Complete Margin Assessment Versus Sectional Assessment in Surgically Excised High-Risk Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
entrez:
1
7
2022
pubmed:
2
7
2022
medline:
8
7
2022
Statut:
ppublish
Résumé
Keratinocyte carcinomas (KCs) are the most diagnosed cancers worldwide and are commonly excised via complete margin assessment (CMA) or excision with sectional assessment (SA). National Comprehensive Cancer Network guidelines encourage CMA for KC with high-risk features. To systematically compare recurrence outcomes for CMA vs SA in high-risk KC based on National Comprehensive Cancer Network guidelines criteria. EMBASE and MEDLINE were searched for articles reporting recurrences of high-risk KC undergoing excision using CMA or SA. High-risk KCs were defined as recurrent, having perineural invasion (PNI), or basal cell carcinomas (BCC) with aggressive histology. Chi-squared tests and risk ratios evaluated differences between CMA and SA groups, and a random-effects meta-analysis was performed. Twenty-eight studies met inclusion criteria. Pooled percentages of locoregional recurrences were significantly lower with CMA vs SA for all KCs (3.9% [95% CI: 2.9-4.9] vs 13.5% [7.7, 19.2, p = .001]), cutaneous squamous cell carcinoma with PNI (9.8% [5.4-14.1] vs 32.0% [25.0-39.0], p < .001), and recurrent BCC (4.4% [2.9-5.9] vs 11.9% [8.0-15.8], p < .001). For high-risk KCs, recurrence risk was over 3-times greater with SA compared with CMA. Expanded access to CMA for high-risk KC is likely to reduce recurrence risk and improve clinical outcomes.
Sections du résumé
BACKGROUND
Keratinocyte carcinomas (KCs) are the most diagnosed cancers worldwide and are commonly excised via complete margin assessment (CMA) or excision with sectional assessment (SA). National Comprehensive Cancer Network guidelines encourage CMA for KC with high-risk features.
OBJECTIVE
To systematically compare recurrence outcomes for CMA vs SA in high-risk KC based on National Comprehensive Cancer Network guidelines criteria.
MATERIALS AND METHODS
EMBASE and MEDLINE were searched for articles reporting recurrences of high-risk KC undergoing excision using CMA or SA. High-risk KCs were defined as recurrent, having perineural invasion (PNI), or basal cell carcinomas (BCC) with aggressive histology. Chi-squared tests and risk ratios evaluated differences between CMA and SA groups, and a random-effects meta-analysis was performed.
RESULTS
Twenty-eight studies met inclusion criteria. Pooled percentages of locoregional recurrences were significantly lower with CMA vs SA for all KCs (3.9% [95% CI: 2.9-4.9] vs 13.5% [7.7, 19.2, p = .001]), cutaneous squamous cell carcinoma with PNI (9.8% [5.4-14.1] vs 32.0% [25.0-39.0], p < .001), and recurrent BCC (4.4% [2.9-5.9] vs 11.9% [8.0-15.8], p < .001).
CONCLUSION
For high-risk KCs, recurrence risk was over 3-times greater with SA compared with CMA. Expanded access to CMA for high-risk KC is likely to reduce recurrence risk and improve clinical outcomes.
Identifiants
pubmed: 35778249
doi: 10.1097/DSS.0000000000003462
pii: 00042728-202207000-00002
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
704-710Informations de copyright
Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Cakir BÖ, Adamson P, Cingi C. Epidemiology and economic burden of nonmelanoma skin cancer. Facial Plast Surg Clin 2012;20:419–22.
Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population. JAMA Dermatol 2015;151:1081–6.
Housman TS, Feldman SR, Williford PM, Fleischer AB Jr, et al. Skin cancer is among the most costly of all cancers to treat for the Medicare population. J Am Acad Dermatol 2003;48:425–9.
Vuyk HD, Lohuis PJ. Mohs micrographic surgery for facial skin cancer. Clin Otolaryngol Allied Sci 2001;26:265–73.
van Loo E, Mosterd K, Krekels GAM, Roozeboom MH, et al. Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10year follow-up. Eur J Cancer 2014;50:3011–20.
van der Eerden PA, Prins MEF, Lohuis PJFM, Balm FAJM, et al. Eighteen years of experience in Mohs micrographic surgery and conventional excision for nonmelanoma skin cancer treated by a single facial plastic surgeon and pathologist. Laryngoscope 2010;120:2378–84.
Abide JM, Nahai F, Bennett RG. The meaning of surgical margins. Plast Reconstr Surg 1984;73:492–6.
Stratigos A, Garbe C, Lebbe C, Malvehy J, et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer 2015;51:1989–2007.
Nasr I, McGrath EJ, Harwood CA, Botting J, et al. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021;185:899–920.
Rapini RP. Comparison of methods for checking surgical margins. J Am Acad Dermatol 1990;23:288–94.
Breuninger H, Schaumburg-Lever G. Control of excisional margins by conventional histopathological techniques in the treatment of skin tumours. An alternative to Mohs' technique. J Pathol 1988;154:167–71.
Breuninger H. Histologic control of excised tissue edges in the operative treatment of basal-cell carcinomas. J Dermatol Surg Oncol 1984;10:724–8.
Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 1989;15:424–31.
Rowe DE, CarrollDay RJCL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 1989;15:315–28.
Morgan FC, Ruiz ES, Karia PS, Besaw RJ, et al. Factors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter. J Am Acad Dermatol 2020;83:832–8.
Marrazzo G, Zitelli JA, Brodland D. Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone. J Am Acad Dermatol 2019;80:633–8.
Schmults CD, Karia PS, Carter JB, Han J, et al. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-Institution cohort study. JAMA Dermatol 2013;149:541–7.
