Search

Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive.The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia.Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020.In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1-102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old-old group (≥75-84 years) included 491 patients and the oldest-old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow-up period was 4.9 days (range 1-28 days). 92.0% (719/782) suffered from pre-existing comorbidities. Systemic complications occurred in 10.2% (80/782; old-olds: 8.6%, oldest-olds: 13.1%). Hypertensive crisis (180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life-threatening complications directly related to tumescent local anaesthesia were found.Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre-existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high-tumescent concentrations or volume quantities.

Zusammenfassung Hintergrund Im Kindesalter ist die Indikationsstellung zur operativen Therapie und histologischen Diagnostik bei melanozytären Nävi eine große Herausforderung im klinischen Alltag. In der Beratung der Kinder und Eltern nimmt auf der einen Seite der Ausschluss von malignen Befunden, auf der anderen Seite das Risiko für Komplikationen die größte Rolle ein. Patienten und Methodik Es wurden 946 Kinder unter 10 Jahren eingeschlossen, die mit der Verdachtsdiagnose eines Melanozytennävus an der Universitätshautklinik Tübingen zwischen 2008 und 2018 operiert wurden. Erfasst wurden der dermatohistopathologische Befund sowie postoperative Komplikationen. Ergebnisse Die klinische Diagnose eines melanozytären Nävus wurde in 93,2 % (882/946) der Fälle histologisch bestätigt. Darunter fanden sich 41 Spitz-Nävi und 18 pigmentierte Spindelzelltumoren. Bei 2 Kindern (0,2 %) aus dem Kollektiv wurde die Diagnose eines Melanoms gestellt. Bei weiteren 6,6 % fanden sich nichtmelanozytäre Befunde (u. a. Naevus sebaceus, epidermale Nävi). Die Komplikationsrate war mit 3 % gering. Die häufigste Komplikation war in 1,7 % das Auftreten eines postoperativen Wundinfektes. Schlussfolgerung Es ist auch im Kleinkindesalter möglich, kongenitale Nävi unterschiedlicher Größe zu biopsieren oder operativ zu entfernen. Ein wichtiges Instrument hierfür ist die serielle Exzision kongenitaler Nävi. Im untersuchten Kollektiv zeigte sich eine geringe Komplikationsrate. Eine histologische Sicherung ist bei klinisch suspekten oder untypischen Befunden unabdingbar.

Background and Objectives After local flaps, it may be necessary to reconstruct the contour of the nasal ala. This is possible with a single-stage all-layer shaping suture. In the present study, the functional and aesthetic results after single-stage reconstruction of the nasal ala were prospectively evaluated. Patients and methods Patients who underwent surgery for skin tumors of the nose between 06/2019 and 06/2020 who required reconstruction of the nasal ala as part of the defect closure and had an all-layer suture used were prospectively included in the study. A standardized evaluation of aesthetic and functional outcome was conducted by the patient and a physician at discharge as well as 4 weeks later. Patients additionally underwent a follow-up survey 6 months later. Results Thirty-seven patients were included in the study. Four weeks postoperatively, all flaps were found to be fully healed and vital. Aesthetic outcome at 4 weeks was rated as very good or good by physicians in 73% and by patients in 78.4%. Persistent complications due to reduced blood flow were not observed. Conclusion The reshaping of the nasal ala as part of the defect reconstruction with an all-layer suture demonstrates very good aesthetic as well as functional results and can be performed in a single-stage procedure.

BACKGROUND: Although inflammation and thrombosis are tightly connected, only 45% of patients with lower leg cellulitis receive anticoagulant therapy. Available data about the prevalence of concomitant deep venous thrombosis (DVT) in patients with cellulitis of the lower extremity is scarce and general guidelines regarding diagnosis and prevention of venous thromboembolism are missing. OBJECTIVE: We sought to determine how frequently DVT occurs as an incidental finding in patients with cellulitis and to provide recommendations for diagnostics and anticoagulant therapy. METHODS: Patients’ records were analysed and 192 consecutive patients with cellulitis were included in this study. The prevalence of concomitant DVT was examined by duplex ultrasound, as well as comorbidities and risk factors. RESULTS: We detected thrombosis in 12.0% of the patients with lower leg cellulitis, of which 43.5% were located in a proximal vein and 52.2% in the veins of the calf. CONCLUSIONS: Our results clearly indicate that cellulitis is not only a differential diagnosis, but should be considered a risk factor for venous thrombosis. Therefore, prophylactic anticoagulation should be considered in patients suffering from cellulitis and a systematic screening for venous thrombosis in patients with cellulitis should be performed.

