Evolution of Excisional Surgery Practices For Melanoma

From 2001 to 2016, the use of Mohs surgery for melanoma increase more than threefold; according to a study publish online Aug. 28 in JAMA Dermatology. Michael P. Lee, from Eastern Virginia Medical School in Norfolk, and colleagues conduct a national cross sectional analysis involving 79,108 patients undergoing surgical excision for melanoma from Jan. 1, 2001, through Dec. 31, 2016. The likelihood of a melanoma being treat with Mohs surgery was examine over time.

National Comprehensive Cancer Network guidelines for melanoma have consistently recommend wide local excision as the standard of care since their inception. Although surgery with more comprehensive margin assessment (eg, Mohs surgery) has been advocated for certain subsets of melanoma, how often these techniques are used in clinical practice is uncertain. To examine trends in the use of comprehensive margin assessment surgery for melanoma by tracking claims data for Mohs surgery.

Surgery for melanoma

This study evaluated trends in comprehensive margin assessment surgery for melanoma from 2001 to 2016 via a nationally representative claims database by analyzing the likelihood of using Mohs surgery to treat a melanoma over time. They also evaluated how Mohs surgery for melanoma has evolve over time by analyzing the likelihood of the use of IHC during Mohs surgery over time.

This study was a cross-sectional analysis using the Optum Clinformatics Data Mart from January 1, 2001, through December 2016. The Optum database contains deidentified paid claims data for approximately 12 to 14 million annually insure patients in the United States. The Optum patient population has demonstrate to be similar to the US population in respect to sex, age, and geographic distribution.

The data include medical claims along with patient demographic information such as age, sex, educational attainment, income, and geographic location. This study was approve by the institutional review board of the University of Pennsylvania; which waived the need for inform consent for the use of deidentified data. This study follow the Strengthening the Reporting of Observational Studies in Epidemiology
reporting guideline.

Randomized clinical trial

The researchers find that 75,047 patients were treat with conventional surgery; also 4,061 were treat with Mohs surgery. Mohs surgery was use in 5.1% of all surgical cases and increase 304% from 2.06 to 7.9% from 2001 to 2016. In more recent calendar years, the odds of receiving Mohs surgery for melanoma increase significantly (odds ratio, 1.02 per calendar year). In 1,087 cases (26.8%); immunohistochemistry use was coded with Mohs surgery; more recently; so the odds of receiving Mohs surgery with immunohistochemistry.

So For every period, there was considerable geographic variation; with more than threefold variation between the regions with highest; also lowest use of Mohs surgery and Mohs surgery with immunohistochemistry. “Despite stable guidelines and no randomized clinical trial data evaluating outcomes of comprehensive margin assessment surgery for melanoma; surgical excision practices for melanoma continue to evolve,” the authors write. One author disclose financial ties to the pharmaceutical industry.

Despite stable guidelines for melanoma surgery; the results of this study suggest that surgical practices for melanoma are evolving. Wide variations in surgical practice patterns for melanoma are present in the United States. This study’s findings suggest that the effect of variations in surgical techniques on outcomes requires scrutiny and further study.