๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Tumor characteristics
Tumor characteristics
The preoperative biopsy should be reviewed for signs of aggressive histologic features, as such BCCs and SCCs are more likely to locally recur and metastasize. Morpheaform/fibrosing/sclerosing, infiltrating, metatypical/keratotic, and micronodular BCCs contain small nests of malignant cells and have a high propensity for recurrence.1,9 Sclerosing, basosquamous, poorly differentiated or undifferentiated, infiltrating, keratoacanthoma (central facial), clear cell, sarcomatoid, Breslow depth 2 mm or more, Clark level 4 or greater, pagetoid, single cell, lymphoepithelial, and small cell tumors similarly have an increased risk of recurrence and metastasis.7,10,11
According to the appropriate-use criteria, any aggressive histologic feature for SCC makes it appropriate for MMS, regardless of all other characteristics. This guideline is similar for BCCs, with the exception of aggressive BCCs on location L that measure <5 mm in diameter. For all subtypes of BCC and SCC, perivascular and perineural involvement are indications for MMS. The presence of significant pain or paresthesia should alert the physician to the possibility of perineural invasion,12 as this finding is not always seen on initial biopsy due to sampling error. MMS is also appropriate for all tumors occurring within radiated skin, traumatic scars, areas of osteomyelitis, patients with genetic syndromes, and areas of chronic inflammation. Recurrence of a previously treated BCC or SCC is also a strong indication for using MMS.10,13