Decreasing loco-regional recurrence for oral cavity cancer with total Mohs margins technique

Abstract

Background

The conventional technique for cancer resection margin analysis studies only 0.1% of the surgical margins. Complete frozen section margins - also known as Mohs margins – allows for analysis of 100% of the surgical margins.

Methods

The objective of our study is to compare oral cavity cancer loco-regional recurrence rates when treated by total frozen sections technique (Total Mohs margins) versus conventional margins. We conducted a multicenter retrospective cohort chart review. Loco-regional oral cancer recurrence rates were compared between patients treated with total Mohs margins (2007–2013) and patients treated with conventional margins techniques (2002–2007).

Results

After applying inclusion criteria, a total of 60 patients treated by total Mohs margins and 57 patients with conventional margins were identified. Patients had similar baseline cancer stages, pathological types, past head and neck cancers and comorbidities (all p > 0.05). One-year recurrence rate was lower (10.0% vs 21.1%, p = 0.019) in favor of Mohs total margins and stayed significantly lower at 5 years of follow-up. When adjusted for T grade with N0 disease, Mohs technique was still beneficial in loco-regional recurrence for Tis-T4N0 up to 2 years (10.5% vs 25.7%, z-score 1.849, p = 0.032). The Number Needed to Treat at 2 years of follow-up for this subgroup of patients (Tis-T4N0) is 6.6. Margins had to be retaken more often intra-operatively in Mohs technique (68.3% vs 12.3%, p < 0.0001), mainly for positive deep margins (48.6% of all margins, p = 0.028). Duration of surgery was not increased with Mohs vs conventional technique (380 min vs 475 min respectively, p = 0.025).

Conclusions

Mohs total margins may result in a significant reduction in cancer recurrence rate at 5 years compare to conventional surgery. Moreover, duration of surgery was not increased when using Mohs technique when judiciously performed.

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Moms, Remember THIS and Survive Holiday Stress!

Need help surviving holiday stress this year? Dr. Dehra Harris shares tips for surviving the holidays and dealing with holiday stress in this week's episode of Mom Docs!

The key to surviving the holidays is remembering that you matter just as much as everyone else. Don't take on the responsibilities by yourself – let someone else take the pictures for once!

The post Moms, Remember THIS and Survive Holiday Stress! appeared first on ChildrensMD.

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A mutually beneficial collaboration between the European Academy of Allergy and Clinical Immunology Junior Members and Clinical and Translational Allergy

The European Academy of Allergy and Clinical Immunology (EAACI) Junior Members (JM) comprise the largest EAACI section with around 4000 clinicians and scientists under 35 years of age working in the field of a...

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Decreasing loco-regional recurrence for oral cavity cancer with total Mohs margins technique

The conventional technique for cancer resection margin analysis studies only 0.1% of the surgical margins. Complete frozen section margins - also known as Mohs margins – allows for analysis of 100% of the surg...

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C1q as an autocrine and paracrine regulator of cellular functions

Publication date: Available online 30 November 2016
Source:Molecular Immunology
Author(s): Berhane Ghebrehiwet, Kinga H. Hosszu, Ellinor I.B. Peerschke
Most of the complement proteins in circulation are, by and large, synthesized in the liver. However data accumulated over the past several decades provide incontrovertible evidence that some if not most of the individual complement proteins are also synthesized extrahepatically by activated as well as non-activated cells. The question that is finally being addressed by various investigators is: are the locally synthesized proteins solely responsible for the myriad of biological functions in situ without the contribution of systemic complement? The answer is probably "yes". Among the proteins that are synthesized locally, C1q takes center stage for several reasons. First, it is synthesized predominantly by potent antigen presenting cells such as monocytes, macrophages and dendritic cells (DCs), which by itself is a clue that it plays an important role in antigen presentation and/or DC maturation. Second, it is transiently anchored on the cell surface via a transmembrane domain located in its A chain before it is cleaved off and released into the pericellular milieu. The membrane-associated C1q in turn, is able to sense danger patterns via its versatile antigen-capturing globular head domains. More importantly, locally synthesized C1q has been shown to induce a plethora of biological functions through the induction of immunomodulatory molecules by an autocrine- or paracrine- mediated signaling in a manner that mimics those of TNFα. These include recognition of pathogen- and danger- associated molecular patterns, phagocytosis, angiogenesis, apoptosis and induction of cytokines or chemokines that are important in modulating the inflammatory response. The functional convergence between C1q and TNFα in turn is attributed to their shared genetic ancestry. In this paper, we will infer to the aforementioned "local-synthesis-for-local function" paradigm using as an example, the role played by locally synthesized C1q in autoimmunity in general and in systemic lupus erythematosus in particular.



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Community raises funds for EMT student shot while aiding victim

By EMS1 Staff

BATON ROUGE, La. — After a 17-year-old EMT student put his life on the line to save a shooting victim, his community has begun raising funds to pay for his medical bills.

Daniel Wesley was on his way home from a Sunday shopping trip with his mother when he saw a shooting victim lying on the side of the road. Wesley rushed to the victim, April Peck, and attempted to aid her. 

During the incident, the shooter, Terrell Walker, shot Wesley in the arm and leg, and ran over him twice as he fled from the scene, reported WBRZ. Peck did not survive. Walker was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Wesley was transported to the hospital, where he underwent surgery on his leg and arm, which "shattered into 18 pieces," his mother, Kathy Wesley, said.

Wesley comes from an EMS family; his father was a longtime paramedic and his mother is also a first responder. 

Wesley's high school has started to sell bracelets to help raise funds for his medical expenses. The school's principal, David Prescott, said, "We're very proud of him. He's always in service to some else. He's come to me before this year with a fundraiser of his own to help someone out."

A GoFundMe page has also been created and it has raised over $6,000.

"Daniel wants to tell all of his friends out there, he's sending a shout out to them, and he's thinking of them as well during this time," Wesley's mother said. 

Heroic, selfless effort by this incredible young man. Strong work Daniel Wesley. https://t.co/SfRMYhYCzY

— MONOC EMS (@MONOCEMS) November 29, 2016

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Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons

We aim to study surgical technique and analyze the related factors affecting tumor total removal and postoperative endocrinological remission for endoscopic endonasal pituitary adenomas surgery.

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