Description of patients excluded for Mohs surgery after pre-surgical evaluation: data from the Regesmohs Spanish registry.

Abstract

BACKGROUND:

Regesmohs registry is a nationwide registry including patients evaluated for Mohs surgery in 17 Spanish centres since July 2013. Given that Mohs surgery is the therapy with best results for high risk basal cell carcinoma (BCC) and other skin tumours, we wanted to describe the reasons that lead to some patients being excluded from this therapy and the alternative treatments that they received. These data may be useful to avoid excluding patients for Mohs surgery use, to estimate the healthcare demand of these patients and the demand for Hedgehog inhibitors therapy in this group.

OBJECTIVE:

To describe patients excluded for Mohs surgery after pre-surgical assessment, and the treatments that they received.

METHODS:

Regesmohs includes all consecutive patients assessed for Mohs surgery in the participating centres, collecting data on patient characteristics, intervention, and short and long-term results. Patients excluded for Mohs surgery after pre-surgical evaluation were described.

RESULTS:

3011 patients were included in Regesmohs from July 2013 to October 2016. In 85, Mohs surgery was not performed as they were considered inadequate candidates. 67 had BCC. Reasons for exclusion were: medical contraindication (27.1%, n=23) low-risk tumour in (18.8%, n=16) and giant tumour and bone invasion (15.3%, n=13). Only 1 patient (1.2%) showed lymph node involvement and no patients had visceral metastases. Of the 85 excluded patients, 29 (34.1%) were treated with conventional surgery, 24 (28.3%) with radiotherapy, 4 (4.7%) with inhibitors of the Hedgehog pathway (only indicated for BCC), and 2 (2.4%) received palliative care. We had no follow-up data on 14 patients (16.5%).

CONCLUSION:

Medical comorbidities were the most common reason for withholding Mohs surgery. Withholding therapy on the basis of distant extension is uncommon. Most excluded patients received simpler therapies: conventional surgery or radiotherapy, with hedgehog inhibitors being a new option.

• Authors: V Ruiz-Salas, J R Garcés, T Alonso-Alonso, M A Rodríguez-Prieto, A Toll-Abelló, E Eusebio Murillo, R Miñano, J L López-Estebaranz, O Sanmartín-Jiménez, C Guillén Barona, I Allende Markixana, A Alfaro Rubio, Y Delgado Jiménez, R Navarro, L Barchino Ortiz, P Lázaro Ochaita, E Vilarasa, C Ciudad Blanco, H Vázquez-Veiga, J L Artola Igarza, M L Alonso, I García-Doval, M A Descalzo, P Redondo Bellón
• Journal: Actas dermo-sifiliograficas (Actas Dermosifiliogr (Engl Ed)) Vol. 109 Issue 4 Pg. 346-350 (May 2018) ISSN: 2173-5778 [Electronic] Spain
• Vernacular Title: Descripción de pacientes no aptos para ser sometidos a cirugía de Mohs tras valoración prequirúrgica: datos del registro español Regesmohs.
• PMID: 29373111 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Chemical References

• Hedgehog Proteins
• Neoplasm Proteins

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Basal Cell (drug therapy, radiotherapy, surgery)
• Carcinoma, Squamous Cell (drug therapy, radiotherapy, surgery)
• Comorbidity
• Contraindications, Procedure
• Female
• Hedgehog Proteins (antagonists & inhibitors)
• Humans
• Male
• Mohs Surgery
• Neoplasm Proteins (antagonists & inhibitors)
• Palliative Care
• Patient Selection
• Prospective Studies
• Registries
• Skin Neoplasms (drug therapy, radiotherapy, surgery)
• Spain
• Withholding Treatment