Development and validation of a model to predict complex Mohs Micrographic Surgery in clinical practice: REGESMOSH scale
Trinidad Montero-Vilchez 1 , Joan R Garcés 2 3 , Manuel A Rodríguez-Prieto 4 , Verónica Ruiz-Salas 2 3 , Esther de Eusebio-Murillo 5 , Román Miñano-Medrano 6 , Begoña Escutia-Muñoz 7 , Beatriz González-Sixto 8 , Juan L Artola-Igarza 9 , Alberto Alfaro-Rubio 10 , Pedro Redondo 11 , Yolanda Delgado-Jiménez 12 13 , Julia M Sánchez-Schmidt 14 , Irati Allende-Markixana 15 , María L Alonso-Pacheco 16 , Beatriz García-Bracamonte 17 , Pablo de la Cueva-Dobao 18 , Raquel Navarro-Tejedor 13 , Cristina Ciudad-Blanco 19 20 , Lucía Carnero-González 21 , Hugo Vázquez-Veiga 22 , Natividad Cano-Martínez 18 20 , Eva Vilarrasa 2 3 , Pedro Sánchez-Sambucety 4 , José L López-Estebaranz 6 , Rafael Botella-Estrada 7 , Juan Carlos Feal-Cortizas 8 , Antonio Martorell-Calatayud 10 , Pilar Gil 11 , Victoriano Morales-Gordillo 12 , Agustí Toll-Abelló 14 , Izascun Ocerin-Guerra 15 , Matías Mayor-Arenal 16 , Ricardo Suárez-Fernández 19 , Laura Sainz-Gaspar 22 , Miguel A Descalzo 23 , Ignacio Garcia-Doval 23 24 , Onofre Sanmartin-Jiménez 25 ; REGESMOHS (Registro Español de Cirugía de Mohs)
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.
Material 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 3 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: 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required 3 or more stages. A model to predict the need for 3 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.
CITATION J Eur Acad Dermatol Venereol. 2023 Mar 23. doi: 10.1111/jdv.19056