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首页> 外文期刊>JAMA facial plastic surgery >Mohs needs a better look
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Mohs needs a better look

机译：莫斯需要更好的外观

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To the Editor In the thoughtful study by Schell et al,1 the authors predicate their conclusions on the assumption that all surgeons view the initial lesion with equal ability. This is not the case. In their article, the lighting and magnification for determining the initial size of the lesion is not described. When superior lighting and loop magnification are used at the time of surgery, the true extent of the cancer can be better visualized, making one question many findings in this study, including the conclusion that "traditional" surgical excision would incompletely excise 14.2% to 27.6% of lesions. Furthermore, I am disappointed that the authors included in their article "before and after" pictures of defects that do not support their findings and further the misconception that facial nonmelanoma skin carcinomas are difficult and best treated by Mohs micrographic surgery.This distinction has broad implications about what constitutes the standard of care or gold standard for skin cancer excisions and, consequently, what access will be available for patients with skin carcinoma. The American Academy of Dermatology seized upon this article and reported that "Mohs is the only recommended treatment for certain facial skin cancers."2 This is not a valid conclusion based on this study, but a historical pattern that proponents of Mohs micrographic surgery have repeated. The most important of these is the claim that the Mohs technique has superior cure rates comparable with those of standard surgery. These claims come from articles that compare Mohs cure rates to those in a heterogeneous surgical population treated with unknown surgical techniques.3 When intraoperative frozen sections and loop magnification are used, however, randomized control and retrospective trials demonstrate equal cure rates to the Mohs technique.4-5 Because cure rates are similar between these 2 techniques, Mohs should not be the gold standard for excision of non-melanoma skin carcinoma, because Mohs surgical times are lengthy, and not all wounds created by Mohs can be closed by the dermatologist. The standard of care should be excision and repair utilizing intraoperative frozen sections and loop magnification by a facial plastic surgeon.
机译：致编辑在Schell等人1的深入研究中，作者基于所有外科医生均以相同能力看待初始病变的假设来得出他们的结论。不是这种情况。在他们的文章中，没有描述确定病变的初始大小的照明和放大倍数。如果在手术时使用卓越的照明和环形放大倍数，则可以更好地可视化癌症的真实范围，这使本研究中的许多发现成为一个问题，包括“传统”手术切除将不完全切除的结论为14.2％至27.6。病变百分比。此外，令我感到失望的是，作者在文章“前后”包含的缺陷图片不支持他们的发现，并进一步使人误解了面部非黑素瘤皮肤癌很难用Mohs显微外科手术进行最佳治疗。这种区别具有广泛的意义。关于什么构成皮肤癌切除术的护理标准或黄金标准，因此，皮肤癌患者可以使用哪些途径。美国皮肤病学会（Academy of Dermatology）抓住了这篇文章，并报告说：“莫氏（Mohs）是某些面部皮肤癌的唯一推荐治疗方法。” 2根据这项研究，这不是一个有效的结论，而是莫氏显微术的支持者不断重复的历史模式。其中最重要的是声称Mohs技术具有与标准手术相当的治愈率。这些主张来自将Mohs治愈率与采用未知手术技术治疗的异类手术人群中的Mohs治愈率进行比较的文章。3然而，当使用术中冰冻切片和loop放大倍数时，随机对照和回顾性试验表明Mohs治愈率与Mohs技术相同。 4-5因为这两种技术的治愈率相似，所以莫斯不应该成为切除非黑素瘤皮肤癌的金标准，因为莫斯的手术时间很长，而且并非所有的莫斯造成的伤口都可以由皮肤科医生闭合。护理的标准应该是使用术中冷冻切片并由面部整形外科医生进行放大和放大来进行切除和修复。

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