Mohs micrographic surgery in the Philippines: A 15-year review

Abstract

Basal cell carcinoma 315 (78.0) Squamous cell carcinoma 43 (10.6) Bowen’s disease 21 (5.2) Basosquamous carcinoma 8 (2.0) Dermatofibrosarcoma protuberans 4 (1.0) Extramammary Paget’s disease 3 (0.7) Atypical fibroxanthoma 2 (0.5) Merkel cell carcinoma 1 (0.2) Mucinous eccrine gland carcinoma 1 (0.2) Benign fibrohistiocytic tumor 1 (0.2) Mammary Paget’s disease 1 (0.2) Primary adenocarcinoma of the scrotal skin 1 (0.2) Atypical keratinocytes on intradermal nevus 1 (0.2) Vulvar intraepithelial neoplasia 1 (0.2) Eccrine porocarcinoma 1 (0.2) To The Editor:Mohs micrographic surgery (MMS) has proven to be effective for microscopically removing tumor foci with normal tissue sparing. This retrospective review describes the clinicohistopathologic profile of patients who underwent MMS at the Dermatology Center of St. Luke’s Medical Center, Philippines from March 2003 to March 2018. Of 476 total MMS cases, 404 cases with complete data were included. Patients’ mean age was 64.8 years, with 94.9% in the [40 year age group. The majority of patients (83.7%), both Filipino and Caucasian, were residing in the Philippines at the time of diagnosis and surgery. A total of 242 patients were Asians (Table I). Although nonmelanoma skin cancer (NMSC) has been proven to bemore common among Caucasians, this study has shown that Asians can be similarly susceptible to NMSCs as well. After 15 years, the number of Asians diagnosed with NMSC, especially Filipinos, was almost twice as many as Caucasians. This may reflect either an increasing incidence of NMSCs among Asians or an increased awareness of NMSCs. More than 90% of MMS cases were primary, while \\10% were recurrent. Recurrent cases included incompletely excised NMSCs or those that reappeared after standard wide excision, MMS, radiation, cryotherapy, or topical chemotherapy. Most recurrent cases had undergone wide excision more than twice before referral to the center. The most common tumor was basal cell carcinoma (BCC) (78%), a finding which is similar to the majority reported in the literature. Squamous cell carcinoma (SCC) and SCC in situ followed second at 16% (Table II). Most tumors were located on the face (290 cases, 72%), especially the nose (27.2%). More than 1/3 of tumors were [2 cm (largest dimension) before surgery. The postoperative defect size is evidence of the subclinical spread of NMSCs, especially BCC. This observation is corroborated by a three-fold increase in the mean area from preoperative tumor size to postoperative defect size. Most tumors cleared after 2 stages (65%). Most of the postoperative defects were closed using flaps (40.1%), followed