Epidemiology of malignant skin tumors
Malignant skin tumors are divided into two major classes: the most commonly known melanocyte is the most common melanoma and nonmelanocyte in this category is basal cell carcinoma.
Nonmelanocyte skin cancers are the most common malignant tumors in the Caucasian breed. They represent 30%-40% of all neoplasms in Caucasians. For the other breeds with darker skin the incidence is much lower reflecting the important role of ultraviolet (UV) radiation in the ethiopathogeny of this neoplasm.
Between CCNM the most common tumor is CBC which represents about 75 of all cases in the U.S. the incidence of this tumor increases annually reaching to double every 14 years. The data on the incidence of this tumor appear to be undervaluation because many of the lesions are treated without a histological confirmation. Advanced age and male sex are associated with higher risk of developing a CBC. More than 99 patients with this type of tumor are white and 95 of them are aged 40 to 79 years. Once a person develops a cancer CCNM there is an increased risk that a new skin cancer may occur in the coming years. The highest risk for a new skin cancer is to show up in the first year.
Basal cell carcinoma (CBC) are the most common skin cancers constituting over 80 of all malignant skin tumors. If these tumors are discovered at the early stage then treatment can be summarized in topical or non invasive therapies: 5-fluorouracil (5-FU), radiotherapy (RT), electrocauterization or mechanical curettage. For certain tumors that exhibit characters of aggressiveness micrographic surgery can be used. However, the most common method of treatment remains surgery.
Surgical methods are most commonly used for the treatment of CBC. Of the surgical techniques we can cite: classical surgery without immediate verification of the edges of the excised workpiece, surgical excision with histopathological clearance of edges and micrographic surgery or Mohs surgery.
Advantages of micrographic Surgical techniques Mohs
In the case of histopathological techniques the tissue can be examined in vertical, horizontal or obligial plane. Traditional techniques involve vertical examination similar to a feli in a loaf of bread. In Micrographic surgery, the examination in the OBLIIC or horizontal plane is used (Fig. 1). The advantage of this method is that it assesses almost 100 the edges of the workpiece. In the standard histopathological assessment (Fig. 2) which performs vertical sections in paraffin or extemporaneous, less than 0.1 of the margin is evaluated. By assessing in full the edges of the workpiece the risk of remaining uncontaminated tumor is greatly reduced consecutively with the reduction of the relapse rate.
Dr. Olimpiu’s expertise in Mohs surgery
Dr. Hârceagă, conducted a PhD study on the subject of Mohs surgery, the theme of doctoral thesis sustained in June 2014 was “comparing the clinical and histological margins for basal cell carcinoma of the face and throat through the technique of micrographic surgery “. Dr. Hârceagă implemented in the year 2013 Mohs micrographic Surgery as a method of treatment in the dermatology clinic Cluj-Napoca. It is the only hospital in the Romanian state system where patients can benefit from this type of treatment for non-melanocyte skin tumors for free.
In literature Mohs surgery has the lowest recurrence rates 1-2 for CBC and almost double for CCS, for classical Surgery The percentage is about 10. Besides the advantage of the very small recurrence, Mohs surgery has the major advantage of healthy tissue preservation, important in areas with important anatomical structures especially in the face.
Operation Cost by Mohs surgery
Mohs surgery represents gold standard in the surgical treatment of skin cancers especially in the face where the preservation of the slew tissue is important. Dr. Hârceagă may perform this type of operation in Cluj-Napoca for a fee. The cost of an operation of Mohs surgery is between 800-1500 euro depending on the size of the tumor treated
How to perform the operation through Mohs surgery
The Mohs Chiurgia aims to fully excize the tumor with minimal sacrifice of healthy tissue. The operation is usually performed in local anesthesia and consists of several stages.
Initial excision of the tumor is done with minimum safety margins of approximately 2-3 mm. The tumor thus exbooted is sent in the same day in the Pathological Anatomy laboratory where a special technique is examined examining the edges of the resection altogether.
Depending on the result of the examination of edges in the laboratory, a new recuse is extrised if a particular segment is tumoral infiltrated. The laboratory examination is repeated for the new recuse.
This sequence of work repeats up to qassecuring some free edges of the tumor.
In most cases, two excisions are sufficient for the objection of tumour-free edges to be atypical.
Usually the operation is carried out over the course of a day.
At the end of the area is rebuilt by the principles of plastic surgery trying to restore shape and function.