Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery

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.

Sebaceous Carcinoma of the Face Treated With Mohs Micrographic Surgery

“…Furthermore, in this study, the patient with recurrence carried a diagnosis of Muir-Torre syndrome, which predisposed the patient to the development of numerous sebaceous lesions, regardless of excision technique (MMS vs WLE). 19,[25][26][27] Given the exceedingly low recurrence rate, it is also important to discuss the care provided and how that might contribute to long-term low recurrence outcomes after MMS for SC. In particular, the care offered at this institution was unique in that a multidisciplinary team cared for the majority of patients.…”

“…Several studies have sought to characterize the efficacy of MMS for sebaceous carcinoma of the face and eyelid. 8,13,16,18,19,22–24 Elias and colleagues 25 shared a similar distribution of tumor size and was able to show equivalent survival rates among those with WLE and MMS; however, they did not specifically report recurrence rates, and the study was limited by information present in the national cancer database. A larger multicenter study showed a higher recurrence rate of 15.7% with 7.8% metastasis of sebaceous carcinoma in patients treated with MMS, in a median follow-up time of 60 months, a much higher recurrence rate than found at the authors’ institution with similar provision of tertiary and quaternary care.…”

“…Furthermore, in this study, the patient with recurrence carried a diagnosis of Muir–Torre syndrome, which predisposed the patient to the development of numerous sebaceous lesions, regardless of excision technique (MMS vs WLE). 19,25–27…”

Surgical management of adnexal carcinomas with Mohs micrographic surgery and wide excision: a survival analysis

“…The mean (SD) age of the cohort was 65. practice for sebaceous carcinoma. 2,3 These results suggest that a large proportion of porocarcinoma and MAC are managed with MMS despite the limited evidence. This information challenges recent studies describing MMS as an infrequently used modality for porocarcinoma.…”

“…Of interest, the average daily dose of ISO in the exposed women was 12 mg (range: 5.0-20.0). 3 In a recent systematic review and meta-analysis, Choi et al 4 noted that 85% of the fetuses exposed to ISO were likely to be delivered without MM. The authors attributed that to smaller doses of ISO and shorter duration of exposure during pregnancy.…”