Mohs Surgery for High-Risk Squamous Cell Carcinoma
Posted: Wednesday, November 7, 2018
Exclusive treatment with Mohs micrographic surgery seems to improve outcomes for patients with high-risk squamous cell carcinoma. In reportedly the largest cohort study described to date, Mohs surgery was associated with lower rates of local tumor recurrence, nodal metastasis, and disease-specific death. In addition, invasion of tumor beyond the subcutaneous fat and poor histologic differentiation may be linked to poorer outcomes. Gerardo Marrazzo, MD, of The Skin Surgery Center, Hickory, North Carolina, and colleagues from the University of Pittsburgh Medical Center, published their findings in the Journal of the American Academy of Dermatology.
Their retrospective chart review centered on 647 high-risk squamous cell tumors, for which patients were treated exclusively with Mohs micrographic surgery (with no preoperative imaging or sentinel lymph node biopsy). Tumors were stratified according to risk/likelihood of poor outcomes using the Brigham and Women’s Hospital alternate staging system, and follow-up occurred over a median of 3 years.
Of the patients with poor outcomes who were identified, 19 experienced local tumor recurrence (2.9%), 31 experienced nodal metastases (4.8%), 7 experienced distant metastases (1.1%), and 7 died (1.1%). Consistent with the Brigham and Women’s staging system stratification, poor histologic differentiation and cell invasion beyond subcutaneous fat were specifically associated with a poorer outcome.
“Mohs surgery alone provides excellent marginal control,” concluded the authors. Furthermore, “continued refinement of what constitutes high-risk squamous cell carcinoma will help to identify which tumors may benefit from adjuvant prognostic testing such as sentinel lymph node biopsy or genetic expression profiling, which is now being explored in [cutaneous squamous cell carcinoma].”