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Focus 2-2 (FS 2-2) : Is Mohs micrographic surgery really necessary?
정기양 ( Kee Yang Chung ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2
Mohs micrographic surgery (MMS), first developed by Dr. Frederic E. Mohs in 1936, is a microscopically controlled surgery used to treat skin cancers such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma in situ. Currently, indications for MMS have been expanded encompassing dermatofibrosarcoma protuberans (DFSP), sebaceous carcinoma, microcystic adnexal carcinoma, extramammary paget’s disease (EMPD), angiosarcoma and atypical fibroxanthoma and many other benign and malignant lesions. The goal of MMS is to remove the skin cancer completely with free margins to maximize cure rates and also to achieve minimal surgical defects. This procedure therefore allows to achieve a high cure rate and excellent cosmetic result. MMS is usually performed as follows; 1. Outline the visible tumor and remove the main mass with very small safety margin. 2. Mark and map the resected tissue by color encoding. 3. Make frozen sections of the margin and stain. 4. Microscopic examination of the frozen sections and map any residual tumor for 2nd stage removal. Repeat the procedure until completely tumor free margin is acquired. 5. Reconstruction of the surgical defect The cure rate of MMS is superior to other treatment modalities and MMS is expanded to treat dermatofibrosarcoma protuberans, sebaceous carcinoma, microcystic adnexal carcinoma, extramammary Paget’s disease, angiosarcoma, atypical fibroxanthoma and various other skin tumors. This lecture will outline why MMS is necessary in surgically managing skin cancers as compared toconventional wide excision and introduce challenging cases that were successfully treated by MMS.
Dialogues and Debates in Dermatology (DDD 1) : Which is the best option? To treat ASAP vs wait & see
정기양 ( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
Actinic keratosis (AK) is a precancerous lesion caused by chronic exposure to ultraviolet light. It is known to occur mainly in Caucasians but the incidence in Korea is known to increase as well. Not all AKs progress into squamous cell carcinoma (SCC) but approximately 90% of SCCs have contiguous AKs which is consistent with the perception that SCCs are preceded by AKs. A study found that up to 60% of SCCs arise directly from an AK and another study showed that 136 of 165 SCCs have close relationship to AKs. Of these SCCs, 26.7% were seen to have occurred directly from an existing AKlesion and 55.7% were closely situated to an AK lesion. How much of the AKs actually progress into invasive SCCs is not yet known with certainty but the range is known to be anywhere from 0.075% to 16% or even more. This means that the majority of AKs remain stable or they may even regress. A review found that annual rates of regression for a single AK to be 15% to 63% with recurrence rates of 15% to 53%. These clinical data are not conclusive and it is still impossible to predict which AK will progress into an invasive SCC and which will regress. This uncertainty has ignited much discussion regarding the best treatment approach for AKs, with some encouraging careful follow up and others claiming aggressive approach.
정기양(Kee Yang Chung),전수일(Soo Il Chun) 대한피부과학회 1986 대한피부과학회지 Vol.24 No.4
An 89- Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.