RESUMEN
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults, characterized by the accumulation of abnormal lymphocytes in the blood and bone marrow. Its incidence increases with age, typically affecting older adults, with a median age at diagnosis around 70 years. CLL prevalence varies geographically, with higher rates observed in Western countries compared to Asian populations. Despite advancements in treatment, CLL remains an incurable disease, often managed through monitoring and therapy to control symptoms and slow disease progression. The purpose of this case report is to highlight two unique incidents of previously undiagnosed CLL, incidentally found during Mohs micrographic surgery (MMS). One case features a cutaneous squamous cell carcinoma in situ and the other a basal cell carcinoma. We present these cases to highlight the importance of diagnostic vigilance during Mohs histopathological processing. Diagnosis of CLL is typically through routine complete blood panels. However, these cases present unique initial presentations that warrant careful detection in medical practice. Detecting CLL during the examination of pathology samples from MMS excision may not be common practice, but its presence emphasizes the significance of thorough patient evaluation during medical procedures. This unexpected finding underscores the importance of thorough pathology examination during surgical procedures, highlighting the potential for detecting concurrent or underlying systemic conditions. Early identification of CLL in this context allows for prompt intervention and comprehensive management, emphasizing the necessity of integrated care approaches in medical practice.
RESUMEN
Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.