Skip to main content
Erschienen in: Die Dermatologie 6/2023

30.05.2023 | Operative Dermatologie | CME

Mikroskopisch kontrollierte Chirurgie im dermatochirurgischen Alltag

verfasst von: Prof. Dr. med. Cornelia Sigrid Lissi Müller, Nina Hauer, Katrin Kofler, Lukas Kofler

Erschienen in: Die Dermatologie | Ausgabe 6/2023

zum CME-Kurs Einloggen, um Zugang zu erhalten

Zusammenfassung

Die mikroskopisch kontrollierte Chirurgie (MKC) hat sich in den vergangenen Jahren in der Dermatochirurgie etabliert und umfasst diverse Methoden, um die histologisch nachgewiesene vollständige Entfernung maligner Tumoren bei gleichzeitig maximaler Schonung des tumorfreien Gewebes in unmittelbarer Umgebung zu ermöglichen. Von herausragender Bedeutung ist die MKC in der operativen Therapie kutaner Malignome in Problemlokalisationen und bei aggressiven Tumorsubtypen sowie Rezidivsituationen. Gemeinsamkeit aller unter MKC zugeordneten Verfahren ist die Markierung des Tumorexzidates zur topografischen Orientierung, wodurch eine Lokalisierung verbliebener Tumorreste möglich wird. Es existieren diverse Methoden der MKC (3‑D-Histologie, Horizontalmethode oder Mohs-Chirurgie), die im vorliegenden Beitrag vorgestellt werden sollen. Ziel dieses Beitrags ist durch eine Vorstellung der aktualisierten AWMF(Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.)-Leitlinie die Darstellung der Methoden, Vorteile, die Sensibilisierung für die Möglichkeiten, aber auch Grenzen der mikroskopisch kontrollierten Chirurgie.
Literatur
1.
Zurück zum Zitat Kofler L, Ziemer M, Andrulis M, Horn D, Kulas P, Kunte C et al (2022) S1-Leitlinie Mikroskopisch kontrollierte Chirurgie (AWMF-Register-Nr.: 013-064)CrossRef Kofler L, Ziemer M, Andrulis M, Horn D, Kulas P, Kunte C et al (2022) S1-Leitlinie Mikroskopisch kontrollierte Chirurgie (AWMF-Register-Nr.: 013-064)CrossRef
2.
Zurück zum Zitat Moehrle M, Breuninger H, Rocken M (2007) A confusing world: what to call histology of three-dimensional tumour margins? J Eur Acad Dermatol Venereol 21(5):591–595PubMed Moehrle M, Breuninger H, Rocken M (2007) A confusing world: what to call histology of three-dimensional tumour margins? J Eur Acad Dermatol Venereol 21(5):591–595PubMed
3.
Zurück zum Zitat Tischendorf L (2007) Mikroskopisch kontrollierte Chirurgie bei malignen Hauttumoren: MKC bei Rezidivtumoren zwingend. Dtsch Arztebl Int 104(26):A-1922 Tischendorf L (2007) Mikroskopisch kontrollierte Chirurgie bei malignen Hauttumoren: MKC bei Rezidivtumoren zwingend. Dtsch Arztebl Int 104(26):A-1922
4.
Zurück zum Zitat Eberle FC, Kanyildiz M, Schnabl SM, Schulz C, Hafner HM, Adam P et al (2014) Three dimensional (3D) histology in daily routine: practical implementation and its evaluation. J Dtsch Dermatol Ges 12(11):1028–1035PubMedCrossRef Eberle FC, Kanyildiz M, Schnabl SM, Schulz C, Hafner HM, Adam P et al (2014) Three dimensional (3D) histology in daily routine: practical implementation and its evaluation. J Dtsch Dermatol Ges 12(11):1028–1035PubMedCrossRef
5.
Zurück zum Zitat Boyer JD, Zitelli JA, Brodland DG, D’Angelo G (2002) Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol 47(6):885–892PubMedCrossRef Boyer JD, Zitelli JA, Brodland DG, D’Angelo G (2002) Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol 47(6):885–892PubMedCrossRef
6.
Zurück zum Zitat Boztepe G, Hohenleutner S, Landthaler M, Hohenleutner U (2004) Munich method of micrographic surgery for basal cell carcinomas: 5‑year recurrence rates with life-table analysis. Acta Derm Venereol 84(3):218–222PubMedCrossRef Boztepe G, Hohenleutner S, Landthaler M, Hohenleutner U (2004) Munich method of micrographic surgery for basal cell carcinomas: 5‑year recurrence rates with life-table analysis. Acta Derm Venereol 84(3):218–222PubMedCrossRef
7.
Zurück zum Zitat Cohen LM, McCall MW, Zax RH (1998) Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study. Dermatol Surg 24(6):673–677PubMedCrossRef Cohen LM, McCall MW, Zax RH (1998) Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study. Dermatol Surg 24(6):673–677PubMedCrossRef
8.
Zurück zum Zitat Dinehart SM, Dodge R, Stanley WE, Franks HH, Pollack SV (1992) Basal cell carcinoma treated with Mohs surgery. A comparison of 54 younger patients with 1050 older patients. J Dermatol Surg Oncol 18(7):560–566PubMedCrossRef Dinehart SM, Dodge R, Stanley WE, Franks HH, Pollack SV (1992) Basal cell carcinoma treated with Mohs surgery. A comparison of 54 younger patients with 1050 older patients. J Dermatol Surg Oncol 18(7):560–566PubMedCrossRef
9.
Zurück zum Zitat Gloster HM Jr., Harris KR, Roenigk RK (1996) A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans. J Am Acad Dermatol 35(1):82–87PubMed Gloster HM Jr., Harris KR, Roenigk RK (1996) A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans. J Am Acad Dermatol 35(1):82–87PubMed
10.
