McSweeney William, Leaning Matthew, Dastouri Darius
Caboolture Hospital, 120 McKean Street, Caboolture 4310, QLD, Australia.
J Skin Cancer. 2021 Apr 13;2021:5537273. doi: 10.1155/2021/5537273. eCollection 2021.
Keratinocyte skin cancers are common in Australia, incurring disproportionately high health expenditure in comparison with mortality. General surgeons often excise these lesions as day-surgery. Balancing individual complexities of these cancers with trainee supervision and health expenditure is key to deliver efficacious care and maintain day-surgery volume for patients during a pandemic.
A retrospective, cross-sectional study was performed, examining 414 procedures from January 2019 to December 2020. Pathology was reviewed, and benign lesions excluded. Complete excision was based on 5 mm margins for squamous cell carcinoma (SCC), 0.5 mm microscopic margins for low-risk basal cell carcinoma (BCC) subtypes, and 3 mm for high-risk. Results of trainee-performed local anesthetic (LA) excision and general anesthetic (GA) excision (consultant scrubbed) were compared.
288 excisions were reviewed for completeness, location, and reconstruction modality. 69% were BCC (199), and 31% were SCC (89). These were excised under GA (72.5%) and LA (27.5%). 25.6% of BCC excisions were "close," and 22.6% were "positive" under GA, whilst 31% were "close" and 15.5% were "positive" under LA. 52.8% of SCC excisions were "close," and 7.8% were "positive" under GA, compared with 42.8% "close" and 9.5% "positive" under LA. Complex reconstruction (skin graft, flap) was more common under GA (38% SCC and 36.1% BCC), but occurred at a modest rate under LA (22% BCC and 28.5% SCC).
The results confirm that comparable margins and reconstruction options are achievable when excising keratinocyte cancers under LA by surgical trainees. This is fundamental in cost and timesaving, as well as reducing risk of aerosolisation of virus during GA, in a pandemic.
在澳大利亚，角质形成细胞皮肤癌很常见，与死亡率相比，其医疗支出高得不成比例。普通外科医生通常将这些病变作为日间手术切除。在大流行期间，平衡这些癌症的个体复杂性、实习医生的监督和医疗支出，是为患者提供有效护理并维持日间手术量的关键。
进行了一项回顾性横断面研究，检查了2019年1月至2020年12月期间的414例手术。对病理进行了复查，并排除了良性病变。鳞状细胞癌（SCC）的完整切除基于5毫米切缘，低风险基底细胞癌（BCC）亚型的显微镜下切缘为0.5毫米，高风险的为3毫米。比较了实习医生进行的局部麻醉（LA）切除和全身麻醉（GA）切除（顾问刷手）的结果。
对288例切除病例进行了完整性、位置和重建方式的复查。69%为BCC（199例），31%为SCC（89例）。这些病例在GA（72.5%）和LA（27.5%）下切除。在GA下，25.6%的BCC切除为“切缘接近”，22.6%为“阳性”，而在LA下，31%为“切缘接近”，15.5%为“阳性”。在GA下，52.8%的SCC切除为“切缘接近”，7.8%为“阳性”，而在LA下，分别为42.8%“切缘接近”和9.5%“阳性”。复杂重建（皮肤移植、皮瓣）在GA下更常见（SCC为38%，BCC为36.1%），但在LA下发生率适中（BCC为22%，SCC为28.5%）。
结果证实，外科实习医生在LA下切除角质形成细胞癌时，可实现相当的切缘和重建选择。这在成本和节省时间方面至关重要，同时在大流行期间降低了GA期间病毒雾化的风险。
