Demographic and Tumor Characteristics of Patients Younger Than 50 Years With Nonmelanoma Skin Cancer Referred for Mohs Micrographic Surgery

May 2018 | Volume 17 | Issue 5 | Original Article | 499 | Copyright © May 2018

Nicola A. Quatrano MD,a Euphemia W. Mu MD,a David E. Orbuch MD,a Adele Haimovic MD,a Roy G. Geronemus MD,a,b and Jeremy A. Brauer MDa,b

aNew York University School of Medicine, New York, NY bLaser & Skin Surgery Center of New York, New York, NY

Abstract
BACKGROUND: An increase in nonmelanoma skin cancer (NMSC) in younger patients has been reported. Many are treated with Mohs micrographic surgery (MMS). OBJECTIVE: Investigate patient and tumor characteristics in patients less than 50 years undergoing MMS for NMSC at a large, referral-based practice. METHODS & MATERIALS: Retrospective chart review of 1,332 tumors occurring in 1,018 consecutive patients over a five-year period. RESULTS: 81.7% of tumors were BCC and 55.3% occurred in women. Patients less than 30 years were more likely to be female (P equals 0.016) and women were more likely to have BCC (P equals 0.010). SCCs were more likely with increasing age (P less than 0.001). Of all tumors, 3.6% were recurrent, 2.7% had diameters ≥ 2 centimeters, and 5.5% of all BCCs had a high-risk histologic subtype. Women were more than twice as likely as men to be referred to plastic surgery for repair (P equals 0.020). CONCLUSION: Patients < 50 years with NMSC may represent a growing population referred for MMS, especially young women with BCC. High-risk tumor features were rare among young patients, and female gender was associated with an increased rate of referral for repair by a plastics subspecialty. Study was performed at the Laser & Skin Surgery Center of New York. IRB STATUS: Approved by Essex Institutional Review Board, Protocol #MOHS40-65

J Drugs Dermatol. 2018;17(5):499-505.

INTRODUCTION

Nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common malignancy in Caucasian populations worldwide. However, because NMSC are typically not reported to national and state registries, the exact incidence rates are unknown and are likely underestimated. In the United States, it is estimated that over 5.4 million cases of NMSC are treated in more than 3.3 million people annually and that the incidence is increasing each year.1 A significant increase in NMSC diagnosed in patients younger than 40 years, particularly in women diagnosed with BCC, has been reported.2-4 Yet, little is known about this patient population beyond age and gender. Additionally, as many of these patients are being treated with Mohs micrographic surgery (MMS), the surgical implications of both patient and tumor characteristics in this patient population become of greater clinical interest. The purpose of this study was to further investigate patient demographics and tumor characteristics in patients younger than 50 years undergoing MMS for NMSC at a large, referral-based practice. Differences in tumor characteristics based on gender, age range, smoking status, immunosuppression, and hormonal influence in this patient population were also considered. In particular, this study aimed to elucidate patient characteristics that may predispose to high-risk tumor characteristics or more extensive surgical intervention. 

METHODS

After institutional review board approval, a retrospective chart review was performed on consecutive patients younger than 50 years treated with MMS for BCC or SCC from January 2009 to December 2013. This population was treated at the Laser & Skin Surgery Center of New York, a referral-based, private practice, outpatient surgical center, where nearly 3,000 MMS are performed annually. Given the relative infrequency of NMSCs such as dermatofibrosarcoma protuberans (DFSP), merkel cell carcinoma, and atypical fibroxanthoma, patients undergoing MMS for treatment of these tumors were excluded. Data were collected on patient age, gender, Fitzpatrick skin type (FST), personal and family history of NMSC or malignant melanoma, and smoking, immunosuppression, and hormonal status at the time of initial presentation for MMS within the study period. Family history was considered positive if the patient reported a parent with NMSC or MM. Patients were considered immunosuppressed if they