The Indonesian Journal of Cancer Control

5 Years, layer by layer: mohs micrographic surgery insights from Indonesia cancer center dharmais cancer hospital

Raissa Putri Raspati — 2025-12-27

Abstract:

Background: Mohs micrographic surgery (MMS) is the gold standard for treating high-risk non-melanoma skin cancer (NMSC). However, epidemiological data on MMS in Indonesia remain limited. This study aims to evaluate MMS use, tumor characteristics, and surgical outcomes at a single center in Indonesia.

Methods: A retrospective review of 83 MMS cases at Dharmais Cancer Hospital (2020–2024) was conducted. Data on demographics, tumor characteristics, and surgical outcomes were analyzed. Tumor locations were classified into high-risk (H area), moderate-risk (M area), and low-risk (L area) anatomical zones.

Results: Most tumors were located in the H area (57.8%). Basal cell carcinoma (BCC) was the most common diagnosis (79.5%), with infiltrative BCC as the predominant subtype (41.0%). A surgical margin of ≥3 mm was significantly associated with achieving tumor clearance in a single stage (p = 0.018). Multiple-stage MMS was required in 15.0% of cases. Defect closure was primarily performed using grafts or flaps (69.9%), with dermatologists performing most reconstructions (83.1%).

Conclusion: MMS is effective for treating high-risk NMSC in Indonesia, with findings comparable to global data. The study highlights the importance of appropriate surgical margins and the need for further research, particularly in Asian countries. Establishing a national skin cancer registry would enhance future epidemiological studies.

Keywords: Mohs micrographic surgery, basal cell carcinoma, surgical margin, H area, Indonesia

Knowledge, attitude, and practices of Islamic scholars on cancer care and preventive measures in Ile-Ife, Nigeria

Abdulakeem Ahmed — 2024-12-27

Abstract

Background: Cancer is currently one of the leading causes of morbidity and mortality, especially among adults globally. It is important to understand the perspectives of religious leaders on cancer prevention and care since their doctrines have tremendous impacts on the behaviour of their followers.

Aim: This study assessed the knowledge, attitudes, and practices of Islamic scholars/clerics on cancer care and prevention.

Methods: A cross-sectional design using a mixed-method approach and a two-stage sampling technique was used to recruit 128 consenting Islamic scholars. An interviewer-administered questionnaire and focus group discussion guide were used for data collection. Quantitative data were analysed using the SPSS software version 20 with p ≤ 0.05 taken as significant. Qualitative data from 36 participants with the results analysed using thematic content analysis.

Results: The majority of the respondents had heard of cancer, and 60% of them had poor knowledge of cancer care and prevention. The statistically significant predictors of good practice among the respondents include being not married (AOR 3.64; 95%CI 1.26-10.47; p=0.017), being new members of an Islamic congregation (AOR 6.00; 95%CI 2.22-16.19; p=0.0001) and having good knowledge (AOR 4.85; 95%CI 1.66-14.11; p=0.004). The FGD sessions revealed several myths and misconceptions about cancer.

Conclusion: This study revealed predominantly poor cancer knowledge, negative preventive attitude, and poor cancer care/preventive practices. It underscores the need for an educational intervention targeting Islamic scholars to equip them with the right cancer-related information, which can be passed down to their followers.

Keywords: Knowledge; Attitude; Practice; Cancer Awareness; Islamic scholars.

Rare Delayed Tracheal Perforation after Total Thyroidectomy Repaired With Autologous Pericardial Pacth

Daan Khambri — 2025-12-27

Background: Thyroidectomy is a general surgical procedure that is very common with 3–5% complication rate. Tracheal perforation after thyroidectomy is rare at 0.06%, and is usually identified and repaired intraoperatively. Delayed tracheal perforation is even rarer, with only few cases reports with different management.^1–3

Case illustration: We report a case of a 57-year-old female who underwent total thyroidectomy for infiltrating bilateral thyroid cancer. Tumor infiltration to the trachea was shaved, followed by tracheostomy to secure the airway. Perforation symptoms appear on day 4 after the patient experienced choking in the form of progressive slem production. Perforation was found in the shaven area fused to the tracheostomy hole sized 2x3 cm. The patient was managed in stages, initially with debridement and antibiotics followed by surgical repair. Tracheal repair surgery performed an autologous pericardial pacth combined with a PTFE vascular implant. The patient was extubated 1 week after repair and discharged alive. No further complications on follow-up.

