Learn more surgical medical institute Dr. Paul Umbert

Mohs surgery or CMM has no relation with the classical surgical excision or with preoperative piece extirpated, nematodes where histopathological can give false negative 5 to 10% (20). Neither is related to slow Mohs surgery, which requires several days between paraffin tissue processing and operation in case of positivity.
The patient reported previously think of different ways in the treatment of his tumor, the possible risks and complications. Are informed of which medications should refrain from taking 7 days before, in agreement with their general practitioner.
Before beginning nematodes the intervention, it is important nematodes to review the histologic biopsy dermatologist who referred them to observe the histological pattern and facilitate reading during surgery.
Remove the affected area macroscopically (debulking) with a horizontal cut surface of the affected area. The three-dimensional image of basal cell carcinoma nematodes helps to understand the character polylobulate different nematodes legs pop invades healthy tissue disorderly and anarchic.
We started the technique to two millimeters of the resected area with a scalpel with an inclination of 45 degrees including epidermis and the back of the base of the tumor in a single plan to avoid steps.
Histologic examination of the immediate base of the tumor and the entire rear area where the tumor resided in the mode Opening a book allows us to examine histologically all The area without any theoretical possibility of leaving us see an islet cell malignant.
For its realization requires a coincidence photographic map preforman with resected area where the tumor tissue removed is deposited respecting the same orientation. They mark the edges of the piece with red and black coloring. These dyes, along with over epidermal allow us to locate the microscopic level possible malignant cells.
Histologic examination of the immediate base of the tumor and the entire rear area where the tumor resided in the mode Opening a book allows us to examine histologically all The area without any theoretical possibility of leaving us see an islet cell malignant.
Cut with a thickness of 5 microns started from the back of the piece, inserted into the cryostat, less than 20 C and stained with toluidine blue, whether it is a basal cell tumor as squamous cell.
When the last stage has been negative tumor removal was achieved with a minimal sacrifice of healthy tissue and simultaneously guarantees 97% healing in primary carcinomas and 93% in recurrent already have been previously nematodes treated with other techniques.
In most cases perform reconstruction following Mohs surgery or CMM. The patient, in most times, still has numb the area, but we must add more anesthesia within safety margins because it takes a greater area of skin tissue for reconstruction.
In large recurrent carcinoma in high-risk locations, such as in the areas of the exit foramina of the cranial nerves for facial bone, a skin graft is advisable total, for the best possible arrest of a relapse. Or use pelleringues edge to edge in most cases, due to its better aesthetic result and be assured nematodes of the absence of the tumor. Tumors such as carcinomas or mutilating queratocantoma giant Centrofacial is advisable to delay reconstruction (1-2 months) to easily detect a possible recurrence.
Learn more surgical medical institute Dr. Paul Umbert
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