Mohs Surgery Associated With Improved Survival vs Wide Local Excision for Merkel Cell Carcinoma

In a retrospective national cohort study, researchers found that excising early-stage Merkel cell carcinoma (MCC) with Mohs micrographic surgery (MMS) was associated with improved survival outcomes compared with wide local excision (WLE).

Although surgery is the best treatment option for localized tumors like MCC, current guidelines suggest that either Mohs micrographic surgery or wide local excision is a viable surgical approach for this patient population. But is there superiority between these two surgical approaches when examining long-term patient survival? Researchers evaluated the association between surgical excision approach and overall survival for patients with pathologically confirmed, localized, early-stage T1/T2 MCC.

For their study, Cheraghlou and colleagues used the National Cancer Database to assess 2313 patients (mean age 71 years; 57.9% men) with early-stage MCC who were diagnosed between January 1, 2004, and December 31, 2018, and treated with surgery.

The study results showed that survival rates among patients who underwent MMS were 87.4% after 3 years, 84.5% after 5 years, and 81.8% after 10 years. Among those who underwent WLE, the survival rates were 86.1% after 3 years, 76.9% after 5 years, and 60.9% after 10 years. A multivariable survival analysis confirmed that excision with MMS was associated with improved survival compared with WLE (hazard ratio = 0.59; [95% CI, 0.36-0.97]; P = 0.04). Further, narrow-margin excision had similar survival rates to that of WLE.

Additionally, high-volume cancer centers were more likely to use MMS vs WLE when compared with other centers (odds ratio = 1.99; 95% CI, 1.63-2.44; P < 0.001).

This study had limitations, including the lack of randomization, limited case numbers, and the potential for selection bias. Considering these limitations, the authors noted that more prospective research is still needed. 

“These data suggest that MMS may provide a survival benefit in the treatment of localized MCC, although further prospective work studying this issue is required,” the authors concluded. “Future directions may also focus on elucidating the benefit of adjuvant radiotherapy in localized cases treated with MMS.”

Reference
Cheraghlou S, Doudican NA, Criscito MC, Stevenson ML, Carucci JA. Overall survival after Mohs surgery for early-stage Merkel cell carcinoma. JAMA Dermatol. 2023;159(10):1068-1075. doi:10.1001/jamadermatol.2023.2822.