Discipline of Dermatology, Federal University of Roraima (UFRR), Boa Vista, Brazil
Department of Dermatology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
In Vivo. 2020 Jul-Aug;34(4):2107-2111. doi: 10.21873/invivo.12015.
BACKGROUND/AIM: Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer in adults. Surgery remains the golden-standard treatment for this disease. Mohs micrographic surgery (MMS), a surgical technique, is based on the three-dimensional histopathological examination of the margin and surgical bed, layer by layer, in the excised tissue allowing for the determination of the location of the residual tumor, for its complete excision, with high cure rates and preservation of the unaffected tissue. The aim of this study was to present the epidemiological characteristics of the population that was submitted to MMS, as well as, correlate these characteristics with the characteristics of the tumor itself and the surgical procedure.
A retrospective cross-sectional study was conducted over a 10-year period with an analysis of patient medical records submitted for MMS at the Department of Dermatology of the ABC School of Medicine. Data were presented and evaluated by non-parametric and parametric analyses, using absolute and relative frequency values for the continuous variable, to which a Chi-square test was applied for the verification of power with a significance level of 5%. For the independent variables, the Student's t-test was used to compare means, with a confidence interval (CI) ranging from 95 to 99%, and Friedman's test was used to verify if there were significant differences in the variables of interest.
Female patients accounted for 67% of all enrolled patients (n=335). The mean age was 67 years (SD±12.04; median=68; range=25-93 years). The predominant skin phototype (Fitzpatrick's classification) was phototype II (n=228, 46%). All procedures were performed under local anesthesia. Flap reconstruction was the most predominant surgery type (n=17, 68%). The mean number of MMS's stages was 1.6 (range=1-8). There was a mean of 3.8 fragments of skin tissue (range=1-29) per stage. The mean tumor size was 30 mm (92%). This was associated with female sex (p=0.03), H-zone area (p<0.001), flap reconstruction (p=0.004), tumor removal 7 to 12 months after diagnosis (p<0.001) and non-recurrence tumors (p=0.02).
NMSCs were frequently observed in older women with skin phototypes II/III. Reconstruction of the primary defect was feasible under local anesthesia, even in tumors with a marked diameter, decreasing the morbidity of this surgery, providing very satisfactory functional and aesthetic results, reduction costs and ease of access to the surgical procedure.
背景/目的：非黑色素瘤皮肤癌（NMSC）是成年人中最常见的癌症类型。手术仍然是这种疾病的金标准治疗方法。Mohs 显微外科手术（MMS）是一种基于对切除组织的边缘和手术床进行三维组织病理学检查的手术技术，逐层进行，以确定残留肿瘤的位置，进行完整切除，具有高治愈率和保留未受影响的组织。本研究旨在介绍接受 MMS 治疗的人群的流行病学特征，并将这些特征与肿瘤本身和手术过程的特征相关联。
这是一项回顾性的、10 年的病例对照研究，对 ABC 医学院皮肤科接受 MMS 治疗的患者的病历进行了分析。使用绝对和相对频率值对连续变量进行了数据呈现和评估，并应用卡方检验进行了功率验证，置信区间（CI）为 95%至 99%，显著性水平为 5%。对于自变量，使用学生 t 检验比较平均值，置信区间为 95%至 99%，并用 Friedman 检验验证感兴趣变量是否存在显著差异。
女性患者占所有入组患者的 67%（n=335）。平均年龄为 67 岁（SD±12.04；中位数=68；范围=25-93 岁）。最常见的皮肤光型（Fitzpatrick 分类）为光型 II（n=228，46%）。所有手术均在局部麻醉下进行。皮瓣重建是最主要的手术类型（n=17，68%）。MMS 分期的平均数量为 1.6（范围=1-8）。每个阶段平均有 3.8 块皮肤组织（范围=1-29）。平均肿瘤大小为 30 毫米（92%）。这与女性（p=0.03）、H 区（p<0.001）、皮瓣重建（p=0.004）、诊断后 7 至 12 个月切除肿瘤（p<0.001）和非复发性肿瘤（p=0.02）有关。
NMSC 多见于皮肤光型 II/III 的老年女性。即使在直径较大的肿瘤中，局部麻醉下也能进行原发性缺陷的重建，降低了这种手术的发病率，提供了非常满意的功能和美学效果，降低了成本，并且便于进行手术。
