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  • 1 Országos Onkológiai Intézet Általános és Mellkassebészeti Osztály Budapest Ráth Gy. u. 7–9. 1122
  • 2 Országos Onkológiai Intézet Sebészi és Molekuláris Daganatpatológiai Centrum Budapest
  • 3 Országos Onkológiai Intézet Onkodermatológiai Osztály Budapest
  • 4 Országos Onkológiai Intézet Központi Aneszteziológiai és Intenzív Terápiás Osztály Budapest
  • 5 Országos Onkológiai Intézet Intézeti Gyógyszertár Budapest
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Meghatározott bőrtumoroknál a Mohs-féle mikrográfikus sebészeti eljárás kínálja a legjobb lehetőséget a tumor teljes eltávolítása mellett a maximális funkcionális és kozmetikai állapot megtartására. A módszer előnye, hogy horizontálisan vezetett fagyasztásos metszetekkel a specimen sebészi széleinek 100%-át, beleértve a perifériás és mély felszínt is, intraoperatívan vizsgálja. Ez az eljárás a konvencionális sebészi kimetszéssel vagy más technikával szemben szignifikánsan magasabb ablasticitást eredményez. A Mohs-féle mikrográfikus sebészet a választandó beavatkozás nagy, kiújult vagy inkomplett módon eltávolított bőrdaganatok esetén, illetve ha a daganat funkcionálisan vagy esztétikailag kényes anatómiai régiót érint. A szerzők egy 75 éves férfi esetét mutatják be, akinél a talpon másodszor lokálisan kiújult invazív melanoma malignumot kezeltek sikeresen Mohs-féle mikrográfikus sebészeti technikával, azonnali rekonstrukcióval, félvastag lebenyt alkalmazva.

  • Mohs, F. E., Guyer, M. F.: Preexcisional fixation of tissue in the treatment of cancer in rats. Cancer Res., 1941, 1 , 49–51.

    Guyer M. F. , 'Preexcisional fixation of tissue in the treatment of cancer in rats ' (1941 ) 1 Cancer Res. : 49 -51.

    • Search Google Scholar
  • Mohs, F. E.: Mohs micrographic surgery. A historical perspective. Dermatol. Clin., 1989, 7 , 609–611.

    Mohs F. E. , 'Mohs micrographic surgery. A historical perspective ' (1989 ) 7 Dermatol. Clin. : 609 -611.

    • Search Google Scholar
  • Tromovitch, T. A., Stegman, S. J.: Microscopic-controlled excision of cutaneous tumors: chemosurgery, fresh tissue technique. Cancer, 1978, 41 , 653–658.

    Stegman S. J. , 'Microscopic-controlled excision of cutaneous tumors: chemosurgery, fresh tissue technique ' (1978 ) 41 Cancer : 653 -658.

    • Search Google Scholar
  • Thosani, M. K., Marghoob, A., Chen, C. S.: Current progress of immunostains in Mohs micrographic surgery: a review. Dermatol. Surg., 2008, 34 , 1621–1636.

    Chen C. S. , 'Current progress of immunostains in Mohs micrographic surgery: a review ' (2008 ) 34 Dermatol. Surg. : 1621 -1636.

    • Search Google Scholar
  • Drake, L. A., Dinehart, S. M., Goltz, R. W. és mtsai: Guidelines of care for Mohs micrographic surgery. American Academy of Dermatology. J. Am. Acad. Dermatol., 1995, 33 , 271–278.

    Goltz R. W. , 'Guidelines of care for Mohs micrographic surgery. American Academy of Dermatology ' (1995 ) 33 J. Am. Acad. Dermatol. : 271 -278.

    • Search Google Scholar
  • Robinson, J. K.: Current histologic preparation methods for Mohs’ micrographic surgery. Dermatol. Surg., 2001, 27 , 555–560.

    Robinson J. K. , 'Current histologic preparation methods for Mohs’ micrographic surgery ' (2001 ) 27 Dermatol. Surg. : 555 -560.

