Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery. Issue 6 (6th August 2020)

• Record Type: Journal Article
• Authors: Elias, Marcus L.; Skula, Steven R.; Behbahani, Sara; Lambert, W. Clark; Schwartz, Robert A.
• Is Part Of: Dermatologic therapy. Volume 33:Issue 6(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-08-06
• Subjects: Mohs micrographic surgery -- National Cancer Database -- sebaceous carcinoma -- survival -- wide local excision; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/dth.13991
• Languages: English
• ISSNs: 1396-0296

Abstract

Abstract: The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi‐squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan‐Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non‐acad; OR = 2.273; CI95% [1.448‐3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203‐0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182‐0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan‐Meier survival showed no significant difference in outcomes ( P = .611), with WLE and MMS demonstrating 5‐year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996‐3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.