Mohs micrographic surgery in the elderly. Comparison of tumours, surgery, and first-year follow-up in patients younger and older than 80 years-old in REGESMOHS
Camarero-Mulas C (1), Delgado Jiménez Y (1,2), Sanmartín-Jiménez O (3), Garcés JR (4,5), Rodríguez-Prieto MA (6), Alonso-Alonso T (6), Miñano Medrano R (7), López-Estebaranz JL (7), de Eusebio Murillo E (8), Redondo P (9), Ciudad-Blanco C (10,11), Toll-Abelló A (12), Artola Igarza JL (13), Allende Markixana I (14), Suarez Fernández R (11), Alfaro Rubio A (15), Alonso Pacheco ML (16), Vázquez-Veiga H (17), de la Cueva Dobao P (18), Ruiz-Salas V (4), Vilarrasa Rull E (4,5), Barchino L (10), Morales-Gordillo V (2), Ocerin-Guerra I (14), Navarro Tejedor R (1), Hueso L (15), Mayor Arenal M (16), Seoane-Pose MJ (17), Cano-Martinez N (10,18), Garcia-Doval I (19), Descalzo MA (19); REGESMOHS (Registro Español de Cirugía de Mohs).
(1) Hospital de la Princesa, Madrid.
(2) Hospital Universitario Quirón Salud, Madrid.
(3) Instituto Valenciano de Oncología, Valencia.
(4) Hospital de la Santa Creu i Sant Pau, Barcelona.
(5) Centro Médico Teknon.
(6) Complejo Asistencial Universitario de León, León.
(7) Hospital Universitario Fundación Alcorcón, Madrid.
(8) Complejo Hospitalario Universitario de Guadalajara, Guadalajara.
(9) Clínica Universidad de Navarra, Pamplona.
(10) Hospital La Zarzuela, Madrid.
(11) H Gregorio Marañón, Madrid.
(12) Hospital del Mar, Barcelona.
(13) Hospital Galdakao, Galdakao.
(14) Hospital Universitario de Cruces, Barakaldo.
(15) Hospital Manises, Valencia.
(16) Hospital La Paz, Madrid.
(17) Complexo Hospitalario Universitario de Santiago, Santiago.
(18) Hospital Infanta Leonor, Madrid, Madrid.
(19) Unidad de investigación. Fundación Piel Sana Academia Española de Dermatología, Madrid.
The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery. The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single centre studies without a comparison group.
To compare the characteristics of patients, tumours, MMS, and one-year follow-up in patients younger than 80 years, with patients older than 80 years at the time of surgery.
Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour, and surgery were recorded. Follow-up data was collected from two visits; the first within one month post-surgery and the second within the first year.
From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75,4%) were aged < 80 years and 633 (24,6%) were ≥80 years-old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma.
Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects, and requiring more time in the operating room. Despite this, the incidence of post-operative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first-year follow-up.
The risk of short term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly.
CITA DEL ARTÍCULO J Eur Acad Dermatol Venereol. 2017 Sep 12. doi: 10.1111/jdv.14586