Title : Mohs micrographic surgery versus standard excision for basal cell carcinoma in the head and neck: Systematic review and meta-analysis
Abstract:
The objective of this study was to quantitatively compare outcomes between standard excision (SE) and Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC). A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic databases was conducted to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of SE versus MMS for BCC. The primary outcome was the recurrence rate for primary and recurrent BCC. The secondary outcomes included the cost of treatment, aesthetic results, the rate of incomplete excision, and the surgical defect size post excision. Five studies enrolling 2060 lesions were identified. There was a statistically significant difference between MMS and SE groups in terms of recurrence rate for primary BCCs (odds ratio (OR) = 0.44, confidence interval (CI) = 0.16 to 0.97, P = 0.04) and recurrent BCCs (OR = 0.33, CI = 0.12 to 0.97, P = 0.04). For secondary outcomes, MMS had improved results compared with SE, except for mean cost. In conclusion, both primary and secondary BCCs treated with MMS have a reduced recurrence rate and defect size thus simplifying reconstruction. However, due to higher costs and operative time attributed to MMS, it should be reserved for high-risk BCCs.
Audience Take Away Notes:
- Comparative Analysis of Treatment Modalities: The presentation highlights a detailed comparative analysis of the outcomes between standard excision and Mohs micrographic surgery for basal cell carcinoma. Attendees can gain a comprehensive understanding of the efficacy of each treatment option and make informed decisions when choosing an appropriate approach for different clinical scenarios
- Emphasis on Primary and Secondary Outcomes: The significance of considering both primary and secondary outcomes in treatment evaluation is underscored. The audience can learn about the critical importance of not only focusing on the recurrence rate but also considering factors such as aesthetic results, the rate of incomplete excision, and the surgical defect size post excision for a holistic assessment of treatment success
- Understanding the Economic Implications of Treatment Options: Attendees will gain insights into the economic implications associated with different treatment modalities, particularly the higher costs and longer operative times related to Mohs micrographic surgery. This understanding can aid healthcare professionals in making well-informed decisions concerning resource allocation and cost-effective treatment strategies
- Stratification of Treatment for High-Risk Cases: The presentation underscores the significance of stratifying treatment based on the risk profile of basal cell carcinomas. Attendees can learn about the importance of identifying high-risk cases and tailoring the treatment accordingly, thereby optimising patient outcomes and resource utilisation
