Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs...Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24% ). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size(R2 =0.39) and were used as control variables. Selfreported delay between initial physician examination and MMS predicted defect size (P=0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3- 3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7- 8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5- 18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5- 83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5- 15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.展开更多
A 23- year- old woman with basal cell nevus syndrome (BCNS), or Gorlin’ s syndrome,was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiati...A 23- year- old woman with basal cell nevus syndrome (BCNS), or Gorlin’ s syndrome,was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiation. Multiple basal cell carcinomas developed at the craniospinal irradiation port site 8 years later. She subsequently developed multiple meningiomas within the area of irradiation at age 20 years. This case reviews early presentation of BCNS, newly described differences between medulloblastomas in patients with BCNS and nonsyndromic medulloblastomas, and global assessment of patients by the treating dermatologist of this patient population. This is the first report in the dermatologic literature, to our knowledge, of radiation- induced meningiomas in a patient with BCNS.展开更多
文摘Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24% ). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size(R2 =0.39) and were used as control variables. Selfreported delay between initial physician examination and MMS predicted defect size (P=0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3- 3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7- 8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5- 18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5- 83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5- 15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.
文摘A 23- year- old woman with basal cell nevus syndrome (BCNS), or Gorlin’ s syndrome,was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiation. Multiple basal cell carcinomas developed at the craniospinal irradiation port site 8 years later. She subsequently developed multiple meningiomas within the area of irradiation at age 20 years. This case reviews early presentation of BCNS, newly described differences between medulloblastomas in patients with BCNS and nonsyndromic medulloblastomas, and global assessment of patients by the treating dermatologist of this patient population. This is the first report in the dermatologic literature, to our knowledge, of radiation- induced meningiomas in a patient with BCNS.
