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SCCIS of ear treated with Mohs micrographic surgery occurred primarily in men
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Patients with squamous cell carcinoma in situ of the ear who were treated using Mohs micrographic surgery were predominantly men, according to study results.
Using a retrospective review from 2005 to 2011, researchers studied 173 patients (mean age, 71 years; 94% men) with squamous cell carcinoma in situ (SCCIS) of the ear treated with Mohs micrographic surgery (MMS) at Warren Alpert School of Medicine, Brown University. Ten percent to 15 percent of referrals came from Providence Veterans Affairs Medical Center in Rhode Island, and 85% to 90% were from private practices. Left ears were involved in 93 cases, and 73 occurred on the right ear; the differences were without statistical significance.
Initial tumor size averaged 1.2 cm2 and final tumor size averaged 3.2 cm2. After previous treatment, 8% of tumors were recurrent and occurred exclusively with men. Recurrent tumors (60%, left ear) had larger mean initial size than primary tumors (2.2 cm2 vs. 1.2 cm2; P=.05), more layers for clearance than primary tumors (2.0 ± 0.6 vs. 1.6 ± .08; P=.059) and accounted for larger final defect size (P=.01).
Older age was associated with tumors with larger initial area (P<.01), and researchers said repair closure, including more flaps and grafts, was associated with more layers (P<.01), larger initial area (P=.01) and larger final area (P=.02). Repair type was unaffected by gender.
“SCCIS appears to be a predominantly male disease, although a Veterans Affairs Medical Center referral base skewed the study population,” the researchers concluded. “Tumors designated as recurrent were associated with greater subclinical spread of tumor and more MMS layers required for clearance. Even primary tumors, on average, required 1.6 Mohs layers with approximately 2- to 3-mm margins, suggesting the presence of subclinical spread regardless of recurrence.
“Thus, MMS is valuable in delineating the subclinical spread of this tumor type in this location.”
Perspective
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Joseph F. Sobanko, MD
The recent Dermatologic Surgery articles addressing basal cell carcinoma (BCC) of the upper lip and squamous cell carcinoma in situ (SCCIS) of the ear are retrospective studies from a single academic institution in the Northeastern United States. While the design and cohort are significant limitations of the studies, many of the findings support much of what we already know about nonmelanoma skin cancers:
* Recurrent nonmelanoma skin cancers are more challenging to extirpate and the resultant defects are more challenging to reconstruct.
* Primary and recurrent nonmelanoma skin cancers of the head and neck frequently demonstrate subclinical spread.
* Mohs surgery addresses the above challenges by providing precise microscopic margin control while also sparing tissue in these cosmetically sensitive areas.
Additionally, the data by Lee et al reveal unique epidemiological trends. The group reports a male preponderance of SCC is on the ear while the male:female ratio of upper lip BCCs is closer to 1 to 1. While these findings are interesting, the aforementioned study flaws limit their applicability and further research into these trends is warranted.
There is an epidemic of skin cancer in the United States with nonmelanoma and melanoma skin cancer increasing at staggering rates. Studies such as these allow for physicians and researchers to better understand patient and tumor risk factors so that tumors may be detected earlier and treatment outcomes may be improved. It is imperative that patients understand the risk factors for skin cancer development. Additionally, those patients susceptible to skin cancer must be counseled on early detection strategies and the importance of skin cancer screenings by skilled health professionals.
Finally, if detected, skin cancer should be treated in a manner that ensures complete extirpation as recurrent tumors introduce a greater risk of cosmetic disfigurement and/or distant metastasis.
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