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Outcomes in intermediate-risk squamous cell carcinomas treated with Mohs micrographic surgery compared with wide local excision.
Journal of the American Academy of Dermatology ( IF 12.8 ) Pub Date : 2019-12-27 , DOI: 10.1016/j.jaad.2019.12.049 David D Xiong 1 , Brandon T Beal 2 , Vamsi Varra 3 , Marla Rodriguez 3 , Hannah Cundall 3 , Neil M Woody 4 , Allison T Vidimos 2 , Shlomo A Koyfman 4 , Thomas J Knackstedt 5
Journal of the American Academy of Dermatology ( IF 12.8 ) Pub Date : 2019-12-27 , DOI: 10.1016/j.jaad.2019.12.049 David D Xiong 1 , Brandon T Beal 2 , Vamsi Varra 3 , Marla Rodriguez 3 , Hannah Cundall 3 , Neil M Woody 4 , Allison T Vidimos 2 , Shlomo A Koyfman 4 , Thomas J Knackstedt 5
Affiliation
BACKGROUND
Brigham and Women's Hospital stage T2a squamous cell carcinomas, demonstrating a single high-risk feature, have a low risk of metastasis and death but an increased risk of local recurrence. Little evidence exists for the best treatment modality and associated outcomes in T2a squamous cell carcinoma.
OBJECTIVE
We aimed to compare outcomes for T2a squamous cell carcinoma treated by Mohs micrographic surgery compared with wide local excision with permanent sections.
METHODS
Retrospective review of an institutional review board-approved single-institution registry of T2a squamous cell carcinoma.
RESULTS
Three hundred sixty-six primary T2a tumors were identified, including 240 squamous cell carcinomas (65.6%) treated with Mohs micrographic surgery and 126 (34.4%) treated with wide local excision. A total of 32.5% of patients were immunosuppressed and mean oncologic follow-up was 2.8 years. Local recurrence was significantly more likely after wide local excision (4.0%) than after Mohs micrographic surgery (1.2%) (P = .03). Multiple logistic regression demonstrated immunocompromised state (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.1-23.3; P = .03) and wide local excision (OR 4.8; 95% CI 1.1-21.6; P = .04) associated with local recurrence; and wide local excision (OR 7.8; 95% CI 2.4-25.4; P < .001), high-risk head and neck location (OR 8.3; 95% CI 1.8-38.7; P = .004), and poor histologic differentiation (OR 4.7; 95% CI 1.4-15.4; P = .03) associated with poor outcomes (overall recurrence or disease-specific death).
CONCLUSION
Mohs micrographic surgery provides improved outcomes in Brigham and Women's Hospital T2a squamous cell carcinoma.
中文翻译：
与广泛局部切除术相比，用Mohs显微外科手术治疗的中危鳞状细胞癌的结果。
背景百老汇妇女医院的T2a期鳞状细胞癌表现出单一的高风险特征，转移和死亡的风险较低，但局部复发的风险较高。很少有证据表明T2a鳞状细胞癌的最佳治疗方式和相关结局。目的我们的目的是比较采用Mohs显微外科手术治疗的T2a鳞状细胞癌与采用永久性切片的广泛局部切除术相比的结果。方法对机构审查委员会批准的T2a鳞状细胞癌单机构登记册进行回顾性审查。结果确定了366例原发性T2a肿瘤，包括240例鳞状细胞癌（65.6％）接受了Mohs显微外科手术治疗，126例（34.4％）经广泛局部切除治疗。总共32个。5％的患者被免疫抑制，平均肿瘤随访时间为2.8年。广泛的局部切除后（4.0％）比莫氏显微外科手术后（1.2％）更可能发生局部复发（P = .03）。多元logistic回归显示免疫功能低下状态（比值比[OR] 5.1; 95％置信区间[CI] 1.1-23.3; P = .03）和广泛的局部切除（OR 4.8; 95％CI 1.1-21.6; P = .04）与局部复发有关；和广泛的局部切除（OR 7.8; 95％CI 2.4-25.4; P <.001），高风险的头颈部位置（OR 8.3; 95％CI 1.8-38.7; P = .004）和组织学分化差（ OR 4.7； 95％CI 1.4-15.4； P = .03）与不良预后（整体复发或特定疾病的死亡）相关。结论Mohs显微外科手术可改善布莱根妇女医院T2a鳞状细胞癌的疗效。
更新日期：2019-12-27
中文翻译：
与广泛局部切除术相比，用Mohs显微外科手术治疗的中危鳞状细胞癌的结果。
背景百老汇妇女医院的T2a期鳞状细胞癌表现出单一的高风险特征，转移和死亡的风险较低，但局部复发的风险较高。很少有证据表明T2a鳞状细胞癌的最佳治疗方式和相关结局。目的我们的目的是比较采用Mohs显微外科手术治疗的T2a鳞状细胞癌与采用永久性切片的广泛局部切除术相比的结果。方法对机构审查委员会批准的T2a鳞状细胞癌单机构登记册进行回顾性审查。结果确定了366例原发性T2a肿瘤，包括240例鳞状细胞癌（65.6％）接受了Mohs显微外科手术治疗，126例（34.4％）经广泛局部切除治疗。总共32个。5％的患者被免疫抑制，平均肿瘤随访时间为2.8年。广泛的局部切除后（4.0％）比莫氏显微外科手术后（1.2％）更可能发生局部复发（P = .03）。多元logistic回归显示免疫功能低下状态（比值比[OR] 5.1; 95％置信区间[CI] 1.1-23.3; P = .03）和广泛的局部切除（OR 4.8; 95％CI 1.1-21.6; P = .04）与局部复发有关；和广泛的局部切除（OR 7.8; 95％CI 2.4-25.4; P <.001），高风险的头颈部位置（OR 8.3; 95％CI 1.8-38.7; P = .004）和组织学分化差（ OR 4.7； 95％CI 1.4-15.4； P = .03）与不良预后（整体复发或特定疾病的死亡）相关。结论Mohs显微外科手术可改善布莱根妇女医院T2a鳞状细胞癌的疗效。
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