Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance

Sebaratnam, Deshan F; Choy, Bonita; Lee, Michael; Paver, Robert; Fernández‐Peñas, Pablo

doi:10.1097/dss.0000000000000756

Cited by 20 publications

(12 citation statements)

References 15 publications

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“…Compared with surgical excision, total treatment costs of MMS seem to be higher, but the debate is still ongoing due to the higher recurrence rate of traditional excision 4,7,8,21,26‐28 . In the European experience, differing health systems make it difficult to obtain a specific estimate of the economic weight of these procedures 26,29 .…”

Section: Discussionmentioning

confidence: 99%

“…In our experience, relapsed BCCs were treated again with MMS and are currently Compared with surgical excision, total treatment costs of MMS seem to be higher, but the debate is still ongoing due to the higher recurrence rate of traditional excision. 4,7,8,21,[26][27][28] In the European experience, differing health systems make it difficult to obtain a specific estimate of the economic weight of these procedures. 26,29 This lack of clarity on the costs of MMS and the complex management strategy may explain the low application of the technique in many countries, including Italy.…”

Section: Discussionmentioning

confidence: 99%

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It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Dika

Veronesi

Patrizi

et al. 2020

Dermatologic Therapy

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Basal cell carcinoma (BCC) is the most common variety of non‐melanoma skin cancer and its incidence is increasing worldwide. The centrofacial sites (area H) are considered a high‐risk factor for BCC local recurrence. Mohs micrographic surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins and is a good treatment option when tissue conservation is required for esthetic or functional reasons or for high‐risk lesions. The present study aimed to evaluate the recurrence rate of head and neck high‐risk BCCs comparing MMS vs conventional surgical excision. Clinical data of patients diagnosed from September 2014 to March 2017, referring to the Dermatology Unit of the Policlinico Sant'Orsola‐Malpighi, University of Bologna, were retrospectively evaluated (285 treated with MMS and 378 treated with traditional surgery). Of the 285 patients treated with MMS, 9 experienced a recurrence (3.1%). Of the 378 patients treated with traditional surgery, 53 relapsed (14%), 13 of whom presented residual tumor on the deep or lateral margins of the main surgical specimen. Our study confirms the trend reported in the literature that MMS represents the best treatment option for high‐risk BCCs arising in the head and neck region or presenting as a recurrence (P < .00001). Many more MMS centers and more trained dermatologists are needed worldwide in order to deal with the increasing number of BCC diagnosed every year.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Dika

Veronesi

Patrizi

et al. 2020

Dermatologic Therapy

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“…In contrast, the costs of CE and MMS are substantially less. Not including the cost of pathology, the costs of MMS and CE for BCC have been reported s roughly $600 to $1000 and $600 to $750, respectively, for truncal lesions …”

Section: Discussionmentioning

confidence: 99%

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Lee

Lehrer

Aphale

et al. 2019

Cancer

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BACKGROUND:The objective of this study was to compare the cosmesis and recurrence rates of conventional excision (CE), Mohs micrographic surgery (MMS), external-beam radiation therapy (EBRT), or brachytherapy (BT), for basal cell carcinoma and squamous cell carcinoma of the skin. METHODS: Population, Intervention, Control, Outcome, Study Design (PICOS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) methods were used to identify studies on PubMed (from 1985 to 2018), including patients with American Joint Committee on Cancer (AJCC) T1-T2N0 basal cell carcinomas and squamous cell carcinomas and ≥10 months follow-up who received CE, MMS, EBRT, or BT. The primary endpoint was cosmesis, classified as "good," "fair," or "poor." The secondary endpoint was 1-year recurrence. Fixed-effects and random-effects meta-analyses were performed to evaluate primary and secondary outcomes with respect to treatment modality. RESULTS: In total, 18,095 studies met initial search criteria. There were 24 CE, 13 MMS, 19 EBRT, and 7 BT studies included with a total of 21,371 patients. The summary effect size for "good" cosmesis was 81% (95% CI, 70.6%-89.6%), 74.6% (95% CI, 63%-84.6%), and 97.6% (95% CI, 91.3%-100%) for CE, EBRT, and BT, respectively. Good cosmesis was 96.0% in the only MMS study that reported cosmesis. BT had improved "good" cosmesis over EBRT (P = .0025) and was similar to CE and MMS. No significant differences were seen for "fair" or "poor" cosmesis. One-year recurrence rates were low throughout at 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%) for CE, MMS, EBRT, and BT, respectively. CONCLUSIONS: For T1-T2N0 skin cancers, BT and MMS have improved cosmesis over EBRT and CE. It is unclear whether this is because of treatment superiority or selection and reporting bias. Local control is similar among all modalities at 1 year. Cancer 2019;125:3582-3594.

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“…SE AU $628.47 vs. AU$587.51). 38 In the SE group, 37.8% would have had incomplete margins and were assumed to require further SE.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…An Australian study (2–3 mm for standard margin and 3–4 mm for high‐risk tumours) on head and neck BCC ( n = 397, 309 pBCC) showed that overall cost difference was AU$40.96 ( P < 0.01) more expensive for MMS (mean cost of MMS vs. SE AU$628.47 vs. AU$587.51) 38 . In the SE group, 37.8% would have had incomplete margins and were assumed to require further SE.…”

Section: Data Analysedmentioning

confidence: 99%

A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma

Brown

Brindley

Hunt

et al. 2022

Clinical and Experimental Dermatology

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Mohs micrographic surgery (MMS) is considered the gold-standard treatment for basal cell carcinoma (BCC) particularly for sites with a high risk of incomplete excision such as the central face, for tumours with an aggressive growth pattern and consequent unpredictable subclinical extension and for recurrent tumours. However, the process is more time-consuming than for standard excision (SE), and the magnitude of benefit is uncertain. This article aims to provide a more complete picture of current evidence, including a review of cosmetic outcomes, tissue-sparing ability and cost-effectiveness of MMS. Although robust evidence is lacking, there is a large volume of observational data supporting a low recurrence rate after MMS. The risk of incomplete excision and higher recurrence rate of SE favours the use of MMS at high-risk sites. There is some low-certainty evidence that MMS results in a smaller defect size compared with SE, and that incomplete excision with SE results in larger defects. Larger defects may affect cosmetic outcome but there is no direct evidence that MMS improves cosmetic outcome compared with SE. There is conflicting evidence regarding the cost of MMS compared with SE, as some studies consider MMS less expensive than SE and others consider it more expensive, which may reflect the healthcare setting. A multicentre 10-year randomized controlled trial comparing MMS and SE in the treatment of high-risk BCC would be desirable, but is unlikely to be feasible or ethical. Collection of robust registry data capturing both MMS and SE outcomes would provide additional long-term outcomes.

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Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance

Cited by 20 publications

References 15 publications

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

It's time forMohs: Micrographic surgery for the treatment of high‐risk basal cell carcinomas of the head and neck regions

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma

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