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Review: Microscopically controlled surgery

  • Perry Robins
  • R. Michael Nix

Zusammenfassung

Für die operative Behandlung der kleinen superfiziellen und soliden nodulären Basaliome und kleinen superfiziellen Spinaliome, sind Kurettage und Electrodessication, chirurgisch operatives Vorgehen, die Chemochirurgie und die Kryochirurgie alle gleichermassen gute Methoden mit zufriedenstellenden Heilungsraten.

Jedoch für die operative Therapie der schwierigen Basaliome, wie das primäre sklerosierende Basaliom mit stark ausgeprägtem subklinischem Wachstum wie auch die verschiedenen Spinaliome ist die mikroskopisch kontrollierte Chirurgie nach Mohs eine wertvolle Methode mit niedrigen Rezidivquoten.

Besonders für diese Problemtumoren ist die intraoperative histologische Kontrolle des entnommenen Exzisats von besonderer Wichtigkeit. Wir beschreiben die Chemochirurgie nach Mohs und vergleichen die Vor- und Nachteile der sogenannten Fresh-tissue-Technik mit der Gewebefixierung.

Ferner wird die Besonderheit der histologischen Aufarbeitung des entnommenen Exzisats durch horizontale Stufenschnitte besprochen. Außerdem werden unsere Behandlungsergebnisse im Verlauf von 7 Jahren in Relation zu den anderen operativen Maßnahmen gestellt.

Summary

In the treatment of small well-defined basal cell carcinomas and squamous cell carcinomas, all five major modalities (conventional surgical excision, chemosurgery, x-ray therapy, electrodessication and curettage and cryosurgery, achieve satisfactory results. However, in patients with primary or recurrent lesions that are found to be larger than 2 cm in diameter on clinical examination, patients with lesions of any size that are multiple recurrent and patients with a histological subtype of morphea/form basal cell carcinoma, all present a high risk for inadequate excision and possible recurrence and should be treated by the Mohs’ technique.

The histographic surgical technique by Mohs is described comparing the advantage and disadvantage of the fresh and fixed-tissue approaches including listing the major indications for this modality.

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References

  1. 1.
    Knox, J M, Lyles, T W, Shapiro, E M, Martin, R D: Curettage and electrodesiccation in the treatment of skin cancer. Arch. Dermatol. 82, 197–204, 1960.PubMedCrossRefGoogle Scholar
  2. 2.
    Tromovitch, TA: Skin cancer, treatment by curettage and desication. Calif. Med. 103, 107–108, 1965.PubMedGoogle Scholar
  3. 3.
    Bart, R S, Schrager, D, Kopf, A W, Bromberg, J, Dubin, N: Scalpel excision of basal cell carcinoma. Arch. Dermatol. 114, 739–742, 1978.PubMedCrossRefGoogle Scholar
  4. 4.
    Popkin, G L, Bart, R S: Excision versus curettage and electrodesication as dermatologic office procedure for the treatment of BCC. J. Dermatol. Surg. 1, 33–35, 1975.PubMedGoogle Scholar
  5. 5.
    Crissey, J T: Curettage and electrodesication as a method of treatment for epitheliomas of the skin. J. Surg. Oncol. 3, 287–290, 1971.PubMedCrossRefGoogle Scholar
  6. 6.
    Torre, D: Cradle of cryosurgery. NY State J. Med. 67, 465–467, 1967.Google Scholar
  7. 7.
    Zacarin, S A: Cryosurgery of skin cancer: Fundamentals of technique and application. Cutis 16, 449–460, 1975.Google Scholar
  8. 8.
    Mohs F E: Chemosurgery for microscopically controlled excision of cutaneous cancer, in Epstein E, Epstein E Jr: Skin surgery ed 4 Springfield IL, 1977.Google Scholar
  9. 9.
    Robins, P: Mohs’ s surgery - 15 years experience in teaching-research-treatment. Exhibit at 39th Annual Meeting of the American Academy of Dermatology New-York, Dec 6–11, 1980.Google Scholar
  10. 10.
    Hayes, H: Basal cell carcinoma: The East Grinstead experience. Plast and Reconstr. Surg. 30, 273, 1962.CrossRefGoogle Scholar
  11. 11.
    Menn, H et al: The recurrent basal cell epithelioma. Arch. Dermat. 103, 628, 1971.CrossRefGoogle Scholar
  12. 12.
    Mohs, F E: Chemosurgery: a microscopically controlled method of cancer excision. Arch. Surg. 42, 279–295, 1941.CrossRefGoogle Scholar
  13. 13.
    Mohs, F E, Guyer, M F: Pre-excisional fixation of tissues in the treatment of cancer in rats. Cancer Res. 1, 49–51, 1941.Google Scholar
  14. 14.
    Canquoin, C: Cited by J. Wolff. Die Lehre von der Krebskrankheit. Vol 3 p 107, Gustav Fisher Jena, 1913.Google Scholar
  15. 15.
    Tromovitch, T A, Stegman, S J: Microscopic controlled excision of cutaneous tumors. Cancer 41, 653–658, 1978.PubMedCrossRefGoogle Scholar
  16. 16.
    Albright: Treatment of skin cancer using multiple modalities. J. Am. Acad. Dermatol. 7, 143–171, 1982.PubMedCrossRefGoogle Scholar
  17. 17.
    Litzow, TJ, Perry, H O, Soderstrom, C W: Morpheaform basal cell carcinoma. Am. J. Surg. 116, 499–505, 1968.PubMedCrossRefGoogle Scholar
  18. 18.
    Panje, W R, Ceilley, R I: The influence of embryology of the mid-face on the spread of epithelial malignancies. Laryngoscope 89, 1914–1920, 1979.PubMedCrossRefGoogle Scholar
  19. 19.
    Mora, R G, Robins, P: Basal cell carcinoma in the center of the face: Special diagnostic, prognostic and therapeutic considerations. J. Dermatol. Surg. Oncol. 4, 315–321, 1978.PubMedGoogle Scholar
  20. 20.
    Pollack, S V et al: The biology of basal cell carcinoma: A review. J. Am. Acad. Dermatol. 7, 569–577, 1982.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • Perry Robins
    • 1
  • R. Michael Nix
    • 1
  1. 1.Chemosurgery UnitNew York University Medical CenterNew YorkUSA

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