Recurrence rates of cutaneous SCC of the head and neck after surgery

Abstract

Squamous cell carcinoma (SCC) is the second most common type of skin cancer in the UK, affecting 10,000 people in England and Wales alone. The risk factors include prolonged sun or tanning bed exposure, having fair skin, older age and having a family member who has had the condition. It is a slow growing cancer involving the outer layer of the skin but can spread to other areas of the body if untreated. SCCs are treated by removing them and this is usually through surgery, but in milder cases freezing and creams are sometimes used. This study was based in the Netherlands looking back at 579 patients with SCC, comparing the rates of cancer returning after undergoing two different forms of surgical treatment. 292 patients underwent standard excision, whereby the SCC and a small margin of skin was cut out and sent to the laboratory to confirm diagnosis and check that all of the cancer was removed. The other 380 patients underwent a newer, specialist procedure called Mohs micrographic surgery. This involves cutting the cancer out layer by layer, each time examining the sample under the microscope during the surgery to see how much cancer has been removed. While this is a much longer procedure, the aim is to preserve as much normal skin as possible, which is particularly important on the face for cosmetic reasons. The researchers followed up the group that underwent standard excision after 5‐7 years and found 8% of the SCCs had returned. In comparison, in the group who had Mohs surgery, only 3% of SCCs came back after 4‐9 years. In total, more SCCs came back in the group having standard excision. Adjusting for the size and depth of the cancer, it can be concluded that patients were three times less likely to have their SCC return if they had Mohs surgery in comparison to standard excision.