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On the recurrence rate of cutaneous tumors treated exclusively by micrographic surgery
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(A) Septate, brownish hyphae (“Borelli spiders”). Direct microscopy, KOH 20% + DMSO, ×40. (B) Colony micromorphology showing brownish, septate hyphae, from which conidiophores with elongated conidia at their extremities arise, giving the appearance of a gnarled staff. <span class="elsevierStyleItalic">Rhinocladiella</span> spp., lactophenol, ×40.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jessica Lana Conceição e Silva Baka, Gabriela Giraldelli, Andrea Reis Bernardes-Engemann, Carlos Baptista Barcaui, Rosane Orofino-Costa" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Jessica Lana Conceição e Silva" "apellidos" => "Baka" ] 1 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Giraldelli" ] 2 => array:2 [ "nombre" => "Andrea Reis" "apellidos" => "Bernardes-Engemann" ] 3 => array:2 [ "nombre" => "Carlos Baptista" "apellidos" => "Barcaui" ] 4 => array:2 [ "nombre" => "Rosane" "apellidos" => "Orofino-Costa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000322" "doi" => "10.1016/j.abdp.2023.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000322?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000077?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000077/v3_202305121633/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "On the recurrence rate of cutaneous tumors treated exclusively by micrographic surgery" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "426" "paginaFinal" => "427" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luiz Eduardo Fabrício de Melo Garbers, Ana Carolina Miola, Luis Fernando Figueiredo Kopke, Hélio Amante Miot" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Luiz Eduardo Fabrício de Melo" "apellidos" => "Garbers" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Ana Carolina" "apellidos" => "Miola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Luis Fernando Figueiredo" "apellidos" => "Kopke" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" "email" => array:1 [ 0 => "heliomiot@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article by Dr. Otsuka et al., in which they used a peripheral sampling technique with a parallel incision of the lateral and deep surgical margins of cutaneous carcinomas (basal cell and squamous cell carcinomas). Moreover, they validated the concordance of the identification of compromised margins with subsequent analysis of the paraffin-embedded specimens.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We would like to congratulate the authors and make comments regarding the method, its validation, and conclusions about the recurrence rate.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We encourage the study of operative techniques in micrographic surgery, as well as in the processing of surgical specimens, which may lead to effective and faster procedures, with lower cost and morbidity rates. Initially, for clarifying purposes, it should be noted that the technique used by the authors is identical to the Tübingen method, one of the most employed modalities in Europe.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">When meta-analytically analyzed, the results of 10,424 basal cell carcinomas operated on by micrographic surgery, the different micrographic surgery techniques do not show overall differences in recurrence rates between them (1% to 3%), although there are no parallel comparative studies that could explore their peculiarities. Primary tumors have a recurrence rate that ranges from 1% to 3%, and relapses, of 2% to 5%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Interestingly, false-negative margins can occur in discontinuous tumors (such as multicentric basal cell carcinoma - BCCs), with thin areas (e.g., tumors with perineural invasion), recurrences under flaps/grafts, and because of technical problems during preparation of the slides. On the other hand, false-positive margins can occur due to confusion with cross-sections of follicular bulbs, due to the inflammatory infiltrate, or in the initial spare sectionning of specimens in the cryostat, necessary for preparing the slides. For this reason, validation of the coincidence of surgical margins in paraffin, as used in the work by Otsuka et al., may not be plausible, as it may overestimate the involvement of the margins, since the outermost sections were previously sampled and analyzed intraoperatively, in thicker sections than the ones in paraffin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">When analyzing, separately the recurrence rates described by the authors for primary basal cell carcinomas (0.3%) and the recurrent ones (4.3%), we found that there was supplementation of the surgical treatment with radiotherapy in 97% of the cases, which is unusual, especially for basal cell carcinomas (80% of the sample), given the use of a surgical technique that verifies 100% of the surgical margins aiming at complete cure and recurrence prevention. Although the literature has publications that suggest exclusive radiotherapy as a treatment option for BCCs, with good results and local control of up to 96% of cases, studies on the effectiveness of adjuvant radiotherapy in preventing recurrences in micrographic surgeries are still necessary.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the meantime, the recurrence rate found by the authors cannot be attributed only to the surgical technique, but to the combination between micrographic surgery and complementary radiotherapy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, the completion of micrographic surgeries with only one stage in 72% of cases prompts the discussion of indication criteria, aiming to maximize the cost-benefit to the detriment of conventional oncological surgery, since the latter is more accessible, both technically and financially for the health system.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Luiz Eduardo Fabrício de Melo Garbers: Design of the study; writing of the manuscript; review and approval of the final version of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ana Carolina Miola: Design of the study; writing of the manuscript; review and approval of the final version of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Luis Fernando Figueiredo Kopke: Design of the study; writing of the manuscript; review and approval of the final version of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Hélio Amante Miot: Design of the study; writing of the manuscript; review and approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-10-27" "fechaAceptado" => "2022-12-21" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative assessment of surgical margins using “en face” frozen sections in the management of cutaneous carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. 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Kopke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.abd.2020.02.004" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2020" "volumen" => "95" "paginaInicial" => "545" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32522450" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrence rate of basal cell carcinoma among different micrographic surgery techniques: systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.N. Lacerda" 1 => "E.P. Lange" 2 => "N.M. Luna" 3 => "H.A. Miot" 4 => "V.S.N. Nogueira" 5 => "L.P.F. 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Desmet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fmed.2022.913269" "Revista" => array:5 [ "tituloSerie" => "Front Med (Lausanne)" "fecha" => "2022" "volumen" => "9" "paginaInicial" => "913269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35833108" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000223/v3_202305121633/en/main.assets" "Apartado" => array:4 [ "identificador" => "81766" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000003/v3_202305121633/S0365059623000223/v3_202305121633/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000223?idApp=UINPBA00008Z" ]
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