The Skin Surgery Center, Hickory, North Carolina.
Zitelli and Brodland PC, University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania.
J Am Acad Dermatol. 2019 Mar;80(3):633-638. doi: 10.1016/j.jaad.2018.09.015. Epub 2018 Sep 20.
There is little evidence to predict patient outcomes after the treatment of high-risk cutaneous SCC (hrSCC) using Mohs micrographic surgery (MMS).
We sought to report the rates of poor outcomes in patients with hrSCC treated by MMS alone and to determine if any specific clinical factors may be more predictive of these outcomes.
We conducted a retrospective chart review of all patients with hrSCC who were treated in our clinic between October 2011 and December 2015.
We identified 647 hrSCC tumors that met the inclusion criteria. During the follow-up period, there were 19 local recurrences (2.9%), 31 nodal metastases (4.8%), 7 distant metastases (1.1%), and 7 disease-specific deaths (1.1%). Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death through multivariate analysis.
Invasion beyond the subcutaneous fat and poor histologic differentiation may carry a greater risk of poor outcomes than other factors in hrSCC. MMS alone provides excellent marginal control with low rates of local recurrence, nodal metastasis, and disease-specific death.
采用Mohs 显微外科手术（MMS）治疗高危皮肤 SCC（hrSCC）后，预测患者结局的证据很少。
我们旨在报告单独采用 MMS 治疗的 hrSCC 患者不良结局的发生率，并确定是否存在任何特定的临床因素可能更能预测这些结局。
我们对 2011 年 10 月至 2015 年 12 月在我们诊所接受治疗的所有患有 hrSCC 的患者进行了回顾性图表审查。
我们确定了符合纳入标准的 647 个 hrSCC 肿瘤。在随访期间，有 19 例局部复发（2.9%），31 例淋巴结转移（4.8%），7 例远处转移（1.1%）和 7 例疾病特异性死亡（1.1%）。通过多变量分析，两个因素，即分化不良和侵犯皮下脂肪，与局部复发、淋巴结转移和疾病特异性死亡呈正相关。
侵犯皮下脂肪和组织学分化不良可能比 hrSCC 中的其他因素带来更大的不良结局风险。单独采用 MMS 治疗可提供出色的边缘控制，局部复发、淋巴结转移和疾病特异性死亡的发生率较低。
