Differences in time to surgery and defect sizes after Mohs micrographic surgery for black versus white patients with...

Few studies have examined outcomes for Mohs micrographic surgery (MMS) for cutaneous squamous cell carcinoma (cSCC) in Black versus White patients. We compared time to surgery and defect sizes after MMS between Black versus White patients with cSCC. Patients with biopsy-proven cSCC treated with MMS at the Hospital of the University of Pennsylvania were identified from a prospectively maintained database (2006-2023). Our primary outcomes included time to surgery (days from the diagnostic biopsy to the first MMS) and defect size (final MMS defect surface area). Univariate and multivariate linear regression models were performed to compare outcomes between Black and White patients with adjustments for age, gender, and tumor location. We identified 8445 cSCC, including 8329 (98.2%) in White patients and 116 (1.4%) in Black patients. Mean time to surgery was 31% longer for Black (76 ± 3.9 days) versus White patients (58 ± 0.5 days) [p < 0.001]. Mean post-MMS cSCC defect size was nearly four times larger for Black (18.6 ± 1.2 cm²) versus White patients (4.8 ± 0.1 cm²) [p < 0.0001]. These differences remained significant when adjusted for age, gender, and tumor location [p < 0.0001]. In conclusion, Black patients with cSCC have significantly longer treatment delays and larger MMS defects than White patients. This study highlights the need for earlier diagnosis and more timely access to MMS for Black patients with cSCC.