Conflict of interest Drs. K. Munte and Prof. T. Nijsten are both affiliated to the Erasmus Medical University Center and to a private practice specialized in Mohs micrographic surgery (Mohs klinieken).
Mohs micrographic surgery for basal cell carcinomas: appropriateness of ‘Rotterdam’ criteria and predictive factors for three or more stages
Article first published online: 8 OCT 2012
© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 27, Issue 10, pages 1228–1235, October 2013
How to Cite
Flohil, S.C., van Dorst, A.M.J.M., Nijsten, T., Martino Neumann, H.A. and Munte, K. (2013), Mohs micrographic surgery for basal cell carcinomas: appropriateness of ‘Rotterdam’ criteria and predictive factors for three or more stages. Journal of the European Academy of Dermatology and Venereology, 27: 1228–1235. doi: 10.1111/j.1468-3083.2012.04696.x
- Issue published online: 20 SEP 2013
- Article first published online: 8 OCT 2012
- Received: 7 May 2012; Accepted: 13 August 2012
Background In the Netherlands basal cell carcinomas (BCC) are eligible for Mohs microscopic surgery (MMS) if certain criteria are fulfilled.
Objective To study the MMS indication criteria practised at the department of dermatology of the Erasmus University Medical Center, Rotterdam and to identify predictive factors for extensive subclinical tumour spread among BCCs eligible for MMS.
Methods Pre-operative patient and tumour characteristics were derived retrospectively between January 2nd 2006 and December 28th 2009 from 1174 patient records, accounting for 1464 BCCs. Multivariate logistic regression models were used to calculate crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for one vs. two or more stages and for narrow (≤2 stages) vs. extensive subclinical spread (≥3 stages).
Results H-zone location [adjusted OR 1.51 (95% CI 1.16–1.96)], recurrent tumour [adjusted OR 1.50 (95% CI 1.11–2.02)], aggressive subtype [adjusted OR 1.25 (95% CI 1.01–1.56)] and tumour size ≥11 mm [adjusted OR 1.53 (95% CI 1.20–1.96)] were significantly associated with two or more stages. Predictive factors for extensive subclinical spread were recurrent tumour [adjusted OR 2.26 (95% CI 1.61–3.17)], tumour size ≥21 mm [adjusted OR 1.69 (95% CI 1.13–2.51)] and location in the H-zone [adjusted OR 1.68 (95% CI 1.15–2.46)].
Conclusion ‘Rotterdam’ indication criteria used for MMS are appropriate. Predictors for extensive subclinical spread are important for patients’ and surgeons’ expectations prior to the operation about time span, defect size, reconstruction and possible associated morbidity.