Brachytherapy, Mohs Surgery Better for Improved Cosmesis in Skin Cancers

A dermatologist examining a woman's chest
A dermatologist examining a woman’s chest
Cosmetic outcomes are best in patients with skin cancer who receive brachytherapy or Mohs micrographic surgery, suggest results from a novel study comparing cosmetic and cancer control outcomes of surgical and radiotherapeutic modalities.

Brachytherapy and Mohs micrographic surgery (MMS) improve cosmesis better than external-beam radiation therapy (EBRT) and conventional excision (CE) in patients with T1-T2N0 skin cancers, study data published in Cancer suggest.

The study was a systematic review and meta-analysis of studies in PubMed that included patients with T1-T2N0 basal cell carcinomas and squamous cell carcinomas. Only studies that featured ≥10 months of follow-up and enrolled patients who received CE, MMS, EBRT, or BT were included. Overall, data from a total of 21,371 patients were pooled into the meta-analysis.

Cosmesis, classified as “good,” “fair,” or “poor” was the primary endpoint. A secondary endpoint of the study was 1-year recurrence. Primary and secondary endpoints were assessed in relation to treatment modality using fixed-effects and random-effects meta-analyses.

Based on the available data, researchers found high summary effect sizes for “good” cosmesis for CE (81%; 95% CI, 70.6%-89.6%), EBRT (74.6%; 95% CI, 63%-84.6%), and brachytherapy (97.6%; 95% CI, 91.3%-100%). The 96.0% good cosmesis summary effect size was only in the 1 MMS study reporting cosmesis, with 4% of patients experiencing a fair cosmesis outcome in this study.

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The use of brachytherapy was associated with a greater improvement to “good” cosmesis compared with EBRT (P =.0025). The respective 1-year recurrence rates for CE, MMS, EBRT, and brachytherapy were 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%).

Limitations of the study include the subjective nature of cosmesis grading and the relatively short duration of follow-up in the included brachytherapy studies.

While the analysis found a benefit associated with brachytherapy and MMS, the researchers wrote that “it is unclear whether the perceived benefits are because of treatment effectiveness versus selection and reporting bias.”

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Lee CT, Lehrer EJ, Aphale A, Lango M, Galloway TJ, Zaorsky NG. Surgical excision, Mohs micrographic surgery, external-beam radiotherapy, or brachytherapy for indolent skin cancer: an international meta-analysis of 58 studies with 21,000 patients. Cancer. 2019;125(20):3582-3594.