Zurück zum Zitat Hafner HM, Breuninger H, Moehrle M, Trilling B, Krimmel M (2011) 3D histology-guided surgery for basal cell carcinoma and squamous cell carcinoma: recurrence rates and clinical outcome. Int J Oral Maxillofac Surg 40(9):943–948PubMedCrossRef Hafner HM, Breuninger H, Moehrle M, Trilling B, Krimmel M (2011) 3D histology-guided surgery for basal cell carcinoma and squamous cell carcinoma: recurrence rates and clinical outcome. Int J Oral Maxillofac Surg 40(9):943–948PubMedCrossRef
11.
Zurück zum Zitat Hafner HM, Moehrle M, Eder S, Trilling B, Rocken M, Breuninger H (2008) 3D-histological evaluation of surgery in dermatofibrosarcoma protuberans and malignant fibrous histiocytoma: differences in growth patterns and outcome. Eur J Surg Oncol 34(6):680–686PubMedCrossRef Hafner HM, Moehrle M, Eder S, Trilling B, Rocken M, Breuninger H (2008) 3D-histological evaluation of surgery in dermatofibrosarcoma protuberans and malignant fibrous histiocytoma: differences in growth patterns and outcome. Eur J Surg Oncol 34(6):680–686PubMedCrossRef
12.
Zurück zum Zitat Hafner J, Schutz K, Morgenthaler W, Steiger E, Meyer V, Burg G (1999) Micrographic surgery (‘slow Mohs’) in cutaneous sarcomas. Dermatology 198(1):37–43PubMedCrossRef Hafner J, Schutz K, Morgenthaler W, Steiger E, Meyer V, Burg G (1999) Micrographic surgery (‘slow Mohs’) in cutaneous sarcomas. Dermatology 198(1):37–43PubMedCrossRef
13.
Zurück zum Zitat Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5‑year follow-up. J Am Acad Dermatol 53(3):452–457PubMedCrossRef Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5‑year follow-up. J Am Acad Dermatol 53(3):452–457PubMedCrossRef
14.
Zurück zum Zitat Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years. J Am Acad Dermatol 53(3):445–451PubMedCrossRef Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R (2005) Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years. J Am Acad Dermatol 53(3):445–451PubMedCrossRef
15.
Zurück zum Zitat Moehrle M, Dietz K, Garbe C, Breuninger H (2006) Conventional histology vs. three-dimensional histology in lentigo maligna melanoma. Br J Dermatol 154(3):453–459PubMedCrossRef Moehrle M, Dietz K, Garbe C, Breuninger H (2006) Conventional histology vs. three-dimensional histology in lentigo maligna melanoma. Br J Dermatol 154(3):453–459PubMedCrossRef
16.
Zurück zum Zitat Thissen MR, Neumann MH, Schouten LJ (1999) A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol 135(10):1177–1183PubMedCrossRef Thissen MR, Neumann MH, Schouten LJ (1999) A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol 135(10):1177–1183PubMedCrossRef
18.
Zurück zum Zitat Rowe DE, Carroll RJ, Day CL Jr. (1989) Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 15(4):424–431PubMedCrossRef Rowe DE, Carroll RJ, Day CL Jr. (1989) Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 15(4):424–431PubMedCrossRef
19.
Zurück zum Zitat van Loo E, Mosterd K, Krekels GA, Roozeboom MH, Ostertag JU, Dirksen CD et al (2014) Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. Eur J Cancer 50(17):3011–3020PubMedCrossRef van Loo E, Mosterd K, Krekels GA, Roozeboom MH, Ostertag JU, Dirksen CD et al (2014) Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. Eur J Cancer 50(17):3011–3020PubMedCrossRef
20.
Zurück zum Zitat Breuninger H, Schaumburg-Lever G, Holzschuh J, Horny HP (1997) Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer 79(5):915–919PubMedCrossRef Breuninger H, Schaumburg-Lever G, Holzschuh J, Horny HP (1997) Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer 79(5):915–919PubMedCrossRef
21.
Zurück zum Zitat Hafner HM, Schnabl S, Breuninger H, Schulz C (2013) Surgical treatment of epithelial skin tumors and their precursors. Hautarzt 64(8):558–566PubMed Hafner HM, Schnabl S, Breuninger H, Schulz C (2013) Surgical treatment of epithelial skin tumors and their precursors. Hautarzt 64(8):558–566PubMed
22.
Zurück zum Zitat Telfer NR (2000) Mohs’ micrographic surgery for cutaneous squamous cell carcinoma: practical considerations. Br J Dermatol 142(4):631–633PubMedCrossRef Telfer NR (2000) Mohs’ micrographic surgery for cutaneous squamous cell carcinoma: practical considerations. Br J Dermatol 142(4):631–633PubMedCrossRef
23.
Zurück zum Zitat Loghdey MS, Varma S, Rajpara SM, Al-Rawi H, Perks G, Perkins W (2014) Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP): a single-centre series of 76 patients treated by frozen-section Mohs micrographic surgery with a review of the literature. J Plast Reconstr Aesthet Surg 67(10):1315–1321PubMedCrossRef Loghdey MS, Varma S, Rajpara SM, Al-Rawi H, Perks G, Perkins W (2014) Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP): a single-centre series of 76 patients treated by frozen-section Mohs micrographic surgery with a review of the literature. J Plast Reconstr Aesthet Surg 67(10):1315–1321PubMedCrossRef
24.
