This article is more than 5 years old. Information may no longer be current.
Surgeon errors among factors for tumor recurrence after MMS
Click Here to Manage Email Alerts
Surgeon errors resulting in persistent unexcised tissue, tissue drop out and aggressive tumor types were significant factors with tumor recurrence after Mohs micrographic surgery, according to study results.
In a case-control study, researchers compared the slide characteristics of 19 patients who experienced skin cancer recurrence after Mohs micrographic surgery (MMS; mean age, 69.3 years; 52.6% men) and 95 control patients who had MMS but no cancer recurrence (mean age, 64.6 years; 64.2% men). A database of 6,208 MMS cases from 2002 to 2009 at the University of California, Davis, was used to select controls.
Of the tumors, 72.8% were basal cell carcinoma and 27.2% were squamous cell carcinoma. Tumor involvement included the face (54%), ears (16%), neck or scalp (11%), trunk or extremities (9%), eyelids (5%), lips (3%) and digits (2%).
Tumor type, surgeon error, tissue drop out of slide, dense inflammation, aggressive tumor subtype and surgeries with three or more layers were significant factors for recurrences (P≤.1), according to chi-square or Fisher exact tests. Surgeon error (OR=16.9; 95% CI, 2.46-116), tissue drop out (OR=8.12; 95% CI, 1.57-42) and aggressive tumor subtype (OR=6.52; 95% CI, 1.80-23.7) remained significant after multivariate analysis with stepwise regression model.
The study was limited by only having two surgeons, a single center, and not all recurrences were likely identified, the researchers reported.
“Two of these factors [surgeon error and tissue drop out] are within the control of the treating physician, and thus potentially improvable,” the researchers concluded.
“These findings support the role of continuing quality improvement measures for MMS slide review. It is possible … that error rates might be reduced and cure rates further improved for this already highly effective treatment method. Careful review of the original slides from all recurrent tumors would also seem like a worthwhile endeavor.”
Click Here to Manage Email Alerts