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Predictors of Extensive Subclinical Spread in Nonmelanoma Skin Cancer Treated With Mohs Micrographic Surgery
R. Sonia Batra, MD, MSc, MPH;
Larisa C. Kelley, MD
Arch Dermatol. 2002;138:1043-1051.
Background In nonmelanoma skin cancer, the clinically visible portion may represent
a small fraction of microscopic tumor spread. Previous studies have examined
individual risk factors for subclinical spread based on patient and tumor
characteristics. However, these risk factors have not been prioritized or
studied in combination.
Objective To identify the most predictive risk factors for extensive subclinical
tumor spread.
Design Retrospective analysis of 1131 Mohs micrographic surgical cases. Variables
analyzed included patient age, sex, and immune status and lesion size, location,
histologic subtype, and recurrence. Logistic regression was applied to identify
important combinations of tumor characteristics and to quantify relative odds
of spread.
Setting Academic referral center.
Patients Consecutive sample of all referred patients treated by a single Mohs
micrographic surgeon in a 3-year period.
Main Outcome Measure Number of Mohs micrographic surgical layers required to clear a tumor,
with 3 or more layers defined as extensive subclinical spread.
Results The highest-risk tumors, with odds ratios greater than 6.0, were basosquamous
and morpheaform basal cell carcinoma (BCC) on the nose, morpheaform BCC on
the cheek, and those with a preoperative size greater than 25 mm. Other important
risk factors were recurrent and nodular BCC on the nose; location on the eyelid,
temple, or ear helix; neck tumors and recurrent BCC in men; and tumor size
greater than 10 mm. Patients younger than 35 years were at lower risk. Increasing
age and immunocompromise were not significant predictors.
Conclusion Identification of lesions likely to exhibit extensive subclinical spread
can help guide management to ensure complete tumor eradication and thereby
reduce the risk of recurrence and its associated morbidity and cost.
From the Departments of Dermatology, Stanford University School of
Medicine, Stanford, Calif (Dr Batra), and Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Mass (Dr Kelley).
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ABSTRACT
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Predicting Subclinical Spread in Nonmelanoma Skin Cancer
Journal Watch Dermatology 2002;2002:1-1.
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