Zurück zum Zitat Mullen JT (2016) Dermatofibrosarcoma protuberans: wide local excision versus Mohs micrographic surgery. Surg Oncol Clin N Am 25(4):827–839PubMedCrossRef Mullen JT (2016) Dermatofibrosarcoma protuberans: wide local excision versus Mohs micrographic surgery. Surg Oncol Clin N Am 25(4):827–839PubMedCrossRef
25.
Zurück zum Zitat Kunishige JH, Doan L, Brodland DG, Zitelli JA (2019) Comparison of surgical margins for lentigo maligna versus melanoma in situ. J Am Acad Dermatol 81(1):204–212PubMedCrossRef Kunishige JH, Doan L, Brodland DG, Zitelli JA (2019) Comparison of surgical margins for lentigo maligna versus melanoma in situ. J Am Acad Dermatol 81(1):204–212PubMedCrossRef
26.
Zurück zum Zitat Lichte V, Breuninger H, Metzler G, Haefner HM, Moehrle M (2009) Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol 160(3):591–599PubMedCrossRef Lichte V, Breuninger H, Metzler G, Haefner HM, Moehrle M (2009) Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol 160(3):591–599PubMedCrossRef
27.
Zurück zum Zitat Newman J, Beal M, Schram SE, Lee PK (2013) Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel‑5 immunostaining: an update from the University of Minnesota. Dermatol Surg 39(12):1794–1799PubMedCrossRef Newman J, Beal M, Schram SE, Lee PK (2013) Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel‑5 immunostaining: an update from the University of Minnesota. Dermatol Surg 39(12):1794–1799PubMedCrossRef
28.
Zurück zum Zitat Schulz C, Hafner HM, Breuninger H, Leiter U (2014) Local recurrence and survival in acral lentiginous melanoma comparing 3D histology and conventional histology. J Dtsch Dermatol Ges 12(10):881–890PubMed Schulz C, Hafner HM, Breuninger H, Leiter U (2014) Local recurrence and survival in acral lentiginous melanoma comparing 3D histology and conventional histology. J Dtsch Dermatol Ges 12(10):881–890PubMed
29.
Zurück zum Zitat Sharma AN, Foulad DP, Doan L, Lee PK, Atanaskova Mesinkovska N (2021) Mohs surgery for the treatment of lentigo maligna and lentigo maligna melanoma—a systematic review. J Dermatolog Treat 32(2):157–163PubMedCrossRef Sharma AN, Foulad DP, Doan L, Lee PK, Atanaskova Mesinkovska N (2021) Mohs surgery for the treatment of lentigo maligna and lentigo maligna melanoma—a systematic review. J Dermatolog Treat 32(2):157–163PubMedCrossRef
30.
Zurück zum Zitat Kline L, Coldiron B (2016) Mohs micrographic surgery for the treatment of Merkel cell carcinoma. Dermatol Surg 42(8):945–951PubMedCrossRef Kline L, Coldiron B (2016) Mohs micrographic surgery for the treatment of Merkel cell carcinoma. Dermatol Surg 42(8):945–951PubMedCrossRef
31.
Zurück zum Zitat O’Connor WJ, Roenigk RK, Brodland DG (1997) Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg 23(10):929–933PubMedCrossRef O’Connor WJ, Roenigk RK, Brodland DG (1997) Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg 23(10):929–933PubMedCrossRef
32.
Zurück zum Zitat Soleymani T, Bennett RG (2020) Mohs micrographic surgery for exophytic kaposi sarcoma. Dermatol Surg 46(9):1232–1235PubMedCrossRef Soleymani T, Bennett RG (2020) Mohs micrographic surgery for exophytic kaposi sarcoma. Dermatol Surg 46(9):1232–1235PubMedCrossRef
33.
Zurück zum Zitat Tolkachjov SN, Kelley BF, Alahdab F, Erwin PJ, Brewer JD (2018) Atypical fibroxanthoma: systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision. J Am Acad Dermatol 79(5):929–34.e6PubMedCrossRef Tolkachjov SN, Kelley BF, Alahdab F, Erwin PJ, Brewer JD (2018) Atypical fibroxanthoma: systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision. J Am Acad Dermatol 79(5):929–34.e6PubMedCrossRef
34.
Zurück zum Zitat Lonie S, Yau B, Henderson M, Gyorki D, Angel C, Webb A (2020) Management of pleomorphic dermal sarcoma. ANZ J Surg 90(11):2322–2324PubMedCrossRef Lonie S, Yau B, Henderson M, Gyorki D, Angel C, Webb A (2020) Management of pleomorphic dermal sarcoma. ANZ J Surg 90(11):2322–2324PubMedCrossRef
35.
Zurück zum Zitat Persa OD, Loquai C, Wobser M, Baltaci M, Dengler S, Kreuter A et al (2019) Extended surgical safety margins and ulceration are associated with an improved prognosis in pleomorphic dermal sarcomas. J Eur Acad Dermatol Venereol 33(8):1577–1580PubMedCrossRef Persa OD, Loquai C, Wobser M, Baltaci M, Dengler S, Kreuter A et al (2019) Extended surgical safety margins and ulceration are associated with an improved prognosis in pleomorphic dermal sarcomas. J Eur Acad Dermatol Venereol 33(8):1577–1580PubMedCrossRef
36.
Zurück zum Zitat Bae JM, Choi YY, Kim H, Oh BH, Roh MR, Nam K et al (2013) Mohs micrographic surgery for extramammary Paget disease: a pooled analysis of individual patient data. J Am Acad Dermatol 68(4):632–637PubMedCrossRef Bae JM, Choi YY, Kim H, Oh BH, Roh MR, Nam K et al (2013) Mohs micrographic surgery for extramammary Paget disease: a pooled analysis of individual patient data. J Am Acad Dermatol 68(4):632–637PubMedCrossRef
37.