We present a brief report of an 81-year-old man with a pretreated leiomyosarcoma of the skull. Histologically the diagnosis of a dedifferentiated cutaneous leiomyosarcoma with an infiltration of the skull was confirmed. In an interdisciplinary approach together with the University Clinic for Neurosurgery, complete removal of the tumour was performed. Cutaneous leiomyosarcoma are rare tumors of the skin and typically present as slowly growing erythematosus nodes. Because of the risk of metastatic spread, complete micrographically confirmed resection is necessary.Wir berichten über einen 81-jährigen Patienten mit bereits mehrfach voroperiertem Tumor der Kopfhaut. In der histologischen erneuten Aufarbeitung ließ sich ein dedifferenziertes Leiomyosarkom nachweisen, das bereits die Schädeldecke infiltriert hatte. In einem interdisziplinären Ansatz mit den Kollegen der Klinik für Neurochirurgie konnte eine Komplettexzision erreicht werden. Kutane Leiomyosarkome sind seltene Tumoren der Haut, die typischerweise als langsam wachsende, erythematöse Knoten imponieren. Aufgrund des Metastasierungspotenzials ist eine komplette, schnittrandkontrollierte Resektion erforderlich.

Background Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. Patients and methods We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. Results 32 % of the patients reported post-operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA. Conclusions SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.

The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found.The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification.We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and HE staining. Re-excisions were performed until the tumor was completely removed.Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease.Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.

Cutaneous squamous cell carcinoma (cSCC) is a common tumor of elderly Caucasian patients.Competing multivariable risk models to analyze different types of cSCC associated death (local infiltration [LI], locoregional [LR], and distant metastases [DM]) in terms of prognostic factors.1400 patients were analyzed. In the adjusted multivariable subdistribution hazard approach for tumor volume, the best model for death of cSCC overall revealed the presence of desmoplasia (HR 4.52; p lt; 0.001), bone invasion (HR 10.06; p lt; 0.01), and immunosuppression (HR 3.19; p = 0.003) as significant factors. Death due to LI indicated desmoplasia (HR 15.39; p lt; 0.01) and bone invasion (HR 16.9; p lt; 0.001) as significant factors. For death by LM, immunosuppression with a HR of 3.27; p = 0.004 was the only significant prognostic factors as well as in death by DM with a HR of 4.54; p = 0.02.The three types of death caused by cSCC can be distinguished based on risk factors with different weights. Patients with these factors should be monitored closely.

Perusal of the literature of cutaneous squamous cell carcinoma (SCC) reveals that the role of the desmoplastic subtype is indistinct. Data on local infiltration and recurrence are inconsistent dependent on surgical technique, histological method, and investigated collective.The aim of the study was to analyze local infiltration and locoregional recurrence of the desmoplastic subtype under a uniform procedure.Between 2005 and 2015, 320 SCCs were analyzed and histological sections of all tumors were examined. Data collection included locoregional recurrence, metastasis rate, and tumor-specific death. The median follow-up was 36.5 months.The desmoplastic subtype required significant more re-excisions (70.0% vs 23.9%, p.001), more interventions until tumor-free margins were achieved (maximal 6 vs 2; p.001), showed more widespread tumor infiltration with larger excisional margins (median 9 mm, 2-51 mm vs median 4 mm, 1-10 mm; p.001), and a 5-fold higher local recurrence rate (26.7% vs 5.0%, p.001). The metastasis rate (16.6% vs 2.3%, p.001) was increased.The desmoplastic subtype is characterized by a widespread local infiltration associated with perineural infiltration. It seems to be a marker for decreased histological detectability with a high rate of locoregional recurrence and metastasis.

