Mohs micrographic surgery improves survival in cutaneous squamous cell carcinomas

Mohs micrographic surgery yielded improved survival rates and lower rates of recurrence compared with historical data for wide local excision in patients with high-risk cutaneous squamous cell carcinomas, according to study findings.

“The incidence of cutaneous squamous cell carcinomas (cSCC) continues to increase, and is now predicted that deaths from cSCC will surpass that of melanoma within the next 5 years,” Teo Soleymani, MD, of Zitelli & Brodland Skin Cancer Center in Pittsburgh and of the division of dermatologic surgery at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues wrote.

The researchers suggested that, while many of these carcinomas undergo successful treatment, an “important” subset of tumors remain at risk for a number of adverse outcomes, including local recurrence, nodal metastasis and disease-specific death. In addition to evaluating for these outcomes, the progression-free survival also underwent analysis, as did disease-specific death in patients who underwent salvage procedures in the head and neck to manage regional nodal metastases.

The retrospective review included data for 581 high-risk primary cSCCs which were identified in 527 patients who had been treated with Mohs micrographic surgery alone. The final analysis included data for 579 of these tumors.

Eligible participants had been treated at two private Mohs surgery referral centers between Jan. 1, 2000, and Jan. 1, 2020. The follow-up period extended through April 1, 2020.

Results showed a 5-year disease-specific survival rate of 95.7%. The mean survival duration was 18.6 years, according to the findings.

The 5-year local recurrence-free survival rate was 96.9%, which was comparable with both the regional nodal metastasis-free survival rate of 93.8% and the distant metastasis-free survival rate of 97.3%.

The 5-year PFS rate was 92.6%, whereas the 10-year PFS rate was 90%.

Regarding those patients who experienced regional nodal metastases that required salvage dissection with or without radiation, a 2-year disease-specific survival rate of 90.5% was observed.

The researchers stressed that this was the largest such cohort of cSCC patients treated with Mohs micrographic surgery to date. They highlighted the lower rates of recurrence, metastasis and survival compared with previous similar cohorts.

“We demonstrate that [Mohs micrographic surgery] confers a disease-specific survival advantage over historical [wide local excision] for high-risk tumors,” they wrote. “Moreover, by improving local tumor control, [Mohs micrographic surgery] appears to reduce the frequency of regional metastatic disease and may confer a survival advantage even for those patients who develop regional metastases.”