Zurück zum Zitat Wollina U (2015) Bowen’s disease of the nail apparatus: a series of 8 patients and a literature review. Wien Med Wochenschr 165(19–20):401–405PubMedCrossRef Wollina U (2015) Bowen’s disease of the nail apparatus: a series of 8 patients and a literature review. Wien Med Wochenschr 165(19–20):401–405PubMedCrossRef
38.
Zurück zum Zitat Mohs FE (1959) Chemosurgery: a method for the microscopically controlled excision of cancer of the skin and lips. Geriatrics 14(2):78–88PubMed Mohs FE (1959) Chemosurgery: a method for the microscopically controlled excision of cancer of the skin and lips. Geriatrics 14(2):78–88PubMed
39.
Zurück zum Zitat Ishii L, Arshanapalli A, Surprenant D, Reserva J, Moy L, Martin B et al (2019) Contemporary Mohs micrographic surgery histologic preparation methods, laboratory-assistive personnel training, and practice setting—a survey study. Dermatol Surg 45(6):768–771PubMedCrossRef Ishii L, Arshanapalli A, Surprenant D, Reserva J, Moy L, Martin B et al (2019) Contemporary Mohs micrographic surgery histologic preparation methods, laboratory-assistive personnel training, and practice setting—a survey study. Dermatol Surg 45(6):768–771PubMedCrossRef
40.
Zurück zum Zitat Muller CSL (2022) Pitfalls in dermatohistology : stumbling blocks and problems in routine dermatopathology. Hautarzt 73(2):138–145PubMed Muller CSL (2022) Pitfalls in dermatohistology : stumbling blocks and problems in routine dermatopathology. Hautarzt 73(2):138–145PubMed
41.
Zurück zum Zitat Breuninger H, Konz B, Burg G (2007) Mikroskopisch kontrollierte Chirurgie bei malignen Huttumoren. Dtsch Ärztebl 104:A427–32 Breuninger H, Konz B, Burg G (2007) Mikroskopisch kontrollierte Chirurgie bei malignen Huttumoren. Dtsch Ärztebl 104:A427–32
42.
Zurück zum Zitat Boehringer A, Adam P, Schnabl S, Hafner HM, Breuninger H (2015) Analysis of incomplete excisions of basal-cell carcinomas after breadloaf microscopy compared with 3D-microscopy: a prospective randomized and blinded study. J Cutan Pathol 42(8):542–553PubMedCrossRef Boehringer A, Adam P, Schnabl S, Hafner HM, Breuninger H (2015) Analysis of incomplete excisions of basal-cell carcinomas after breadloaf microscopy compared with 3D-microscopy: a prospective randomized and blinded study. J Cutan Pathol 42(8):542–553PubMedCrossRef
43.
Zurück zum Zitat Lang BM, Balermpas P, Bauer A, Blum A, Brolsch GF, Dirschka T et al (2019) S2k-Leitlinie Basalzellkarzinom der Haut – Teil 1: Epidemiologie, Genetik und Diagnostik. J Dtsch Dermatol Ges 17(1):94–104PubMed Lang BM, Balermpas P, Bauer A, Blum A, Brolsch GF, Dirschka T et al (2019) S2k-Leitlinie Basalzellkarzinom der Haut – Teil 1: Epidemiologie, Genetik und Diagnostik. J Dtsch Dermatol Ges 17(1):94–104PubMed
44.
Zurück zum Zitat Lang BM, Balermpas P, Bauer A, Blum A, Brolsch GF, Dirschka T et al (2019) S2k-Leitlinie Basalzellkarzinom der Haut – Teil 2: Therapie, Pravention und Nachsorge. J Dtsch Dermatol Ges 17(2):214–231PubMed Lang BM, Balermpas P, Bauer A, Blum A, Brolsch GF, Dirschka T et al (2019) S2k-Leitlinie Basalzellkarzinom der Haut – Teil 2: Therapie, Pravention und Nachsorge. J Dtsch Dermatol Ges 17(2):214–231PubMed
45.
Zurück zum Zitat Rowe DE, Carroll RJ, Day CL Jr. (1989) Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 15(3):315–328PubMedCrossRef Rowe DE, Carroll RJ, Day CL Jr. (1989) Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 15(3):315–328PubMedCrossRef
46.
Zurück zum Zitat Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH et al (2004) Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet 364(9447):1766–1772PubMedCrossRef Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH et al (2004) Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet 364(9447):1766–1772PubMedCrossRef
47.
Zurück zum Zitat Wetzig T, Woitek M, Eichhorn K, Simon JC, Paasch U (2010) Surgical excision of basal cell carcinoma with complete margin control: outcome at 5‑year follow-up. Dermatology 220(4):363–369PubMedCrossRef Wetzig T, Woitek M, Eichhorn K, Simon JC, Paasch U (2010) Surgical excision of basal cell carcinoma with complete margin control: outcome at 5‑year follow-up. Dermatology 220(4):363–369PubMedCrossRef
48.
Zurück zum Zitat Armstrong LTD, Magnusson MR, Guppy MPB (2017) Risk factors for recurrence of facial basal cell carcinoma after surgical excision: a follow-up analysis. J Plast Reconstr Aesthet Surg 70(12):1738–1745PubMedCrossRef Armstrong LTD, Magnusson MR, Guppy MPB (2017) Risk factors for recurrence of facial basal cell carcinoma after surgical excision: a follow-up analysis. J Plast Reconstr Aesthet Surg 70(12):1738–1745PubMedCrossRef
49.
