E. de Eusebio Murillo

Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015)

INTRODUCTION The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.

Mujer de 54 años con fiebre alta, erupción cutánea cervicofacial y artralgias de 72 horas de evolución

espanolMujer de 54 anos con antecedentes patologicos de hipertension arterial en tratamiento con enalapril, hipercolesterolemia en tratamiento con simvastatina, colecistectomia por litiasis biliar hace 6 meses y cuadro depresivo en tratamiento con sertralina desde hace 2 anos. La paciente consulto por presentar fiebre elevada de hasta 39 °C y una erupcion cutanea de 3 dias de evolucion. Ademas refiere artralgias y mal estado general. Las lesiones cutaneas se habian iniciado en la cara y cuello afectando posteriormente, aunque con menor intensidad, a tronco y extremidades. Exploracion dermatologica: se aprecian papulas y placas eritematoedematosas de bordes irregulares, pseudovesiculosos y muy bien delimitados distribuidas en cara y cuello fundamentalmente (fig. 1). En las extremidades se aprecian lesiones similares pero menos sobreelevadas. Alguna de las lesiones situadas en el dorso de las manos presentan un aspecto dianiforme, con papula pseudovesiculosa central purpurica (fig. 2). En el caso de las extremidades inferiores adoptan un aspecto casi de nodulos subcutaneos mas palpables que visibles (fig. 3). Las lesiones eran, en todos los casos, dolorosas a la palpacion. espanolExploracion sistemica: la exploracion por organos y aparatos no revelo ninguna anomalia salvo fiebre de 39,3 °C. Exploraciones complementarias: en el hemograma se encontro una velocidad de sedimentacion globular (VSG) de 67, 19.000 leucocitos/mm3 con 80% de neutrofilos; bioquimica basica sin alteraciones significativas; proteinograma: gammapatia monoclonal IgG kappa. El resto de las exploraciones complementarias, incluyendo el analisis sistematico de orina, radiologia de torax y ecografia abdominal, fueron normales o negativas.