Surgical Delays in Mohs Micrographic Surgery Are Associated With Tumor Growth in Moderate- and Poorly-Differentiated SCCs

TAKE-HOME MESSAGE

• The mean time from biopsy to surgery was 55 days among patients with squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) treated with Mohs surgery. The mean change in major diameter for all lesions was 0.9 cm. SCCs showed a larger change in diameter than BCCs. For SCCs, a histologic subtype of poor or moderate differentiation were independent predictors of change in mean diameter, with growth of 0.28 cm and 0.24 cm per month of delay, respectively. BCC histologic subtypes did not demonstrate a relationship between change in diameter and surgical delay.

• Prompt treatment is most important for moderate and poorly differentiated SCCs.

–  Katherine M. Stiff, MD

Abstract

BACKGROUND

Evidence is controversial and limited surrounding whether surgical delays are associated with tumor growth for cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs).

OBJECTIVE

Identify tumor subpopulations that may demonstrate an association between tumor growth and surgical delay.

METHODS

We retrospectively analyzed 299 SCCs and 802 BCCs treated with Mohs surgery at a single institution. Time interval from biopsy to surgery represented surgical delay. Change in major diameter (ΔMD) from size at biopsy to postoperative defect represented tumor growth. Independent predictors of ΔMD were identified by multivariate analysis. Linear regression was then utilized to assess for whether the ΔMD from these independent predictors trended with surgical delay.

RESULTS

Surgical delays ranged 0-331 days. Among SCCs, histologic subtype and prior treatment were identified as independent predictors of ΔMD. Significant associations between ΔMD and surgical delay were found for poorly- and moderately differentiated SCCs, demonstrating growth rates of 0.28cm and 0.24cm per month of delay, respectively. The ΔMD for SCCs with prior treatment and BCC subgroups did not vary with surgical delay.

LIMITATIONS

Retrospective design, single center.

CONCLUSION

Surgical delays under a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance.

ournal of the American Academy of Dermatology

Surgical delays less than 1 year in Mohs micrographic surgery associated with tumor growth in moderate- and poorly-differentiated squamous cell carcinomas but not lower-grade squamous cell carcinomas or basal cell carcinomas, a retrospective analysis

J Am Acad Dermatol 2021 Sep 06;[EPub Ahead of Print], J Lee, VJ Forrester, WM Novicoff, DJ Guffey, MA Russell 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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