Zurück zum Zitat Bourlidou E, Vahtsevanos K, Kyrgidis A, Tilaveridis I, Patsatsi A, Andreadis D et al (2019) Risk factors for local recurrence of basal cell carcinoma and cutaneous squamous cell carcinoma of the middle third of the face: a 15-year retrospective analysis based on a single centre. Eur J Dermatol 29(5):490–499PubMedCrossRef Bourlidou E, Vahtsevanos K, Kyrgidis A, Tilaveridis I, Patsatsi A, Andreadis D et al (2019) Risk factors for local recurrence of basal cell carcinoma and cutaneous squamous cell carcinoma of the middle third of the face: a 15-year retrospective analysis based on a single centre. Eur J Dermatol 29(5):490–499PubMedCrossRef
50.
Zurück zum Zitat Raasch BA, Buettner PG, Garbe C (2006) Basal cell carcinoma: histological classification and body-site distribution. Br J Dermatol 155(2):401–407PubMedCrossRef Raasch BA, Buettner PG, Garbe C (2006) Basal cell carcinoma: histological classification and body-site distribution. Br J Dermatol 155(2):401–407PubMedCrossRef
51.
Zurück zum Zitat Saldanha G, Fletcher A, Slater DN (2003) Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol 148(2):195–202PubMedCrossRef Saldanha G, Fletcher A, Slater DN (2003) Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol 148(2):195–202PubMedCrossRef
52.
Zurück zum Zitat Yalcin O, Sezer E, Kabukcuoglu F, Kilic AI, Sari AG, Cerman AA et al (2015) Presence of ulceration, but not high risk zone location, correlates with unfavorable histopathological subtype in facial basal cell carcinoma. Int J Clin Exp Pathol 8(11):15448–15453PubMedPubMedCentral Yalcin O, Sezer E, Kabukcuoglu F, Kilic AI, Sari AG, Cerman AA et al (2015) Presence of ulceration, but not high risk zone location, correlates with unfavorable histopathological subtype in facial basal cell carcinoma. Int J Clin Exp Pathol 8(11):15448–15453PubMedPubMedCentral
53.
Zurück zum Zitat Bichakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Berg D et al (2016) Basal cell skin cancer, version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 14(5):574–597PubMedCrossRef Bichakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Berg D et al (2016) Basal cell skin cancer, version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 14(5):574–597PubMedCrossRef
54.
Zurück zum Zitat Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC et al (2020) J Dtsch Dermatol Ges 18(3):275–294PubMed Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC et al (2020) J Dtsch Dermatol Ges 18(3):275–294PubMed
55.
Zurück zum Zitat Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC et al (2020) J Dtsch Dermatol Ges 18(4):400–413PubMed Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC et al (2020) J Dtsch Dermatol Ges 18(4):400–413PubMed
56.
Zurück zum Zitat Marrazzo G, Zitelli JA, Brodland D (2019) Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone. J Am Acad Dermatol 80(3):633–638PubMedCrossRef Marrazzo G, Zitelli JA, Brodland D (2019) Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone. J Am Acad Dermatol 80(3):633–638PubMedCrossRef
57.
Zurück zum Zitat Montuno MA, Brown B, Konda S, Motaparthi K (2018) Impact of Mohs micrographic surgery on tumor staging of cutaneous squamous cell carcinoma: a comparison of the 7th and 8th editions of the American joint committee on cancer guidelines. Dermatol Surg 44(8):1057–1064PubMedCrossRef Montuno MA, Brown B, Konda S, Motaparthi K (2018) Impact of Mohs micrographic surgery on tumor staging of cutaneous squamous cell carcinoma: a comparison of the 7th and 8th editions of the American joint committee on cancer guidelines. Dermatol Surg 44(8):1057–1064PubMedCrossRef
58.
Zurück zum Zitat van Lee CB, Roorda BM, Wakkee M, Voorham Q, Mooyaart AL, de Vijlder HC et al (2019) Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study. Br J Dermatol 181(2):338–343PubMedCrossRef van Lee CB, Roorda BM, Wakkee M, Voorham Q, Mooyaart AL, de Vijlder HC et al (2019) Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study. Br J Dermatol 181(2):338–343PubMedCrossRef
59.
Zurück zum Zitat Velazquez EF, Werchniack AE, Granter SR (2010) Desmoplastic/spindle cell squamous cell carcinoma of the skin. A diagnostically challenging tumor mimicking a scar: clinicopathologic and immunohistochemical study of 6 cases. Am J Dermatopathol 32(4):333–339PubMedCrossRef Velazquez EF, Werchniack AE, Granter SR (2010) Desmoplastic/spindle cell squamous cell carcinoma of the skin. A diagnostically challenging tumor mimicking a scar: clinicopathologic and immunohistochemical study of 6 cases. Am J Dermatopathol 32(4):333–339PubMedCrossRef
60.
Zurück zum Zitat Foroozan M, Sei JF, Amini M, Beauchet A, Saiag P (2012) Efficacy of Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans: systematic review. Arch Dermatol 148(9):1055–1063PubMedCrossRef Foroozan M, Sei JF, Amini M, Beauchet A, Saiag P (2012) Efficacy of Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans: systematic review. Arch Dermatol 148(9):1055–1063PubMedCrossRef
61.
Zurück zum Zitat Ugurel S, Kortmann RD, Mohr P, Mentzel T, Garbe C, Breuninger H et al (2019) S1 guidelines for dermatofibrosarcoma protuberans (DFSP)—update 2018. J Dtsch Dermatol Ges 17(6):663–668PubMed Ugurel S, Kortmann RD, Mohr P, Mentzel T, Garbe C, Breuninger H et al (2019) S1 guidelines for dermatofibrosarcoma protuberans (DFSP)—update 2018. J Dtsch Dermatol Ges 17(6):663–668PubMed
