Scientific publications

Development and validation of a model to predict complex Mohs Micrographic Surgery in clinical practice: REGESMOSH scale. Scientific Publication

Mar 23, 2023 | Magazine: Journal of the European Academy of Dermatology and Venereology

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

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