From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2018 Sep;142(3):373e-387e. doi: 10.1097/PRS.0000000000004696.
After studying this article, the participant should be able to: 1. Characterize basal and squamous cell carcinomas as low or high risk based on size, location, histology, and clinical features. 2. Understand appropriate surgical margins in low- and high-risk lesions, and other management options, including Mohs micrographic surgery, electrodissection and curettage, topical agents, cryotherapy, photodynamic therapy, and radiation therapy. 3. Discuss adjuvant therapies for locally advanced and metastatic disease, including radiation therapy, chemotherapy, and targeted therapies such as hedgehog pathway inhibitors. 4. Educate patients on preventive measures such as skin examinations, sun protection, oral retinoids, and oral nicotinamide (vitamin B3). 5. Devise a reconstructive plan once clear oncologic margins are obtained.
With the growing incidence of basal and squamous cell carcinoma, there is an increasing demand for appropriate oncologic management and aesthetic reconstruction. The goal of this CME article is to provide a foundation of knowledge to accurately diagnose, stage, and treat nonmelanoma skin cancers. In addition, it provides the practicing plastic surgeon alternate tools for managing these skin lesions, including topical agents, destructive therapies, and radiation therapy. Lastly, reconstructive plans for selected soft-tissue defects are discussed.
学习本文后，参与者应能够：1. 根据大小、位置、组织学和临床特征将基底细胞癌和鳞状细胞癌定性为低风险或高风险。2. 了解低风险和高风险病变的适当手术切缘以及其他治疗选择，包括Mohs 显微外科手术、电切和刮除、局部治疗药物、冷冻疗法、光动力疗法和放射疗法。3. 讨论局部晚期和转移性疾病的辅助治疗，包括放射治疗、化学治疗和靶向治疗，如 Hedgehog 通路抑制剂。4. 对患者进行预防措施教育，如皮肤检查、防晒、口服维 A 酸和口服烟酰胺（维生素 B3）。5. 在获得明确的肿瘤学切缘后，制定重建计划。
随着基底细胞癌和鳞状细胞癌发病率的增加，对适当的肿瘤学管理和美学重建的需求也在不断增加。本 CME 文章的目的是为准确诊断、分期和治疗非黑色素瘤皮肤癌提供基础知识。此外，它还为皮肤科医生提供了治疗这些皮肤病变的替代工具，包括局部治疗药物、破坏性治疗和放射治疗。最后，还讨论了选定软组织缺损的重建计划。
