skin Cancers
- •42.2.2 Present State of MMS in East Asia
- •Summary: Conclusion
- •42.3 Conclusion
- •References
- •43.1 Introduction and Brief History of Mohs Micrographic Surgery in Australia and New Zealand
- •43.2 Work Practices of Australian Mohs Surgeons
- •43.2.1 Background
- •43.2.2 Mohs Caseload
- •43.2.3 Conclusion
- •Summary: The Australian Mohs Database
- •43.3 The Australian Mohs Database
- •43.3.1 Introduction
- •43.3.3 Squamous Cell Carcinoma Treated with Mohs Micrographic Surgery in Australia
- •43.3.4 Conclusion
- •43.4.1 Mohs for Invasive SCC and SCC In Situ of the Nail Apparatus
- •43.4.2 Extensive Use of Secondary Wound Healing in a Knowledgeable Patient
- •Summary: Mohs Surgery in New Zealand
- •43.5 Mohs Surgery in New Zealand
- •Summary: Conclusions
- •43.6 Conclusions
- •References
- •Summary: Introduction
- •44.1 Introduction
- •Summary: Patient Safety Considerations
- •44.2 Patient Safety Considerations
- •44.2.1 The Preoperative Visit
- •44.2.2 Past Medical History and Physical Exam
- •Summary: Information for Patients
- •44.3 Information for Patients
- •44.3.1 Cardiovascular Complications
- •44.3.2 Antibiotic Prophylaxis
- •44.3.3 Anticoagulation
- •44.3.4 Anesthesia
- •44.3.5 Allergies
- •Summary: Planning for the Surgical Day
- •44.4 Planning for the Surgical Day
- •44.5.1 Patient Emergencies
- •44.5.2 Staff Safety
- •44.5.3 Mohs Lab Safety
- •Summary: Conclusion
- •44.6 Conclusion
- •References
- •Summary: Introduction
- •45.1 Introduction
- •Summary: The Four Elements
- •45.2 The Four Elements
- •Summary: Standard of Care
- •45.3 Standard of Care
- •Summary: Clinical Guidelines
- •45.4 Clinical Guidelines
- •Summary: Legal Relevance
- •45.5 Legal Relevance
- •Summary: Case Example 1
- •45.6 Case Example 1
- •Summary: Case Example 2
- •45.7 Case Example 2
- •Summary: Ethical Relevance
- •45.8 Ethical Relevance
- •45.8.1 Actinic Keratoses
- •45.8.1.1 Invasive Techniques
- •Cryosurgery
- •Curettage and Electrodessication
- •Dermabrasion and Chemical Peels
- •Carbon Dioxide or Erbium:YAG Laser Ablation
- •45.8.1.2 Non-invasive Techniques
- •Topical Chemotherapy
- •Photodynamic Therapy (PDT)
- •References
- •Summary: Introduction
- •46.1 Introduction
- •Summary: Medical Malpractice
- •46.2 Medical Malpractice
- •46.2.1 Duty
- •46.2.2 Breach of Duty
- •46.2.3 Causation
- •46.2.4 Damages
- •Summary: Consent/Refusal for Treatment
- •46.3 Consent/Refusal for Treatment
- •46.3.1 Implied Consent
- •46.3.2 Express Consent
- •46.3.3 Informed Consent
- •46.3.3.2 Reasonable Patient Standard/Legal Standard
- •Summary: Medical Records
- •46.4 Medical Records
- •46.5 Complications in Skin Cancer Treatment
- •Summary: Rectifying Adverse Events: Key Steps
- •46.6 Rectifying Adverse Events: Key Steps
- •46.6.1 Build Trust
- •46.6.2 Take an Active Role
- •46.6.3 Help the Patient
- •46.6.4 Enlist Help from Others
- •46.6.5 Be Available
- •46.6.6 Contact the Malpractice Carrier
- •46.6.7 Preserve Evidence
- •46.6.8 Document the Facts of the Event
- •Summary: Conclusion
- •46.7 Conclusion
- •References
- •Summary: Introduction
- •47.1 Introduction
- •47.3 The Potential Detrimental Impact of Mohs Surgery
- •47.3.4 Negative Self-Image
- •47.4.1 Social Phobia
- •47.4.2 Generalized Anxiety Disorder
- •47.4.3 Depression
- •Summary: Conclusion
- •47.5 Conclusion
- •References
- •Index
Mohs Surgery for Periungual |
28 |
and Subungual Skin Cancer |
Steven Chow and Richard G. Bennett
Abstract
Mohs surgery for a malignancy in the periungual and subungual location is advantageous because it is a tissue-sparing technique that preserves maximum function and normal appearance. Traditional surgical treatment for such tumors is wide local excision and closure; in some cases, amputation of the digit is considered. The amount of tissue removed with these standard surgical treatments may be quite debilitating for the patient. Often, Mohs surgery will preserve a significant amount of nail matrix so that an almost normal-appearing nail regrows.
Keywords
Mohs surgery • Nails • Nail unit • Digit
Summary: Introduction
•Traditional surgical treatment for malignancy in the periungual and subungual is wide local excision.
•Mohs surgery is advantageous because it is a tissue sparing technique and preserves a significant amount of nail matrix.
S. Chow
Department of Dermatology, University of Southern California,
Santa Monica, CA, USA
R.G. Bennett (*)
Department of Dermatology, UCLA and USC, Santa Monica, CA, USA
e-mail: drrgb@ucla.edu
28.1Introduction
Mohs surgery for a malignancy in the periungual and subungual location is advantageous because it is a tis- sue-sparing technique that preserves maximum function and normal appearance. Traditional surgical treatment for such tumors is wide local excision and closure; in some cases, amputation of the digit is considered. The amount of tissue removed with these standard surgical treatments may be quite debilitating for the patient. Often, Mohs surgery will preserve a significant amount of nail matrix so that an almost nor- mal-appearing nail regrows.
K. Nouri (ed.), Mohs Micrographic Surgery, |
341 |
DOI 10.1007/978-1-4471-2152-7_28, © Springer-Verlag London Limited 2012 |
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