Neoplasms

All Conditions

Skin and Connective Tissue Diseases

Symptoms and General Pathology

Rare Diseases

Carcinoma

Carcinoma, Squamous Cell

Skin Diseases

Recurrence

Melanoma

Carcinoma, Basal Cell

Skin Neoplasms

Lentigo

Hutchinson's Melanotic Freckle

Postoperative Complications

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Neuroendocrine Tumors

Neuroectodermal Tumors

Neuroectodermal Tumors, Primitive

Neoplasms, Germ Cell and Embryonal

Neoplasms, Nerve Tissue

Nevus, Pigmented

Nevus

Nevi and Melanomas

Disease Attributes

Neoplasms, Basal Cell

Melanosis

Hyperpigmentation

Pigmentation Disorders

Lentigo Maligna Melanoma

Neuroendocrine Tumor

Neuroepithelioma

Anti-Infective Agents

All Drugs and Chemicals

Formaldehyde

Patients treated with Mohs Micrographic Surgery in the dermatology department of Maastricht University Medical Center +, Maastricht, the Netherlands

Patients treated with Slow Mohs in the dermatology department of Maastricht University Medical Center +, Maastricht, the Netherlands

Treatment of a skin disease by Mohs micrographic surgery technique (frozen sections).

Mohs surgery

Treatment of a skin disease by Slow Mohs technique (formalin fixation and paraffin-embedded sections).

Slow Mohs surgery

Emmy Cruts, MD

E Cruts, MD

K Mosterd, MD, PhD

Mohs micro-graphic surgery (Mohs) is a tissue-sparing, surgical treatment for different types of skin cancer (e.g. basal cell carcinoma, squamous cell carcinoma, lentigo maligna (melanoma). It is a procedure performed with frozen sections. Slow Mohs, a variant of micro-graphic surgery, is performed by formalin fixation and paraffin-embedded sections. Both in Mohs and Slow Mohs tumor margins are assessed to achieve complete removal. This study aims to investigate the clinical presentation and outcomes (i.e. complications and recurrence rates) in patients treated with Mohs or Slow Mohs in the dermatology department of the Maastricht University Medical Center+ in Maastricht, the Netherlands.

Complications and Recurrences After Mohs Micrographic Surgery and Slow Mohs

Clinical Presentation and Surgical Outcomes in Patients With Skin Disorders Treated With Mohs Micrographic Surgery and Slow Mohs.

The incidence of complications after Mohs and Slow Mohs, expressed as absolute numbers and percentages.

The incidence of complications after Mohs and Slow Mohs, expressed as absolute numbers and percentages. Recurrence is defined as disease relapse after completion of treatment.

Predisposing factors (patient- and tumor characteristics) for complications after Mohs and Slow Mohs, expressed in Hazard Ratio's and 95% confidence intervals. It is not possible to define the predisposing factors in advance, because this is currently unknown. We hypothesize the presence of diabetes, tobacco use and medication use to be predisposing factors for complications.

Predisposing factors (patient- and tumor characteristics) for recurrences after Mohs and Slow Mohs, expressed in Hazard Ratio's and 95% confidence intervals. It is not possible to define the predisposing factors in advance, because this is currently unknown. We hypothesize incomplete treatment, worse prognostic tumor factors (Stage III of IV, presence of perineural invasion or lymphovascular invasion) to be predisposing factors for recurrence.

Maastricht University Medical Center

Nodular, micronodular, or sclerosing BCCs

The tumor is marked at the 12 o'clock-position. Excision with a safety margin between 2 and 10 mm, depending on tumor size and location. Plastic reconstruction. Removal of the specimen's margins and base as thin layers, using a scalpel. These primarily three-dimensional layers of the specimen's borders are flattened to one level and microscopically screened for tumor cells. 3D-histology is combined with representative vertical sections for histologic diagnosis. Consecutive excisions are performed topographically at the tumor-positive areas and 3D-histology is repeated until tumor-free margins are obtained.

3D-histology

Tumor removal by shave excision with a safety margin. Healing by secondary intention. Histologic diagnosis of BCC type (nodular, superficial, morpheaform, micronodular, other type, mixed type) or diagnosis of another tumor than BCC. Comment on complete removal (R0 versus R1).

Shave excision

Helmut Breuninger, M.D.

Kay Brantsch, M.D.

Currently, we conduct a prospective, randomized trial comparing the outcome of surgical excision with the outcome of curettage in nodular and superficial BCCs. Larger BCCs and micronodular or sclerosing BCCs are not included in the randomized study. They are mainly operated using three-dimensional histology (3D-histology, micrographic surgery). In this observational study we measure the cosmetic result and the recurrence rate of all BCCs not included in the randomized trial.

1. Disinfection
2. Local anesthesia
3. Surgery
4. Dressing
5. Preparation with paraffin for histopathologic evaluation
6. Staining with hematoxylin-eosin
7. Adjuvant radiotherapy is not applied in any of our patients.
8. If histopathology discovers another tumor than BCC, the tumor is excluded.
9. If recurrence is suspected, a punch biopsy is taken. If recurrence is confirmed, the endpoint is achieved.
10. Patients who provide no feedback receive phone calls.
11. The patient receives a letter containing a list of the BCCs treated within the study. She or he is asked to visit the private practitioner with the list after 12 and 48 months (+/- 30 days) referring to the last operation in the recruitment period. The practitioner or the patient return the questionnaire to our department.
12. The letter contains a questionnaire about suspicion of recurrence of BCC.
13. The patient is asked to assess the esthetic outcome on a scale of excellent, good, satisfactory, mediocre, and poor.
14. The physician is asked to assess the esthetic outcome on a scale of excellent, good, satisfactory, mediocre, and poor.
15. When follow-up is closed for an individual patient, the reason is recorded:

    1. Planned end of follow-up after 48 months
    2. Patient has moved.
    3. Death (date of death)
    4. Consent withdrawn
    5. Meanwhile, the patient has become so ill or high-maintenance that no more follow-up visits can be planned.
    6. Recurrence of all of the patient's BCCs with histopathologic confirmation.

Paraffinized histology blocks and sections.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Complications and Recurrences After Mohs Micrographic Surgery and Slow Mohs	NCT06014619	Skin Cancer Complication Complication of... Complication,Po... Recurrence Recurrent Disea... Cutaneous Squam... Basal Cell Carc... Lentigo Maligna Lentigo Maligna...	Mohs surgery Slow Mohs surge...	16 Years -	Maastricht University Medical Center
Recurrence Rate and Esthetic Outcome After Excision of Basal Cell Carcinomas Excluded From Trial NCT00515970	NCT00639652	Carcinoma, Basa...	3D-histology Shave excision	-	University Hospital Tuebingen

Spots Global Cancer Trial Database for micrographic surgery