• Archives of Plastic Surgery
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• v.41 no.6
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• pp.753-758
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• 2014

Background Extramammary Paget's disease (EMPD) is an intraepithelial carcinoma usually occurring on the skin or mucosa of the perineum. Clinically, it resembles eczema or dermatitis, and misdiagnosis and treatment delays are common. The treatment of choice for EMPD is a wide excision with adequate margins. Wide excision with intraoperative frozen biopsy and Mohs micrographic surgery are common methods; however, these are associated with a high recurrence rate and long operation time, respectively. Methods Between January 2010 and June 2013, 21 patients diagnosed with EMPD underwent mapping biopsy. Biopsy specimens were collected from at least 10 areas, 2 cm from the tumor margin. When the specimens were positive for malignancy, additional mapping biopsy was performed around the biopsy site of the positive result, and continued until no cancer cells were found. Based on the results, excision margins and reconstruction plans were established preoperatively. Results The patients (18 male, 3 female) had a mean age of 66.5 years (range, 50-82 years). Almost all cases involved in the perineal area, except one case of axillary involvement. Permanent biopsy revealed one case (4.8%) of positive cancer cells on the resection margin, in which additional mapping biopsy and re-operation was performed. At the latest follow-up (mean, 27.4 months; range, 12-53 months), recurrence had not occurred. Conclusions Preoperative mapping biopsy enables accurate resection margins and a preoperative reconstructing plan. Additionally, it reduces the operation time and risk of recurrence. Accordingly, it represents an effective alternative to Mohs micrographic surgery and wide excision with intraoperative frozen biopsy.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.377-383
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• 2023

Background Squamous cell carcinoma (SCC) is the most common malignancy on the lower lip. Surgical excision, the standard treatment for SCC, requires full-thickness excision. However, no consensus exists about the appropriate surgical margin. Therefore, we investigated the appropriate surgical margin and excision technique by analyzing 23 years of surgical experience with lower-lip SCC. Methods We reviewed 44 patients with lower-lip SCC who underwent surgery from November 1997 to October 2020. Frozen biopsy was performed with an appropriate margin on the left and right sides of the lesion, and the margin below the lesion was the skin above the sulcus boundary. If the frozen biopsy result was positive, an additional session was performed to secure a negative margin. Full-thickness excision was performed until the final negative margin. In each patient, the total number of sessions performed, final surgical margin, and recurrence were analyzed. Results Forty-one cases ended in the first session, 2 ended in the second session, and 1 ended in the third session. The final surgical margins (left and right; n = 88) were 5 mm (66%), 7 mm (9%), 8 mm (2.3%), 10 mm (20.4%), and 15 mm (2.3%). During an average follow-up of 67.4 months (range, 12-227 months), recurrence occurred in one patient. Conclusion The final surgical margin was 5 mm in 66% (58/88) of the cases, and 97.7% (86/88) were within 10 mm. Therefore, we set the first frozen biopsy margin to 5 mm, and we suggest that a 5-mm additional excision is appropriate when frozen biopsy results are positive.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.10
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• pp.4989-4992
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• 2012

Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. Methods: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Results: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was $71.5cm^3$. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.5
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• pp.1715-1718
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• 2015

Background: Magnetic resonance imaging of breast, reported to be a high sensitivity of 94% to 100%, is the most sensitive method for detection of breast cancer. The purpose of this study was to investigate our clinical experience in MRI-guided breast lesion wire localization in Chinese women. Materials and Methods: A total of 44 patients with 46 lesions undergoing MRI-guided breast lesion localization were prospectively entered into this study between November 2013 and September 2014. Samples were collected using a 1.5-T magnet with a special MR biopsy positioning frame device. We evaluated clinical lesion characteristics on pre-biopsy MRI, pathologic results, and dynamic curve type baseline analysis. Results: Of the total of 46 wire localization excision biopsied lesions carried out in 44 female patients, pathology revealed fourteen malignancies (14/46, 30.4%) and thirty-two benign lesions (32/46, 69.6%). All lesions were successfully localized followed by excision biopsy and assessed for morphologic features highly suggestive of malignancy according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category of MRI (C4a=18, C4b=17, C4c=8,C5=3). Of 46 lesions, 37 were masses and 9 were non-mass enhancement lesions. Thirty-two lesions showed a continuous kinetics curve, 11 were plateau and 3 were washout. Conclusions: Our study showed success in MRI-guided breast lesion wire localization with a satisfactory cancer diagnosis rate of 30.4%. MRI-guided wire localization breast lesion open biopsy is a safe and effective tool for the workup of suspicious lesions seen on breast MRI alone without major complications. This may contribute to increasing the diagnosis rate of early breast cancer and improve the prognosis in Chinese women.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.2
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• pp.349-353
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• 2007

Mucocele is a clinical term of the localized superficial mucosal swelling caused by salivary retention after the obstruction or the rupture of minor salivary ducts. Various treatment methods have been suggested to lower its recurrence rate, including complete excision of lesion Biopsy punch can be used easily and simply for complete excision of mucocele. It has several advantages, such as convenience in use, low bleeding tendency, and nearly no requirements for post-operative management. In this case, biopsy punch was used for the removal of mucocele in an uncooperative child, which enable fast, simple and safe procedure, with a good result.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.285-288
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• 2010

