Plastic Surgery Research Council

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Use of Mohs Micrographic Surgery for Invasive Melanoma in the US - NCBD Analysis: 2004-2015
Daniel Boczar, Maria T. Huayllani, David J Restrepo, Andrea Sisti, Jeremie D. Oliver, Aaron C Spaulding, Jordan J Cochuyat, Sanjay Bagaria, Emmanuel Gabriel, Brian D RInker, Antonio Jorge Forte.
Mayo Clinic Florida, Jacksonville, FL, USA.

PURPOSE
Several publications describe the use of Mohs Micrographic Surgery (MMS) for invasive melanoma, which diverges from current guidelines indications. We hypothesize that the frequency of MMS for invasive melanoma is increasing in the United States. We analyzed a national database to describe the incidence of MMS for invasive melanoma by year and assess the characteristics of the patients, hospitals, tumors, and resection margins (RMs).
METHODS
By using the National Cancer Data Base (NCDB), we selected all patients with invasive melanoma between 2004 and 2015. Patients whose diagnosis was done at autopsy were excluded. We categorized patients by type of surgical procedure (MMS Vs. Others) and assessed variables related to characteristics of the patients, hospital, tumor, and RMs. Chi-Square test and multivariable logistic regression were used to estimate factors independently associated with MMS utilization.
RESULTS
A total of 368314 patients met the criteria of the study. The overall prevalence of MMS was 2.6% (n=9660) and we noticed an increase of 258% in absolute numbers from 2004 (n=478, 2.0%) to 2015 (n=1234, 3.3%). The mean age of the patients was 62.9 years (SD 16.09) and they were predominantly men (n=5704, 59%), white (n=9391, 97.2%), with tumor Stage I (n=6927, 71.7%) and Breslow depth 0.01-1.00mm (n=7121, 73.7%). Regarding body's location, 42.9% (n=4143) were on the Head and neck, and 56.3% (n=5442) on the trunk or extremities. 35.5% (n=201) of the tumors with depth 2.01-4.00mm and 39.6% (n=153) with depth >4mm, had RMs equal or smaller than 1cm. Controlling for confounding variables, we noticed an increased odds ratio (OR) of MMS in Academic/Research Programs compared to Community Cancer Programs (OR, 2.66; 95% CI, 2.353.00) and Regions of Mountain (OR, 2.45; 95% CI, 2.162.77) and New England (OR, 1.90; 95% CI, 1.68-2.15), compared to East South Central.
CONCLUSION
Even without guideline recommendation, MMS for invasive melanoma increased 258% between 2004 and 2015. It is imperative to rethink the utilization of this therapeutic approach for invasive melanoma because this study demonstrated that physicians are noncompliant to guidelines and Academic/Research centers are contributing to this trend.


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