Highlights from the Literature
Overall Survival After Mohs Surgery for Early-Stage Merkel Cell Carcinoma
By Sherrif F. Ibrahim, MD, PhD, FACMS
In this article, the authors evaluate the use of Mohs micrographic surgery (MMS) in the treatment of early stage (T1/T2) Merkel cell carcinoma (MCC). Using a retrospective cohort study design, a large number of MCC patients (n=2313) treated from 2004 – 2018 were included for study. Patients were negative for regional or distant disease and treated surgically.
Current NCCN guidelines recommend either wide local excision (WLE) or MMS, however this is the largest study of its kind to evaluate the association of surgical excision technique and patient outcomes in those patients who had pathologically-confirmed node-negative disease. The study used the National Cancer Database (NCDB), a national database from over 1500 participating centers.
With univariable survival analysis, treatment with MMS was associated with significantly improved overall survival as compared to WLE, with long-term follow-up data included in the study. With additional multivariable analyses, the authors found that MMS was more commonly used in high-volume MCC centers and with T1 tumors. Overall, treatment with MMS was associated with an approximately 40% reduction in hazard death when compared with WLE, suggesting that MMS may be the preferred treatment approach in this patient population.
Limitations of this study include the retrospective nature, fewer cases of patients treated with MMS as compared to WLE, and possible selection biases discussed in the paper.