Bumsted R M, Ceilley R I
Arch Otolaryngol. 1982 Apr;108(4):225-31. doi: 10.1001/archotol.1982.00790520025008.
A prospective study of 17 auricular malignant neoplasms was conducted comparing recommended margins for conventional surgical excision to the actual margins obtained after microscopically controlled excision (Mohs' chemosurgery technique) to identify lesions at high risk for inadequate excision with conventional excision. High-risk lesions included all tumors larger than 1 cm, morpheaform basal cell carcinoma, and multiply recurrent lesions of any size. Successful excision by conventional surgery would have resulted in a defect notably larger than the actual Mohs' defect in all cases. The excess tissue excised by conventional surgery averaged 180% larger than the actual defect in primary lesions and 347% larger in recurrent lesions. Methods of reconstruction used include the following: secondary intention (granulation), primary closure, skin grafts, local flaps, and meatoplasty. The incidence, indications, and usual results obtained are discussed in detail. Mohs' chemosurgery technique provides substantial benefit and should be considered in all recurrent lesions and primary lesions larger than 1 cm to reduce recurrence and minimize the resultant deformity.
对17例耳廓恶性肿瘤进行了一项前瞻性研究，比较了传统手术切除推荐切缘与显微镜控制切除（莫氏化学外科技术）后获得的实际切缘，以确定传统切除时切除不充分风险高的病变。高风险病变包括所有直径大于1厘米的肿瘤、硬斑病样基底细胞癌以及任何大小的多次复发病变。在所有病例中，传统手术成功切除后造成的缺损明显大于实际的莫氏手术缺损。传统手术切除的多余组织在原发性病变中平均比实际缺损大180%，在复发性病变中则大347%。所采用的重建方法包括以下几种：二期愈合（肉芽组织形成）、一期缝合、植皮、局部皮瓣和尿道口成形术。详细讨论了其发生率、适应证和常见结果。莫氏化学外科技术具有显著优势，对于所有复发性病变和直径大于1厘米的原发性病变，均应考虑采用该技术以降低复发率并使由此产生的畸形最小化。
