Mohs surgery is effective for high-risk cutaneous squamous cell carcinoma.
BACKGROUND
Mohs micrographic surgery (MMS) is effective in the treatment of invasive cutaneous squamous cell carcinoma (SCC). High-risk SCC has a more guarded prognosis.


OBJECTIVE
To report the outcome of patients with high-risk SCCs treated with MMS.


METHODS
Two hundred fifteen patients with 260 high-risk cutaneous SCCs were reviewed in a single-center retrospective study, considering rates of recurrence, metastasis, and death. Cases were analyzed according to sex, age, immunocompetency status, tumor depth, lesion site, perineural disease, death rate, cause of death, secondary SCC, and melanoma. Seventy-seven percent of patients were male; 23% were female. Average age was 70.6. Twenty percent of patients were immunosuppressed. Mean follow-up was 3.9 years.


RESULTS
There were three local recurrences (1.2%). Twelve (4.6%) tumors involved named nerve trunks. In eight of these cases, adjuvant radiation therapy was employed. Six (2.3%) tumors metastasized, with one fatality from disease. Seventy-five percent of patients developed another cutaneous SCC, and 7.7% developed a subsequent malignant melanoma.


CONCLUSIONS
MMS is an effective treatment for high-risk cutaneous SCC. This represents the largest single-center study of high-risk SCC supporting the use of MMS. Adjuvant radiotherapy was reserved for large-nerve perineural disease. There was a low recurrence rate and disease-specific mortality. Prompt recognition of metastatic disease allowed for curative therapy. Patients with one high-risk SCC are likely to develop secondary primary SCC and melanoma.
Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Melissa
M
Pugliano-Mauro
Glenn
G
Goldman
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology*; D008875:Middle Aged; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome