The goal of this single-arm clinical trial is to learn about the effectiveness and safety of the X A-DERM™ mADM in promoting wound healing and improving scar formation after MMS surgery for removing BCC, SCC, or MIS lesions on the face, head, and upper limbs. The main questions it aims to answer are how well this intervention works and what is the safety profile.
The primary hypothesis is that the use of X A-DERM™ will result improved wound healing and scar formation after 60 days post-procedure.
Participants will undergo MMS surgery to remove BCC, SCC, or MIS lesions, and then will receive the X A-DERM™ mADM graft at the surgical site. Participants will return to the office four additional times for the clinician to collect data on their wound healing. This will involve taking pictures of the wound, conducting clinical assessments (CROs), and documenting the patient's reported outcomes (PROs).
Conditions
Conditions (4)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
The participants will receive the X A-DERM™ mADM following MMS for removal of BCC, SCC, or MIS lesions in the face, head, or upper extremities. After complete excision of the tumor and removal of all cancerous tissue, reconstruction immediately follows with placement of the mADM into the defect. Subjects will receive the standard of care for post-op and at-home wound care and will be recalled for a total of 5 in-office visits to evaluate wound healing.
interventionNames
Device: A microsurfaced ADM (acellular dermal matrix)
Primary outcomes (2)
measure
To evaluate the effectiveness of X A-DERM™ mADM on clinician- and patient-based assessments and objective measurements of wound healing and scar quality.
This will be done by capturing digital photographs. Digital photographs of the wound bed site will be acquired pre- and post-placement of the mADM perioperatively and at follow-up visits.
Eligibility
Eligibility (as posted)
Sex
All
Minimum age
18 Years
Maximum age
85 Years
Show eligibility criteria text
Inclusion Criteria: Subjects must meet all the following criteria to be entered into the study:
1. Between 18 and 85 years of age, inclusive
2. Subject in good health, or with stable treated medical condition, as determined by the investigator.
3. Scheduled to undergo elective Mohs surgery to remove a single biopsy-proven basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma in situ (MIS) lesion on the head, face, or upper extremity that is amenable to Mohs surgery.
4. Tumor location and size meets the following criteria for immediate MMS:
* Largest total surface area of ≤16cm2 and smallest total surface area per PI discretion.
* Depth with majority of tumor excision at least to subcutaneous tissue.
* Adequate dermal contract with graft.
5. Willing and able to complete and comply with procedures, protocol requirements, and instructions, including self-performed wound care and completion of all required visits.
6. Able to speak, read, write, and understand the language of the informed consent form (ICF) and study questionnaires.
7. Willingness and ability to understand the risks, benefits, and alternatives to participation, and give informed consent.
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Exclusion Criteria: Subjects who meet the above inclusion criteria will be eligible for the study, unless they present with any of the following:
1. History of wound abnormalities or any other findings that would impede participation in the trial, as per PI discretion.
2. Post-operative defects superficial and deemed not appropriate for second intention healing, as determined by the investigator.
3. Pregnant, lactating/breast feeding, or planning a pregnancy. A negative urine pregnancy test will be required at screening for female subjects of childbearing potential; a woman will be considered to be of childbearing potential unless she has had a tubal ligation, total hysterectomy, bilateral oophorectomy, or is postmenopausal (without a menstrual period for at least one year).
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References
Publications (87)
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measure
To evaluate the effectiveness of X A-DERM™ mADM on clinician- and patient-based assessments and objective measurements of wound healing and scar quality.
This will be done by requesting patients and clinicians to complete POSAS assessments, the Patient and Observer Scar Assessment Scale. The POSAS contains two assessments. The first assessment captures patients' views on scar pain, itchiness, if the scar color is different, if the scar is more stiff, is the thickness of the scar different, and is the scar irregular by ranking their answer from a scale of 1-10. 1 being "no, no complaints" and 10 being "yes, worst imaginable". The second assessment is the clinician's portion. It involves objective scoring based on standardized criteria for characteristics such as vascularity, pigmentation, thickness, relief, pliability, and surface area using a scale from 1-10 1 being "Normal skin" and 10 being "worst scar imaginable".
Secondary outcomes (5)
measure
To evaluate the effectiveness of X A-DERM™ mADM on objective metrics of wound healing based on physical measurements as well as subjective assessments on wound management, pain, functional outcomes, quality of life, and cosmetic appearance
This will be done by completing clinician reported outcomes. The first clinician reported outcome tool used is the Visual Analog Scale (VAS) for scar appearance. It is completed by making a mark across the line corresponding to the clinician observation between the statements at each of the extremes. The associated "lines" encapsulate a spectrum of scar appearance with "excellent" on one end and "poor" on the opposite.
measure
To evaluate the effectiveness of X A-DERM™ mADM on objective metrics of wound healing based on physical measurements as well as subjective assessments on wound management, pain, functional outcomes, quality of life, and cosmetic appearance
This will be done by completing clinician reported outcomes. The second clinician reported outcome tool used is the Manchester Scar Satisfaction Scale (MSSS). It is completed by the clinician evaluating the patient's scar by checking the box of the corresponding characteristic that best matches their assessment for 5 parameters. The first parameter is color (compared to surrounding skin), and the options are perfect, slight mismatch, obvious mismatch, and gross mismatch. The second matte or shiny, and those are the two options. The third is contour, the options being flush with surrounding area, slightly proud (indented), hypertrophic, and keloid. The fourth is distortion with options of none, mild, moderate, and severe. The last parameter is texture with options of normal, just palpable, firm, and hard.
