Mohs similar to wide excision in observational study of patients with stage I melanoma (most < 0.8 mm thickness)

Référence

Cheraghlou S, Christensen SR, Agogo GO, Girardi M. Comparison of survival after Mohs micrographic surgery vs wide margin excision for early-stage invasive melanoma. JAMA Dermatol 2019;155(11):1252-1259.

Sommaire

These authors used data from a prospective cohort of cancer patients (the National Cancer Database) who were given a diagnosis of stage I melanoma between 2004 and 2014. More than 80% had a Breslow thickness of less than 0.8 mm. The authors excluded those with in situ disease or nodal or extranodal metastasis and those who underwent radiotherapy or chemotherapy. They used propensity score matching to create 2 groups of patients: one group was treated with Mohs micrographic surgery (MMS) and the other was treated with the more traditional wide margin excision (WME). The groups were matched by age, sex, race, comorbidities, type of insurance, academic versus nonacademic site of treatment, and anatomical location of the lesion. Prior to adjustment there was no difference in survival between MMS and WME. After propensity score adjustment, survival was slightly better and mortality lower for MMS (hazard ratio [HR] 0.82; 95% CI 0.68 - 0.98). The authors also did a multivariate analysis with overall survival as the dependent variable and the factors used in the propensity score matching as the covariates along with type of excision (MMS vs WME). In this analysis, MMS was associated with a significantly lower mortality rate (HR 0.86; 0.76 - 0.97). ERRATUM: The POEM from 12 February 2020 describing a study of ubrogepant for treatment of acute migraine mistakenly identified it as a monoclonal antibody in the Clinical Question and Bottom-Line sections. It is actually a calcitonin gene-related peptide antagonist.