    • Search Google Scholar
  • Burg, G., Hirsch, R. D., Konz, B. és mtsa: Histographic surgery: accuracy of visual assessment of the margins of basal-cell epithelioma. J. Dermatol. Surg., 1975, 1 , 21–24.

    Konz B. , 'Histographic surgery: accuracy of visual assessment of the margins of basal-cell epithelioma ' (1975 ) 1 J. Dermatol. Surg. : 21 -24.

    • Search Google Scholar
  • Martinez, J. C., Otley, C. C.: The management of melanoma and nonmelanoma skin cancer: a review for the primary care physician. Mayo Clin. Proc., 2001, 76 , 1253–1265.

    Otley C. C. , 'The management of melanoma and nonmelanoma skin cancer: a review for the primary care physician ' (2001 ) 76 Mayo Clin. Proc. : 1253 -1265.

    • Search Google Scholar
  • Mohs, F. E.: Chemosurgical treatment of melanoma; a microscopically controlled method of excision. Arch. Derm. Syphilol., 1950, 62 , 269–279.

    Mohs F. E. , 'Chemosurgical treatment of melanoma; a microscopically controlled method of excision ' (1950 ) 62 Arch. Derm. Syphilol. : 269 -279.

    • Search Google Scholar
  • Cook, J., Zitelli, J. A.: Mohs micrographic surgery: a cost analysis. J. Am. Acad. Dermatol., 1998, 39 , 698–703.

    Zitelli J. A. , 'Mohs micrographic surgery: a cost analysis ' (1998 ) 39 J. Am. Acad. Dermatol. : 698 -703.

    • Search Google Scholar
  • Cook, J. L., Perone, J. B.: A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Archives of Dermatology, 2003, 139 , 143–152.

    Perone J. B. , 'A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery ' (2003 ) 139 Archives of Dermatology : 143 -152.

    • Search Google Scholar
  • Smeets, N. W., Krekels, G. A., Ostertag, J. U. és mtsai: Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet, 2004, 364 , 1766–1772.

    Ostertag J. U. , 'Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial ' (2004 ) 364 Lancet : 1766 -1772.

    • Search Google Scholar
  • Maragh, S. L., Brown, M. D.: Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics. J. Am. Acad. Dermatol., 2008, 59 , 275–278.

    Brown M. D. , 'Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics ' (2008 ) 59 J. Am. Acad. Dermatol. : 275 -278.

    • Search Google Scholar
  • Albertini, J. G., Elston, D. M., Libow, L. F.: Mohs’ micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique. Dermatol. Surg., 2002, 28 , 656–665.

    Libow L. F. , 'Mohs’ micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique ' (2002 ) 28 Dermatol. Surg. : 656 -665.

    • Search Google Scholar
  • Chung, V. Q., Bernardo, L., Jiang, S. B.: Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins. Dermatol. Surg., 2005, 31 , 1094–1099.

    Jiang S. B. , 'Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins ' (2005 ) 31 Dermatol. Surg. : 1094 -1099.

    • Search Google Scholar
  • Ng, A. K., Jones, W. O., Shaw, J. H.: Analysis of local recurrence and optimizing excision margins for cutaneous melanoma. Br. J. Surg., 2001, 88 , 137–142.

    Shaw J. H. , 'Analysis of local recurrence and optimizing excision margins for cutaneous melanoma ' (2001 ) 88 Br. J. Surg. : 137 -142.

    • Search Google Scholar
  • Bhardwaj, S. S., Tope, W. D., Lee, P. K.: Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using mel-5 immunostaining: University of Minnesota experience. Dermatol. Surg., 2006, 32 , 690–696.

    Lee P. K. , 'Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using mel-5 immunostaining: University of Minnesota experience ' (2006 ) 32 Dermatol. Surg. : 690 -696.