Hintergrund Basalzellkarzinome sind die häufigsten epithelialen Hauttumoren und eine häufige Indikation für dermatologische Eingriffe. Trotz der Etablierung medikamentöser Therapieoptionen stellt die Operation weiterhin die Therapie der Wahl dar. Hierbei stehen verschiedene Möglichkeiten zur Verfügung, die von der Kürettage bis hin zu komplexen dermatochirurgischen Eingriffen reichen. Neben dem Hauptaspekt der geringen lokalen Rezidivraten sind auch ästhetische Faktoren und die Anzahl der Eingriffe für die Wahl der Therapie wichtig. Methoden In dieser Studie wurden 347 Patienten mit 398 Basalzellkarzinomen (nodulärer Typ, Durchmesser bis 10 mm) prospektiv untersucht. Die Patienten wurden randomisiert in 2 Behandlungsarme eingeteilt: In einer Gruppe wurden die Tumoren kürettiert, in der anderen Gruppe exzidiert. Als Kontrolle dienten Patienten, die im gleichen Untersuchungszeitraum 3‑D-histologisch kontrolliert operiert wurden. Ergebnisse Die höchste lokale Rezidivrate wurde nach der Kürettage (14,0 %) beobachtet, während die Gruppe mit 3‑D-Histologie die niedrigste Rezidivrate (0,9 %; p

Background For basal cell carcinoma (BCC), only few controlled data have been published so far, which directly compare micrographically controlled surgery with conventional serial section histology. In addition to Mohs surgery, which uses cryostat sections, also three-dimensional histology (3D-histology), based on paraffin sections, is available to ensure complete control of the margins and basic sections. Objectives To investigate the rate of local recurrence (LR) as well as the number of required re-excisions for basal cell carcinomas with serial section histology vs. 3D-histology. Methods We compared serial sections histology with 3D-histology in a prospective, randomized, controlled blinded trial and analysed 569 BCC of all subtypes up to 30 mm diameter, 287 BCC in the 3D group and 282 BCC in the serial section group. Excisions were performed with adapted primary resection margin according to location and size of the tumour. Surgeons were blinded at the time of surgery as they did not know which histological method will be used. Both methods used paraffin sections. Results Both groups did not differ regarding patients age, tumour location, tumour diameter, tumour subtypes or primary resection margins. In the serial section group, re-excisions were required in 21%; 24 tumours (8.4%) recurred after a median of 2.2 years. In the 3D-histology group, re-excisions were required in 39%; 10 tumours recurred (3.5%) after a median of 2.8 years. The recurrence rates differed significantly between both groups. Mean follow-up was 4.5 years. Conclusions 3D-histology is a useful technique to detect tumour outgrowths at the excision margins, but required a high rate of re-excisions. 3D-histology was associated with a significantly lower LR rate than serial section histology.

Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long-lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia-associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long-lasting pain control.

Epinephrine supplements in local anesthetics are regularly used for surgery in areas with terminal vessels. According to the pharmaceutical guidelines, the use of epinephrine as an additive to local anesthetics is contraindicated for these areas. This review provides an overview of the current scientific data as well as new clinical developments in various fields. It also reviews the current legal situation. A literature research was carried out to survey the current status of relevant data. Written inquiries to several German institutions (Institute for Quality and Efficiency in Health Care, National Association of Statutory Health Insurance Physicians, Center for Clinical Studies Tubingen, Federal Institute for Drugs and Medical Devices) were made to determine the legal situation. No evidence was found in the literature for a causal relationship between the use of epinephrine as a vasoconstrictor and necrosis of the finger or penis. Studies and reviews show that the use of local anesthetics with epinephrine on the fingers or penis is a safe procedure with many clinical and economic advantages. In routine clinical practice, the WALANT method (Wide Awake Local Anesthesia No Tourniquet) as well as the increasing incidence of skin tumors in acral areas has led to a tendency towards increasing use. However, its use is still legally contraindicated, and the pharmaceutical companies show no interest in supporting a drug study. Further clinical trials - regardless of the strength of the evidence - would not change the current legal contraindication.

Electrical impedance spectroscopy is a non-invasive technique that can help clinicians in diagnosing malignant skin tumours. Depending on the cellular irregularity of the lesion, electrical impedance spectroscopy can reveal changes in the structure and form of the cells, using a harmless electrical current applied to the skin. A score between 0 and 10 is generated by the electrical impedance spectrometer, where 0 is considered benign and 10 is malignant. This prospective study was conducted in 101 patients with a total of 200 skin lesions; 62 benign and 138 malignant. There was a significant difference between the electrical impedance of malignant and benign lesions (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of electrical impedance spectroscopy for non-melanoma skin cancer were 94.2%, 41.9%, 78.3% and 76.5%, respectively, when the cut-off for the electrical impedance spectroscopy score was set between 5 and 6. The area under the curve in receiver operating characteristics analyses was 0.758., NA