measure
To evaluate the effectiveness of X A-DERM™ mADM on objective metrics of wound healing based on physical measurements as well as subjective assessments on wound management, pain, functional outcomes, quality of life, and cosmetic appearance
This will be done by completing patient reported outcomes. The first patient reported outcome tool used is the Visual Analog Scale (VAS) for pain intensity, itching intensity, and cosmetic appearance. It is completed by the patient making a mark across the line corresponding to their observation between the statements at each of the extremes. The associated "lines" encapsulate a spectrum of pain intensity ("no pain" and "worst pain imaginable"), itching intensity ("no itch" and "worst itch imaginable"), and cosmetic appearance ("worst scar" and "best scar").
measure
To evaluate the effectiveness of X A-DERM™ mADM on objective metrics of wound healing based on physical measurements as well as subjective assessments on wound management, pain, functional outcomes, quality of life, and cosmetic appearance
This will be done by completing patient reported outcomes. The second patient reported outcome tool used is the ease of wound care numerical rating scale (NRS). The patient reports on a scale from 0 to 10, where 0 represents "Very Easy" and 10 represents "Impossible," please rate how easy it was for them to care for the wound by themself?
measure
To evaluate the effectiveness of X A-DERM™ mADM on objective metrics of wound healing based on physical measurements as well as subjective assessments on wound management, pain, functional outcomes, quality of life, and cosmetic appearance
This will be done by completing patient reported outcomes. The third patient reported outcome tool used is the Skindex-16 questionnaire. The patient will for each of the following questions, make a mark in the box corresponding to your feelings about each of the statements. The scale is "never bothered" to "always bothered" on a 0-6 numerical rank and the various conditions are as follows: itching, burning or stinging, hurting, your skin condition being irritated, the persistence/reoccurrence of your skin condition, worry about your skin condition, the appearance, frustration, embarrassment, being annoyed about your skin condition, feeling depressed about your skin condition, the effects of your skin condition on your desire to be with people, your skin condition making it hard to show affection, the effects of your skin condition on your daily activities, and your skin condition making it hard to work or do what you enjoy.
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BACKGROUNDHong SN, Le Van D, Ngan GP, et al. MOHS MICROGRAPHIC SURGERY FOR BASAL CELL CARCINOMA: A REVIEW OF TREATMENT RESULTS. Tạp chí Da liễu học Việt Nam 2023.
BACKGROUNDWood LD, Ammirati CT. An overview of Mohs micrographic surgery for the treatment of basal cell carcinoma. Dermatol Clin. 2011 Apr;29(2):153-60, vii. doi: 10.1016/j.det.2011.02.005. PMID 21421141
BACKGROUNDvan Loo E, Mosterd K, Krekels GA, Roozeboom MH, Ostertag JU, Dirksen CD, Steijlen PM, Neumann HA, Nelemans PJ, Kelleners-Smeets NW. Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up. Eur J Cancer. 2014 Nov;50(17):3011-20. doi: 10.1016/j.ejca.2014.08.018. Epub 2014 Sep 25. PMID 25262378
BACKGROUNDRowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. 1989 Mar;15(3):315-28. doi: 10.1111/j.1524-4725.1989.tb03166.x. PMID 2646336
BACKGROUNDSnow SN, Larson PO, Lucarelli MJ, Lemke BN, Madjar DD. Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg. 2002 Jul;28(7):623-31. doi: 10.1046/j.1524-4725.2002.01306.x. PMID 12135523
BACKGROUNDAmerican Academy of Dermatology; American College of Mohs Surgery; American Society for Dermatologic Surgery Association; American Society for Mohs Surgery; Ad Hoc Task Force; Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Begolka WS, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA Jr, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. Dermatol Surg. 2012 Oct;38(10):1582-603. doi: 10.1111/j.1524-4725.2012.02574.x. Epub 2012 Sep 7. PMID 22958088
BACKGROUNDRogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, Coldiron BM. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010 Mar;146(3):283-7. doi: 10.1001/archdermatol.2010.19. PMID 20231499
BACKGROUNDMiller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, Cheney RT, Glass LF, Grekin RC, Kessinger A, Lee NY, Liegeois N, Lydiatt DD, Michalski J, Morrison WH, Nehal KS, Nelson KC, Nghiem P, Olencki T, Perlis CS, Rosenberg EW, Shaha AR, Urist MM, Wang LC, Zic JA. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw. 2010 Aug;8(8):836-64. doi: 10.6004/jnccn.2010.0062. No abstract available. PMID 20870631
BACKGROUNDMiller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, Cheney RT, Glass F, Grekin RC, Grichnik JM, Kessinger A, Lee NY, Lessin S, Lydiatt DD, Margolis LW, Michalski J, Nehal KS, Nghiem P, Oseroff AR, Rosenberg EW, Shaha AR, Siegle RJ, Urist MM; National Comprehensive Cancer Network. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw. 2007 May;5(5):506-29. doi: 10.6004/jnccn.2007.0045. No abstract available. PMID 17509254
BACKGROUNDLane JE, Kent DE. Surgical margins in the treatment of nonmelanoma skin cancer and mohs micrographic surgery. Curr Surg. 2005 Sep-Oct;62(5):518-26. doi: 10.1016/j.cursur.2005.01.003. PMID 16125611
BACKGROUNDGamret AC, Roberts JE, Srivastava D, Nijhawan RI. Mohs Micrographic Surgery: A Brief Overview. Semin Plast Surg. 2024 Nov 4;38(4):264-267. doi: 10.1055/s-0044-1791563. eCollection 2024 Nov. PMID 39697403
BACKGROUNDDonaldson MR, Coldiron BM. Scars after second intention healing. Facial Plast Surg. 2012 Oct;28(5):497-503. doi: 10.1055/s-0032-1325643. Epub 2012 Oct 1. PMID 23027216