    • Search Google Scholar
  • Bricca, G. M., Brodland, D. G., Zitelli, J. A.: Immunostaining melanoma frozen sections: the 1-hour protocol. Dermatol. Surg., 2004, 30 , 403–408.

    Zitelli J. A. , 'Immunostaining melanoma frozen sections: the 1-hour protocol ' (2004 ) 30 Dermatol. Surg. : 403 -408.

    • Search Google Scholar
  • Kelley, L. C., Starkus, L.: Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-1. J. Am. Acad. Dermatol., 2002, 46 , 78–84.

    Starkus L. , 'Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-1 ' (2002 ) 46 J. Am. Acad. Dermatol. : 78 -84.

    • Search Google Scholar
  • Menaker, G. M., Chiang, J. K., Tabila, B. és mtsai: Rapid HMB-45 staining in Mohs micrographic surgery for melanoma in situ and invasive melanoma. Dermatol. Surg., 2001, 44 , 833–836.

    Tabila B. , 'Rapid HMB-45 staining in Mohs micrographic surgery for melanoma in situ and invasive melanoma ' (2001 ) 44 Dermatol. Surg. : 833 -836.

    • Search Google Scholar
  • Then, S. Y., Malhotra, R., Barlow, R. és mtsai: Early cure rates with narrow-margin slow-mohs surgery for periocular malignant melanoma. Dermatol. Surg., 2009, 35 , 17–23.

    Barlow R. , 'Early cure rates with narrow-margin slow-mohs surgery for periocular malignant melanoma ' (2009 ) 35 Dermatol. Surg. : 17 -23.

    • Search Google Scholar
  • Snow, S. N., Mohs, F. E., Oriba, H. A. és mtsai: Cutaneous malignant melanoma treated by Mohs surgery. Review of the treatment results of 179 cases from the Mohs Melanoma Registry. Dermatol. Surg., 1997, 23 , 1055–1060.

    Oriba H. A. , 'Cutaneous malignant melanoma treated by Mohs surgery. Review of the treatment results of 179 cases from the Mohs Melanoma Registry ' (1997 ) 23 Dermatol. Surg. : 1055 -1060.

    • Search Google Scholar
  • Berlin, A. L., Amin, S. P., Goldberg, D. J.: Extraocular sebaceous carcinoma treated with Mohs micrographic surgery: report of a case and review of literature. Dermatol. Surg., 2008, 34 , 254–257.

    Goldberg D. J. , 'Extraocular sebaceous carcinoma treated with Mohs micrographic surgery: report of a case and review of literature ' (2008 ) 34 Dermatol. Surg. : 254 -257.

    • Search Google Scholar
  • Burns, M. K., Chen, S. P., Goldberg, L. H.: Microcystic adnexal carcinoma. Ten cases treated by Mohs micrographic surgery. J. Dermatol. Surg. Oncol., 1994, 20 , 429–434.

    Goldberg L. H. , 'Microcystic adnexal carcinoma. Ten cases treated by Mohs micrographic surgery ' (1994 ) 20 J. Dermatol. Surg. Oncol. : 429 -434.

    • Search Google Scholar
  • Geist, D. E., Garcia-Moliner, M., Fitzek, M. M. és mtsai: Perineural invasion of cutaneous squamous cell carcinoma and basal cell carcinoma: raising awareness and optimizing management. Dermatol. Surg., 2008, 34 , 1642–1651.

    Fitzek M. M. , 'Perineural invasion of cutaneous squamous cell carcinoma and basal cell carcinoma: raising awareness and optimizing management ' (2008 ) 34 Dermatol. Surg. : 1642 -1651.

    • Search Google Scholar
  • Nagi, C., O’Grady, T. C., Izadpanah, A.: Mohs micrographically controlled surgery and the treatment of malignant melanoma. Semin. Oncol., 2002, 29 , 336–340.

    Izadpanah A. , 'Mohs micrographically controlled surgery and the treatment of malignant melanoma ' (2002 ) 29 Semin. Oncol. : 336 -340.