Purpose: Dermatofibrosarcoma protuberans is a rare tumor, accounting for 0.1% of all malignant tumors. Although metastasis is very uncommon, local recurrence occur frequently. Dermatofibrosarcoma protuberans occurring in children is even more rare; this is the first case report of congenital dermatofibrosarcoma protuberans in Korea. Methods: The patient is a 14-month-old male infant with a lesion that was first thought to be a birthmark. The lesion grew larger, and a punch biopsy revealed dermatofibrosarcoma protuberans. A wide local excision was performed with a 2 cm peripheral resection margin beyond the gross tumor lesion. Deep fascia and a portion of muscle underneath the central part of the lesion were also taken. The surgical defect was covered by a split-thickness skin graft. Results: There has been no clinical sign of recurrence over one year after the surgery. Conclusion: A patient with congenital dermatofibrosarcoma protuberans detected at an early stage underwent a wide local excision of the tumor after accurate diagnosis was carried out by biopsy and immunohistochemical studies. There was no clinical evidence of tumor recurrence during over a 1-year follow-up.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8917-8921
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• 2014

Objective: To observe and compare the effects of multi-patch biopsy under conventional white light imaging endoscopy (C-WLI) and precise targeted biopsy under magnifying narrow-band imaging endoscopy (M-NBI) on the endoscopic submucosal dissection (ESD) of early gastric cancers and intraepithelial neoplasias. Methods: According to the way of selecting biopsy specimens, patients were divided into C-WLI and M-NBI groups, 20 cases. The ESD operations of the 2 groups were compared quantitively. Results: The mean frequency of biopsy in M-NBI group was ($1.00{\pm}0.00$), obviously lower than in the C-WLI group ($4.78{\pm}1.02$) (P<0.01).The average total number of selected biopsy specimens was also fewer ($1.45{\pm}0.12$ and $7.82{\pm}2.22$, respectively, P<0.01). There was no significant difference in the time of determining excision extension, marking time and the time of specimen excision of 2 groups during the ESD (P>0.05), whereas submucosal injection time, mucosal dissection time, stopping bleeding time, wound processing time in the M-NBI group were significantly shorter than in the C-WLI group (P<0.01). Conclusion: Precise targeted biopsy under M-NBI can obviously shorten the time of ESD operation, with small quantity of tissues but high pathological positive rate.

• Archives of Craniofacial Surgery
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• v.24 no.5
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• pp.236-239
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• 2023

Porocarcinoma (PC) and basal cell carcinoma (BCC) are distinct skin cancers. Few studies have documented the occurrence of two concurrent types of skin cancers, and to the best of our knowledge, this represents the inaugural report of such a coexisting lesion arising from a capillary malformation. Herein, we report a case of concurrent PC and BCC presenting with capillary malformation. A 93-year-old woman visited our hospital with a protruding mass in her right nasal ala that appeared as a capillary malformation. A biopsy was performed on the skin lesion, and BCC was diagnosed. A wide excision was performed. Permanent biopsy revealed that the skin lesion was a PC with basal cells and squamous differentiation. The safety margin of the deep tissue margin was < 0.1 cm; however, considering the advanced age of the patient, further excision was deemed to not possess any benefits. This case illustrates the importance of recognizing the possibility of multiple skin cancers, even in patients with benign lesions such as capillary malformations. The rarity of this presentation highlights the importance of thorough investigation and histopathological examination of skin lesions in guiding appropriate surgical excision.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.629-633
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• 1998

Implantation of malignant cells along the needle aspiration tract is an extremely rare potential complication following a percutaneous fine needle aspiration biopsy of a lung carcinoma. The dissemination of malignant cells by a needle aspiration biopsy may convert an operable and potentially curable lesion into a fatal disease. We report two cases of chest wall implantation of carcinoma of the lung after a thin needle aspiration biopsy. A fifty-five year old male was successfully treated by a radical full-thickness excision of the chest wall and immediate reconstruction with the latissimus dorsi musculocutaneous island flap. A sixty-eight year old female was treated with a partial-thickness excision of the chest wall and skin graft due to superimposed infection and ulceration of the metastatic chest wall carcinoma. One case lived for 31 months up to November 1994, and the other's condtion has been uneventful for 3 months up to now.

• Korean Journal of Radiology
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• v.21 no.11
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• pp.1220-1229
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• 2020

Objective: Stereotactic vacuum-assisted breast biopsy (VABB) is considered a reliable alternative to surgical biopsy for suspicious calcifications. In most cases, the management of flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) after VABB with residual calcifications requires surgical excision. This study aimed to evaluate the impact of pathology of non-calcified specimens on the underestimation of malignancy. Materials and Methods: We retrospectively reviewed 1147 consecutive cases of stereotactic VABB of suspicious calcifications without mass from January 2010 to December 2016 and identified 46 (4.0%) FEA and 52 (4.5%) ADH cases that were surgically excised for the retrieval of residual calcifications. Mammographic features and pathology of the calcified and non-calcified specimens were reviewed. Results: Seventeen specimens (17.3%) were upgraded to malignancy. Mammographic features associated with the underestimation of malignancy were calcification extent (> 34.5 mm: odds ratio = 6.059, p = 0.026). According to the pathology of calcified versus non-calcified specimens, four risk groups were identified: Group A (ADH vs. high-risk lesions), Group B (ADH vs. non-high-risk lesions), Group C (FEA vs. high-risk lesions), and Group D (FEA vs. non-high-risk lesions). The lowest underestimation rate was observed in Group D (Group A vs. Group B vs. Group C vs. Group D: 35.0% vs. 20.0% vs. 15.0% vs. 3.6%, p = 0.041, respectively). Conclusion: Considering that the calcification extent and pathology of non-calcified specimens may be beneficial in determining the likelihood of malignancy underestimation, excision after FEA or ADH diagnosis by VABB is required, except for the diagnoses of FEA coexisting without atypia lesions in non-calcified specimens.