Hintergrund Nach Tumoroperationen erfolgt ein Defektverschluss mit den fur den individuellen Fall optimalen chirurgischen Methoden. Besonders im Kopf-Hals--Bereich ist das Ergebnis sehr wichtig. Ziel der retrospektiven Studie war es, Rekonstruktionsmethoden von Defekten entsprechend Alter, Lokalisation und Grose nach funktionellen und asthetischen Gesichtspunkten zu vergleichen. Patienten und methodik Die betroffenen Patienten wurden mittels Fragebogen angeschrieben. 1827 Patienten (Alter von 18 bis 92 Jahren, Median: 56 Jahre) beurteilten postoperative Probleme, asthetisches sowie funktionelles Ergebnis und das Gesamtresultat. Aus der Patientenakte wurden Grose und Lokalisation des Defektes sowie die Art des Verschlusses dokumentiert. Ergebnisse Die Dehnungslappenplastik erhielt bezuglich des Gesamtresultats mit einer sehr guten oder guten Bewertung (86 %) das beste Ergebnis. Lappenplastiken und Hauttransplantate wurden schlechter beurteilt. Postoperative Beschwerden traten signifikant haufiger nach lokalen Lappenplastiken auf. Die Sichtbarkeit der Narbe wurde von alteren Patienten bei allen Defektgrosen ( 300 mm2 ) geringer beurteilt als von jungeren. Narben in der zentralen Gesichtspartie wurden als sichtbarer wahrgenommen. Geschlecht und Rauchen hatten keinen Einfluss. Schlussfolgerungen Narben in zentralen Gesichtsregionen werden starker wahrgenommen. Altere Patienten beurteilten die Narbenbildung insgesamt als unauffalliger. Dehnungslappenplastiken, auch unter Wundrandspannung, fuhren zu sehr guten Ergebnissen und einer hohen Patientenzufriedenheit.

Background Defect coverage following tumor excision requires a case-by-case decision as regards the optimal reconstruction technique. In the head and neck region in particular, the cosmetic outcome is of major importance. The objective of the present study was to compare various reconstruction methods in terms of their functional and aesthetic outcome based on patient age, defect size and site. Patients and methods Overall, 1,827 patients (age: 18-92 years, median age: 56 years) were contacted. Using a standardized questionnaire, they were asked to assess postoperative complications, cosmetic and functional outcome, and the overall result of the surgical procedure. In addition, patient records were used to collect data on defect size and site as well as the type of surgical procedure employed. Results Rated as very good or good (86 %), defect closure by advancement flaps received the highest scores in terms of overall result. Other flaps and skin grafts were rated less favorably. Postoperative complications were significantly more common after local flaps. Irrespective of defect size ( 300 mm2 ), older patients considered the visibility of the scar to be less prominent than younger individuals. Scars in the central facial region were perceived to be more visible. Gender and smoking habits had no impact on the results of the survey. Conclusions Scars in the central facial region were perceived to be more prominent. Overall, older individuals considered their scars to be less conspicuous. Even though they are initially associated with greater tension, advancement flaps resulted in very good aesthetic and functional results and a high level of patient satisfaction.

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with increasing incidence. Severe disease stages are seen as a therapeutic challenge and pose the threat of significant restrictions on patients' life quality. Objectives We evaluated postoperative outcome after wide local excision for HS as well as postoperative course, cosmetic results, disease recurrence and quality of life. Methods All patients receiving radical surgical treatment for HS (Hurley III) between 2006 and 2015 were identified and received a letter-based survey. They were asked about postoperative course, cosmetic results, recurrence and life quality. Results Two hundred and fifty-five patients (103 men, 152 women) answered the questionnaire. Ninety-five percentage of patients reported disease-specific restrictions on everyday life. Seventy-five percentage of patients did not experience any postoperative adverse events; however, postoperative pain with need for analgesics was reported in 38%. The majority of patients (80%) were very satisfied or satisfied after surgery, and 85% of patients would recommend surgery to other affected persons. Limitations The retrospective design of the study was a limitation. Conclusions The well-known negative psychological and social effects are a relevant part of HS and emphasize the importance of immediate therapy. As long-lasting local disease-control can be achieved, surgery should be considered as first-line therapy.

Background Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin-elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia many other local anaesthetics do not bare any major risks for infants. Objective In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia (TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey. Methods 92 infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%). Results Infants were mainly operated for removal of a melanocytic nevus (n=54), followed by haemangioma (n=23), nevus sebaceous (n=6) and other lesions (n=9). The lesions were located on the scalp or neck (n=31), on the extremities (n=31), on the trunk (n=21), in the face (n=6) or on the buttocks (n=3). The median size of excision was 509mm2 (range: 16mm2; 3600mm2). Primary defect closure was performed by intracutaneous (n=68) or extracutaneous (n=24) suture techniques. No side effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%). Conclusions The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side effects and the benefit of prolonged postoperative analgesia. This article is protected by copyright. All rights reserved.

