Methods of microscopically controlled recurrence-free surgery of pigmented skin tumors in children

Abstract

The high prevalence of pigmented skin neoplasms, due to the peculiarities of tumor progress, including melanoma of the skin, in the pediatric population, brings the problem of rational removal of pigmented skin objects in one of the most relevant. Given the existing complications and negative treatment results, it requires an immediate solution, taking into account the capabilities of modern equipment and minimally invasive treatment approaches to the treatment of this complex pathology. Purpose - to improve the quality of treatment of patients by clarifying the indications for surgical treatment of skin pigmented nevi and the method without recurrent removal. Materials and methods. The paper analyzes 550 clinical cases of melanocytic nevus of the skin of different localization in children of different ages who were hospitalized in the pediatric surgery clinic of Vinnytsya National Medical University M.I. Pirogov during 2009-2020. All observations were divided into two periods: retrospective (2009-2017) - 350 patients; prospective (2018-2020) - 200 patients. Among patients with a retrospective period, 11 patients were diagnosed with melanoma, and among children with a prospective period - 3 patients. Analysis of medical records revealed 18 (3.85%) cases of recurrent (prolonged) melanocyte nevi in children of different ages, 10 (55.56%) girls and 8 (44.44%) boys. Results. In the prospective study group 138 patients regardless of age and sex based on the obtained data on the optimal configuration of the postoperative wound and the most rational way to remove pigmented skin tumors, managed to avoid incomplete removal of the object with good aesthetic results. According to the data obtained, the index of validity of biopsies is needed to determine melanoma of the skin during the entire study period was 39.29. At the same time, for the retrospective period of observation index of validity of biopsies was in the range of 31.82, in the prospective period - 66.66, namely the decrease in the value of the index was 2.09 times, or 52.27%. Conclusions. The use in clinical practice of the proposed method of incisional biopsy has reduced the number of recurrences of the pathology by 5.2 times from 2.60% in retrospect to 0.50% in the prospective period (p<0.05). The rational individual approach to clarify the indications for surgical treatment of pigmented skin nevi allowed to reduce by 52.7% the index of validity of biopsies. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: pigmented skin neoplasms, children, biopsy, recurrences.