Schmults CD, Blitzblau R, Aasi SZ, Alam M, et al. NCCN Guidelines® insights: squamous cell skin cancer, version 1.2022. J Natl Compr Cancer Netw JNCCN 2021;19:1382–94.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology for Basal Cell Skin Cancer , (Version 1.2022). National Comprehensive Cancer Network; 2022. Available from: https://www.nccn.org/login?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf . Accessed February 1, 2022.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1–e34.
Karia PS, Jambusaria-Pahlajani A, Harrington DP, Murphy GF, et al. Evaluation of american joint committee on cancer, international union against cancer, and brigham and women's hospital tumor staging for cutaneous squamous cell carcinoma. J Clin Oncol 2014;32:327–34.
Silverman MK, Kopf AW, Bart RS, Grin CM, et al. Recurrence rates of treated basal cell carcinomas. J Dermatol Surg Oncol 1992;18:471–6.
Lawrence N, Cottel WI. Squamous cell carcinoma of skin with perineural invasion. J Am Acad Dermatol 1994;31:30–3.
Wennberg AM, Larkö O, Stenquist B. Five-year results of Mohs' micrographic surgery for aggressive facial basal cell carcinoma in Sweden. Acta Derm Venereol 1999;79:370–2.
McCord MW, Mendenhall WM, Parsons JT, Flowers FP. Skin cancer of the head and neck with incidental microscopic perineural invasion. Int J Radiat Oncol 1999;43:591–5.
Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up. Ophthalmology 2004;111:631–6.
Smeets N, Kuijpers D, Nelemans P, Ostertag JU, et al. Mohs' micrographic surgery for treatment of basal cell carcinoma of the face——results of a retrospective study and review of the literature. Br J Dermatol 2004;151:141–7.
Hamada S, Kersey T, Thaller VT. Eyelid basal cell carcinoma: non-Mohs excision, repair, and outcome. Br J Ophthalmol 2005;89:992–4.
Leibovitch I, Huilgol SC, Selva D, Richards S, et al. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 2005;53:452–7.
Leibovitch I, Huilgol SC, Selva D, Hill D, et al. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. J Am Acad Dermatol 2005;53:261–6.
Leibovitch I, Huilgol SC, Selva D, Richards S, et al. Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. J Am Acad Dermatol 2005;53:458–63.
Dhingra N, Gajdasty A, Neal JW, Mukherjee AN, et al. Confident complete excision of lid-margin BCCs using a marginal strip: an alternative to Mohs' surgery. Br J Ophthalmol 2007;91:794–6.
Mourouzis C, Boynton A, Grant J, Umar T, et al. Cutaneous head and neck SCCs and risk of nodal metastasis – UK experience. J Cranio-maxillofac Surg 2009;37:443–7.
Pugliano-Mauro M, Goldman G. Mohs surgery is effective for high-risk cutaneous squamous cell carcinoma. Dermatol Surg 2010;36:1544–53.
Cecchi R, Bartoli L, Brunetti L, Pavesi M, et al. Surgical margin marking for high-risk basal cell carcinomas of the cephalic region: a single-centre experience. G Ital Dermatol E Venereol 2011;146:79–84.
Paoli J, Daryoni S, Wennberg AM, Mölne L, et al. 5-year recurrence rates of Mohs micrographic surgery for aggressive and recurrent facial basal cell carcinoma. Acta Derm Venereol 2011;91:689–93.
Lin C, Tripcony L, Keller J, Poulsen M, et al. Perineural infiltration of cutaneous squamous cell carcinoma and basal cell carcinoma without clinical features. Int J Radiat Oncol Biol Phys 2012;82:334–40.
Veronese F, Farinelli P, Zavattaro E, Zuccoli R, et al. Basal cell carcinoma of the head region: therapeutical results of 350 lesions treated with Mohs micrographic surgery. J Eur Acad Dermatol Venereol 2012;26:838–43.
Kropp L, Balamucki CJ, Morris CG, Kirwan J, et al. Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion. Am J Otolaryngol 2013;34:373–7.
Takenouchi T, Takatsuka S. Long-term prognosis after surgical excision of basal cell carcinoma: a single institutional study in Japan. J Dermatol 2013;40:696–9.
Eberle FC, Kanyildiz M, Schnabl SM, Schulz C, et al. Three dimensional (3D) histology in daily routine: practical implementation and its evaluation. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG 2014;12:1028–35.
Armstrong LTD, Magnusson MR, Guppy MPB. Risk factors for recurrence of facial basal cell carcinoma after surgical excision: a follow-up analysis. J Plast Reconstr Aesthet Surg JPRAS 2017;70:1738–45.
Kuiper EM, van den Berge BA, Spoo JR, Kuiper J, et al. Low recurrence rate of head and neck basal cell carcinoma treated with Mohs micrographic surgery: a retrospective study of 1021 cases. Clin Otolaryngol 2018;43:1321–7.
Ruiz ES, Koyfman SA, Que SKT, Kass J, et al. Evaluation of the utility of localized adjuvant radiation for node-negative primary cutaneous squamous cell carcinoma with clear histologic margins. J Am Acad Dermatol 2020;82:420–9.
Miller J, Chang T, Schwartz D, Peters M, et al. Outcomes of adjuvant radiotherapy following negative surgical margins for cutaneous squamous cell carcinoma. Dermatol Surg 2019;45:1111–6.
Sun L, Chin RI, Gastman B, Thorstad W, et al. Association of disease recurrence with survival outcomes in patients with cutaneous squamous cell carcinoma of the head and neck treated with multimodality therapy. JAMA Dermatol 2019;155:442–7.
van Lee CB, Roorda BM, Wakkee M, Voorham Q, et al. Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study. Br J Dermatol 2019;181:338–43.