Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Gerardo Marrazzo, John A. Zitelli, David Brodland

Abstract

Background

There is little evidence to predict patient outcomes following the treatment of high risk cutaneous SCC (hrSCC) using Mohs micrographic surgery (MMS).

Objective

To report the rates of poor outcomes in patients with hrSCC treated by MMS alone, and determine if any specific clinical factors may be more predictive of these outcomes.

Methods

We conducted a retrospective chart review of all hrSCC patients treated in our clinic from October 2011 to December 2015.

Results

We identified 647 hrSCC tumors that met inclusion criteria. During the follow-up period, there were 19 local recurrences(LR) (2.9%), 31 nodal metastases(NM) (4.8%), 7 distant metastases(DM) (1.1%), and 7 disease-specific deaths(DSD) (1.1%). Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death through multivariate analysis.

Conclusions

Invasion beyond subcutaneous fat and poor histologic differentiation may carry a greater risk of poor outcomes than other factors in hrSCC. Mohs surgery alone provides excellent marginal control with low rates of local recurrence, nodal metastasis and disease-specific death.