Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 23.
doi: 10.1111/jdv.19056. Online ahead of print.

Development and validation of a model to predict complex Mohs micrographic surgery in clinical practice: REGESMOSH scale

Trinidad Montero-Vilchez  1   2 , Joan R Garcés  3   4 , Manuel A Rodríguez-Prieto  5 , Verónica Ruiz-Salas  3   4 , Esther de Eusebio-Murillo  6 , Román Miñano-Medrano  7 , Begoña Escutia-Muñoz  8 , Beatriz González-Sixto  9 , Juan L Artola-Igarza  10 , Alberto Alfaro-Rubio  11 , Pedro Redondo  12 , Yolanda Delgado-Jiménez  13   14 , Julia M Sánchez-Schmidt  15 , Irati Allende-Markixana  16 , María L Alonso-Pacheco  17 , Beatriz García-Bracamonte  18 , Pablo de la Cueva-Dobao  19 , Raquel Navarro-Tejedor  14 , Cristina Ciudad-Blanco  20   21 , Lucía Carnero-González  22 , Hugo Vázquez-Veiga  23 , Natividad Cano-Martínez  19   21 , Eva Vilarrasa  3   4 , Pedro Sánchez-Sambucety  5 , José L López-Estebaranz  7 , Rafael Botella-Estrada  8 , Juan Carlos Feal-Cortizas  9 , Antonio Martorell-Calatayud  11 , Pilar Gil  12 , Victoriano Morales-Gordillo  13 , Agustí Toll-Abelló  15 , Izascun Ocerin-Guerra  16 , Matías Mayor-Arenal  17 , Ricardo Suárez-Fernández  20 , Laura Sainz-Gaspar  23 , Miguel A Descalzo  24 , Ignacio Garcia-Doval  24   25 , Onofre Sanmartin-Jiménez  26 ; REGESMOHS (Registro Español de Cirugía de Mohs)
Affiliations

Development and validation of a model to predict complex Mohs micrographic surgery in clinical practice: REGESMOSH scale

Trinidad Montero-Vilchez et al. J Eur Acad Dermatol Venereol. .

Abstract

Introduction: There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs micrographic surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure.

Materials and methods: A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to three or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale.

Results: A total of 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. A total of 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required three or more stages. A model to predict the need for three or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non-complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location.

Conclusion: We present a model to predict MMS needing ≥3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration.

PubMed Disclaimer

References

REFERENCES

    1. Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence-based treatment update. Am J Clin Dermatol. 2014;15(3):197-216.
    1. van Loo E, Mosterd K, Krekels GA, Roozeboom MH, Ostertag JU, Dirksen CD, et al. Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. Eur J Cancer. 2014;50(17):3011-20.
    1. Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH, et al. Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. 2004;364(9447):1766-72.
    1. Bittner GC, Cerci FB, Kubo EM, Tolkachjov SN. Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations. An Bras Dermatol. 2021;96(3):263-77.
    1. Kofler L, Ziemer M, Andrulis M, Horn D, Kulas P, Kunte C, et al. S1-guideline: microscopically controlled surgery. J Dtsch Dermatol Ges. 2022;20(12):1663-74.

LinkOut - more resources