DS20 Longevity of patients following Mohs micrographic surgery for the treatment of basal cell carcinomas

Abstract

Abstract Basal cell carcinomas (BCCs) are slow-growing, nonaggressive skin cancers (metastatic rate < 0.1%). They are common, especially in the elderly population (Sreekantaswamy S, Endo J, Chen A et al. Aging and the treatment of basal cell carcinoma. Clin Dermatol 2019; 37:373–8). Basal cell carcinoma guidelines recommend Mohs micrographic surgery (MMS) for primary high-risk BCCs and high-risk recurrent BCCs suitable for surgery (Mosterd K, Krekels GA, Nieman FH et al. Surgical excision vs. Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol 2008; 9:1149–56). Mohs micrographic surgery allows for the removal of the tumour in stages with rapid processing of specimens using frozen section analysis. Complete surgical margins are analysed in near real time. It has, compared with other treatments, lower recurrence rates (< 1%) and often better cosmetic outcomes, but it has higher costs and longer operating times (Sreekantaswamy et al.; Mosterd et al.). Factors that need to be considered when deciding on treatment options are comorbidities, performance status and the risk of causing harm if left untreated. The term ‘lag time to benefit’ entails not only looking at how effective a specific treatment is, but also when a treatment will become beneficial in relation to the patient’s life expectancy (Sreekantaswamy et al.). In patients with a limited life expectancy, nonsurgical treatment can be an appropriate and possibly even the preferred choice (Sreekantaswamy et al.). A retrospective single-centre review of all available BCC MMS patient data from January 2011 to December 2017 was performed. Patients from out of area or with tumour syndromes were excluded. Survival rates following MMS were recorded. Of the 2518 patients reviewed, 1905 met the inclusion criteria. In total, 357 (18.7%) were aged ≥ 80 years; at 5 years post-MMS, 24% and 30.7% of the 80–89-year-old females and males had died, respectively, suggesting they had a higher life expectancy than the same general demographic. It would be interesting to compare these results with survival rates following other treatments, such as conventional excision or curettage and cautery. Limitations include missing documentation (n = 258) and not all internal logs being tracked appropriately (19.6% were not tracked, n = 615/3133). We propose a patient-centred, tailored approach to the treatment of BCCs. Based on the fundamental ethical principles, informed and effective shared decision-making is vital; patient values, preferences and experiences should also be considered.