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Poorly differentiated cutaneous squamous cell carcinomas have high incomplete excision rates with UK minimum recommended pre-determined surgical margins.

低分化皮肤鳞状细胞癌不完全切除率高,英国最小推荐预先确定的手术切缘。

  • 影响因子:1.32
  • DOI:10.1016/j.bjps.2019.06.034
  • 作者列表:"Kiely J","Kostusiak M","Bloom O","Roshan A
  • 发表时间:2020-01-01
Abstract

BACKGROUND:In the UK, the British Association of Dermatology-British Association of Plastic, Reconstructive and Aesthetic Surgery (BAD-BAPRAS) guidelines recommend excision of high-risk cutaneous squamous cell carcinomas (cSCCs), including poorly differentiated cSCCs, with a minimum peripheral margin of 6 mm1. OBJECTIVES:We assess whether the BAD-BAPRAS minimum margin achieves histological clearance in poorly differentiated cSCCs. PATIENTS AND METHODS:Demographics, surgical notes and histological reports from all patients having a primary cSCC excised at the Plastic Surgery Department of Addenbrooke's Hospital, Cambridge, UK, between January 2017 and April 2018 were analysed. Ordinal regression was performed for excision margin status versus histological grade by using size and site as co-variates. RESULTS:Of 296 cSCCs, 38(12.8%) were poorly differentiated. Patients with poorly differentiated cSCCs were older (81.1 years vs. 76.7 years, p = 0.038), had lesions on the face or scalp (89.2% vs. 52.1%, p = 0.0001), and had lymphovascular (10.5% vs. 0%, p = 0.001) or perineural invasion (15.8% vs. 2%, p = 0.002). Well-differentiated cSCCs were excised with an average peripheral margin of 4.72 mm (95% CI 4.25-5.18 mm), while poorly differentiated cSCCs were excised with a margin of 6.42 mm(95% CI 5.58-7.28 mm). Close or involved peripheral margins were seen in 3% of well-differentiated lesions but in 13.2% of poorly differentiated lesions (OR=45.02; p = 0.003). Deep margins were close in 13.1% (none involved) of well-differentiated lesions but close or involved in 50% of poorly differentiated lesions (OR=11.94; p = 0.001). CONCLUSIONS:We demonstrate that poorly differentiated cSCCs are frequently incompletely excised in both peripheral and deep planes, despite adherence to guidelines. The UK BAD-BAPRAS guidelines should be urgently updated in line with international consensus.

摘要

背景: 在英国,英国皮肤科协会-英国整形、重建及美容外科协会 (BAD-BAPRAS) 指南推荐切除高危皮肤鳞状细胞癌 (cSCCs),包括低分化cSCCs,最小周边边缘为 6 mm1。 目的: 我们评估BAD-BAPRAS最小边缘在低分化cSCCs中是否达到组织学清除。 患者和方法: 英国剑桥Addenbrooke医院整形外科切除原发性cSCC的所有患者的人口统计学、手术记录和组织学报告,2017 年 1 月至 2018 年 4 月进行了分析。采用大小和部位作为协变量,对切缘状态与组织学分级进行有序回归。 结果: 296 例cSCCs中,38 例 (12.8%) 为低分化。低分化cSCCs患者年龄较大 (81.1 岁vs. 76.7 年,p = 0.038),面部或头皮有病变 (89.2% vs. 52.1%,p = 0.0001),有淋巴血管 (10.5% vs. 0%,p = 0.001) 或神经周围侵犯 (15.8% vs. 2%,p = 0.002)。切除分化良好的cSCCs,平均周边边缘为 4.72mm (95% CI 4.25-5.18mm),而低分化cSCCs切除边缘为 6.42mm (95% CI 5.58-7.28mm)。3% 的高分化病灶可见周围边缘接近或受累,但 13.2% 的低分化病灶可见周边边缘 (or = 45.02; P = 0.003)。深切缘在 13.1% (无受累) 的高分化病灶中接近,而在 50% 的低分化病灶中接近或受累 (or = 11.94; P = 0.001)。 结论: 我们证明,尽管遵守了指南,但低分化cSCCs在外周和深部平面上经常切除不完全。英国BAD-BAPRAS指南应根据国际共识紧急更新。

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皮肤肿瘤方向

皮肤肿瘤是发生在皮肤的细胞增生性疾病,是一种常见病。发生于皮内或皮下组织的新生物,种类很多,临床上分良性肿瘤和恶性肿瘤。恶性肿瘤可以不断增殖,引起转移,威胁生命,称为皮肤癌。

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