Retrospective cohort study of overall survival after Mohs surgery versus wide local excision for early-stage Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare cutaneous malignant neoplasm with increasing incidence and high mortality. NCCN guidelines state that for localized MCC Mohs micrographic surgery (MMS) and wide local excision (WLE) can both be used. A retrospective cohort study using the National Cancer Database compared MMS versus WLE for early stage MCC. The study included 2313 adult patients. Mean survival rates at ten years were 81.8% after MMS versus 60.9% after WLE. On multivariable survival analysis, MMS was associated with significant improved survival compared with WLE (HR 0.59; p=0.04). The authors conclude that, for early-stage MCC with negative regional lymph node disease, use of MMS versus conventional WLE as the primary surgical modality may lead to improved patient survival.