Surgical delays may lead to tumor growth in SCCs

Surgical delays of 1 year or less were associated with tumor growth in a cohort of patients with squamous cell carcinomas, according to a study.

“Evidence is controversial and limited surrounding whether surgical delays are associated with tumor growth for cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs),” Jack Lee, MD, of the department of dermatology at the University of Virginia Health System in Charlottesville, Virginia, and colleagues wrote.

The retrospective single-center study analyzed 299 SCCs and 802 BCCs from 889 patients treated with Mohs micrographic surgery. Researchers identified tumor subpopulations that resulted in tumor growth after surgical delay.

Change in major diameter between biopsy and post-operative assessment served as the primary outcome measure.

Surgical delays had a median duration of 48 days and a mean duration of 55 days (range, 0-331 days).

For SCCs, results showed that histological subtype (P = .001) and prior treatment (P = .002) were the only independent predictors of the primary outcome measures. Other factors that underwent analysis, including age, large size at biopsy, location, immunosuppression, gender, diabetes, smoking and alcohol, failed to predict major change in tumor diameter.

Poorly differentiated and moderately differentiated SCCs showed significant association with change in tumor diameter and surgical delay. Poorly differentiated tumors showed growth rates of 0.28 cm for every month of delay (P = .005), while moderately differentiated tumors grew 0.24 cm per month of delay (P = .016).

Findings for BCCs showed that age (P = .001), male gender (P = .001), aggressive histology (P = .001), location (P = .001) and prior treatment (P = .001) independently predicted the primary outcome measure. Conversely, large size at biopsy, immunosuppression, smoking, diabetes and alcohol use failed to predict this outcome.

Surgical delay, however, did not impact the change in tumor growth for SCCs with previous treatment or in BCC subgroups, according to the findings.

The single center nature and retrospective design of the study may limit its findings.

“Surgical delays under a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance,” the researchers wrote.