Department of Dermatology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands.
Department of Dermatology, University Medical Centre Groningen, Groningen, the Netherlands.
Br J Dermatol. 2019 Aug;181(2):338-343. doi: 10.1111/bjd.17188. Epub 2018 Oct 28.
Recurrent cutaneous squamous cell carcinoma (cSCC) has been associated with an increased risk of local functional and aesthetic comorbidity, metastasis and mortality.
To compare the risk of recurrence between Mohs micrographic surgery (MMS) and standard excision for cSCC of the head and neck.
This was a retrospective cohort study of all patients with a cSCC treated with MMS or standard excision at the departments of dermatology of a secondary or tertiary care hospital in the Netherlands between 2003 and 2012. To detect all recurrences, patients were linked to the Dutch pathology registry. To compare the risk of recurrence between MMS and standard excision, hazard ratios (HRs) were used adjusted for clinical tumour size > 2 cm and deep tumour invasion.
A total of 579 patients with 672 cSCCs were included: 380 cSCCs were treated with MMS and 292 with standard excision. The risk of recurrence was 8% (22 of 292) after standard excision during a median follow-up of 5·7 years [interquartile range (IQR) 3·5-7·8], which was higher than the 3% (12 of 380) after MMS during a median follow-up of 4·9 years (IQR 2·3-6·0). The cumulative incidence of recurrence was higher for standard excision than for MMS during the entire follow-up period of 8·6 years. Carcinomas treated with MMS were at a three times lower risk of recurrence than those treated with standard excision when adjusted for tumour size and deep tumour invasion (adjusted HR 0·31, 95% confidence interval 0·12-0·66).
MMS might be superior to standard excision for cSCCs of the head and neck because of a lower rate of recurrence.
复发性皮肤鳞状细胞癌（cSCC）与局部功能和美容合并症、转移和死亡率增加有关。
比较Mohs 显微外科手术（MMS）与标准切除术治疗头颈部 cSCC 的复发风险。
这是一项回顾性队列研究，纳入了 2003 年至 2012 年期间荷兰一家二级或三级保健医院皮肤科接受 MMS 或标准切除术治疗的所有 cSCC 患者。为了检测所有复发，患者与荷兰病理登记处相关联。为了比较 MMS 和标准切除之间的复发风险，使用调整了临床肿瘤大小＞2cm 和肿瘤深部浸润的风险比（HRs）。
共纳入 579 例患者，672 例 cSCC：292 例接受标准切除术，380 例接受 MMS 治疗。在中位随访 5.7 年（IQR 3.5-7.8）期间，标准切除后复发风险为 8%（22/292），高于 MMS 后 3%（12/380），中位随访 4.9 年（IQR 2.3-6.0）。在整个 8.6 年随访期间，标准切除的累积复发率高于 MMS。调整肿瘤大小和肿瘤深部浸润后，MMS 治疗的癌复发风险比标准切除低 3 倍（调整 HR 0.31，95%置信区间 0.12-0.66）。
MMS 可能优于标准切除术，因为其复发率较低，适用于头颈部 cSCC。
