Limitations in the literature regarding Mohs surgery and staged excision for melanoma: A critical review of quality and data reporting - 11/05/21

Doi : 10.1016/j.jaad.2021.02.091

Jonas A. Adalsteinsson, MD ^a,^⁎ , Victoria J. Stoj, BSc ^a, Haitham Algzlan, MD ^b, Helen Swede, PhD ^c, Richard L. Torbeck, MD ^b, Désirée Ratner, MD ^d
^a University of Connecticut Department of Dermatology, Farmington, Connecticut
^b Icahn School of Medicine Department of Dermatology at Mt Sinai, New York, New York
^c Department of Community Medicine, School of Medicine, Farmington, Connecticut
^d New York University Langone Health, Department of Dermatology, New York, New York

^∗Correspondence to: Jonas A. Adalsteinsson MD, University of Connecticut Department of Dermatology, 263 Farmington Ave, Farmington, Connecticut 06003.University of Connecticut Department of Dermatology263 Farmington AveFarmingtonConnecticut06003

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 11 May 2021
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Abstract

Background and Objectives

The literature supporting Mohs micrographic surgery and staged excision in treating primary cutaneous melanoma is growing but has not been critically reviewed for bias.

Methods

Articles concerning Mohs micrographic surgery and staged excision for melanoma were assessed using modified “Risk of Bias in Non-randomized Studies of Interventions” (ROBINS-I) criteria, which measures bias in 7 categories.

Results

Forty-seven of 48 (97.9%) studies reviewed had serious or critical bias. None were randomized controlled trials. The most frequent cause of critical bias was poorly defined outcomes. The least frequent form of bias observed was change in intervention.

Limitations

The modified ROBINS-I criteria cannot account for all study limitations. Modification of the criteria leads to some degree of subjectivity.

Conclusion

The current body of literature suffers from limitations due to serious or critical bias in 1 or more ROBINS-I criteria. Local recurrence rate definitions are often poorly defined or not defined at all. Longer follow-up times, clear tumor classifications, and prospective, randomized study designs are necessary to improve the quality of future research.

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Key words : bias, melanoma, Mohs micrographic surgery, staged excision, wide excision

Abbreviations used : IHC, LM, MART-1, MIS, MM, MMS, RCT, ROBINS-I, RR, SE, WLE