Department of Dermatology, University of Iowa, Iowa City, IA 52241, USA.
J Dermatolog Treat. 2012 Dec;23(6):421-7. doi: 10.3109/09546634.2011.579083. Epub 2011 Jul 25.
Mohs surgery allows excision of skin cancer in a tissue-sparing fashion that minimizes recurrence risk. While the indications for Mohs surgery are well established, factors predictive of complex Mohs cases are less studied.
To determine patient, tumor, and surgeon characteristics associated with complex Mohs cases.
A retrospective review was performed for a 3-year period (7/2006-6/2009) to identify Mohs cases requiring ≥4 stages ("complex"), and a control population requiring ≤3 stages ("non-complex"). Surgical logs for four fellowship-trained Mohs surgeons were reviewed.
77 complex cases (51 academic practice vs. 26 private practice) were compared with 154 control cases (102 academic practice vs. 52 private practice). There were no significant differences in patient age, gender, immunosuppression, academic (2.7% complex) versus private practice (3.5% complex), or surgeons' years of experience. Factors associated with complexity included: recurrent tumors (p < 0.001; odds ratio (OR) 6.88; 95% confidence interval (CI) 2.8-17); basal cell carcinoma (BCC) with infiltrative or morpheaform histology (p = 0.0019; OR 3.0; 95% CI 1.5-6.3); tumors of the nose (p = 0.0168; OR 2.05; 95% CI 1.1-3.7), especially nasal tip (p = 0.0103; OR 3.68; 95% CI 1.3-10.6) and ear (p = 0.0178; OR 3.0; 95% CI 1.2-7.9), especially helix (p = 0.00744; OR 5.9; 95% CI 1.5-22.7); tumors with pre-operative size >1 cm (p = 0.018; OR 2.0; 95% CI 1.1-3.6); and tumors involving >1 cosmetic subunit (p = 0.0072; OR 5.0; 95% CI 1.5-16.7). Complex tumors had greater post-operative area (10.6 ± 1.3 vs. 3.6 ± 0.7 cm2; p < 0.0001), and more often required flap/graft repair (p < 0.0001; OR 6.9; 95% CI 3.7-13.1).
A retrospective study representing a single geographic area.
Mohs cases are similar in complexity whether in academic or private practice. Recurrent/aggressive histology tumors, tumors >1 cm, and tumors on the nose or ear are more likely to prove surgically complex. Advanced knowledge of these factors may be useful pre-operatively as Mohs surgeons plan their scheduled cases.
Mohs 手术可实现以保存组织的方式切除皮肤癌，从而最大限度地降低复发风险。虽然 Mohs 手术的适应证已经明确，但预测复杂 Mohs 病例的因素研究较少。
确定与复杂 Mohs 病例相关的患者、肿瘤和外科医生特征。
对 3 年（2006 年 7 月至 2009 年 6 月）期间的 Mohs 病例进行回顾性分析，以确定需要≥4 个阶段（“复杂”）的病例，以及需要≤3 个阶段（“非复杂”）的对照人群。回顾了四名 fellowship培训的 Mohs 外科医生的手术记录。
与 154 例对照病例（102 例来自学术实践，52 例来自私人实践）相比，77 例复杂病例（51 例来自学术实践，26 例来自私人实践）中没有明显差异在患者年龄、性别、免疫抑制、学术（2.7%复杂）与私人实践（3.5%复杂）或外科医生的工作经验。与复杂性相关的因素包括：复发性肿瘤（p<0.001；优势比（OR）6.88；95%置信区间（CI）2.8-17）；基底细胞癌（BCC）伴浸润或硬皮病样组织学（p=0.0019；OR 3.0；95%CI 1.5-6.3）；鼻部肿瘤（p=0.0168；OR 2.05；95%CI 1.1-3.7），特别是鼻尖（p=0.0103；OR 3.68；95%CI 1.3-10.6）和耳部（p=0.0178；OR 3.0；95%CI 1.2-7.9），特别是耳轮（p=0.00744；OR 5.9；95%CI 1.5-22.7）；术前大小>1cm（p=0.018；OR 2.0；95%CI 1.1-3.6）；以及累及>1 个美容亚单位的肿瘤（p=0.0072；OR 5.0；95%CI 1.5-16.7）。复杂肿瘤的术后面积更大（10.6±1.3cm2 比 3.6±0.7cm2；p<0.0001），更常需要皮瓣/移植物修复（p<0.0001；OR 6.9；95%CI 3.7-13.1）。
这是一项回顾性研究，代表了单一地理位置。
在学术或私人实践中，Mohs 病例的复杂性相似。复发性/侵袭性组织学肿瘤、直径>1cm 的肿瘤以及鼻部或耳部肿瘤更可能被证明具有手术复杂性。在 Mohs 外科医生计划其预定病例时，提前了解这些因素可能会有所帮助。
