PMID- 33742233
OWN - NLM
STAT- MEDLINE
DCOM- 20210609
LR  - 20210609
IS  - 1534-4681 (Electronic)
IS  - 1068-9265 (Linking)
VI  - 28
IP  - 7
DP  - 2021 Jul
TI  - Total Margin-Controlled Excision is Superior to Standard Excision for 
      Keratinocyte Carcinoma on the Nose: A Veterans Affairs Nested Cohort Study.
PG  - 3656-3663
LID - 10.1245/s10434-021-09604-9 [doi]
AB  - BACKGROUND: Keratinocyte carcinoma (KC), including basal and squamous cell 
      carcinoma, is the most common human malignancy. Limited real-world data have 
      compared surgical outcome or cost between total margin-controlled excision (TMCE) 
      and standard excision (SE), the two most common treatments for invasive KC. We 
      compared reconstruction, margin status, and cost between TMCE and SE for KC on 
      the nose at a Veterans Affairs (VA) healthcare system. METHODS: Randomly selected 
      primary KCs on the nose </=3 cm that were confined to soft tissue, without nerve or 
      lymphovascular invasion, and treated with SE or TMCE between 2000 and 2010, were 
      assessed. Utilization of flap or graft reconstruction and margin status following 
      all surgical attempts were recorded. Costs were based on Current Procedural 
      Terminology codes standardized to 2019 Medicare payments. RESULTS: Overall, 148 
      cases were included in each treatment group. Baseline characteristics were 
      similar between groups, although SE tumor median diameter was 1 mm larger. 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). 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. SE cost per 
      tumor was significantly higher than TMCE ($429.03 +/- 143.55; p = 0.003). 
      CONCLUSIONS: 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 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.
FAU - Massey, Paul R
AU  - Massey PR
AD  - Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 
      Boston, MA, USA.
FAU - Gupta, Sameer
AU  - Gupta S
AD  - Department of Dermatology, Massachusetts General Hospital, Harvard Medical 
      School, Boston, MA, USA.
FAU - Rothstein, Brooke E
AU  - Rothstein BE
AD  - Department of Dermatology, Tufts Medical Center, Boston, MA, USA.
FAU - Konnikov, Nellie
AU  - Konnikov N
AD  - Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, 
      MA, USA.
FAU - Mahalingam, Meera
AU  - Mahalingam M
AD  - Dermatopathology Section, Department of Pathology and Laboratory Medicine, 
      Veterans Affairs, Boston Healthcare System, Boston, MA, USA.
FAU - Ruiz, Emily S
AU  - Ruiz ES
AD  - Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 
      Boston, MA, USA.
AD  - Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, 
      MA, USA.
FAU - Schmults, Chrysalyne D
AU  - Schmults CD
AD  - Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 
      Boston, MA, USA.
FAU - Waldman, Abigail
AU  - Waldman A
AD  - Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 
      Boston, MA, USA. awaldman10@bwh.harvard.edu.
AD  - Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, 
      MA, USA. awaldman10@bwh.harvard.edu.
LA  - eng
PT  - Journal Article
DEP - 20210319
PL  - United States
TA  - Ann Surg Oncol
JT  - Annals of surgical oncology
JID - 9420840
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - Humans
MH  - Keratinocytes
MH  - Medicare
MH  - Retrospective Studies
MH  - *Skin Neoplasms/surgery
MH  - United States
MH  - *Veterans
EDAT- 2021/03/21 06:00
MHDA- 2021/06/10 06:00
CRDT- 2021/03/20 06:44
PHST- 2020/08/02 00:00 [received]
PHST- 2020/12/04 00:00 [accepted]
PHST- 2021/03/21 06:00 [pubmed]
PHST- 2021/06/10 06:00 [medline]
PHST- 2021/03/20 06:44 [entrez]
AID - 10.1245/s10434-021-09604-9 [pii]
AID - 10.1245/s10434-021-09604-9 [doi]
PST - ppublish
SO  - Ann Surg Oncol. 2021 Jul;28(7):3656-3663. doi: 10.1245/s10434-021-09604-9. Epub 
      2021 Mar 19.