Mohs micrographic surgery bested wide local excision in squamous cell carcinoma

Mohs micrographic surgery was superior to wide local excision as measured by local recurrence rates in a cohort of patients with T2a squamous cell carcinoma, according to a study.

“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,” David D. Xiong, a medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and colleagues wrote. “Little evidence exists for the best treatment modality and associated outcomes in T2a squamous cell carcinoma.”

The researchers conducted a retrospective review of a single-institution registry of patients with T2a squamous cell carcinoma to compare outcomes in those treated with Mohs micrographic surgery vs. wide local excision with permanent sections.

The analysis included 366 primary T2a squamous cell carcinomas tumors, of which 240 were treated with the Mohs procedure and 126 were treated with wide local excision.

Mohs micrographic surgery was superior to wide local excision as measured by local recurrence rates in a cohort of patients with T2a squamous cell carcinoma.

Immunosuppression was reported in 32.5% of the cohort. The mean oncologic follow-up duration was 2.8 years.

Local recurrence occurred in 1.2% of patients in the Mohs micrographic surgery arm and 4% of those who underwent excision (P = .03).

Multivariable analysis results showed two factors associated with local recurrence: being in an immunocompromised state (OR = 5.1; 95% CI, 1.1-23.3; P = .03) and wide local excision (OR = 4.8; 95% CI, 1.1-21.6; P = .04).

Factors associated with poor outcomes, which the researchers defined as overall recurrence or disease-specific death, included 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).

Other findings showed that, compared with Mohs micrographic surgery, wide local excision yielded a cumulative incidence of local recurrences that approached statistical significance (subdistribution HR = 3.3; 95% CI, 0.8-13.7) and a significant increase in overall disease progression (subdistribution HR = 2.9; 95% CI, 1.1-7.6; P = .03).

“Mohs micrographic surgery provides superior long-term outcomes for patients with T2a squamous cell carcinoma and has a definitive role in the management of T2a tumors,” the researchers wrote. “The inclusion of immunosuppressed patients and recurrent tumors greatly enhances the generalizability of these data.” – by Rob Volansky

Disclosures: The authors report no relevant financial disclosures.