Highlights from the Literature 1

Surgical delays of less than 1 year in Mohs surgery associated with tumor growth in moderately- and poorly differentiated squamous cell carcinomas but not lower-grade squamous cell carcinomas or basal cell carcinomas: A retrospective analysis

Jack Lee, MD, Vernon J. Forrester, MD, Wendy M. Novicoff, PhD, Darren J. Guffey, MD, and Mark A. Russell, MD. J Am Acad Dermatol. 2021; 86(1): 131-39. DOI: 10.1016/j.jaad.2021.08.059

by Sherrif Ibrahim, MD, PhD, FACMS

In many of our Mohs surgery practices, we are often faced with long wait times for procedures or patients who wish to delay treatment for a variety of reasons. In this report, Lee et al present a retrospective analysis of BCCs and SCCs treated by Mohs surgery at a single institution and measured change in tumor diameter between the time of biopsy and Mohs surgery. Surgical delays ranged from 0 to 331 days. Interestingly, histologic subtype of SCC was a statistically significant determinant of tumor growth, with more aggressive histology –  moderate or poorly differentiated tumors – exhibiting a growth rate of 0.2 and 0.3cm per month, respectively. Well-differentiated SCCs exhibited an inverse rate of growth, with the average tumor diameter decreasing by 0.2cm per month over the study period. BCC tumor growth was difficult to predict, with some tumors growing much more quickly than others with no correlation to histologic subtype. These results may help us better triage tumors in need of Mohs surgery, and support minimizing delays in treatment of more aggressive SCCs or BCCs that show rapid growth.