Müller Cornelia Sigrid Lissi, Hauer Nina, Kofler Katrin, Kofler Lukas
MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland.
Medizinische Fakultät, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
Dermatologie (Heidelb). 2023 Jun;74(6):457-470. doi: 10.1007/s00105-023-05158-x. Epub 2023 May 30.
Micrographic controlled surgery (MCS) has become established in dermatosurgery in recent years and includes various methods to enable the histologically proven complete resection of malignant cutaneous tumors, while at the same time sparing tumor-free tissue in the immediate vicinity as much as possible. MCS is of great importance in the surgical treatment of cutaneous malignancies in so-called problem locations and aggressive tumor subtypes. Indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease and Bowen's carcinoma, melanoma in chronic light-damaged skin with acral lentiginous melanoma, dermatofibrosarcoma protuberans (DFSP), and Merkel cell carcinoma. However, other tumor entities are also treated using MCS, such as extramammary Paget's disease and various cutaneous sarcomas. All procedures subsumed under MCS have in common the marking of the surgical specimen for topographical orientation, which provides assignment of remaining tumor remnants. Various methods of MCS (3D histology, the horizontal method or Mohs surgery) are presented in this article. Furthermore, this article aims to raise awareness of the possibilities and limitations of micrographically controlled surgery.
近年来,显微控制手术(MCS)已在皮肤外科领域确立了地位,它包括各种方法,旨在实现经组织学证实的恶性皮肤肿瘤的完整切除,同时尽可能多地保留紧邻肿瘤的无瘤组织。MCS在所谓的疑难部位和侵袭性肿瘤亚型的皮肤恶性肿瘤手术治疗中具有重要意义。MCS的适应症包括基底细胞癌、皮肤鳞状细胞癌、鲍温病和鲍温癌、慢性光损伤皮肤伴肢端雀斑样痣性黑色素瘤的黑色素瘤、隆突性皮肤纤维肉瘤(DFSP)和默克尔细胞癌。然而,其他肿瘤实体也可采用MCS进行治疗,如乳腺外佩吉特病和各种皮肤肉瘤。所有归入MCS的手术操作都有一个共同点,即对手术标本进行标记以确定其位置,这有助于确定残留肿瘤组织的位置。本文介绍了MCS的各种方法(三维组织学、水平法或莫氏手术)。此外,本文旨在提高人们对显微控制手术的可能性和局限性的认识。