Differentiation of Different Nonmelanoma Skin Cancer Types Using OCT

Background: Early detection of various types of nonmelanoma skin cancer has been a challenge in dermatology. Noninvasive examination procedures such as optical coherence tomography (OCT) play an increasingly important role, besides the established gold standard of histological tissue sample analysis. OCT is a noninvasive, cross-sectional, real-time technique that allows conclusions to be drawn with regard to the presence of pathologies. Objective: The objective of this study was to investigate whether it is possible to distinguish between different types of nonmelanoma skin cancer using OCT or not. Methods: A study population of a total of 25 cases, comprising 5 cases, each, of 5 tumor entities (i.e., basal cell carcinoma, superficial basal cell carcinoma, actinic keratosis, squamous cell carcinoma, and Bowen disease) was examined. Relevant lesions were scanned both centrally and peripherally in the multislice mode. All OCT images were blinded, randomized, analyzed, and evaluated by 2 clinicians experienced in OCT. Results: This study demonstrated that it is possible to determine correlations between various types of tumors and recurring tumor characteristics. Conclusion: This study showed that it is possible to distinguish between the different nonmelanoma skin cancers by using OCT, but further prospective studies have to be conducted to validate the sensitivity and specificity of the criteria

Optical coherence tomography for presurgical margin assessment of non-melanoma skin cancer

Hintergrund: Optische Kohärenztomografie (OCT) ist ein optisches Verfahren zur Darstellung von oberflächlichen, anatomischen Strukturen basierend auf dem Prinzip der Michelson Interferometrie. Es erlaubt die In-vivo-und Echtzeitmessung von Gewebe bis zu 2 mm Eindringtiefe. Im klinischen Gebrauch kann die OCT für die nicht invasive Diagnose von nicht melanozytären Hauttumoren (NMSC) und insbesondere für die präoperative Bestimmung von Tumorgrenzen sinnvoll sein. Durch die OCT könnte die Erfolgsrate für R0-Resektionen erhöht und des Weiteren durch kontrollierte Grenzbestimmung gesundes Gewebe vor der Exzision bewahrt werden. Zielsetzung: Das Ziel der nachfolgenden Arbeiten ist es, den diagnostischen Wert, die Praktikabilität und die Technik zur Tumorgrenzbestimmung bei NMSC zu beurteilen, morphologische Kriterien für das Mikrozystische Adnexkarzinom (MAC) zu beschreiben und überdies die Beurteilung von morphologischen Änderungen während des Wundheilungsprozesses zu evaluieren. Material und Methoden: Durch OCT-Messungen wurden bei 18 Patienten, die zur Exzision geplant waren, die Tumorgrenzen von 19 Läsionen präoperativ definiert und durch die Ex-vivo Markierung unter dem Mikroskop auf Tumorfreiheit untersucht. Für die Beschreibung des MAC wurde die zentrale Region der Läsion analysiert und retrospektiv mit der Histologie korreliert. Zur Beurteilung des Wundheilungsprozesses wurden 6 Patienten mit chronischer Wundheilungsstörung objektiv durch OCT über einen Zeitraum von 2 Wochen untersucht. Für die Optimierung der Scan-Qualität wurde je ein gesundes Hautareal bei 10 Patienten mit hyperosmolaren Lösungen wie Glycerol oder Glukose behandelt und über einen Zeitraum von insgesamt 60 Minuten untersucht. Ergebnisse: Es wurden 61 Grenzpunkte und 5 komplette Tumorgrenzen von 18 Patienten mit insgesamt 19 Läsionen analysiert. Von diesen waren 63% Basalzellkarzinome (n=12), 16% (n=3) Plattenepithelkarzinome und 21% (n=4) andere Tumore wie Morbus Bowen (n=1), Aktinische Keratose (n=1), Seborrhoische Keratose (n=1) und einem Porom (n=1). In 84% der Fälle (n=16) waren die lateralen Grenzen In-sano, während die Tumorfreiheit in der Tiefe eine Rate von 95% erreichte. Die Tumorgrenzen des Operateurs unterschritten in keinem Fall die mit OCT-definierten Grenzen. Spezifische OCT-Charakteristika zeigten sich sowohl bei der Wundheilung als auch beim MAC. Eine Optimierung der Scan-Tiefe und Qualität konnte sowohl für Glukose als auch für Glycerol festgestellt werden. Schlussfolgerung: Die nachfolgenden Studien zeigen, dass die Grenzen nicht melanozytärer Hauttumore effektiv mit OCT definiert werden können, ohne die Rate von R0-Resektionen zu reduzieren, und dass OCT-Kriterien für die Beschreibung von Tumorläsionen wie dem MAC verwendbar sind. Zudem kann die OCT als potentielle nicht invasive Diagnostikmethode zum Monitoring von kutanen Wundheilungsprozessen dienen.Background: In the clinical setting, Optical Coherence Tomography (OCT) can visualize superficial, anatomical structures with a scan depth of up to 2 mm based on Michelson interferometry and may in particular be used for margin definition prior to excision. In this regard, OCT may improve the success rate of removing tumor lesions more effectively, preventing repetitive excisions. Objective: The purpose of the following work was to evaluate the feasibility of OCT for In-vivo pre-surgical margin assessment of non-melanocytic skin tumors (NMSC), to define specific criteria for MAC as well as to evaluate morphologic changes in the process of wound healing. Material and methods: Based on OCT, specific tumor margins of 18 patients with a total number of 19 lesions planned for excision of lesions suspicious of NMSC preoperatively using different scanning modalities were defined. For the analysis of MAC multi-slice images were obtained from the central portion of the lesion. Correlation of OCT findings and histology was performed retrospectively. To determine, whether OCT is suited to display the phases of wound healing, 6 patients with chronic wounds were objectively characterized by OCT during a period of 2 weeks. Finally, we investigated the increase of scan quality by using of hyperosmolar agents like Glycerol and Glucose on 10 patients and subsequent scans for 60 minutes. Results: 61 margin points and 5 complete tumor margins were analyzed on 18 patients with a total of 19 lesions including 63% Basal Cell Carcinoma (BCC) (n=12), 16% (n=3) Squamous-cell carcinoma (SCC) and 21% of other types of skin tumors (n=4) that we classified as Morbus Bowen (n=1), Actinic Keratosis (n=1), Seborrhoic Keratosis (n=1) and a Poroma (n=1). In 84% of the cases (n=16) the OCT-defined lateral margins correctly indicated complete removal of the tumor. The surgical margins chosen by the surgeon never fell below these OCT-defined margins. MAC as well as the wound healing process featured specific criteria in OCT covered by the same findings in histology. In addition, an optimization of scan depth and quality could be shown for both agents Glycerol and Glucose. Conclusion: This study shows that suspected NMSC can effectively be confirmed and, furthermore, resection margin can be minimized under OCT control without reducing the rate of R0-resection. Criteria of MAC could be achieved, thus enabling prompt diagnosis before surgery. In addition OCT could be a potential non-invasive diagnostic tool for the characterization and monitoring of cutaneous wound healing processes over time

