Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery)
Alejandra Tomás‐Velázquez, O. Sanmartín‐Jiménez, Joan R. Garcés, M.Á. Rodríguez-Prieto, Verónica Ruiz‐Salas, E. de Eusebio‐Murillo, R. Miñano Medrano, Begoña Escutia‐Muñoz, Á. Flórez-Menéndez, Juan L. Artola‐Igarza, A. Alfaro‐Rubio, Pilar Gil, Yolanda Delgado‐Jiménez, Julia M. Sánchez‐Schmidt, Irati Allende‐Markixana, M.L. Alonso‐Pacheco, B. García‐Bracamonte, Pablo De la Cueva-Dobao, Raquel Navarro, C. Ciudad‐Blanco, L. Carnero‐González, H. Vázquez‐Veiga, N. Cano-Martínez, E. Vilarrasa‐Rull, P. Sánchez‐Sambucety, J.L. López‐Estebaranz, Rafael Botella‐Estrada, B. González‐Sixto, Antonio Martorell, Victoriano Morales‐Gordillo, Agustí Toll-Abelló, Izascun Ocerin‐Guerra, M. Mayor-Arenal, R. Suárez‐Fernández, L. Sainz-Gaspar, M.Á. Descalzo, I. García‐Doval, Pedro Redondo
Abstract
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the "real-life" results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1-1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3-6.1), being constant over time (0-5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.