Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin

Diehl, Joseph; Choi, Young Mee; Liang, Li‐Jung; Chiu, Melvin

doi:10.1097/dss.0000000000000378

Cited by 12 publications

(13 citation statements)

References 39 publications

(51 reference statements)

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“…Contrary to our study, in which only 10% of the cases were submitted to the procedure within the first 6 months after NMSC diagnosis, the mean waiting time for MMS in a study by Diehl et al was 133 days (17). Changes in the largest diameter had no correlation with the time until surgery, suggesting that the growth of small BCCs may not be linear (19).…”

Section: Discussioncontrasting

confidence: 96%

“…Several tumor characteristics are associated with high relapse rates, including location, histological subtype (morpheaform, infiltrative, micronodular and basosquamous), perineural and perivascular infiltration, lack of well-defined clinical margins, and incompletely excised or recurrent lesions (17). Our sample included almost all types of patients, including non-recurrent NMSC patients, who showed a significant association with lesion sizes up to 30 mm.…”

Section: Discussionmentioning

confidence: 99%

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Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery

Weimann

Brandão

Terzian

et al. 2020

In Vivo

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Background/Aim: Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer in adults. Surgery remains the golden-standard treatment for this disease. Mohs micrographic surgery (MMS), a surgical technique, is based on the three-dimensional histopathological examination of the margin and surgical bed, layer by layer, in the excised tissue allowing for the determination of the location of the residual tumor, for its complete excision, with high cure rates and preservation of the unaffected tissue. The aim of this study was to present the epidemiological characteristics of the population that was submitted to MMS, as well as, correlate these characteristics with the characteristics of the tumor itself and the surgical procedure. Patients and Methods: A retrospective cross-sectional study was conducted over a 10-year period with an analysis of patient medical records submitted for MMS at the Department of Dermatology of the ABC School of Medicine. Data were presented and evaluated by nonparametric and parametric analyses, using absolute and relative frequency values for the continuous variable, to which a Chi-square test was applied for the verification of power with a significance level of 5%. For the independent variables, the Student's t-test was used to compare means, with a confidence interval (CI) ranging from 95 to 99%, and Friedman's test was used to verify if there were significant differences in the variables of interest. Results: Female patients accounted for 67% of all enrolled patients (n=335). The mean age was 67 years (SD±12.04; median=68; range=25-93 years). The predominant skin phototype (Fitzpatrick's classification) was phototype II (n=228, 46%). All procedures were performed under local anesthesia. Flap reconstruction was the most predominant surgery type (n=17, 68%). The mean number of MMS's stages was 1.6 (range=1-8). There was a mean of 3.8 fragments of skin tissue (range=1-29) per stage. The mean tumor size was 30 mm (92%). This was associated with female sex (p=0.03), H-zone area (p<0.001), flap reconstruction (p=0.004), tumor removal 7 to 12 months after diagnosis (p<0.001) and non-recurrence tumors (p=0.02). Conclusion: NMSCs were frequently observed in older women with skin phototypes II/III. Reconstruction of the primary defect was feasible under local anesthesia, even in tumors with a marked diameter, decreasing the morbidity of this surgery, providing very satisfactory functional and aesthetic results, reduction costs and ease of access to the surgical procedure. Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer in adults (1, 2). NMSC refers to keratinocytic carcinomas classified as basal cell carcinoma, squamous cell carcinoma and Bowen's disease (3). Surgery remains the gold-standard treatment for this disease. Mohs micrographic surgery (MMS) is replacing the excision and destruction of NMSC in the head, neck, hands, feet and genitalia, due to its advantage in providing high cure rates, preserving normal tissue and optimizing the aesthetic aspects (4). The ...

