de Eusebio Murillo E, Martín Fuentes A, Ruiz-Salas V, Garcés J R, Miñano Medrano R, López-Estebaranz J L, Alonso-Alonso T, Rodríguez-Prieto M Á, Delgado Jiménez Y, Morales V, Redondo Bellón P, Manubens-Mercadé E, Sanmartín-Jiménez O, Guillén Barona C, Cabeza R, Cano N, Toll-Abelló A, Navarro Tejedor R, Artola Igarza J L, Allende Markixana I, Alfaro Rubio A, Ciudad Blanco C, Vázquez-Veiga H, Barchino Ortiz L, Descalzo M A, García-Doval I
Hospital Universitario de Guadalajara, Guadalajara, España.
Hospital Universitario de Guadalajara, Guadalajara, España.
Actas Dermosifiliogr. 2017 Nov;108(9):836-843. doi: 10.1016/j.ad.2017.04.018. Epub 2017 Aug 9.
The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016.
Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications.
Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes.
The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.
西班牙莫氏手术登记处用于收集西班牙莫氏显微外科手术（MMS）的使用情况及结果数据。本研究的目的是描述2013年7月（登记处开始启用时）至2016年1月期间进行的MMS手术所记录的围手术期和术中数据。
对来自18家医院的数据进行前瞻性队列研究。收集的数据包括麻醉类型、手术技术、住院情况、莫氏分期数量、术前危险因素的处理、额外治疗、既往治疗、肿瘤类型、手术时间和并发症。
有1796例手术的数据可用。MMS治疗的最常见肿瘤是基底细胞癌（85.96%），其次是鳞状细胞癌（6.18%）、恶性雀斑样痣（2.81%）和隆突性皮肤纤维肉瘤（1.97%）。原发性肿瘤占所有手术肿瘤的66.9%；19.2%的肿瘤为复发性，13.9%为持续性。最常见的既往治疗是手术治疗。MMS大多在局部麻醉下进行（86.7%的病例）且为门诊手术（71.8%）。89.5%的病例使用了冰冻切片技术。56.45%的患者需要一个阶段来实现切缘无肿瘤；32.1%的患者需要两个阶段，7.1%需要三个阶段，2.7%需要四个阶段，1.8%需要五个或更多阶段。98%的患者由皮肤科医生重建缺损，最常见的技术是皮瓣闭合（47.2%）。仅1.62%的患者记录了术中并发症，手术的中位（四分位间距）持续时间为75（60 - 100）分钟。
MMS治疗的患者和肿瘤特征与其他地理区域类似研究报告的特征相似。在我们的系列中，恶性雀斑样痣和隆突性皮肤纤维肉瘤占比更高，由皮肤科医生修复手术缺损也更常见。MMS的手术时间并不比其他手术报告的时间长得多，术中并发症发生率非常低。
