Mohs Surgery Is Effective for High-Risk Cutaneous Squamous Cell Carcinoma

Abstract

MMS is an effective treatment for high-risk cutaneous SCC. This represents the largest single-center study of high-risk SCC supporting the use of MMS. Adjuvant radiotherapy was reserved for large-nerve perineural disease. There was a low recurrence rate and disease-specific mortality. Prompt recognition of metastatic disease allowed for curative therapy. Patients with one high-risk SCC are likely to develop secondary primary SCC and melanoma.

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…568,572 Six studies reported recurrence in the regional lymph nodes after treatment with MMS. 545,564,565,567,569,573 On pooled analysis (comprising 1162 patients) the average regional recurrence was 4.2% (95% CI 2.3% to 6.6%; I 2 = 56%) ( Figure 37). There was no significant impact on regional recurrence in the sensitivity analysis, which included only four studies meeting the criteria, 545,565,567,569 with average recurrence of 3.2% (95% CI 1.9% to 5.0%, I 2 = 29%).…”

“…Four studies with mean follow-up of between 2 and 5 years reported death attributable to SCC, 564,565,569,571 with an average of 1.1% (95% CI 0.2% to 2.6%; I 2 = 49%) of the 941 eligible patients dying from disease on pooled analysis (Figure 39). One of the included studies reported a relatively high proportion of deaths compared with the other studies.…”

“…545,558,[564][565][566][567][568][569][570][571][572][573][574][575][576][577] In a seminal series of papers, Mohs reported 5-year cure rates for previously untreated SCCs of 95.7% for SCC of the trunk and extremities; 578 96.6% for the ear; 579 97.8% for facial, scalp and neck SCCs; 578 98.5% for eyelid SCCs; 580 and 98.8% for SCCs of the nose. 578 These rates translated to a pooled 5-year cure rate 97.4% for the 2133 SCCs at all sites (95% CI 96.2% to 98.3%; I 2 = 48%).…”

“…Specified mean follow-up was between 2 and 5 years in five studies, 545,564,565,567,569 with pooled regional recurrence of 3.4% (95% CI 1.8% to 5.3%; I 2 = 34%). None of the studies had mean follow-up of > 5 years.…”

High-risk Cutaneous Squamous Cell Carcinoma

“…[71][72][73] Tissue is excised and examined intraoperatively as frozen section to confirm clear margins and limit unnecessary further resection. 71,72 The systematic review of Lansbury et al 74 reports pooled estimate of local recurrence during variable follow-up periods after MMS from 10 studies was 3.0% (2.2 to 3.9%), which was nonsignificantly lower than the pooled average local recurrence of 5.4% (2.5-9.1%) after standard surgical excision (12 studies), and 6.4% (3.0-11.0%) after external radiotherapy (7 studies).…”