Clinical and functional outcomes of squamous cell carcinoma of the hand and wrist treated with Mohs micrographic and reconstructive surgery

Abstract

Mohs micrographic surgery (MMS) can clear oncologic margins and minimize tissue resection to limit morbidity in difficult anatomic areas such as the hand. We evaluated clinical and patient-reported outcomes of patients undergoing MMS with reconstruction for squamous cell cancer (SCC) of the hand and wrist. Patients undergoing MMS with reconstruction for hand or wrist SCC from 2006 to 2018 at the University of Pennsylvania were identified. Demographic, disease, and treatment data were analyzed. Post-intervention upper extremity function was measured with the PROMIS-UE survey. 424 patients with 615 surgeries met inclusion criteria, with 173 completed surveys. Mean age was 73.9 ± 11.8 years. 97.4% of lesions were located dorsally, most commonly on the hand (65.4%). Mean defect size was 4.85 ± 7.8 cm 2 . Most defects were reconstructed by complex closure (53.8%) and secondary intention (22.4%). Complications were seen in 8.0%, and most commonly included dehiscence (4.7%) and surgical site infection (2.0%). For 262 patients with at least 1-year of oncologic follow-up (mean 3.9 ± 2.7 years), cancer recurrence rate was 3.8%. Mean T-score for PROMIS-UE was 52.9 ± 7.9, indicating function within normal population limits. Mohs surgery with subsequent reconstruction for hand and wrist SCC has low risk of complication and recurrence and good preservation of hand and upper extremity function. • Mohs micrographic surgery with subsequent reconstruction successfully treats squamous cell carcinoma of the hand and wrist. • Reconstruction depends on the defect size and characteristics after excision. • Reconstruction includes complex closure, secondary intention, grafts, flaps, and amputation. • This coordinated treatment has low local recurrence rates and complication rates. • Patients maintain good upper extremity function, regardless of reconstruction technique.