Rhinophyma is a deforming soft tissue hyperplasia of the nose and surgical removal represents the treatment of choice. Comprehensive data on surgical therapy and the impact of rhinophyma on patient quality of life are lacking. Patients who received surgery for rhinophyma between 2006 and 2015 were retrospectively evaluated for postoperative complications, clinical outcome, recurrence of rhinophyma, and the impact of rhinophyma on daily life. A total of 143 patients were treated with superficial tumour decortication by scalpel under tumescent anaesthesia. Outcomes were determined by clinical review, clinical files, and a patient questionnaire. Of 143 patients, 70 answered the questionnaire and were included in this study with a mean follow-up time of 54 months. Cosmetic results were evaluated as very good or good in 77% of patients. The majority of patients (87%) were very satisfied or satisfied with the postoperative result. Surgical treatment of rhinophyma improved patients' quality of life in 67% of patients. Recurrence of rhinophyma was detected in 38% of patients. Surgery is an effective therapy for rhinophyma with excellent outcome.

Perineural infiltration (PNI) and desmoplasia are believed to be high-risk factors in the prognosis of squamous cell carcinoma (SCC). In the literature, dependences between PNI, de-differentiation, and desmoplasia remain unclear. The aim of this study was to analyze the respective prognostic impact of these factors in regard to local recurrence and metastasis. Between 2005 and 2015, 1,399 unselected primary SCCs of 1,434 patients were diagnosed. If a patient had multiple tumors, the tumor with the highest risk profile was selected. Histological sections of all tumors with a tumor thickness of ≥6 mm and desmoplastic SCC with a tumor thickness of 2.1–5.9 mm were re-examined for PNI. Median follow-up was 36.5 months. PNI was present exclusively within tumors of the desmoplastic type (14.5%). PNI was present significantly more often in patients developing lymph node metastasis (3% all non–desmoplastic SCC, 17% desmoplastic SCC, and 29% desmoplastic SCC with PNI) and local recurrence (3%, 26%, and 64%) and associated with overall tumor-specific death (4%, 25%, and 54%). Using a multivariate model of disease recurrence, tumor thickness ≥6 mm, tumor horizontal size ≥20 mm, immunosuppression, desmoplasia, and PNI remained significant factors. In conclusion, PNI was found to be an additional marker indicative of an unfavorable prognosis and an independent high-risk factor within the desmoplastic type of SCC.

Removal of the deep fascia is recommended in therapy for dermatofibrosarcoma protuberans, but its necessity in the context of micrographic surgery is unclear. A retrospective clinicopathological analysis of 48 patients with dermatofibrosarcoma protuberans treated by micrographic surgery was performed, to determine in which tumours fascia preservation was feasible and safe. Histologically, 93% of tumours on the trunk and extremities and 14% of tumours in the head and neck region were fully located above the fascia. Localization on the head and neck was the only significant risk factor for tumour extension beyond the subcutis (p

Desmoplastic squamous cell carcinoma (DSCC) as a rare subtype of cutaneous SCC has specific histological features, characterized by columns, bands, and strands of squamoid cells infiltrating a dense collagenous stroma. To decrease the high rates of local recurrence in DSSC, improvement of diagnostic methods is highly demanded. Objective was to evaluate whether immunohistochemistry (IHC) is suited to increase diagnostic accuracy. A total number of 18 patients were included in this study. After recutting of the original paraffin blocks, parallel staining of serial sections with conventionally H&E and cytokeratin AE1/AE3-immunohistochemical staining was performed. Results were evaluated by an experienced dermatohistopathologist. In 55.6% (n = 10), the margins of 3D-histology still showed no evidence of neoplastic lesions in both stainings. In contrast, we found neoplastic lesions in 5 of 18 cases (27.8%) with cytokeratin AE1/AE3 staining, while H&E-staining remained negative. In addition, neoplastic lesions were found in both, H&E as well as cytokeratin AE1/AE3 staining in three cases (16.7%). The data presented show improvement of diagnosis in 27.8% of cases using IHC and 3D-histology. This method is suitable to improve the diagnosis of DSCC.