改良Mohs显微描记手术方式在皮肤鳞状细胞癌治疗中的应用及意义

Application and Significance of Modified Mohs Micrographic Surgery in the Treatment of Cutaneous Squamous Cell Carcinoma

目标:研究优化Mohs微切片手术方法对于完全移除皮肤鳞状细胞癌的重要性。方法:通过对2022年6月至2023年6月在新疆医科大学第一附属医院皮肤病科运用优化Mohs微切片手术方法的皮肤鳞状细胞癌20例患者的资料进行回顾性分析。利用优化的Mohs微切片手术方法进行手术:即从肿瘤边缘和肿瘤底部分别进行取样。步骤1:扩切肿瘤边缘皮肤组织;步骤2:在前次手术缺损边缘下切除肿瘤底部组织。肿瘤边缘及底部均遵循《2021NCCN皮肤鳞状细胞癌诊疗指南中文版》。对两组样本分别进行染色制片处理,接着根据样本的边缘和底部的常规病理切片结果决定是否逐步增加切除区域和加深切除层次,直至病理学证实肿瘤已全部剔除。在20个鳞状细胞癌病例中,有4个病例(占20%)经过两次或以上扩大切除,后经病理学检查证实肿瘤已被完全去除。典型病理展示了手术过程。结论:通过改良Mohs显微镜手术技术,我们能够更加精确地移除皮肤鳞状细胞癌的发源地,使得制作病理切片的过程变得相对简单。这种手术技术有效地避免了肿瘤底部的不足切除和过度切除,充分体现了个性化治疗和最小影响的医疗发展方向。

Purpose: Investigate the significance of the mode of modified Mohs micrographic surgery in remov-ing cutaneous squamous cell carcinoma. An examination looking back in time was performed on 20 patients with cutaneous squamous cell carcinomas. These individuals received modified Mohs mi-crographic surgical procedures in the Dermatology Department at the First Affiliated Hospital of Xinjiang Medical University. The study spans from June 2022 to June 2023. The method adapted to modified Mohs micrographic surgery: That is, samples are taken from the edges of tumors and bot-toms of the tumors. Step 1: Extensively resect the tumor margin skin tissues. Step 2: Remove the underlying tissues of the tumors below the defective edges from the previous surgery. Both the edges and the bottoms of the tumors follow the “2021 NCCN Cutaneous Squamous Cell Carcinoma Diagnosis and Treatment Guideline (Chinese Version)”. Two groups of specimen sections are stained separately, then according to routine pathological section results at the edges of specimens and their bottoms, to decide whether to gradually expand the scope and depth of excision, until the tu-mor is confirmed to be cleared pathologically. Result: Of the 20 squamous cell carcinoma cases, 4 (20%) had two or more extensive resections, and then it was confirmed that the tumors were cleared pathologically. Conclusion: The mode of modified Mohs micrographic surgery can remove the primary lesions of cutaneous squamous cell carcinoma in an appropriate method, reducing the difficulty of pathological sections, avoiding cutting the bottoms of the tumors uncleanly and resect-ing excessively the tumor margins. It is fully reflected in the clinical trend of individualized treat-ment and trauma minimization.