Handbook of Dermatology (eBook)

A Practical Manual

Margaret W. Mann, Daniel L. Popkin (Herausgeber)

eBook Download: EPUB

2019 | 2. Auflage
416 Seiten
Wiley-Blackwell (Verlag)
978-1-118-40852-0 (ISBN)

Infos

The Handbook of Dermatology consolidates the essential information required for best-practice patient care into one pocket-sized volume. This indispensable reference guide enables practicing and prospective dermatologists to easily look up information on a wide range of dermatological diseases and quickly access the algorithms, protocols, guidelines, and staging and scoring systems that are vital to both clinical practice and exam success. Written and edited by former residents and attending physicians, the Handbook contains up-to-date information on general dermatology, surgery, and therapeutics.

Margaret W. Mann is Associate Professor and Director of Aesthetic Dermatology, University Hospitals, Case Western School of Medicine, Cleveland, OH, USA. She is the Co-Founder of Innova Dermatology, Hendersonville, TN, USA.

Daniel L. Popkin is Assistant Chief of Dermatology, Louis Stokes VA Medical Center and Assistant Professor of Dermatology, University Hospitals, Case Western School of Medicine, Cleveland, OH, USA. He is the Co-Founder of Innova Dermatology, Hendersonville, TN, USA.

Textauszug

Part 2
Surgical and Cosmetic Dermatology

SURGICAL DERMATOLOGY

Skin cancer

Surgical margin guidelines

Tumor Type

Tumor characteristics

Excision Margin

Melanoma (see melanoma guide pg.)

In‐situ

0.5–1 cm or Slow Mohs

consider SLN Bx for > 0.8 mm or ulceration

≤1 mm 1.01–2 mm >2 mm

1 cm 1–2 cm 2 cm

Basal Cell Carcinoma (BCC)

Low risk BCC   Well‐defined borders   Small size     Area L < 20 mm     Area M < 10 mm     Area H < 6 mm   Nodular or superficial subtype  Primary tumor

3–4 mm

High Risk BCC   Poorly defined margins   Larger Size     Area L > 20 mm     Area M > 10 mm     Area H > 6 mm  High risk tumor or patient features  (see indication for mohs below)

Mohs or 5–10 mm

Squamous Cell Carcinoma (SCC)

Low risk SCC   Well‐defined borders   Small size     Area L < 20 mm     Area M < 10 mm     Area H < 6 mm   Well differentiated histology  Primary tumor

4–6 mm

High Risk SCC   Poorly defined margins   Larger Size     Area L > 20 mm     Area M > 10 mm     Area H > 6 mm   High risk tumor location (ear, lip)  High risk tumor or patient features  (see indication for mohs below)

Mohs or 6–10 mm

Dermatofibrosarcoma protuberans (DFSP)

NCCN favors Mohs over WLE

2–4 cm to level of deep fascia

Merkel Cell Carcinoma

NCCN favors WLE. Can do Mohs if it does not interfere with SNLBx

1–2 cm to investing fascia layer Advised SLNBx.

Source: Adapted from Nahhas AF et al. J Clin Aesthet Dermatol. 2017 Apr; 10(4):37–46. Huang C and Boyce SM. Surgical margins of excision for basal cell carcinoma and squamous cell carcinoma. Semin Cutan Med Surg. 2004; 23:167–173.

Indication for Mohs micrographic surgery

Adapted from Ad Hoc Task Force, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery. J Am Acad Dermatol 2012; 67:531.

Location

• High risk/area “H”: “mask” areas of face (central aspect of face, eyelids [including inner/outer canthi], eyebrows, nose, lips [cutaneous/mucosal/vermillion], chin, ear and periauricular skin/sulci, temple), genitalia (including perineal and perianal), hands, feet, nail units, ankles, and nipples/areola.

  Moderate risk/area “M”: cheeks, forehead, scalp, neck, jawline, and pretibial surface.

• Low risk/area “L”: trunk and extremities (excluding pretibial surface, hands, feet, nail units, and ankles).

