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Background: Incorporating patient-related factors associated with treatment outcomes could improve personalized care in older patients with basal cell carcinoma (BCC).Objective: To evaluate and identify predictors of treatment burden, treatment outcomes, and overall survival in patients aged ≥70 years, surgically treated for BCC in the head and neck area.Methods: The data from the prospective, multicenter Basal Cell Carcinoma Treatment in Older Adults (BATOA) cohort study were extracted to evaluate the experienced treatment burden (visual analog scale, 0-10 cm; lower scores indicating higher treatment burden), treatment outcomes, and mortality.Results: A total of 539 patients were included (median age, 78 years). The patients experienced a low overall treatment burden (median, 8.6) and good cosmetic results. The predictors of higher treatment burden were instrumental activities of daily living (iADL) dependency, female sex, complications, larger tumor diameter, and polypharmacy. Thirty-five patients (6.5%) died (none of the deaths were due to BCC) within the follow-up period; the predictors of mortality were increasing comorbidity index and iADL dependency. No difference in these outcomes was seen between Mohs micrographic surgery and conventional excision after correction for covariates. Age was not significantly associated with any outcome.Limitations: A selection bias may exist owing to the observational design.Conclusion: BCC management decisions based on chronological age alone should be avoided, whereas more attention is recommended for patient-related factors. Based on these data, early BCC intervention is beneficial for robust and fit patients or those experiencing symptoms. [ABSTRACT FROM AUTHOR]

Background: Basal cell carcinoma (BCC) is the most common type of skin cancer with incidence rates rising each year. Mohs micrographic surgery (MMS) is most often chosen as treatment for BCC on the face for which each frozen section has to be histologically analysed to ensure complete tumor removal. This causes a heavy burden on health economics. Objectives: To develop and evaluate a deep learning model for the automated detection of BCC‐negative slides and classification of BCC in histopathology slides of MMS based on whole‐slide image (WSI). Methods: Two deep learning models were developed on the basis of 171 digitized H&E frozen slides from 70 different patients. The first model had a U‐Net architecture and was used for the segmentation of BCC. A subsequent convolutional neural network used the segmentation to classify the whole slide as BCC or BCC‐negative. Results: Quantitative evaluation over manually labelled ground truth data resulted in a Dice score of 0.66 for the segmentation of BCC and an area under the receiver operating characteristic curve (AUC) of 0.90 for the slide‐level classification. Conclusions: This study demonstrates that through WSIs deep learning models may be a feasible option to improve the clinical workflow and reduce costs in histological analysis of BCC in MMS. [ABSTRACT FROM AUTHOR]

The article focuses on nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin-Goltz syndrome. It describes the management of basal cell carcinomas (BCCs) in three male patients diagnosed with NBCCS at an early age. A combination of treatment usually consisting of Mohs micrographic surgery (MMS), photodynamic therapy (PDT), and standard surgical excisions in one or more megasessions were made to treat numerous BCCs in these patients. The mean time for the overall sessions performed is also noted.

Summary: Background: Basal-cell carcinoma (BCC) is the most common form of skin cancer and its incidence is still rising worldwide. Surgery is the most frequently used treatment for BCC, but large randomised controlled trials with 5-year follow-up to compare treatment modalities are rare. We did a prospective randomised controlled trial to compare the effectiveness of surgical excision with Mohs'' micrographic surgery (MMS) for the treatment of primary and recurrent facial BCC. Methods: Between Oct 5, 1999, and Feb 27, 2002, 408 primary BCCs (pBCCs) and 204 recurrent BCCs (rBCCs) in patients from seven hospitals in the Netherlands were randomly assigned to surgical excision or MMS. Randomisation and allocation was done separately for both groups by a computer-generated allocation scheme. Tumours had a follow-up of 5 years. Analyses were done on an intention-to-treat basis. The primary outcome was recurrence of carcinoma, diagnosed clinically by visual inspection with histological confirmation. Secondary outcomes were determinants of failure and cost-effectiveness. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN65009900. Findings: Of the 397 pBCCs that were treated, 127 pBCCs in 113 patients were lost to follow-up. Of the 11 recurrences that occurred in patients with pBCC, seven (4·1%) occurred in patients treated with surgical excision and four (2·5%) occurred in patients treated with MMS (log-rank test χ2 0·718, p=0·397). Of the 202 rBCCs that were treated, 56 BCCs in 52 patients were lost to follow-up. Two BCCs (2·4%) in two patients treated with MMS recurred, versus ten BCCs (12·1%) in ten patients treated with surgical excision (log-rank test χ2 5·958, p=0·015). The difference in the number of recurrences between treatments was not significant for pBCC, but significantly favoured MMS in rBCC. In pBCC, Cox-regression analysis showed no significant effects from risk factors measured in the study. In rBCC, aggressive histological subtype was a significant risk factor for recurrence in the Cox-regression analysis. For pBCC, total treatment costs were €1248 for MMS and €990 for surgical excision, whereas for rBCC, treatment costs were €1284 and €1043, respectively. Dividing the difference in costs between MMS and surgical excision by their difference in effectiveness leads to an incremental cost-effectiveness ratio of €23 454 for pBCC and €3171 for rBCC. Interpretation: MMS is preferred over surgical excision for the treatment of facial rBCC, on the basis of significantly fewer recurrences after MMS than after surgical excision. However, because there was no significant difference in recurrence of pBCC between treatment groups, treatment with surgical excision is probably sufficient in most cases of pBCC. Funding: The Netherlands Organisation for Scientific Research ZonMW. [Copyright &y& Elsevier]

