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Published on: May 10, 2021
Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on
Stephanie K Lin1, Annika M Deitermann2, Marissa Lubeck3
1Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
Background:
Mohs micrographic surgery may be discontinued with positive margins as an anticipated strategy for multidisciplinary care or as an unanticipated occurrence. Management of primary tumors has not been compared after anticipated versus unanticipated incomplete Mohs micrographic surgery (iMMS).
Objective:
To compare rates and timing of adjuvant surgery after iMMS and final margin status when iMMS is anticipated versus unanticipated. Secondary outcomes were preoperative and intraoperative clinicopathologic factors associated with iMMS.
Methods:
Cases of iMMS of keratinocyte carcinomas at a tertiary academic center between 2005 and 2022 were classified as anticipated (preoperative assembly of multidisciplinary teams) or unanticipated (ad hoc management of positive margins). Rate, timing, and final margin status of adjuvant surgery was compared between anticipated and unanticipated iMMS cohorts using χ2/Fisher exact test for categorical variables and t-test for continuous variables.
Results:
Of 127 iMMS cases, 51.2% (65/127) were anticipated. Anticipated iMMS cases were more likely to undergo additional resection (98.5% vs 72.6%, p < .001), with fewer delays (3.9 vs 13.2 days, p < .001) and higher rates of final margin clearance (84.6% vs 59.7%, p < .001).
Conclusion:
When iMMS is anticipated as part of multidisciplinary care, patients are more likely to undergo additional resection, with fewer delays to next surgery and higher final margin clearance rates.
Insights
Anticipating incomplete Mohs micrographic surgery (iMMS) as part of multidisciplinary care improves outcomes. Patients undergoing anticipated iMMS have higher rates of additional resection, fewer delays, and better final margin clearance.
Area of Science:
- Dermatology
- Surgical Oncology
- Oncology
Background:
- Mohs micrographic surgery may result in positive margins, either planned or unplanned.
- Incomplete Mohs micrographic surgery (iMMS) requires further management.
- Prior comparisons of outcomes after anticipated versus unanticipated iMMS are lacking.
Purpose of the Study:
- To compare adjuvant surgery rates and timing after anticipated versus unanticipated iMMS.
- To evaluate final margin status following anticipated versus unanticipated iMMS.
- To identify clinicopathologic factors associated with iMMS.
Main Methods:
- Retrospective analysis of keratinocyte carcinoma iMMS cases (2005-2022).
- Classification of iMMS as anticipated (multidisciplinary team) or unanticipated (ad hoc).
- Comparison of adjuvant surgery rates, timing, and margin status using statistical tests.
Main Results:
- 51.2% of iMMS cases were anticipated.
- Anticipated iMMS cases had higher rates of additional resection (98.5% vs 72.6%).
- Anticipated iMMS cases experienced fewer delays (3.9 vs 13.2 days) and higher final margin clearance (84.6% vs 59.7%).
Conclusions:
- Anticipating iMMS within multidisciplinary care enhances patient management.
- Proactive planning for iMMS leads to more timely and effective surgical treatment.
- Anticipated iMMS improves final margin clearance rates for keratinocyte carcinomas.