63.
Zurück zum Zitat Irarrazaval I, Redondo P (2012) Three-dimensional histology for dermatofibrosarcoma protuberans: case series and surgical technique. J Am Acad Dermatol 67(5):991–996PubMedCrossRef Irarrazaval I, Redondo P (2012) Three-dimensional histology for dermatofibrosarcoma protuberans: case series and surgical technique. J Am Acad Dermatol 67(5):991–996PubMedCrossRef
64.
Zurück zum Zitat Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Traves V et al (2018) Guidelines for diagnosis and treatment of cutaneous sarcomas: dermatofibrosarcoma protuberans. Actas Dermosifiliogr 109(10):868–877PubMedCrossRef Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Traves V et al (2018) Guidelines for diagnosis and treatment of cutaneous sarcomas: dermatofibrosarcoma protuberans. Actas Dermosifiliogr 109(10):868–877PubMedCrossRef
65.
Zurück zum Zitat Martin-Fuentes A, De Eusebio-Murillo E, Herreros CS, Ballano-Ruiz A, Blazquez EJ, Cuevas-Santos J (2018) Paraffin-embedded micrographic surgery for the treatment of dermatofibrosarcoma protuberans: analysis of 33 patients. Indian J Dermatol Venereol Leprol 84(3):298–303PubMedCrossRef Martin-Fuentes A, De Eusebio-Murillo E, Herreros CS, Ballano-Ruiz A, Blazquez EJ, Cuevas-Santos J (2018) Paraffin-embedded micrographic surgery for the treatment of dermatofibrosarcoma protuberans: analysis of 33 patients. Indian J Dermatol Venereol Leprol 84(3):298–303PubMedCrossRef
66.
Zurück zum Zitat Muller FM, Dawe RS, Moseley H, Fleming CJ (2009) Randomized comparison of Mohs micrographic surgery and surgical excision for small nodular basal cell carcinoma: tissue-sparing outcome. Dermatol Surg 35(9):1349–1354PubMedCrossRef Muller FM, Dawe RS, Moseley H, Fleming CJ (2009) Randomized comparison of Mohs micrographic surgery and surgical excision for small nodular basal cell carcinoma: tissue-sparing outcome. Dermatol Surg 35(9):1349–1354PubMedCrossRef
67.
Zurück zum Zitat Paradisi A, Abeni D, Rusciani A, Cigna E, Wolter M, Scuderi N et al (2008) Dermatofibrosarcoma protuberans: wide local excision vs. Mohs micrographic surgery. Cancer Treat Rev 34(8):728–736PubMedCrossRef Paradisi A, Abeni D, Rusciani A, Cigna E, Wolter M, Scuderi N et al (2008) Dermatofibrosarcoma protuberans: wide local excision vs. Mohs micrographic surgery. Cancer Treat Rev 34(8):728–736PubMedCrossRef
68.
Zurück zum Zitat van Lee CB, Kan WC, Gran S, Mooyaart A, Mureau MAM, Williams HC et al (2019) Dermatofibrosarcoma protuberans re-excision and recurrence rates in the Netherlands between 1989 and 2016. Acta Derm Venereol 99(12):1160–1165PubMed van Lee CB, Kan WC, Gran S, Mooyaart A, Mureau MAM, Williams HC et al (2019) Dermatofibrosarcoma protuberans re-excision and recurrence rates in the Netherlands between 1989 and 2016. Acta Derm Venereol 99(12):1160–1165PubMed
69.
Zurück zum Zitat No authors listed (2022) S3 Guideline “Adult soft tissue sarcomas”. Chirurg 93(5):520 No authors listed (2022) S3 Guideline “Adult soft tissue sarcomas”. Chirurg 93(5):520
71.
Zurück zum Zitat Foxton GC, Elliott TG, Litterick KA (2019) Treating melanoma in situ and lentigo maligna with Mohs micrographic surgery in Australia. Australas J Dermatol 60(1):33–37PubMedCrossRef Foxton GC, Elliott TG, Litterick KA (2019) Treating melanoma in situ and lentigo maligna with Mohs micrographic surgery in Australia. Australas J Dermatol 60(1):33–37PubMedCrossRef
72.
Zurück zum Zitat Temple CL, Arlette JP (2006) Mohs micrographic surgery in the treatment of lentigo maligna and melanoma. J Surg Oncol 94(4):287–292PubMedCrossRef Temple CL, Arlette JP (2006) Mohs micrographic surgery in the treatment of lentigo maligna and melanoma. J Surg Oncol 94(4):287–292PubMedCrossRef
73.
Zurück zum Zitat Singh B, Qureshi MM, Truong MT, Sahni D (2018) Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the national cancer database. J Am Acad Dermatol 79(1):126–34.e3PubMedCrossRef Singh B, Qureshi MM, Truong MT, Sahni D (2018) Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the national cancer database. J Am Acad Dermatol 79(1):126–34.e3PubMedCrossRef
74.
Zurück zum Zitat Tarantola TI, Vallow LA, Halyard MY, Weenig RH, Warschaw KE, Grotz TE et al (2013) Prognostic factors in Merkel cell carcinoma: analysis of 240 cases. J Am Acad Dermatol 68(3):425–432PubMedCrossRef Tarantola TI, Vallow LA, Halyard MY, Weenig RH, Warschaw KE, Grotz TE et al (2013) Prognostic factors in Merkel cell carcinoma: analysis of 240 cases. J Am Acad Dermatol 68(3):425–432PubMedCrossRef
75.
Zurück zum Zitat Ellis DL, Davis RS (2013) Evidence-based management of primary and localized Merkel cell carcinoma: a review. Int J Dermatol 52(10):1248–1258PubMed Ellis DL, Davis RS (2013) Evidence-based management of primary and localized Merkel cell carcinoma: a review. Int J Dermatol 52(10):1248–1258PubMed
