Comparative Efficacy of Mohs Micrographic Surgery and Traditional Surgical Treatment Modalities in Periocular Skin Cancers: A Systematic Review and Meta-analysis

Abstract

Abstract Title: Comparative Efficacy of Mohs Micrographic Surgery and Traditional Surgical Treatment Modalities in Periocular Skin Cancers: A Systematic Review and Meta-analysis Background: Periocular skin cancers are especially challenging to treat due to the proximity of the lesions to essential and sensitive anatomical structures. Surgical options for periocular skin cancers include standard surgical excision (GSE), Mohs micrographic surgery (MMS), wide local excision (WLE) and frozen section evaluation (FSE). Currently, a randomized study comparing the efficacy of MMS and other traditional surgical treatment modalities in the treatment of various of periocular skin cancers does not exist. Methods: A meta-analysis was done using a random-effects model to account for clinical heterogeneity. A meta-analysis of proportions was also conducted for recurrence rates and was evaluated through meta-regression for subgroup analysis to compare results among periocular skin cancer subtypes. Results: Meta-regression analysis of proportions showed that the recurrence rate of basal cell carcinoma for MMS was significantly lower compared to the WLE technique (p<0.003); the recurrence rate of BCC for FSE was also significantly lower compared to the WLE technique (p<0.001). Meta-regression also demonstrated that the recurrence rates of sebaceous carcinoma for MMS was also significantly lower than compared to WLE (p<0.001). Meta-regression on squamous cell carcinoma also demonstrated significantly lower recurrence rates in MMS than that of FSE (p<0.001) and GSE (p=0.001). Conclusion: We conclude that patients who had MMS had lower recurrence rates of sebaceous carcinoma or non-melanomas compared to patients who underwent the WLE technique. Proportionally among all studies, MMS was also demonstrated to have significantly lower recurrence rates in basal cell carcinoma and sebaceous carcinoma compared to WLE. Recurrence rates are also lower post-MMS compared to FSE and GSE in squamous cell carcinoma. Overall, these results illuminate that MMS is an excellent surgical technique for periocular skin cancers. While other surgical modalities such as WLE, FSE, GSE, and nonsurgical CYT can be equally comparable for some periocular skin cancer subtypes, further larger scale studies are needed to determine robust efficacy and guidelines for optimal surgical modality and treatment to improve patient outcomes.