Outcomes in intermediate-risk squamous cell carcinomas treated with Mohs micrographic surgery compared with wide local excision - 26/02/20

Doi : 10.1016/j.jaad.2019.12.049

David D. Xiong, BS ^a, Brandon T. Beal, MD ^b, Vamsi Varra, BS ^c, Marla Rodriguez, BS ^c, Hannah Cundall, BS ^c, Neil M. Woody, MD ^d, Allison T. Vidimos, MD, RPh ^b, Shlomo A. Koyfman, MD ^d, Thomas J. Knackstedt, MD ^c,^e,^⁎
^a Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
^b Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
^c School of Medicine, Case Western Reserve University, Cleveland, Ohio
^d Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
^e Department of Dermatology, MetroHealth System, Cleveland, Ohio

^∗Correspondence to: Thomas J. Knackstedt, MD, 2500 Metrohealth Dr, Cleveland, OH 44109.2500 Metrohealth DrClevelandOH44109

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Abstract

Background

Brigham and Women's Hospital stage T2a squamous cell carcinomas, demonstrating a single high-risk feature, have a low risk of metastasis and death but an increased risk of local recurrence. Little evidence exists for the best treatment modality and associated outcomes in T2a squamous cell carcinoma.

Objective

We aimed to compare outcomes for T2a squamous cell carcinoma treated by Mohs micrographic surgery compared with wide local excision with permanent sections.

Methods

Retrospective review of an institutional review board–approved single-institution registry of T2a squamous cell carcinoma.

Results

Three hundred sixty-six primary T2a tumors were identified, including 240 squamous cell carcinomas (65.6%) treated with Mohs micrographic surgery and 126 (34.4%) treated with wide local excision. A total of 32.5% of patients were immunosuppressed and mean oncologic follow-up was 2.8 years. Local recurrence was significantly more likely after wide local excision (4.0%) than after Mohs micrographic surgery (1.2%) (P = .03). Multiple logistic regression demonstrated immunocompromised state (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.1-23.3; P = .03) and wide local excision (OR 4.8; 95% CI 1.1-21.6; P = .04) associated with local recurrence; and wide local excision (OR 7.8; 95% CI 2.4-25.4; P < .001), high-risk head and neck location (OR 8.3; 95% CI 1.8-38.7; P = .004), and poor histologic differentiation (OR 4.7; 95% CI 1.4-15.4; P = .03) associated with poor outcomes (overall recurrence or disease-specific death).