Planned incomplete Mohs micrographic surgery (iMMS) as part of multidisciplinary care for keratinocyte carcinomas resulted in higher rates of additional surgery, shorter wait times between surgeries, and increased final margin clearing compared to cases where iMMS was not expected and managed on the spot.
The following is a summary of “Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on Treatment Delays and Final Margin Status,” published in the November 2023 issue of Surgery by Lin, et al.
If the borders of Mohs micrographic surgery are positive, the surgery may be stopped. This could be planned as part of multimodal care or happen by accident. It has yet to be studied how to treat main tumors after planned versus unplanned incomplete Mohs micrographic surgery (iMMS). For a study, researchers sought to find out how often and when additional surgery is done after iMMS and what the end margin state is when iMMS is expected versus not expected. The secondary outcomes were the clinicopathologic factors present before and during surgery linked to iMMS.
iMMS of keratinocyte carcinomas cases that happened at a major academic center between 2005 and 2022 were put into two groups: those that were expected (multidisciplinary teams were put together before surgery) and those that were not expected (positive margins were managed on the spot). They compared the rate, time, and end margin status of adjuvant surgery between iMMS groups that were expected and those that were not expected. They used the χ2/Fisher exact test for categorical variables and the t-test for continuous variables.
Of 127 iMMS cases, 65 (127) were expected, 51.2%. Expected iMMS cases were more likely to need more surgery (98.5% vs 72.6%, P <.001), to be delayed (3.9 vs 13.2 days, P <.001), and to have their end margins cleared (84.6% vs. 59.7%, P <.001). When iMMS is planned as part of multidisciplinary care, patients are more likely to have more removal, with shorter wait times between surgeries and higher rates of final margin clearing.