Department of Dermatology, Harvard Combined Dermatology Residency Program, Harvard Medical School, Boston, Massachusetts.
Department of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Dermatol Surg. 2020 Dec;46(12):1473-1480. doi: 10.1097/DSS.0000000000002354.
The National Comprehensive Cancer Network (NCCN) has established guidelines for the treatment of keratinocyte carcinomas (KCs). Complete circumferential peripheral and deep margin assessment (CCPDMA) is recommended for "high-risk" tumors that cannot be closed primarily. If flap or grafts are needed and CCPDMA was not used, it is recommended that reconstruction be delayed until achieving clear margins.
To measure provider utilization rates of the NCCN guidelines for high-risk KCs and assess barriers that are limiting adherence.
A ten-item questionnaire was distributed to NCCN nonmelanoma skin cancer panel members and physicians participating in KC treatment at academic institutions.
Response rate was 49% (57/116). Responses were categorized by practice area: Mohs surgery, pathology, and other specialties: General Dermatology, Otolaryngology, Plastic Surgery, Surgical Oncology, Radiation Oncology, and Oral and Maxillofacial Surgery. Mohs surgeons were most likely to use CCPDMA for tumors meeting NCCN criteria with 14/15 using this technique in a majority of their cases, versus 2/6 pathologists and 10/16 specialists from other fields. Reasons cited for not using CCPDMA included deference to pathologists to determine the appropriate method for margin assessment and logistical difficulty.
Further efforts are needed to increase adherence to NCCN's guidelines regarding CCPDMA in KCs.
美国国家综合癌症网络（NCCN）已制定了治疗角化细胞癌（KC）的指南。对于无法直接缝合的“高危”肿瘤，建议进行完整的环形周边和深层切缘评估（CCPDMA）。如果需要皮瓣或移植物，且未使用 CCPDMA，则建议在获得明确切缘后再进行重建。
测量 NCCN 高危 KC 指南的提供者使用率，并评估限制依从性的障碍。
向 NCCN 非黑素瘤皮肤癌专家组的成员和在学术机构中参与 KC 治疗的医生分发了一份十项的调查问卷。
应答率为 49%（57/116）。应答者按实践领域分类：Mohs 手术、病理学和其他专业：普通皮肤科、耳鼻喉科、整形外科、外科肿瘤学、放射肿瘤学和口腔颌面外科。Mohs 外科医生最有可能对符合 NCCN 标准的肿瘤使用 CCPDMA，其中 14/15 的医生在大多数情况下使用该技术，而病理学家中只有 2/6，其他领域的专家中有 10/16。不使用 CCPDMA 的原因包括听从病理学家的意见，以确定适当的切缘评估方法和实际困难。
需要进一步努力，以提高对 NCCN 关于 KC 中 CCPDMA 指南的依从性。
