Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:76

Article

Stuart, Sarah E.^1,5  Schoen, Patrick^1,6  Jin, Chengshi²  Parvataneni, Rupa^1,7  Arron, Sarah^1,4  Linos, Eleni¹  Boscardin, W. John^2,3  Chren, Mary-Margaret^1,4 

[1] Univ Calif San Francisco, Dept Dermatol, Program Clin Res, San Francisco, CA 94143 USA

[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA

[3] Univ Calif San Francisco, Dept Med, San Francisco, CA USA

[4] San Francisco VA Med Ctr, San Francisco, CA USA

[5] Western Univ Hlth Sci, Coll Osteopath Med Pacific, Pomona, CA USA

[6] Populat Serv Int, Washington, DC USA

[7] Cardiovasc Res Fdn, New York, NY USA

关键词: Appropriate Use Criteria;    basal cell carcinoma;    cutaneous squamous cell carcinoma;    keratinocyte carcinoma;    Mohs micrographic surgery;    outcomes research;   

DOI  :  10.1016/j.jaad.2016.12.045

来源: Elsevier

【 摘 要 】

Background: The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate. Objective: We sought to compare recurrence rates after different treatments in tumors judged appropriate for MMS. Methods: We used data from an observational prospective cohort study and retrospectively categorized consecutive tumors as appropriate for MMS according to the AUC. Among appropriate tumors, we used survival analyses to compare 5-year recurrence rates after treatments. Results: Among tumors appropriate for MMS (N = 1483), adjusted 5-year recurrence rates were 2.9% (range, 1.4-4.3%) after MMS, 5.5% (range, 3.1-7.9%) after excision, 4.0% (range, 0.6-7.2%) after destruction, and 5.9% (range, 1.5-10.2%) after other treatments. In tumors treated only with MMS or excision (the most similar subgroups), the adjusted hazard ratio of 5-year recurrence after MMS was 0.6 (95% confidence interval, 0.3-1.0; P = .06). Limitations: This study is limited by its uncertain generalizability, lack of randomization, and unmeasured characteristics. Conclusion: The AUC identified tumors for which recurrence would be less common after MMS than after excision, but the absolute difference in recurrence rates was small.

【 授权许可】

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