Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A.
Laryngoscope. 2021 Nov;131(11):2490-2496. doi: 10.1002/lary.29570. Epub 2021 Apr 12.
Determine if Mohs micrographic surgery (MMS) is associated with improved overall survival compared to wide local excision (WLE) when treating cutaneous melanoma of the head and neck (CMHN) and to report the proportion of patients treated with MMS versus WLE who also underwent sentinel lymph node biopsy (SLNB).
Retrospective cohort study of the National Cancer Database (NCDB) analyzing the overall survival of patients diagnosed with T1 to T4 CMHN between 2004 and 2016 who were treated with either WLE or MMS.
On multivariable analysis, treatment with WLE versus MMS was not significantly associated with overall survival (HR, 1.094; 95% CI, 0.997-1.201). On multivariable analysis, lower Charlson-Deyo score (HR, 0.489; 95% CI, 0.427-0.560), negative margins (HR, 0.754; 95% CI, 0.705-0.807), and N0 classification (HR 0.698; 95% CI, 0.668-0.730) were associated with improved overall survival. Seventy-seven percent of patients treated with MMS did not undergo SLNB, while 45% of patients treated with WLE did not undergo SLNB (P < .001).
No difference in overall survival between MMS and WLE when treating CMHN. Patients treated with MMS were significantly less likely to undergo SLNB, suggesting an opportunity for enhancement of multidisciplinary care.
4 Laryngoscope, 131:2490-2496, 2021.
确定在治疗头颈部皮肤黑素瘤（CMHN）时，与广泛局部切除术（WLE）相比，Mohs 显微外科手术（MMS）是否与改善总生存率相关，并报告接受 MMS 治疗与接受 WLE 治疗且同时接受前哨淋巴结活检（SLNB）的患者比例。
对国家癌症数据库（NCDB）进行回顾性队列研究，分析 2004 年至 2016 年间 T1 至 T4 CMHN 患者的总生存率，这些患者接受了 WLE 或 MMS 治疗。
多变量分析显示，与 MMS 相比，WLE 治疗与总生存率无显著相关性（HR，1.094；95%CI，0.997-1.201）。多变量分析显示，较低的 Charlson-Deyo 评分（HR，0.489；95%CI，0.427-0.560）、阴性切缘（HR，0.754；95%CI，0.705-0.807）和 N0 分类（HR 0.698；95%CI，0.668-0.730）与改善总生存率相关。77%接受 MMS 治疗的患者未行 SLNB，而 45%接受 WLE 治疗的患者未行 SLNB（P<.001）。
在治疗 CMHN 时，MMS 与 WLE 之间的总生存率无差异。接受 MMS 治疗的患者行 SLNB 的可能性显著降低，这表明有机会加强多学科治疗。
4 级喉镜，131：2490-2496，2021。