High‐risk tumor features

• Recurrence/incomplete prior excision
• Aggressive features (high risk of recurrence):
  • BCC: with morpheaform, fibrosing, sclerosing, infiltrating, micronodular, or metatypical/keratotic type.
    • Size: Area L > 20 mm; Area M > 10 mm; Area H > 6 mm
  • SCC with sclerosing, basosquamous, small cell, poorly/undifferentiated, spindle cell, pageotid, infiltrating, keratoacanthoma on the face, single cell, clear cell, lymphoepithelial, sarcomatoid, Breslow depth 2 mm or greater, and Clark's level IV or greater
  • Perivascular/perineural invasion
  • Other tumors: adenocystic carcinoma, adnexal carcinoma, apocrine/eccrine carcinoma, atypical fibroxanthoma, DFSP, extramammary paget disease, leiomyosarcoma, merkel cell carcinoma, and malignant fibrous histiocytoma

High‐risk patient features

• Immunocompromised (IC): transplant recipient, HIV, hematologic malignancy, or immunosuppressive medications
• Genetic syndromes: basal cell nevus, XP, and bazex syndromes
• Prior radiated skin: tumor arising in site of prior radiation treatment
• Patient with history of aggressive skin cancer with no known risk factors

Melanoma ‐ AJCC TNM classification

Major changes in AJCC eighth edition

• Round to 0.1 mm decimal for tumor depth
• Changes to T1a and T1b to 0.8 mm threshold
• Removal of mitotic rate for T category (recorded but not impacting T category)
• N category – “microscopic” vs. “macroscopic” redefined as “clinically occult” and “clinically apparent”.
• Pregnostic stage III subgroup changed (increased to IIIA–IIID)
• N subcategories revised based on number of tumor involved lymph nodes
• M1 categories changed – LDH no longer upstage to M1c, additional of CNS metastases to M1d.

Tips:

• 0.8–1.0 mm = T1b or Stage IB
• Nodal involvement → at least stage III
• Distant mets → stage IV

T classification

Tx

1° tumor cannot be assessed

T0

No evidence of 1° tumor

Tis

Melanoma in situ

T1

≤1.0 mm

a: <0.8 mm with no ulceration b: 0.8–1.0 mm with no ulceration or <1.0 mm with ulceration

T2

1.0–2.0 mm

a: no ulceration b: + ulceration

T3

2.0–4.0 mm

a: no ulceration b: + ulceration

T4

>4.0 mm

a: no ulceration b: + ulceration

N classification

Survival %

5 yr

10 yr

Nx

Nodes cannot be assessed/not performed

N0

No regional lymphadenopathy/metastases detected

N1

1 node

a: no MSI, node clinically occult b: no MSI, node clinically detected

84 76

75 71

0 node

c: MSI present

81

75

N2

2–3 nodes

a: no MSI, node clinically occult b: no MSI, node clinically detected

79 71

71 71

1 node

c: MSI present, node detectable or occult

69

59

N3

4+ nodes

a: no MSI, node all clinically occult b: no MSI, >1 node clinically detected or matted

60 64

46 57

2+ more nodes

c: MSI present, node clinically detectable or occult

52

43

Microsatellite instability (MSI) = any in‐transit, satellite, locally recurrent, or microsatellite metastases

M classification

M

Site

Serum LDH

Mx

Distant mets cannot be assessed

N/A

M0

No distant mets

N/A

M1a

Distant skin, soft tissue including muscle, and/or nonregional lymph node

(0) Normal (1) Elevated

M1b

Lung mets

(0) Normal (1) Elevated

M1c

Non‐CNS visceral mets

(0) Normal (1) Elevated

M1d

CNS mets

(0) Normal (1) Elevated

Adapted from AJCC Cancer Staging manual, Eighth Edition (2017). Balch CM et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009; 27:6199–6206. Gershenwald JE et al. Melanoma staging: evidence‐based changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J...

Produkt-Details

• Erscheint lt. Verlag: 6.9.2019
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie
• Schlagworte: dermatologic surgery • Dermatologie • Dermatologische Chirurgie • Dermatology • Medical Science • Medizin
• ISBN-10: 1-118-40852-7 / 1118408527
• ISBN-13: 978-1-118-40852-0 / 9781118408520