Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Am Acad Dermatol. 2021 Sep;85(3):588-595. doi: 10.1016/j.jaad.2021.01.063. Epub 2021 Jan 29.
There is limited literature on the long-term outcomes and prognostic factors of high-risk cutaneous squamous cell carcinomas (hrSCC) treated with Mohs micrographic surgery (MMS).
To determine the rates of local recurrence, metastatic disease, and disease-specific death in hrSCCs treated with MMS and patient or tumor factors associated with poor outcomes.
Single-institution, retrospective cohort analysis of hrSCC treated with MMS alone and MMS with adjuvant therapy.
A total of 882 cases of hrSCC treated with MMS were identified, of which 842 were treated with MMS alone, with a median follow-up time of 2.4 years. The rate of local recurrence was 2.5%, of metastatic disease was 1.9%, and of disease-specific death was 0.57%. Perineural invasion, poor differentiation, and immunosuppression were significantly associated with poor outcomes. In propensity score-matched case patients treated with adjuvant therapy and control patients treated with Mohs alone, there was no significant difference in progression-free survival, but matching was imperfect.
Single-institution, retrospective review.
MMS remains an effective treatment for hrSCC. Current SCC staging systems may be limited by inconsistent inclusion of poor differentiation. Immunosuppression, especially transplant, should be considered a high-risk clinical feature. Further study is needed on the effect of adjuvant treatment.
有关接受 Mohs 显微外科手术（MMS）治疗的高危皮肤鳞状细胞癌（hrSCC）的长期结果和预后因素的文献有限。
确定接受 MMS 治疗的 hrSCC 的局部复发率、转移性疾病率和疾病特异性死亡率，以及与不良结局相关的患者或肿瘤因素。
对单独接受 MMS 治疗和 MMS 联合辅助治疗的 hrSCC 进行单机构回顾性队列分析。
共确定了 882 例接受 MMS 治疗的 hrSCC 病例，其中 842 例单独接受 MMS 治疗，中位随访时间为 2.4 年。局部复发率为 2.5%，转移性疾病率为 1.9%，疾病特异性死亡率为 0.57%。神经周围侵犯、低分化和免疫抑制与不良结局显著相关。在接受辅助治疗的倾向评分匹配病例患者和单独接受 Mohs 治疗的对照患者中，无进展生存期无显著差异，但匹配并不完美。
单机构、回顾性研究。
MMS 仍然是治疗 hrSCC 的有效方法。目前的 SCC 分期系统可能受到低分化不一致纳入的限制。免疫抑制，特别是移植，应被视为高危临床特征。需要进一步研究辅助治疗的效果。
