Murray Christian, Sivajohanathan Duvaraga, Hanna Timothy P, Bradshaw Scott, Solish Nowell, Moran Benvon, Hekkenberg Robert, Wei Alice C, Petrella Teresa
1 Division of Dermatology, Women's College Hospital & University of Toronto, Toronto, ON, Canada.
2 Department of Oncology, McMaster University & Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada.
J Cutan Med Surg. 2019 Jan/Feb;23(1):75-90. doi: 10.1177/1203475418786208. Epub 2018 Jul 22.
The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.
本综述的目的是描述对诊断为皮肤癌的患者进行莫氏显微外科手术（MMS）的循证指征。通过对MEDLINE、EMBASE和Cochrane系统评价数据库进行系统检索，确定了1970年至2017年发表的相关研究。纳入随机对照试验（RCT）、患者数大于30例的前瞻性和回顾性比较研究以及进行多变量分析的单臂回顾性研究。共纳入2项RCT、3项前瞻性研究和16项回顾性研究（14项比较研究和2项单臂研究）。提取了复发率、治愈率、并发症、美容效果和生活质量的数据。鉴于缺乏高质量的比较证据，手术（术后或术中切缘评估）或对不适合手术的患者进行放疗仍应作为皮肤癌患者的标准治疗方法。对于组织学确诊的面部复发性基底细胞癌（BCC）患者，推荐使用MMS；对于面部原发性BCC，若直径>1 cm、具有侵袭性组织学特征或位于面部H区，则适合使用MMS。现有证据难以推广至所有皮肤癌患者，因为证据未充分涵盖非BCC皮肤癌；然而，对于这些皮肤癌，可根据具体情况考虑使用MMS。实施MMS的医生应已获得医学学位或同等学历，包括加拿大皇家内科医师与外科医师学院专科证书或同等证书，并接受过MMS的高级培训。
