The following is a summary of “No difference in survival for primary cutaneous Merkel cell carcinoma after Mohs micrographic surgery and wide local excision,” published in the April 2023 issue of Dermatology by Moore, et al.
In clinically node-negative patients, merkel cell carcinoma (MCC) is typically treated with surgical excision and sentinel lymph node biopsy. However, there was limited large-scale research comparing survival outcomes based on different surgical approaches for managing the primary tumor. For a study, researchers sought to compare overall survival and MCC-specific survival outcomes in clinically and pathologically node-negative MCC patients who underwent wide-local excision (WLE) versus Mohs micrographic surgery (MMS) using a nationally representative sample.
The researchers analyzed overall and MCC-specific survival outcomes of primary MCC tumors from the SEER-18 database spanning 1989 to 2015. The patients were stratified based on the surgical modality (WLE or MMS) and analyzed using competing risk analysis.
The analysis included a total of 2,359 US adults with MCC. The study found no significant difference in overall and MCC-specific survival outcomes between patients who underwent WLE and those who underwent MMS on multivariable analysis (hazard ratio, 1.04 [95% CI, 0.88-1.22]; subdistribution hazard ratio, 0.76 [95% CI, 0.53-1.09]). However, sentinel lymph node biopsy was associated with improved overall and MCC-specific survival.
The study’s limitations included its retrospective design using the SEER database and the lack of specific covariates such as comorbidities and immunostaining. The findings suggested no survival disadvantage for patients undergoing MMS compared to WLE as the surgical modality for primary cutaneous MCC. However, it was important to consider coordinating sentinel lymph node biopsy before MMS treatment.