Retalho ou enxerto?: protocolo técnico orientador desenvolvido a partir de resultados do tratamento e reconstrução de tumores não melanoma

Abstract

Introduction: Non-melanoma skin cancers (NMSC), predominantly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common skin cancers. Although they generally have lower lethality compared to melanoma, their high incidence represents a significant cost to healthcare systems. The primary risk factor is exposure to ultraviolet radiation; other factors include fair skin phenotype, genetic predisposition, age, and immunosuppression. Diagnoses are based on clinical examination, dermatoscopy, histopathology, and immunohistochemistry. The gold standard of treatment is surgical excision with safety margins. Objectives: This study compares the efficacy and safety of two surgical techniques in the treatment and reconstruction of NMSC. The results were based on descriptive and quantitative analysis, association/correlation of studied variables, histological subtypes, and reconstruction techniques. POSAS and Vancouver scales were used for study validation. The histological subtypes were crucial for the objectives of these techniques, as were their safety margins. Method: Observational study with a prospective longitudinal design, comparing two types of reconstruction to evaluate the efficacy and safety of non melanoma skin cancer treatments; 54 participants with 81 lesions were included in the study. All suspicious lesions, based on clinical and dermatoscopic evaluation, underwent biopsy, and once the diagnosis of non-melanoma skin cancer was confirmed, excision and reconstruction with skin flaps or grafts were performed. Clinical and photographic records were taken on day 0, after 15 days, and after 150 days post-surgery. Pathological anatomy confirmed the safety of the procedures by evaluating the margins and observing tumor-free margins. The Vancouver and POSAS scales were used to assess participant satisfaction. The study was approved by the institution's ethics and research committee. Results: All participants treated and reconstructed with grafts or skin flaps had diagnoses with tumor-free margins, demonstrating the safety of both procedures. Higher complication rates were observed in participants undergoing reconstruction with grafts. Scars from both procedures had an appearance close to normal skin, as evaluated by both participants and evaluators using the POSAS and Vancouver scales. Conclusions: Both types of reconstructions are safe and effective when safety parameters such as lesion size, location, and tumor histological types are respected, and can be replicated by skin tumor surgeons. Additionally, the study proved that the safety margins adopted in the resections for each type of tumor, compared to the literature, are safe and curative.