Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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37 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 N B ackground: Adequate treatment and follow-up of a patient with nonmelanoma s kin cancer is of utmost concern for a clinician. However, there is a lack of international consensus on recommendations for surgical excision margins. Furthermore, lack of familiarity of the published guidelines leads to a variety in practice styles. Objective: To compare the consistency in global recommendations for surgical excision margins for basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma. Methods: A review of the current literature and global guidelines for surgical excision margins for basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma. Results: Upon review of international guidelines, variations do exist among guidelines for peripheral and deep surgical margins. Guideline recommendations were found to be more globally consistent in margin selection for low-risk basal cell carcinoma and low- risk cutaneous squamous cell carcinoma, however, least consistent when concerning [Abstract continued on next page] A B S T r A C T r E v i E W A Review of the Global Guidelines on Surgical Margins for Nonmelanoma Skin Cancers a AMANDA F. NAHHAS, DO; a CHASE A. SCARBROUGH, DO; b SHANNON TROTTER, DO a OhioHealth O'Bleness Hospital, Athens, Ohio; b Ohio State University Wexner Medical Center, Columbus, Ohio Nonmelanoma skin cancers (NMSC) tend to lie in the shadow of melanoma, despite being more common and resulting in a higher economic burden. A recently published article revealed that from 2007 to 2011, the average annual total treatment costs were $4.8 billion for NMSC and $3.3 billion for melanoma. 1 Proper NMSC management remains as important since local invasion, delay of diagnosis, and metastasis contribute to increased cost and morbidity. Several surgical treatment options exist for NMSC and remain the standard of care. The most widely used surgical excision modalities include standard excision (SE) with postoperative margin assessment, wide local excision (WLE), and Mohs micrographic surgery (MMS), including variations of MMS. The Appropriate Use Criteria for MMS is an additional resource that can facilitate decision-making, as it factors in the affected area of the body (Area H, Area M, Area L), noteworthy patient characteristics (immunocompromised states, history Disclosure: The authors report no relevant conflicts of interest. Author correspondence: Amanda F. Nahhas, DO; E-mail: anahhas1@gmail.com

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