Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma?

Hoefkens, Mirjam F.; Fabre, J; Küsters‐Vandevelde, Heidi V.N.

doi:10.1097/sap.0b013e31826524df

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…reported improved excision margins of a subgroup of BCCs with predetermined 4 mm margins—notably there was no significant difference of incomplete excisions 14 . Similar findings are found in the plastic surgery literature 15 . However, recent meta‐analysis determined that intraoperative use of loupes did not result in differences in incomplete excision rates for keratinocyte cancers compared to surgery without loupes (OR 1.6 [95% CI: 0·3–7·4], p = 0·537) 16 .…”

Section: Discussionsupporting

confidence: 60%

“… 14 Similar findings are found in the plastic surgery literature. 15 However, recent meta‐analysis determined that intraoperative use of loupes did not result in differences in incomplete excision rates for keratinocyte cancers compared to surgery without loupes (OR 1.6 [95% CI: 0·3–7·4], p = 0·537). 16 Moreover, there is minimal literature regarding scar cosmesis and loupe‐use; a recent small experimental in vivo study in rats which were randomized to have linear incisions repaired with subcuticular sutures under nil, 2.5× loupe, and microscopic magnification (assessments at 1,3, and 6 weeks), demonstrated no significant differences in dual observer‐blinded rated Vancouver scar scale ratings.…”

Section: Discussionmentioning

confidence: 98%

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A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery

Hunt

Ashraf²,

Nelson

2022

Skin Research and Technology

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Background:The use of surgical loupes has not been well-documented in dermatological surgery.Objectives: An online questionnaire was developed to characterize the use of loupes in dermatological surgery. Methods:The questionnaire was circulated to the memberships of the British Society of Dermatological Surgery, the European Society of Micrographic Surgery, and the Australasian College of Dermatologists. Responses were analyzed with a mixed methods approach using quantitative data analysis and inductive content analysis.Results: One-hundred twenty-five valid responses were received from 20 nations.Most respondents were from England (40%; 50/125), Australia (16%; 20/125), and the Netherlands (14.4%; 18/125). Overall, 71.2% (89/125) of respondents were consultants/Facharzt/attending. Furthermore, 55.2% (69/125) of respondents were Mohs surgeons. In dermatological surgery 38.4% (48/125) of respondents used surgical loupes routinely. The mode magnification level for loupes was 2.5× (67.5%; 27/40), with 3× second place (12.5%; 5/40). Exactly half (20/40) used through-the-lens style loupes and 40% (16/40) used flip-up-loupes. Inductive content analysis of the 51 freetext responses from nonloupe users uncovered several deterring factor themes, including expense (18/51), can manage without/don't need (14/51), and narrow field of view a(11/51), and uncomfortable/too heavy (9/51).Conclusions: This is the first time the use of surgical loupes in dermatological surgery has been internationally characterized.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 98%

A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery

Hunt

Ashraf²,

Nelson

2022

Skin Research and Technology

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“…A total of 106 832 BCC and 21 569 SCC excisions were included. These were excised from 53 796 patients across all studies (25 studies did not report the number of patients, instead reporting the number of lesions only) 16,17,34,49,59,60,62,68,69,71‐74,78,81,95,103,106,108,111,114,119,131,133,134 . The mean (± SD) age of patients undergoing BCC excision was 67·4 (± 14·9 years) and for SCC excision was 70·9 (± 14·1 years).…”

Section: Resultsmentioning

confidence: 99%

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

et al. 2020

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Summary Background Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta‐analysis of primary clinical studies. Methods A PRISMA‐compliant systematic review and meta‐analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000–27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random‐effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta‐analysis and meta‐regression, which were presented as risk ratios (RRs). Results Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7–12·4] and for SCC 9·4% (95% CI 7·6–11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0–7·3) and SCCs (RR 4·8, 95% CI 1·0–22·8). Studies were heterogeneous (I2 = 98%) and at high risk of bias. Conclusions The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.

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Peripheral histological clearance of cutaneous BCC and SCC excised using the wet blotting technique

2018

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Does Loupe Magnification Reduce the Gap Between the Macroscopic and Microscopic Border of a Basal Cell Carcinoma?

Cited by 4 publications

References 25 publications

A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery

A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

Peripheral histological clearance of cutaneous BCC and SCC excised using the wet blotting technique

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