76.
Zurück zum Zitat Becker JC, Eigentler T, Frerich B, Gambichler T, Grabbe S, Holler U et al (2019) S2k-Leitlinie Merkelzellkarzinom (MZK, MCC, neuroendokrines Karzinom der Haut) – Update 2018. J Dtsch Dermatol Ges 17(5):562–577PubMed Becker JC, Eigentler T, Frerich B, Gambichler T, Grabbe S, Holler U et al (2019) S2k-Leitlinie Merkelzellkarzinom (MZK, MCC, neuroendokrines Karzinom der Haut) – Update 2018. J Dtsch Dermatol Ges 17(5):562–577PubMed
77.
Zurück zum Zitat Kofler L, Breuninger H, Schulz C, Hafner HM, Kofler K (2021) Local recurrence rates of skin tumors after resection with complete circumferential peripheral and deep margin assessment-identification of high-risk entities. Dermatol Surg 47(2):e31–e6PubMedCrossRef Kofler L, Breuninger H, Schulz C, Hafner HM, Kofler K (2021) Local recurrence rates of skin tumors after resection with complete circumferential peripheral and deep margin assessment-identification of high-risk entities. Dermatol Surg 47(2):e31–e6PubMedCrossRef
78.
Zurück zum Zitat Lee KY, Roh MR, Chung WG, Chung KY (2009) Comparison of Mohs micrographic surgery and wide excision for extramammary Paget’s disease: Korean experience. Dermatol Surg 35(1):34–40PubMed Lee KY, Roh MR, Chung WG, Chung KY (2009) Comparison of Mohs micrographic surgery and wide excision for extramammary Paget’s disease: Korean experience. Dermatol Surg 35(1):34–40PubMed
79.
Zurück zum Zitat O’Connor WJ, Lim KK, Zalla MJ, Gagnot M, Otley CC, Nguyen TH et al (2003) Comparison of mohs micrographic surgery and wide excision for extramammary Paget’s disease. Dermatol Surg 29(7):723–727PubMedCrossRef O’Connor WJ, Lim KK, Zalla MJ, Gagnot M, Otley CC, Nguyen TH et al (2003) Comparison of mohs micrographic surgery and wide excision for extramammary Paget’s disease. Dermatol Surg 29(7):723–727PubMedCrossRef
81.
Zurück zum Zitat Wollina U, Goldman A, Bieneck A, Abdel-Naser MB, Petersen S (2018) Surgical treatment for extramammary Paget’s disease. Curr Treat Options Oncol 19(6):27PubMedCrossRef Wollina U, Goldman A, Bieneck A, Abdel-Naser MB, Petersen S (2018) Surgical treatment for extramammary Paget’s disease. Curr Treat Options Oncol 19(6):27PubMedCrossRef
82.
Zurück zum Zitat Kohlmeyer J, Steimle-Grauer SA, Hein R (2017) Cutaneous sarcomas. J Dtsch Dermatol Ges 15(6):630–648PubMed Kohlmeyer J, Steimle-Grauer SA, Hein R (2017) Cutaneous sarcomas. J Dtsch Dermatol Ges 15(6):630–648PubMed
83.
Zurück zum Zitat Wollina U, Schonlebe J, Koch A, Haroske G (2010) Atypical fibroxanthoma: a series of 25 cases. J Eur Acad Dermatol Venereol 24(8):943–946PubMedCrossRef Wollina U, Schonlebe J, Koch A, Haroske G (2010) Atypical fibroxanthoma: a series of 25 cases. J Eur Acad Dermatol Venereol 24(8):943–946PubMedCrossRef
84.
Zurück zum Zitat Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U et al (2022) S1-guideline atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). J Dtsch Dermatol Ges 20(2):235–243PubMed Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U et al (2022) S1-guideline atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). J Dtsch Dermatol Ges 20(2):235–243PubMed
85.
Zurück zum Zitat Kimyai-Asadi A, Goldberg LH, Peterson SR, Silapint S, Jih MH (2005) The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings. J Am Acad Dermatol 53(4):628–634PubMedCrossRef Kimyai-Asadi A, Goldberg LH, Peterson SR, Silapint S, Jih MH (2005) The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings. J Am Acad Dermatol 53(4):628–634PubMedCrossRef
86.
Zurück zum Zitat Rzepecki AK, Hwang CD, Etzkorn JR, Shin TM, Sobanko JF, Howe NM et al (2021) The “rule of 10s” versus the “rule of 2s”: high complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas. J Am Acad Dermatol 85(2):442–452. https://doi.org/10.1016/j.jaad.2018.11.008CrossRefPubMed Rzepecki AK, Hwang CD, Etzkorn JR, Shin TM, Sobanko JF, Howe NM et al (2021) The “rule of 10s” versus the “rule of 2s”: high complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas. J Am Acad Dermatol 85(2):442–452. https://​doi.​org/​10.​1016/​j.​jaad.​2018.​11.​008CrossRefPubMed
87.
Zurück zum Zitat De Carvalho N, Schuh S, Kindermann N, Kastle R, Holmes J, Welzel J (2018) Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery-recommendations regarding the marking and scanning technique. Skin Res Technol 24(1):145–151PubMedCrossRef De Carvalho N, Schuh S, Kindermann N, Kastle R, Holmes J, Welzel J (2018) Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery-recommendations regarding the marking and scanning technique. Skin Res Technol 24(1):145–151PubMedCrossRef
Metadaten
Titel
Mikroskopisch kontrollierte Chirurgie im dermatochirurgischen Alltag
verfasst von
Prof. Dr. med. Cornelia Sigrid Lissi Müller
Nina Hauer
Katrin Kofler
Lukas Kofler
Publikationsdatum
30.05.2023

