Department of Dermatology, Rowan House, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Department of Dermatology, Lauriston Building, Lauriston Place, Edinburgh, UK.
Clin Exp Dermatol. 2022 Oct;47(10):1765-1773. doi: 10.1111/ced.15187. Epub 2022 Jul 26.
This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for cost-effectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta-analyses. We categorized the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with perineural invasion, and cost-effectiveness. Although there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomized controlled trials (RCT) were identified. The evidence from comparitor studies suggests that MMS has a lower recurrence rate than that of other treatments for cSCC, including standard excision. Many studies identified were single-armed, but did demonstrate a low to very low recurrence rate of cSCC following MMS. A single recent study suggests MMS for intermediate cSCC is highly cost-effective compared with wide local excision when all-in costs are considered. Since the overall quality of included studies was mixed and highly heterogeneous, further methodologically robust studies with comparator arms or comprehensive long-term registry data would be valuable. It would be ideal to employ a definitive multicentre RCT but given the evidence to date and multiple advantages to MMS, the lack of clinical equipoise makes this difficult to justify. Comparison with current modalities would likely not be ethical/achievable on a like-for-like basis given MMS provides 100% margin assessment, enables histological clearance prior to reconstruction, and minimizes the removal of uninvolved tissue.
本文综述了 MMS 治疗皮肤鳞状细胞癌（cSCC）的证据。检索了 MEDLINE、Embase 和 Cochrane 数据库；确定了 39 篇关于复发的论文和 2 篇关于成本效益的论文。我们纳入了所有临床试验和观察性研究，包括回顾性报告，并排除了社论和系统评价或荟萃分析。我们根据以下标题对证据进行分类：肿瘤复发、特定部位结局（耳、唇、头皮和眼周）、有神经周围侵犯的 cSCC 以及成本效益。尽管有许多观察性研究表明 MMS 在某些 cSCC 治疗中的潜在益处，但未确定随机对照试验（RCT）。来自比较研究的证据表明，MMS 比其他治疗 cSCC 的方法（包括标准切除）的复发率更低。许多确定的研究都是单臂的，但确实表明 MMS 治疗后 cSCC 的复发率低至非常低。最近的一项研究表明，当考虑所有成本时，MMS 治疗中危 cSCC 与广泛局部切除相比具有高度成本效益。由于纳入研究的总体质量参差不齐且高度异质，因此具有比较臂或全面长期登记数据的进一步方法学稳健研究将是有价值的。采用确定性多中心 RCT 是理想的，但鉴于迄今为止的证据和 MMS 的多种优势，缺乏临床均衡使得这难以证明合理。鉴于 MMS 提供 100%的切缘评估，能够在重建前进行组织学清除，并最大限度地减少非受累组织的切除，因此与当前模式进行比较可能在伦理上/无法实现。
