Dermatologic Surgery
Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years

https://doi.org/10.1016/j.jaad.2005.02.059Get rights and content

Background

Only a few reports have been published on the long-term outcome of surgical excision of cutaneous squamous cell carcinoma (SCC).

Objective

Our purpose was to report the clinical findings and 5-year recurrence rate of all patients with cutaneous SCC treated with Mohs micrographic surgery (MMS) in Australia between 1993 and 2002.

Method

This prospective, multicenter case series included all patients with SCC who were monitored by the Skin and Cancer Foundation. The main outcome measures were patient demographics, reason for referral, duration of tumor, site, preoperative tumor size, postoperative defect size, recurrences before MMS, histological subtypes, and 5-year recurrence after MMS.

Results

The case series comprised 1263 patients (25.7% female and 74.3% male; P < .0001) with a mean age of 66 ± 13 years. In 61.1% of cases the lesion was a primary tumor, and in 38.9% it was a recurrent tumor. Most of the tumors (96.5%) were on the head and neck area. Recurrent tumors were larger than primary tumors (P < .0001), had a larger postexcision defect (P < .0001), required more levels of excision (P < .0001), and had more cases of subclinical extension (P = .002). Recurrence after MMS was diagnosed in 15 of the 381 patients (3.9%) who completed the 5-year follow-up after MMS. The recurrence rate was 2.6% in patients with primary SCC and 5.9% in patients with previously recurrent SCC (P < .001).

Conclusion

This large prospective series of SCC managed by MMS is characterized by a high percentage of high-risk tumors. The low 5-year recurrence rate with MMS emphasizes the importance of margin-controlled excision.

Section snippets

Methods

We conducted a prospective, noncomparative, multicenter, interventional case series of patients with cutaneous SCC treated with MMS in Australia and monitored by the SCFA between 1993 and 2002.

The selection criteria were all cases with histologically confirmed SCC and treated with MMS. The main data recorded were patient age and gender, reason for referral, duration of tumor, site, recurrences before MMS, preoperative tumor size, histological subtypes and evidence of perineural invasion, number

Patients treated with MMS

The study group included 1263 patients who underwent MMS for cutaneous SCC between 1993 and 2002. There were 324 women (25.7%) and 938 men (74.3%) (P < .0001), with a mean age of 66 ± 13 years (median, 68 years; range, 21-96 years). In 772 patients (61.1%) the lesion was a primary tumor, and in 491 patients (38.9%) the tumor was recurrent (previously treated with non-Mohs procedures; Table I).

The most commonly stated reasons for referral for MMS was tumor site (24.4%) and tumor recurrence

Discussion

The significant increase in the incidence of nonmelanoma skin cancers (NMSCs) over the past two decades has resulted in a growing number of studies on epidemiology, risk factors, and treatment modalities. SCC, which constitutes 20% to 25% of NMSC, is mainly associated with ultraviolet radiation, but other possible risk factors are ionizing radiation, chemical agents (arsenic, polycyclic aromatic hydrocarbons, smoking), genodermatoses (albinism and xeroderma pigmentosum), human papillomavirus

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Funding sources: None.

Conflicts of interest: None disclosed.

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