Weitere Artikel der Ausgabe 6/2023

Die Dermatologie 6/2023 Zur Ausgabe

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

16.05.2024 alpha-1-Rezeptorantagonisten Nachrichten

Nach einer Prostatabiopsie treten häufig Probleme beim Wasserlassen auf. Ob sich das durch den periinterventionellen Einsatz von Alphablockern verhindern lässt, haben australische Mediziner im Zuge einer Metaanalyse untersucht.

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

16.05.2024 Zielgerichtete Therapie Nachrichten

Trastuzumab deruxtecan scheint auch jenseits von Lungenkrebs gut gegen solide Tumoren mit HER2-Mutationen zu wirken. Dafür sprechen die Daten einer offenen Pan-Tumor-Studie.

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

15.05.2024 Mammakarzinom Nachrichten

Frauen mit lokalem oder metastasiertem Brustkrebs, die Statine einnehmen, haben eine niedrigere krebsspezifische Mortalität als Patientinnen, die dies nicht tun, legen neue Daten aus den USA nahe.

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

13.05.2024 Pankreaskarzinom Nachrichten

Gerade bei aggressiven Malignomen wie dem duktalen Adenokarzinom des Pankreas könnte Früherkennung die Therapiechancen verbessern. Noch jedoch klafft hier eine Lücke. Ein Studienteam hat einen Weg gesucht, sie zu schließen.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.