College of Medicine, The Ohio State University, Columbus, OH, USA.
Department of Dermatology, Altru Health System, University of North Dakota Medical School, Grand Forks, ND, USA.
Arch Dermatol Res. 2023 Mar;315(2):301-303. doi: 10.1007/s00403-022-02376-6. Epub 2022 Aug 9.
Multiple high-risk factors have been associated with poor outcomes in cutaneous squamous cell carcinoma, including immunosuppression, poor differentiation, depth, diameter, and perineural invasion. While many of these are included in major staging systems, their measurement and reporting vary considerably in clinical practice. We performed a survey study of fellowship-trained Mohs surgeons to explore their attitudes and practices related to recording squamous cell carcinoma high-risk factors and staging information at the time of Mohs. An anonymous Qualtrics survey of 25 questions was distributed to the American College of Mohs Surgery membership listserv. There were 107 complete surveys (response rate 7.1%), with over 95% of subjects from the United States. Fifty-five percent had been practicing 10 years or less, 28% between 11 and 20 years, and the remainder greater than 20 years. Fifty-seven percent were in private or group practices, and 43% were in academia. Nearly all respondents consistently report tumor recurrence (100%), location (100%), immunosuppression (94%), and diameter (93%). Only 70% grade differentiation for every squamous cell carcinoma case. Sixty-six percent of participants consistently record anatomic depth, while only 2% always or almost always record Breslow depth. Although 96% of respondents almost always or always record perineural invasion, only 34% consistently record nerve diameter. Forty-three percent reported that they never or rarely stage cutaneous squamous cell carcinomas, whereas 43% often, almost always, or always stage. In conclusion, certain high-risk factors, such as differentiation, Breslow depth, and stage, are recorded inconsistently by Mohs surgeons. Several participants commented that they prefer to send a central debulk to dermatopathology to assess staging parameters in all tumors with high-risk features. While this strategy may be useful in some practice settings, Mohs surgeons possess the skills necessary to perform a central debulk analysis themselves at the time of Mohs. Whether performed at the time of Mohs or by dermatopathology, assessing high-risk features and accurately staging cutaneous squamous cell carcinoma is paramount to detecting tumors at higher risk of poor outcomes.
多种高危因素与皮肤鳞状细胞癌的不良预后相关，包括免疫抑制、分化差、深度、直径和神经周围侵犯。虽然这些因素中的许多都包含在主要分期系统中，但在临床实践中，它们的测量和报告差异很大。我们对 fellowship 培训的 Mohs 外科医生进行了一项调查研究，以探讨他们在 Mohs 时记录鳞状细胞癌高危因素和分期信息的态度和做法。我们使用 Qualtrics 对 25 个问题进行了匿名调查，并将其分发给美国 Mohs 外科学会会员名单服务。共有 107 份完整的调查（回应率为 7.1%），其中超过 95%的参与者来自美国。55%的人从业时间在 10 年或以下，28%的人从业时间在 11 至 20 年，其余的人从业时间超过 20 年。57%的人在私人或团体诊所工作，43%的人在学术界工作。几乎所有的受访者都一致报告肿瘤复发（100%）、位置（100%）、免疫抑制（94%）和直径（93%）。只有 70%的人一致报告每例鳞状细胞癌的分化程度。66%的参与者一致记录解剖深度，而只有 2%的人始终或几乎始终记录 Breslow 深度。尽管 96%的受访者几乎总是或总是记录神经周围侵犯，但只有 34%的人始终记录神经直径。43%的人报告说他们从不或很少对皮肤鳞状细胞癌进行分期，而 43%的人经常、几乎总是或总是进行分期。总之，Mohs 外科医生对某些高危因素（如分化、Breslow 深度和分期）的记录不一致。一些参与者评论说，他们更愿意将中央减瘤送到皮肤科病理科，以评估所有具有高危特征的肿瘤的分期参数。虽然这种策略在某些实践环境中可能有用，但 Mohs 外科医生具备在 Mohs 时自行进行中央减瘤分析的技能。无论在 Mohs 时还是由皮肤科病理科进行，评估高危特征并准确分期皮肤鳞状细胞癌对于发现预后不良风险较高的肿瘤至关重要。