    • Search Google Scholar
  • Neville, J. A., Welch, E., Leffell, D. J.: Management of nonmelanoma skin cancer in 2007. Nat. Clin. Pract. Oncol., 2007, 4 , 462–469.

    Leffell D. J. , 'Management of nonmelanoma skin cancer in 2007 ' (2007 ) 4 Nat. Clin. Pract. Oncol. : 462 -469.

    • Search Google Scholar
  • Thissen, M. R., Neumann, M. H., Schouten, L. J.: A systematic review of treatment modalities for primary basal cell carcinomas. Arch. Dermatol., 1999, 135 , 1177–1183.

    Schouten L. J. , 'A systematic review of treatment modalities for primary basal cell carcinomas ' (1999 ) 135 Arch. Dermatol. : 1177 -1183.

    • Search Google Scholar
  • Zitelli, J. A., Brown, C. D., Hanusa, B. H.: Surgical margins for excision of primary cutaneous melanoma. J. Am. Acad. Dermatol., 1997, 37 , 422–429.

    Hanusa B. H. , 'Surgical margins for excision of primary cutaneous melanoma ' (1997 ) 37 J. Am. Acad. Dermatol. : 422 -429.

    • Search Google Scholar
  • Mosterd, K., Krekels, G. A., Nieman, F. H. és mtsai: Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol., 2008, 9 , 1119–1120.

    Nieman F. H. , 'Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up ' (2008 ) 9 Lancet Oncol. : 1119 -1120.

    • Search Google Scholar
  • Alonso, P. E., Bescansa, E., Salas, J. és mtsai: Perineural spread of cutaneous squamous cell carcinoma manifesting as ptosis and ophthalmoplegia (orbital apex syndrome). Br. J. Plast. Surg., 1995, 48 , 564–568.

    Salas J. , 'Perineural spread of cutaneous squamous cell carcinoma manifesting as ptosis and ophthalmoplegia (orbital apex syndrome) ' (1995 ) 48 Br. J. Plast. Surg. : 564 -568.

    • Search Google Scholar
  • Leibovitch, I., Huilgol, S. C., Selva, D. és mtsai: Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. J. Am. Acad. Dermatol., 2005, 53 , 261–266.

    Selva D. , 'Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion ' (2005 ) 53 J. Am. Acad. Dermatol. : 261 -266.

    • Search Google Scholar
  • Alkalay, R., Alcalay, J., Shiri, J.: Plantar verrucous carcinoma treated with Mohs micrographic surgery: a case report and literature review. J. Drugs Dermatol., 2006, 5 , 68–73.

    Shiri J. , 'Plantar verrucous carcinoma treated with Mohs micrographic surgery: a case report and literature review ' (2006 ) 5 J. Drugs Dermatol. : 68 -73.

    • Search Google Scholar
  • Chiller, K., Passaro, D., Scheuller, M. és mtsai: Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome. Arch. Dermatol., 2000, 136 , 1355–1359.

    Scheuller M. , 'Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome ' (2000 ) 136 Arch. Dermatol. : 1355 -1359.

    • Search Google Scholar
  • Coldiron, B. M., Goldsmith, B. A., Robinson, J. K.: Surgical treatment of extramammary Paget’s disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision. Cancer, 1991, 67 , 933–938.

    Robinson J. K. , 'Surgical treatment of extramammary Paget’s disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision ' (1991 ) 67 Cancer : 933 -938.

    • Search Google Scholar
  • Friedman, P. M., Friedman, R. H., Jiang, S. B. és mtsai: Microcystic adnexal carcinoma: collaborative series review and update. J. Am. Acad. Dermatol., 1999, 41 , 225–231.

    Jiang S. B. , 'Microcystic adnexal carcinoma: collaborative series review and update ' (1999 ) 41 J. Am. Acad. Dermatol. : 225 -231.