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery

Weimann

Brandão

Terzian

et al. 2020

In Vivo

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“…3 Nonmelanoma skin cancer frequently affects cosmetically sensitive areas and patients may worry about scarring or disfigurement, feel anxious about a cancerous lesion, and have concerns about recurrence. 4,5 Presently, the literature has mixed results on whether longer time to excision is related to increased lesion size 6,7 ; however, it is important to remember that lack of statistical significance does not negate clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Regional Wait Times for Patients With Nonmelanoma Skin Cancer in Southwestern Ontario

et al. 2019

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Background: Nonmelanoma skin cancer (NMSC) affects many Canadians. Although morbidity and mortality are rare, the burden to patients and the health-care system is significant. This study aims to evaluate current plastic surgery wait times and care pathways for patients with NMSC in Southwestern Ontario. Methods: A retrospective chart review of 225 patients treated in Ontario from 2015 to 2018 was conducted. Inclusion criteria included patients with an NMSC managed with surgical excision. Referral information was compared. Primary outcomes were wait times: from referral to consultation, referral to excision, and consultation to excision. Data were analyzed using Student t test with equal variance. Results: One-hundred forty-three patients were included from the academic cohort and 82 from the community cohort. Referrals to academic and community surgeons included lesion location (90% and 97.6%, respectively), but less frequently included size (18% and 29.2%, respectively). Most referrals to academic surgeons included biopsy results (78.6%), as opposed to community referrals (25.6%). Patients in the academic cohort waited 15.3 ± 12.7 weeks from referral to consultation, and 15.7 ± 13 weeks from referral to excision. Patients from the community cohort waited significantly shorter periods of 4.9 ± 3.1 ( P < .001) and 11.7 ± 9.9 weeks ( P = .016), respectively. However, patients of the academic cohort waited 2.4 ± 7.1 weeks from consultation to excision, while patients in the community cohort waited 6.7 ± 9.6 weeks ( P < .001). Rates of negative peripheral margins on pathology were similar between groups, at 89.5% of the academic cohort and 88.9% of the community cohort. Deep margins were positive 5.7% of the time at the academic sites and 6.2% of the time in the community. Conclusions: Patients referred to academic centres waited significantly longer periods of time in several parameters compared to those referred to a community surgeon. However, academic surgeons often had expedited consultation-to-excision time frame. This study provides important data for future quality improvement initiatives in NMSC care.

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“…There are many studies that analyze MMS considering different factors, such as patient age, anatomic location, histologic type of tumor, delay in treatment implementation, and gender . However, there are few studies comparing BCC MMS and SCC MMS . Knowledge of these differences can be useful to optimize the surgery and the follow‐up of these patients.…”

Section: Introductionmentioning

confidence: 99%

“…12 However, there are few studies comparing BCC MMS and SCC MMS. 13 Knowledge of these differences can be useful to optimize the surgery and the follow-up of these patients.…”

Section: Introductionmentioning

confidence: 99%

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma

et al. 2018

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Background The two main tumors treated with Mohs micrographic surgery (MMS) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There are no studies analyzing whether MMS is different when treating these two types of tumors. Objective We aim to compare the characteristics of the patients, the tumors, and MMS, and first‐year follow‐up of MMS in BCC and SCC. Methods REGESMOHS is a prospective cohort study of patients treated with MMS. The participating centers are 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patients, tumors, and surgery were recorded. The follow‐up was done with two visits: the first visit within 1 month after surgery and the second one within the first year. Results From July 2013 to April 2017, a total of 2,669 patients who underwent MMS were included in the registry. Of them, 2,448 (93%) were diagnosed with BCC, and 181 (7%) were diagnosed with SCC. Patients with SCC were older than those with BCC (median age 73 years vs. 68 years) and presented immunosuppression more frequently. The tumor size was significantly larger in the SCC group. Regarding surgery, deeper invasion was more frequent in SCC, resulting in larger defects. Despite this, SCC did not require more stages to get clear margins or more time in the operating room. Incomplete Mohs was more frequent in the SCC group (6%) than in the BCC group (2%). The incidence of perioperative complications was higher when treating SCC. There were more relapses in the first‐year follow‐up in the SCC group. Conclusion There are significant differences when comparing MMS in BCC and SCC. Knowledge of these differences can help to prepare the patient and plan the surgery, optimizing results.

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Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin

Abstract: No evidence was found that time delays of up to 1 year from biopsy to MMS impact the growth of NMSCA.

Cited by 12 publications

References 39 publications

Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery

Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery

Regional Wait Times for Patients With Nonmelanoma Skin Cancer in Southwestern Ontario

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma

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