BOSTON — The most common human malignancy is keratinocyte carcinoma (KC), which includes basal and squamous cell cancers.
A study published in the Annals of Surgical Oncology noted that limited real-world data have compared surgical outcome or cost between total margin-controlled excision (TMCE) and standard excision (SE); those are the two most common treatments for invasive KC.1
Brigham and Women’s Hospital-led researchers compared reconstruction, margin status and cost between TMCE and SE for KC on the nose in a VA healthcare system.
The study team, which also included representation from the VA Boston Healthcare System, Harvard Medical School and Tufts University, used randomly selected primary KCs on the nose 3 cm or smaller that were confined to soft tissue. The malignant neoplasms were without nerve or lymphovascular invasion and were treated with SE or TMCE between 2000 and 2010.
The study team recorded utilization of flap or graft reconstruction and margin status following all surgical attempts, basing those costs on Current Procedural Terminology codes standardized to 2019 Medicare payments.
Included in each treatment group were 148 cases. While baseline characteristics were similar between the two groups, SE tumor median diameter was 1 mm larger.
Results indicated that SE was associated with increased utilization of flap or graft reconstruction (odds ratio 2.05, 95% confidence interval 1.16-3.59, p = 0.01). The authors added that positive margins were present in 24% of SEs initially and remained positive after the final recorded excision in 9% of cases. No positive final margins were noted in TMCE cases, however. Researchers concluded that SE cost per tumor was significantly higher than TMCE ($429.03 ± 143.55; p = 0.003).
“Surgical management of KC with SE is associated with increased reconstruction complexity, a significant risk of positive margins, and higher cost compared with TMCE,” the authors wrote. “The 23% risk of positive margins supports National Comprehensive Cancer Network guidelines for the treatment of high-risk KC with TMCE, unless delayed reconstruction is employed.”
- Massey PR, Gupta S, Rothstein BE, Konnikov N, Mahalingam M, Ruiz ES, Schmults CD, Waldman A. Total Margin-Controlled Excision is Superior to Standard Excision for Keratinocyte Carcinoma on the Nose: A Veterans Affairs Nested Cohort Study. Ann Surg Oncol. 2021 Jul;28(7):3656-3663. doi: 10.1245/s10434-021-09604-9. Epub 2021 Mar 19. PMID: 33742233.