Discussion: In this case, perforation happened due to mechanical force on the remaining thin shaved tracheal wall during choking. Autologous pericardial patch was used due to its several advantages combined with PTFE vascular implant as rigid stenting that prevent colaps when breathing.

Conclusion: Autologous pericardial patch combined with PTFE was sufficient to close delayed perforated trachea after thyroidectomy.

Misdiagnosis of Lung Adenocarcinoma Mimicking of Pulmonary Tuberculosis: A Case Report

Tria Meirissa — 2025-12-27

Background: Pulmonary abnormalities caused by lung cancer can be clinically and radiologically similar to pulmonary tuberculosis (TB). Pulmonary symptom of TB and lung cancer overlap each other such as chronical dyspnea, coughing, hemoptysis, chronic pain and weight loss. Radiologically such as cavities, infiltrates, nodules and miliary. These similarities make it challenging for clinicians and causes misdiagnosis with incidence between 0,03% and 30,4% worldwide.

Case Presentation: A 65-year-old male with chief complaint of shortness of breath and chronic cough for three months, accompanied by symptoms of atypical chest pain, weight loss and indigestion. Chest physical examination found dullness of percussion and decrease breath sound on left side hemithorax. Chest X-ray showed cavity in the left lung. The bronchoscopy result showed mass in the left bronchial and left upper lobe. Biopsy results were obtained adenocarcinoma.

Discussion: Pulmonary tuberculosis and lung cancer often mimic each other on imaging, sharing features such as irregular consolidations and thick-walled cavities. This similarity frequently leads to diagnostic confusion and potential misclassification, especially in regions with high tuberculosis prevalence. Accurate distinction requires thorough pathological and microbiological confirmation to ensure proper management.

Conclusions: Diagnosing pulmonary tuberculosis and lung adenocarcinoma is challenging especially based on similarity of clinical and radiological findings, resulting in significant misdiagnosis. Further examinations and clinician expertise are essential to differentiate.

Bridging the complexity of triple negative breast cancer care through multidisciplinary team approach

Ibnu Purwanto — 2025-12-27

Triple-negative breast cancer (TNBC) is still associated with a grave prognosis, especially compared to other breast cancer subtypes. TNBC carries a high risk of recurrence and distant metastasis, resulting in lower survival rates. Additionally, TNBC exhibits significant heterogeneity at the histopathological and multiomics levels, further complicating the development of effective treatments. While some TNBC subtypes may initially respond to chemotherapy, resistance frequently develops, increasing the risk of aggressive recurrence. The approach to TNBC management has undergone significant transformations in recent years, recognizing it as a heterogeneous disease with diverse biology and behavior. Chemotherapy remains the cornerstone of treatment for most TNBC cases, with the incorporation of PD-L1 CPS or immune cell (IC) scores and BRCA status being crucial for optimizing patient management. Besides the advancement of TNBC treatment, the multidisciplinary team also plays a key role in TNBC management, enabling improved diagnosis, treatment outcomes, disease monitoring, and management of adverse events.

Mechanisms of target therapy resistance in non-small cell lung cancer

Nadia Amalia Haq — 2025-12-27

In the past two decades, research on driver mutations has revolutionized lung cancer treatment with the emergence of targeted therapies as a new therapeutic strategy that significantly improves the prognosis of lung cancer. Targeted therapies are designed to recognize and disrupt specific proteins or pathways involved in the growth, spread and survival of cancer cells with high effectiveness. The use of targeted therapies has been shown to provide better progression-free survival and overall survival compared to traditional chemotherapy in NSCLC patients with targeted mutations. However, most patients eventually develop resistance regardless of the type and line of targeted therapy used. Resistance can occur in patients who initially respond targeted therapy. This is due to adaptive changes in tumor cells and the tumor microenvironment during drug exposure, through genetic and epigenetic processes forming secondary resistance. Understanding targeted therapies and their resistance mechanisms is essential to manage effective treatment for patients.