Mohs Micrographic Surgery in a pediatric patient with Squamous Cell Carcinoma
Clinical Case Reports
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An 11-year old boy presented with biopsy proven squamous cell carcinoma (SCC) of the left cheek. Pathology demonstrated moderate to well-differentiated SCC with positive deep and peripheral margins and no signs of definitive perineural invasion. Past medical history was significant for radiation therapy, chemotherapy, and stem cell transplant seven years prior for the treatment of a spinal embryonal tumor with multilayered rosettes with no signs of recurrence. He never had any direct radiation therapy to the site of his SCC. Mohs micrographic surgery (MMS) was ultimately selected as the treatment of choice for his SCC.
The main concern with MMS in this pediatric patient was regarding his tolerance for the long procedure with only local anesthesia. Therefore, modifications were made to decrease anxiety related to the procedure. Preoperatively, he was familiarized with the facility and the procedure room. Topical anesthetic cream was also applied one hour prior to the procedure. Perioperatively, he was provided a tablet for distraction and his mother was permitted to stay in the room for support. The patient underwent a successful two stage surgery with the final defect measuring 1.7 cm by 1.6 cm, located on the left cheek and inferior lower left eyelid. Primary linear closure was completed, and follow-up at 8 weeks showed a well-healed incisional scar without signs of recurrence.
MMS is an effective treatment for cutaneous neoplasms that display high risk features including recurrence, aggression, poorly defined margins, growth in sensitive areas, or incomplete excision. Despite its frequent use in adults, MMS has not been widely adopted for the pediatric population due to lack of surgeon training and fears of patient tolerance. Several cases have demonstrated successful MMS in appropriate pediatric patients.1,2 The techniques used to optimize pediatric outcomes in MMS are similar to those in other surgical environments including sufficient preoperative preparation, perioperative distraction, and familial support.3
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