The following is a summary of “Clinical outcomes of high-risk cutaneous squamous cell carcinomas treated with Mohs surgery alone: An analysis of local recurrence, regional nodal metastases, progression-free survival, and disease-specific death,” published in the JANUARY 2023 issue of Dermatology by Soleymani, et al.

The frequency of cutaneous squamous cell carcinoma (cSCC) is continuing to rise, and over the next five years, it is anticipated that more people will die from cSCC than from melanoma. Although most cSCCs respond well to treatment, there was a significant minority of high-risk tumors that had the highest tendency for local recurrence (LR), nodal metastasis (NM), and disease-specific mortality (DSD). Therefore, with an eye toward LR, NM, distant metastasis, and DSD, researchers sought to determine the clinical results of high-risk cSCCs treated solely with Mohs surgery (MS). In addition, they also examined the progression-free survival and DSD in patients who had salvage head/neck dissection for local NMs.

Retrospective analysis of every case of high-risk cSCC treated in the clinics between January 1, 2000, and January 1, 2020, with follow-up continuing until April 1, 2020.

About 527 individuals had 581 high-risk primary cSCCs in total, of which 579 tumors had follow-up information available. With a mean survival period of 18.6 years, the 5-year disease-specific survival rate was 95.7%. The localized NM-free survival at 5 years was 93.8%, the distant metastasis-free survival at 5 years was 97.3%, and the LR-free survival at 5 years was 96.9%. The rates of progression-free survival from metastatic illness at 5 and 10 years were 92.6 and 90.0%, respectively. The 2-year disease-specific survival rate was 90.5% in patients who had salvage head and neck dissection with or without radiotherapy and developed localized NMs.

The American Joint Committee on Cancer, Eighth Edition, and Brigham and Women’s Hospital staging systems both showed decreased incidences of LR, NM, and DSD in the cohort, which was the largest high-risk cSCC cohort treated with MS to date. In contrast to conventional extensive local excision for high-risk malignancies, they showed that MS confers a disease-specific survival benefit. Additionally, by enhancing local tumor management, MS seemed to lessen the incidence of regional metastatic illness and may offer a survival benefit even for individuals who experience regional metastases.