CIRUGÍA MICROGRÁFICA DE MOHS TRATAMIENTO DE LOS TUMORES MALIGNOS CUTÁNEOS DE ALTA AGRESIVIDAD Y COMPLEJIDAD.
Palabras clave:
Cirugía de Mohs, cáncer de piel, resección tumoral, histopatología, Mohs surgery, skin cancer, tumor resection, histopathologyResumen
La cirugía micrográfica de Mohs es el tratamiento quirúrgico con más altas tasas de curación de los tumores malignos cutáneos agresivos localmente invasivos, minimizando el sacrificio innecesario de tejidos peritumorales sanos. Los márgenes oncológicos son determinados en etapas sucesivas, los tejidos son evaluados en cortes histológicos horizontales en tres dimensiones, identificando con precisión la localización de la persistencia oncológica y subsecuente escisión hasta la inexistencia del tumor respetando los tejidos sanos que no son removidos. La conclusión diagnóstica de la evaluación de las neoplasias cutáneas, se deriva del laudo histopatológico el cual debe conducir en la elección de la mejor opción terapéutica. El tratamiento del cáncer cutáneo es realizado con métodos quirúrgicos o médicos, bien sea por la destrucción a ciegas o por la evaluación histológica de los márgenes oncológicos que determinan una porción de los límites del tumor. Las neoplasias malignas cutáneas que no han recibido tratamiento o las recurrentes consideraciones de alto riesgo por presentar características clínicas y/o histológicas agresivas, deben recibir la mejor opción terapéutica. Actualmente la cirugía micrográfica de Mohs ofrece la mejor curabilidad de los pacientes con tumores cutáneos, con un menor sacrificio de los tejidos perilesionales sanos, resultando en pequeños defectos quirúrgicos comparados con las consecuentes de resecciones quirúrgicas convencionales, repercutiendo en la complejidad de la reconstrucción. Las altas posibilidades de curación y los menores defectos quirúrgicos resultantes de la cirugía micrográfica de Mohs, crea un impacto costo-efectivo en la reducción de procedimientos quirúrgicos repetidos.
MOHS SURGERY IN TREATING AGGRESSIVE SKIN CANCERS
ABSTRACT
Final diagnosis in assessing skin cancers derives from histopathology, then choosing the best treatment option. Skin cancer treatment could be surgical or medical, either by tissue blind destruction or by histological assessment of cancer margins, determining a portion of tumor boundaries. Skin malignancies that have not been treated or whenever there are recurrent high- risk considerations because of clinical and / or histological aggressive characteristics, should receive the best treatment option. Currently, Mohs micrographic surgery offers the best curability of patients with skin tumors, with less damage of healthy perilesional tissues, resulting in small surgical defects when compared with conventional surgical resections, affecting the complexity of reconstruction. Higher chances of cure and minor surgical defects resulting from Mohs micrographic surgery, creates a cost-effective impact in reducing repeated surgical procedures.
Biografía del autor/a
Michel Faizal Geagea, Academia Nacional de Medicina
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