Mohs Surgery vs Wide Local Excision in Primary High-Stage Cutaneous Squamous Cell Carcinoma

Area of Science:

• Dermatology
• Surgical Oncology
• Cancer Research

Background:

• High-stage cutaneous squamous cell carcinoma (cSCC) carries significant risks of recurrence, metastasis, and mortality.
• Limited studies compare treatment outcomes for high-stage cSCC using Mohs surgery versus wide local excision (WLE).

Purpose of the Study:

• To compare the treatment outcomes of primary high-stage cSCC in patients managed with Mohs surgery versus WLE.
• To evaluate the efficacy of Mohs surgery in reducing adverse events compared to WLE for advanced cSCC.

Main Methods:

• Retrospective cohort study utilizing propensity score weighting in a tertiary academic medical center.
• Inclusion criteria: primary high-stage cSCC treated with Mohs surgery or WLE (2000-2019).
• Outcomes assessed: local recurrence, nodal/distant metastasis, composite recurrence, and disease-specific death using competing risk regression analysis.

Main Results:

• After propensity score weighting, baseline characteristics were balanced between groups.
• Mohs surgery was associated with significantly lower 3-year cumulative incidence of local recurrence (9.6% vs 19.8%), nodal metastasis (11.0% vs 17.9%), any recurrence (15.8% vs 32.0%), and disease-specific death (7.1% vs 17.5%) compared to WLE.
• Weighted cause-specific hazard ratios favored Mohs surgery for all adverse outcomes.

Conclusions:

• Mohs surgery is associated with improved outcomes for primary high-stage cSCC compared to WLE.
• These findings support offering Mohs surgery or similar margin assessment techniques as a first-line treatment for high-stage cSCC.