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Montero-Vilchez T, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Feal-Cortizas JC, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Sanmartin-Jiménez O. Development and validation of a model to predict complex Mohs Micrographic Surgery in clinical practice: REGESMOSH scale. J Eur Acad Dermatol Venereol 2023. [PMID: 36950898 DOI: 10.1111/jdv.19056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
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.
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Affiliation(s)
| | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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