Development and validation of a model to predict complex Mohs micrographic surgery in clinical practice: REGESMOSH
Trinidad Montero-Vilchez1,2, Joan R Garcés3,4, Manuel A Rodríguez-Prieto5
1Hospital Universitario Virgen de las Nieves, Granada, Spain.
Summary
A new model predicts complex Mohs micrographic surgery (MMS) needs, including stages and closure type. This tool aids in optimizing MMS scheduling and patient counseling for basal cell carcinoma treatment.
Area of Science:
- Dermatology
- Surgical Oncology
- Health Informatics
Background:
- Mohs micrographic surgery (MMS) requires optimized scheduling, necessitating algorithms to predict complex cases.
- Identifying factors for complex MMS and closure is crucial for efficient patient management.
Purpose of the Study:
- To identify factors associated with complex Mohs micrographic surgery (MMS).
- To develop and validate a predictive model for the number of surgical stages and complex closure in MMS.
Main Methods:
- A nationwide prospective cohort study (REGESMOHS) analyzed patients with basal cell carcinoma (BCC) undergoing MMS.
- Predictive models were constructed and validated to identify factors for ≥3 stages and complex closures (flaps/grafts).
Main Results:
- The study included 5226 patients; 11.1% required ≥3 MMS stages, and 61.2% needed complex closure.
- Predictors for ≥3 stages included tumor dimension, immunosuppression, recurrence, location, aggressiveness, and prior surgery.
- Predictors for complex closure included aggressiveness, evolution time, age, tumor dimension, and location.
Conclusions:
- A validated model predicts MMS needing ≥3 stages and complex closure using clinical and epidemiological data.
- This model can optimize surgical scheduling and inform patients about procedure duration.
- The REGESMOSH scale offers a practical tool for clinical implementation in MMS planning.
