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Upgrading of Nonmelanoma Skin Cancers at the Time of Mohs Surgery

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Key Points

  • In total, 265 (10.3%) tumors displayed a more aggressive histologic subtype on frozen-section analysis at the time of Mohs surgery vs the initial biopsy.
  • Upgraded tumors required more stages to reach tumor clearance, had a larger postoperative defect size, and often required more complicated repairs than tumors that were not upgraded to a more aggressive subtype.

Nonmelanoma skin cancers may display an aggressive histologic subtype that is not diagnosed on initial biopsy. In a prospective, cross-sectional study reported by Kyllo et al in the Journal of the American Academy of Dermatology, researchers determined that a significant portion of nomelanoma skin cancers were upgraded at the time of Mohs micrographic surgery to a more aggressive subtype than at initial biopsy.

Methods

All patients with nonmelanoma skin cancer undergoing Mohs surgery at the Washington University School of Medicine, St. Louis, over the course of 1 year were screened for study inclusion. Nearly 2,600 frozen tumor sections were reviewed by two fellowship-trained Mohs surgeons.

Findings

In total, 265 (10.3%) tumors displayed a more aggressive histologic subtype on frozen-section analysis at the time of Mohs surgery vs the initial biopsy. These upgraded tumors required more stages to reach tumor clearance, had a larger postoperative defect size, and often required more complicated repairs than tumors that were not upgraded to a more aggressive subtype.

The authors concluded, “A significant portion of Mohs micrographic surgery cases were upgraded at the time of surgery to a more aggressive subtype than that seen at the initial biopsy. Upgraded cases were larger and more surgically challenging than nonupgraded ones. This finding has important implications for primary dermatologists' referral practices and Mohs appropriate use criteria guidelines.”

Disclosure: For full disclosures of the study authors, visit jaad.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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