Study Compares Skin Cancer Treatments, Finds Mohs Micrographic Surgery and Brachytherapy Improve Cosmesis

A study published in Cancer compared the cosmesis and recurrence rates of conventional excision (CE), Mohs micrographic surgery (MMS), external-beam radiation therapy (EBRT), and brachytherapy (BT) for basal cell carcinoma and squamous cell carcinoma and found that MMS and BT result in improved cosmesis (primary endpoint).

“It is unclear whether this is because of treatment superiority or selection and reporting bias,” the researchers noted.

Researchers queried PubMed for articles from 1985 to 2018 that included patients with American Joint Committee on Cancer T1-T2N0 basal cell carcinomas and squamous cell carcinomas with 10 or more months of follow-up who received CE, MMS, EBRT, or BT. Cosmesis was classified as “good,” “fair,” or “poor.”

Mohs and Brachytherapy = Good Cosmesis

The final analysis included 24 CE, 13 MMS, 19 EBRT, and seven BT studies, with a total of 21,371 patients. The summary effect size for “good” cosmesis was 81% (95% CI, 70.6-89.6) with CE, 74.6% (95% CI, 63-84.6) with EBRT, and 97.6% (95% CI, 91.3-100) with BT. Good cosmesis was 96.0% in the one MMS study that reported on cosmesis. BT had improved “good” cosmesis compared with EBRT (P=0.0025) and was similar to CE and MMS.

The researchers observed no significant differences for “fair” or “poor” cosmesis.

One-year recurrence rates (secondary endpoint) were low: 0.8% (95% CI, 0.3-1.6) for CE, 0.2% (95% CI, 0-0.6) for MMS, 2.0% (95% CI, 1.3-2.7) for EBRT, and 0% (95% CI, 0-0.5) for BT.