Sarah E Stuart1, Patrick Schoen2, Chengshi Jin3, Rupa Parvataneni4, Sarah Arron5, Eleni Linos6, W John Boscardin7, Mary-Margaret Chren8. 1. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA. 2. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; Population Services International, Washington, DC. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. 4. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; Cardiovascular Research Foundation, New York, New York. 5. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA. 6. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA. 7. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA. 8. Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: chrenm@derm.ucsf.edu.
Abstract
BACKGROUND: The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate. OBJECTIVE: We sought to compare recurrence rates after different treatments in tumors judged appropriate for MMS. METHODS: We used data from an observational prospective cohort study and retrospectively categorized consecutive tumors as appropriate for MMS according to the AUC. Among appropriate tumors, we used survival analyses to compare 5-year recurrence rates after treatments. RESULTS: Among tumors appropriate for MMS (N = 1483), adjusted 5-year recurrence rates were 2.9% (range, 1.4-4.3%) after MMS, 5.5% (range, 3.1-7.9%) after excision, 4.0% (range, 0.6-7.2%) after destruction, and 5.9% (range, 1.5-10.2%) after other treatments. In tumors treated only with MMS or excision (the most similar subgroups), the adjusted hazard ratio of 5-year recurrence after MMS was 0.6 (95% confidence interval, 0.3-1.0; P = .06). LIMITATIONS: This study is limited by its uncertain generalizability, lack of randomization, and unmeasured characteristics. CONCLUSION: The AUC identified tumors for which recurrence would be less common after MMS than after excision, but the absolute difference in recurrence rates was small.
BACKGROUND: The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate. OBJECTIVE: We sought to compare recurrence rates after different treatments in tumors judged appropriate for MMS. METHODS: We used data from an observational prospective cohort study and retrospectively categorized consecutive tumors as appropriate for MMS according to the AUC. Among appropriate tumors, we used survival analyses to compare 5-year recurrence rates after treatments. RESULTS: Among tumors appropriate for MMS (N = 1483), adjusted 5-year recurrence rates were 2.9% (range, 1.4-4.3%) after MMS, 5.5% (range, 3.1-7.9%) after excision, 4.0% (range, 0.6-7.2%) after destruction, and 5.9% (range, 1.5-10.2%) after other treatments. In tumors treated only with MMS or excision (the most similar subgroups), the adjusted hazard ratio of 5-year recurrence after MMS was 0.6 (95% confidence interval, 0.3-1.0; P = .06). LIMITATIONS: This study is limited by its uncertain generalizability, lack of randomization, and unmeasured characteristics. CONCLUSION: The AUC identified tumors for which recurrence would be less common after MMS than after excision, but the absolute difference in recurrence rates was small.
Authors: Eva van Loo; Klara Mosterd; Gertruud A M Krekels; Marieke H Roozeboom; Judith U Ostertag; Carmen D Dirksen; Peter M Steijlen; H A Martino Neumann; Patty J Nelemans; Nicole W J Kelleners-Smeets Journal: Eur J Cancer Date: 2014-09-25 Impact factor: 9.162
Authors: Suzanne M Connolly; Diane R Baker; Brett M Coldiron; Michael J Fazio; Paul A Storrs; Allison T Vidimos; Mark J Zalla; Jerry D Brewer; Wendy Smith Begolka; Timothy G Berger; Michael Bigby; Jean L Bolognia; David G Brodland; Scott Collins; Terrence A Cronin; Mark V Dahl; Jane M Grant-Kels; C William Hanke; George J Hruza; William D James; Clifford Warren Lober; Elizabeth I McBurney; Scott A Norton; Randall K Roenigk; Ronald G Wheeland; Oliver J Wisco Journal: J Am Acad Dermatol Date: 2012-09-05 Impact factor: 11.527
Authors: Mary-Margaret Chren; Eleni Linos; Jeanette S Torres; Sarah E Stuart; Rupa Parvataneni; W John Boscardin Journal: J Invest Dermatol Date: 2012-11-29 Impact factor: 8.551
Authors: A J G Leus; M Frie; M S Haisma; J B Terra; B E C Plaat; R J H M Steenbakkers; G B Halmos; E Rácz Journal: J Eur Acad Dermatol Venereol Date: 2020-03-30 Impact factor: 6.166