Dermatologic surgery
Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National Cancer Database

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Background

The optimal surgical approach (wide local excision [WLE] vs Mohs micrographic surgery [MMS]) for treating Merkel cell carcinoma (MCC) is yet to be determined.

Objective

To compare survival outcomes in patients with early-stage MCC treated with MMS versus with WLE.

Methods

A retrospective review of all cases in the National Cancer Database (NCDB) of MCC of clinical stage I or II MCC treated with WLE or MMS was performed.

Results

A total of 1795 cases of stage I or II MCC who underwent WLE (n = 1685) or MMS (n = 110) were identified. There was no difference in residual tumor on surgical margins between the 2 treatment groups (P = .588). On multivariate analysis, there was no difference in overall survival between the treatment modalities (adjusted hazard ratio, 1.02; 95% confidence interval, 0.72-1.45; P = .897). There was no difference in overall survival between the 2 groups on propensity score–matched analysis.

Limitations

Disease-specific survival was not reported, as these data are not available in the National Cancer Database.

Conclusions

MMS appears to be as effective as WLE in treating early-stage MCC.

Section snippets

Study population

All cases of early-stage MCC without clinical evidence of nodal disease treated with MMS or WLE from 1998 to 2011 were identified in the National Cancer Database (NCDB), an oncology database sourced from more than 1500 accredited cancer facilities in the United States (49 of 50 states) and Puerto Rico.7 The NCDB is reported to collect approximately 70% of all new cancer diagnoses in the United States each year, and it receives cases from more than 1430 teaching/research hospitals, community

Results

Table II displays all relevant patient and tumor characteristics. A total of 1795 cases of stage I or II MCC were identified in the NCDB as being treated with WLE (n = 1685) or MMS (n = 110). There was no difference in age distribution (P = .754), sex (P = .316), race (white or nonwhite [P = .767]), Charlson-Deyo score (P = .061), or insurance status (P = .229) between patients treated with WLE or MMS. MMS was more likely to be performed at an academic institution than was WLE (65.5% vs 46.9% [P

Discussion

We determined that MMS is more commonly performed at academic centers and on smaller tumors (T1) in the head and neck region. Our study revealed greater 3-year actuarial survival of patients with T1 tumors than with T2 and T3 tumors, validating prior studies that also showed a reduced survival advantage with increasing tumor size.10, 11, 12 No difference was demonstrated in the reported positivity of surgical margins in the WLE and MMS surgical groups. This implies that neither treatment

Conclusions

This is, to our knowledge, the first use of a national cancer database registry comparing MMS and WLE for the treatment of stage I and II MCC. We determined that there was no difference in OS between the 2 treatment modalities. MMS appears to be as efficacious as WLE in the treatment of early-stage MCC. This has implications particularly in the head and neck region, where MMS has the advantage of providing tissue conservation in cosmetically and functionally sensitive areas. Adjuvant radiation

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  • Cited by (0)

    Drs Truong and Sahni are colast authors.

    Funding sources: None.

    Conflicts of interest: None disclosed.

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