Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences, Helsingborg Hospital, Helsingborg, Sweden.
J Eur Acad Dermatol Venereol. 2022 Jul;36(7):1113-1117. doi: 10.1111/jdv.18124. Epub 2022 Apr 12.
Mohs micrographic surgery (MMS) is a precise, tissue-sparing surgical technique that offers superior cure rates compared to traditional surgical excision. However, the degree of difficulty of MMS depends on many variables, and consequently, the number of surgical stages required for each case is quite unpredictable.
To identify risk factors for complicated MMS, defined as MMS requiring ≥3 stages.
In a cohort study design, data were prospectively collected from 612 patients that underwent MMS for basal cell carcinoma (BCC) at the Department of Dermatology, Skåne University Hospital, Lund, between 2009 and 2020. Univariate and multivariate logistic regression were used to estimate the risk of MMS requiring ≥3 stages. Due to the risk of multicollinearity between recurrent or incompletely excised BCC and previous treatments, a partially and a fully adjusted multivariate logistic regression model were constructed.
In fully adjusted multivariate analyses, age (odds ratio (OR) 1.02; confidence interval (CI) 95% 1.00-1.04), previous cryotherapy (OR 2.3; CI 95% 1.1-4.8), and >1 previous surgery (OR 3.4; CI 95% 1.5-7.7) were significantly associated with risk of complicated MMS. Recurrent BCC was associated with the risk of complicated MMS in partially adjusted multivariate analyses, but not in the fully adjusted analyses. In this highly selected cohort, histopathological subtype, and tumour localization were not associated with the risk of complicated MMS.
Older age and tumours previously treated with cryotherapy or multiple prior surgeries increased the risk of MMS requiring ≥3 stages. Whether recurrent BCC is an independent risk factor for complicated MMS needs further evaluation. Knowledge of these risk factors may ameliorate the planning of Mohs surgeries.
Mohs 显微外科手术（MMS）是一种精确的、保留组织的手术技术，与传统的手术切除相比，具有更高的治愈率。然而，MMS 的难度取决于许多变量，因此，每个病例所需的手术阶段数量是非常不可预测的。
确定 MMS 复杂的危险因素，定义为需要≥3 个阶段的 MMS。
在一项队列研究设计中，数据从 2009 年至 2020 年在隆德的斯科讷大学医院皮肤科接受 MMS 治疗基底细胞癌（BCC）的 612 名患者中前瞻性收集。使用单变量和多变量逻辑回归来估计需要≥3 个阶段的 MMS 风险。由于复发性或不完全切除的 BCC 和先前治疗之间存在多线性风险，因此构建了部分和完全调整的多变量逻辑回归模型。
在完全调整的多变量分析中，年龄（比值比（OR）1.02；95%置信区间（CI）1.00-1.04）、先前的冷冻疗法（OR 2.3；CI 95% 1.1-4.8）和>1 次先前手术（OR 3.4；CI 95% 1.5-7.7）与 MMS 复杂的风险显著相关。复发性 BCC 与部分调整的多变量分析中的 MMS 复杂风险相关，但与完全调整的分析无关。在这个高度选择的队列中，组织病理学亚型和肿瘤定位与 MMS 复杂的风险无关。
年龄较大和先前用冷冻疗法或多次先前手术治疗的肿瘤增加了需要≥3 个阶段的 MMS 的风险。复发性 BCC 是否是 MMS 复杂的独立危险因素需要进一步评估。了解这些危险因素可能会改善 Mohs 手术的规划。
