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TOPLINE:

Mohs surgery was associated with improved outcomes compared with wide local excision (WLE) in patients with primary high-stage cutaneous squamous cell carcinoma (cSCC), showing lower rates of recurrence, metastasis, and disease-specific mortality.

METHODOLOGY:

• Researchers conducted a retrospective study of 216 patients with primary high-stage cSCC treated with Mohs surgery or WLE at Brigham and Women’s Hospital, Boston, between 2000 and 2019 (mean age, 73.5 years; 69.9% men; 95.4% White individuals).
• Study outcomes included local recurrence, nodal metastasis, distant metastasis, any recurrence, and disease-specific mortality.
• The median follow-up time was 33.1 months.

TAKEAWAY:

• After inverse probability of treatment weighting, the 3-year cumulative incidence of local recurrence was 19.8% for WLE vs 9.6% for Mohs surgery (cause-specific hazard ratio [HR], 2.33; P = .001).
• The cumulative incidence of nodal metastasis was 17.9% vs 11.0% for WLE and Mohs surgery, respectively (HR, 1.80; P = .03). The incidence of distant metastasis was not significantly different (8.4% for WLE vs 4.4% for Mohs surgery).
• The cumulative incidence of any recurrence was 32.0% for WLE vs 15.8% for Mohs surgery (HR, 2.38; P < .001).
• The cumulative incidence of disease-specific death was 17.5% for WLE vs 7.1% for Mohs surgery (HR, 2.74; P = .001).

IN PRACTICE:

“The findings of this cohort study suggest that Mohs surgery may be superior to WLE for the treatment of high-stage cSCC,” the authors wrote. “Patients presenting with primary high-stage cSCC,” they added, “should be offered first-line treatment with Mohs surgery whenever possible and NCCN [National Comprehensive Cancer Network]-compliant PDEMA [peripheral and deep en face margin assessment] if Mohs surgery is not possible or is unavailable.”

SOURCE:

The study was led by David M. Wang, MD, Department of Dermatology, Brigham and Women’s Hospital. It was published online on February 19 in JAMA Dermatology.

LIMITATIONS:

The main limitations of the study were its single-center data and an observational design.

DISCLOSURES:

The study funding source was not reported. Two authors reported receiving personal fees and grants from various companies, holding patents and stocks, and serving as director for the American Society for Dermatologic Surgery and as founder for Skin Cancer Outcomes Consortium and Chronicle Medical Software.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.