患者行 Mohs 显微外科手术的适应证：临床实践指南。
Patient indications for Mohs micrographic surgery: a clinical practice guideline.
机构信息
Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON.
Department of Oncology, McMaster University, and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON.
出版信息
Curr Oncol. 2019 Feb;26(1):e94-e99. doi: 10.3747/co.26.4439. Epub 2019 Feb 1.
OBJECTIVE
The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.
METHODS
The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews.
RECOMMENDATION 1: Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer.
RECOMMENDATION 2: Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face.
RECOMMENDATION 3: Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
目的
本研究旨在为确诊为皮肤癌的患者制定基于循证医学的 Mohs 显微外科手术适应证。
方法
安大略省癌症护理的循证护理项目与黑色素瘤疾病部位专家组和外科肿瘤学项目合作，通过对相关文献进行系统回顾、患者和护理人员的专门咨询以及内部和外部审查，制定了本指南。
推荐 1：鉴于缺乏高质量的对照证据，手术（术后或术中切缘评估）或放疗（对于不适合手术的患者）应继续作为皮肤癌患者的标准治疗方法。
推荐 2：Mohs 显微外科手术适用于组织学确诊的面部复发性基底细胞癌患者，也适用于位于面部 H 区、直径大于 1cm、组织学侵袭性强或位于面部 H 区的原发性面部基底细胞癌。
推荐 3：Mohs 显微外科手术应由已完成医学学位或同等学历的医生进行，包括加拿大皇家内外科学院专家证书或同等学历，并接受过 Mohs 显微外科手术的高级培训。
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