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Severe hand injuries significantly limit function and esthetics of the affected hand due to massive trauma in skeletal and soft tissues. Surgical reconstruction is often unsatisfactory, so bionic prostheses are a consideration. However, assessment of functional outcomes and quality of life after surgical reconstruction to guide clinical decisions immediately after injury and in the course of treatment remain difficult.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a prospective follow-up analysis of patients with severe hand injuries during 2016–2018. We retrospectively evaluated initial trauma severity and examined current functional status, quality of life, general function, and satisfaction in everyday situations of the hand. We also developed a novel Hand Bionic Score to guide clinical recommendation for selective amputation and bionic prosthesis supply.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We examined 30 patients with a mean age of 53.8 years and mean initial severity of hand injury (iHISS) of 138.4. Measures indicated moderate quality of life limitations, moderate to severe limitation of overall hand function, and slight to moderate limitation of actual hand strength and function. Mean time to follow-up examination was 3.67 years. Using the measured outcomes, we developed a Hand Bionic Score that showed good ability to differentiate patients based on outcome markers. Appropriate cutoff scores for all measured outcome markers were used to determine Hand Bionic Score classifications to guide clinical recommendation for elective amputation and bionic prosthetic supply: < 10 points, bionic hand supply not recommended; 10–14, bionic supply should be considered; or > 14, bionic supply is recommended.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>While iHISS can guide early clinical decisions following severe hand injury, our novel Hand Bionic Score provides orientation for clinical decision-making regarding elective amputation and bionic prosthesis supply later during the course of treatment. The score not only considers hand function but also psychological outcomes and quality of life, which are important considerations for patients with severe hand injuries. However, future randomized multicenter studies are needed to validate Hand Bionic Score before further clinical application.</jats:p> <jats:p>Level of evidence: Level III, risk/prognostic study.</jats:p> </jats:sec&gt

Free flaps in scar treatment

Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality

Quality of life and reconstructive surgery efforts in severe hand injuries

Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process