    • Search Google Scholar
  • Gloster, H. M. Jr., Harris, K. R., Roenigk, R. K.: A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans. J. Am. Acad. Dermatol., 1996, 35 , 82–87.

    Roenigk R. K. , 'A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans ' (1996 ) 35 J. Am. Acad. Dermatol. : 82 -87.

    • Search Google Scholar
  • Hendi, A., Brodland, D. G., Zitelli, J. A.: Extramammary Paget’s disease: surgical treatment with Mohs micrographic surgery. J. Am. Acad. Dermatol., 2004, 51 , 767–773.

    Zitelli J. A. , 'Extramammary Paget’s disease: surgical treatment with Mohs micrographic surgery ' (2004 ) 51 J. Am. Acad. Dermatol. : 767 -773.

    • Search Google Scholar
  • Kleinerman, R., Greenspan, A., Hale, E. K.: Mohs micrographic surgery for an unusual case of keratoacanthoma arising from a longstanding tattoo. J. Drugs Dermatol., 2007, 6 , 931–932.

    Hale E. K. , 'Mohs micrographic surgery for an unusual case of keratoacanthoma arising from a longstanding tattoo ' (2007 ) 6 J. Drugs Dermatol. : 931 -932.

    • Search Google Scholar
  • Marcet, S.: Atypical fibroxanthoma/malignant fibrous histiocytoma. Dermatol. Ther., 2008, 21 , 424–427.

    Marcet S. , 'Atypical fibroxanthoma/malignant fibrous histiocytoma ' (2008 ) 21 Dermatol. Ther. : 424 -427.

    • Search Google Scholar
  • Prieto, V. G., Argenyi, Z. B., Barnhill, R. L. és mtsai: Are en face frozen sections accurate for diagnosing margin status in melanocytic lesions? Am. J. Clin. Pathol., 2003, 120 , 203–208.

    Barnhill R. L. , 'Are en face frozen sections accurate for diagnosing margin status in melanocytic lesions? ' (2003 ) 120 Am. J. Clin. Pathol. : 203 -208.

    • Search Google Scholar
  • Barlow, R. J., White, C. R., Swanson, N. A.: Mohs’ micrographic surgery using frozen sections alone may be unsuitable for detecting single atypical melanocytes at the margins of melanoma in situ. Br. J. Dermatol., 2002, 146 , 290–294.

    Swanson N. A. , 'Mohs’ micrographic surgery using frozen sections alone may be unsuitable for detecting single atypical melanocytes at the margins of melanoma in situ ' (2002 ) 146 Br. J. Dermatol. : 290 -294.

    • Search Google Scholar
  • Cohen, L. M., McCall, M. W., Zax, R. H.: Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study. Dermatol. Surg., 1998, 24 , 673–677.

    Zax R. H. , 'Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study ' (1998 ) 24 Dermatol. Surg. : 673 -677.

    • Search Google Scholar
  • Zitelli, J. A., Moy, R. L., Abell, E.: The reliability of frozen sections in the evaluation of surgical margins for melanoma. J. Am. Acad. Dermatol., 1991, 24 , 102–106.

    Abell E. , 'The reliability of frozen sections in the evaluation of surgical margins for melanoma ' (1991 ) 24 J. Am. Acad. Dermatol. : 102 -106.

    • Search Google Scholar
  • Thomas, J. M., Newton-Bishop, J., A’Hern, R. és mtsai: Excision margins in high-risk malignant melanoma. N. Engl. J. Med., 2004, 350 , 757–766.

    A’Hern R. , 'Excision margins in high-risk malignant melanoma ' (2004 ) 350 N. Engl. J. Med. : 757 -766.

    • Search Google Scholar
  • Walling, H. W., Scupham, R. K., Bean, A. K. és mtsai: Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J. Am. Acad. Dermatol., 2007, 57 , 659–664.

    Bean A. K. , 'Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma ' (2007 ) 57 J. Am. Acad. Dermatol. : 659 -664.

    • Search Google Scholar