BACKGROUND The American Society for Dermatologic Surgery (ASDS) International Traveling Mentorship Program (ITMP) has initiated an International Mohs Fellowship Recognition Program, with 3 centers accredited to date. OBJECTIVE: To describe and compare the outcomes of Mohs micrographic surgery (MMS) at the three units. METHODS: From patient files, we extracted demographic information, as well as tumor type, location of tumor, tumor histology, stages of MMS, and outcomes. RESULTS: At the 3 units, 3,899 patients were treated withMMS over a 5-year period in the South African unit, and 1,141 cases in the Romanian unit. Over a 3-year period, 849 cases were treated in the Netherlands unit. Basal cell carcinomas (BCCs) constituted 78.9% (South African unit), 79% (Romanian unit), and 97.2% (Netherlands unit), and squamous cell carcinomas (SCCs) 17.7% (South African unit), 19% (Romanian unit), and 0.7% (Netherlands unit) of the tumors treated. The recurrence rate following MMS was low, at 0.1% (South African Unit) and 0.17% (Romanian Unit) of cases at the end of the study period, with a median follow-up time of 2 years. CONCLUSION: Mohs micrographic surgery is an effective treatment modality for removing BCC and SCC at ASDS ITMP-recognized International Mohs Fellowship units. [ABSTRACT FROM AUTHOR]

Background Basal cell carcinoma (BCC) is the most common form of cancer among Caucasians and its incidence continues to rise. Surgical excision (SE) is considered standard treatment, though randomised trials with long-term follow-up are rare. We now report the long-term results of a randomised trial comparing surgical excision with Mohs’ micrographic surgery (MMS) for facial BCC. Methods 408 facial, high risk (diameter at least 1 cm, H-zone location or aggressive histological subtype) primary BCCs (pBCCs) and 204 facial recurrent BCCs (rBCCs) were randomly allocated to treatment with either SE or MMS between 5th October 1999 and 27th February 2002. The primary outcome was recurrence of carcinoma. A modified intention to treat analysis was performed. Findings For primary BCC, the 10-year cumulative probabilities of recurrence were 4.4% after MMS and 12 . 2% after SE (Log-rank test χ 2 2.704, p = 0.100). For recurrent BCC, cumulative 10-year recurrence probabilities were 3.9% and 13.5% for MMS and SE, respectively (Log-rank χ 2 5.166, p = 0.023). A substantial proportion of recurrences occurred after more than 5 years post-treatment: 56% for pBCC and 14% for rBCC. Interpretation Fewer recurrences occurred after treatment of high risk facial BCC with MMS compared to treatment with SE. The proportion of recurrences occurring more than 5 years post-treatment was especially high for pBCC, stressing the need for long-term follow-up in patients with high risk facial pBCC. [ABSTRACT FROM AUTHOR]

BACKGROUND. Mohs micrographic surgery (MMS) is a technique that offers excellent cure rates in the treatment of basal cell carcinoma (BCC). One of the reasons for its success is the 100% visualization of the resection margins. Still, recurrences do occur in 2% to 5% of the treated BCCs. It has been suggested that BCC cells in frozen sections stained with hematoxylin and eosin (H&E) may be missed. OBJECTIVE. To determine whether an additional immunohistochemical staining with a cytokeratin marker (MNF 116) indicates BCC cells in sections in which the H&E-stained frozen sections were negative. METHODS. The Mohs procedure was performed under standard conditions in which H&E-stained slides were judged by the Mohs surgeon and the pathologist. After the H&E slides where judged negative, an extra slide was stained using immunohistochemistry and a monoclonal antibody against cytokeratin (MNF 116). RESULTS. A total of 143 complete slides were stained and judged by two Mohs surgeons and a pathologist. One of the 143 slides stained with MNF 116 showed positive staining where the H&E slides were negative, which is 0.7% of the slides. However, this single slide represents a failure of nearly 2% of the treated patients. CONCLUSION. Frozen sections stained with H&E in MMS offer enough security in detecting BCC cells during surgery; however, adjuvant cytokeratin staining can be useful in very selected cases of aggressive growing BCC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The main objective of the study was to assess which health beliefs predict and explain satisfaction with the facial health state of patients undergoing surgery for basal cell carcinoma. Methods: Data were collected by administering a newly developed questionnaire pre-operatively and 6 months post-operatively (n =222). Results: Results show that satisfaction as measured by post-operative worrying, susceptibility and fear of developing a new BCC at other facial sites can be predicted by pre-operative health beliefs. In addition, some patients an increase in perceived susceptibility, fear of recurrence of BCC on the same site or fear of developing a new BCC at other facial sites. Conclusion: Our findings indicate that both pre- and post-operative perceptions predict and explain for a substantial part the extent to which patients are satisfied with their facial health state 6 months after surgery. Practice implications: Administering a short questionnaire at the start of the treatment period will give physicians a better understanding of how patients experience this skin disease. It will also help them to adjust information about BCC and its consequences to the needs of the patient. [Copyright &y& Elsevier]