Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study

Lee, C. B. van; Roorda, Berrit M; Wakkee, Marlies; Voorham, Quirinus J.M.; Mooyaart, Antien L.; Vijlder, H. C. de; Nijsten, Tamar; Bos, R.R. van den

doi:10.1111/bjd.17188

Cited by 76 publications

(45 citation statements)

References 15 publications

(17 reference statements)

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“…Other forms such as ‘slow Mohs’ or the ‘Breuninger’ technique can also be considered, but generally take more time than MMS which can lead to a greater burden of treatment. Cure rates of MMS in BCC and cSCC are superior over conventional surgical excision . Previous studies report that MMS is well‐tolerated in elderly patients .…”

Section: Discussionmentioning

confidence: 98%

Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature

Leus

Frie

Haisma

et al. 2020

Acad Dermatol Venereol

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A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.

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Section: Discussionmentioning

confidence: 98%

Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature

Leus

Frie

Haisma

et al. 2020

Acad Dermatol Venereol

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“…MMS is more time-consuming, labor-intensive, and expensive, compared to conventional excision. A retrospective study including 579 patients with 672 cSCCs of the head and neck (380 treated with MMS and 292 with standard excision) reported that MMS could be superior to standard excision for cSCC of the head and neck because of the lower rate of recurrence [152].…”

Section: Micrographically Controlled Surgerymentioning

confidence: 99%

Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

et al. 2021

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Cutaneous squamous cell carcinoma (cSCC), a non-melanoma skin cancer, is a keratinocyte carcinoma representing one of the most common cancers with an increasing incidence. cSCC could be in situ (e.g., Bowen’s disease) or an invasive form. A significant cSCC risk factor is advanced age, together with cumulative sun exposure, fair skin, prolonged immunosuppression, and previous skin cancer diagnoses. Although most cSCCs can be treated by surgery, a fraction of them recur and metastasize, leading to death. cSCC could arise de novo or be the result of a progression of the actinic keratosis, an in situ carcinoma. The multistage process of cSCC development and progression is characterized by mutations in the genes involved in epidermal homeostasis and by several alterations, such as epigenetic modifications, viral infections, or microenvironmental changes. Thus, cSCC development is a gradual process with several histological- and pathological-defined stages. Dermoscopy and reflectance confocal microscopy enhanced the diagnostic accuracy of cSCC. Surgical excision is the first-line treatment for invasive cSCC. Moreover, radiotherapy may be considered as a primary treatment in patients not candidates for surgery. Extensive studies of cSCC pathogenic mechanisms identified several pharmaceutical targets and allowed the development of new systemic therapies, including immunotherapy with immune checkpoint inhibitors, such as Cemiplimab, and epidermal growth factor receptor inhibitors for metastatic and locally advanced cSCC. Furthermore, the implementation of prevention measures has been useful in patient management.

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“…Since the metastasis rate of SCC increases to 30.3% after recurrence, and the survival rate after metastasis decreases to 34.4%, the authors recommended Mohs surgery because of the low postoperative recurrence rate 67 . Furthermore, van Lee et al 68 . compared patients who underwent Mohs surgery and those who underwent usual surgery among 672 SCC patients.…”

Section: Process Of Guidelines Developmentmentioning

confidence: 99%

Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020

Ansai

Umebayashi

Katsumata

et al. 2021

The Journal of Dermatology

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In consideration of the development of treatment options for squamous cell carcinoma (SCC), the Japanese Skin Cancer Society issued the first guidelines of SCC in 2007 and revised them in 2015. Here, we report the English version of the 2020 edition of the Japanese SCC guidelines. The first half of this article is an overview of SCC including actinic keratosis and Bowen’s disease, and the second half discusses three clinical questions: (i) treatment of actinic keratosis; (ii) determination of the resection margin of the primary lesion; and (iii) treatment of radically incurable cases, as contemporary problems encountered in treating SCC. In these evaluations, all processes were implemented according to the Grading of Recommendations, Assessment, Development, Evaluation system. Also, items of recommendation concerning each clinical question were determined by a multidisciplinary expert panel consisting of dermatologists, plastic/reconstructive surgeons, radiologists, and oncologists through a comprehensive literature search and systematic reviews.

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Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study

Abstract: MMS might be superior to standard excision for cSCCs of the head and neck because of a lower rate of recurrence.

Cited by 76 publications

References 15 publications

Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature

Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature

Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020

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