Gender Differences in Tumor and Patient Characteristics in Those Undergoing Mohs Surgery Kachiu C. Lee, MD, MPH, H. William Higgins II, MD, MBE, Olivia Linden, BA, and Antonio P. Cruz, MD*
BACKGROUND Nonmelanoma skin cancer is the most common cancer in the United States, and when indicated, Mohs micrographic surgery (MMS) is an effective method for tumor removal. Few studies have focused on gender-specific characteristics among those undergoing MMS. OBJECTIVE
To elucidate patient- and tumor-specific characteristics in female MMS patients.
MATERIALS AND METHODS We performed a retrospective chart review of 12,344 consecutive patients undergoing MMS from 2005 to 2012. RESULTS There was a 1.5:1 male predominance in the presentation of basal cell carcinoma (BCC) for MMS. However, BCC comprised 72% of tumors in women compared with 63% in men. Presenting tumor sizes of BCCs were smaller in women (0.9 vs 1.2 cm2, p < .01). Superficial BCCs were more common in women (p < .001). Women had fewer squamous cell carcinoma (p < .01) and squamous cell carcinoma in situ (p < .01). They were more likely to present with tumors on their legs and central facial areas, whereas men had more tumors on their scalps and ears. Plastic surgery referral was over twice as common in the female population (p < .01). CONCLUSION In our data set, significant gender-specific differences were found in women compared with men undergoing MMS. These findings may be the result of discrepancies in sun exposure, protective behavior, and cosmetic concern. The authors have indicated no significant interest with commercial supporters.
N
onmelanoma skin cancer (NMSC) is the most common cancer in the United States, and its increasing incidence is well documented.1 Mohs micrographic surgery (MMS) for the treatment of NMSC is an effective method for the eradication of skin cancers.2 Several differences in tumor and patient characteristics may exist between women and men undergoing MMS. This study further delineates differences in the female MMS population. Methods A retrospective chart review was performed on consecutive patients treated with MMS for basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from January 2005 to December 2012. This population was treated at an academic MMS practice and comprised 85% to 90% referrals from private practice
physicians, with the remainder from a VA Medical Center. The affiliated academic hospital serves as the major referral center for the state and neighboring regions. For this study, data were collected on patient age and sex, tumor location, histologic type and subtype, initial area, subclinical extension (defect size and number of layers), and type of repair. Chi-square tests were used to compare male and female population, as well as ttests, and linear and multivariate regressions were used to compare tumor characteristics and locations. The institutional review board approved this study before initiation of data collection. Results Four different surgeons who perform Mohs surgery performed a total of 12,344 MMS procedures during the study time period (2005–2012). Of these, 7839
*All the authors are affiliated with the Department of Dermatology, Brown University, Providence, Rhode Island
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© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins ISSN: 1076-0512 Dermatol Surg 2014;40:686–690 DOI: 10.1111/dsu.0000000000000020
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686
Copyright © American Society for Dermatologic Surgery. Unauthorized reproduction of this article is prohibited.
LEE ET AL
surgeries were performed on men (63.5%). At the time of tumor removal, women were slightly younger (70 6 14 years) when compared with men (72 6 12 years). Tumor Type BCCs were the most common tumor in both sexes, comprising 67% of all tumors reviewed. There was a 1.5:1 predominance of males to females with BCCs. In women, BCCs made up 72% of all tumors. In men, BCC made up 63% of all tumors. Women had more superficial BCCs and fewer basosquamous (metatypical) BCCs (Table 1). There were no differences in the age of presentation between men and women when looking at the subtypes of BCC. SCC and SCC in situ (SCCIS) were the second and third most prevalent NMSC in our data set (20.7% and 10.1% of all tumors, respectively). Women had fewer SCCs (16% of women vs 24% of men, p < .01) and SCCIS (8% of women vs 11% of men, p < .01). Location
TABLE 1. Subtypes of BCCs by Gender Male, n (%)
Female, n (%)
2578 (63)
1634 (61)
117 (3)
120 (4)
Infiltrative
930 (23)
651 (25)
Morpheaform Micronodular
61 (1) 139 (3)
37 (1) 102 (4)
Basosquamous* (metatypical)
290 (7)
138 (5)
4115
2682
*p # .05.
Scalp* Forehead*
Female, n (%)
650 (8)
184 (4)
708 (9)
556 (12)
Periocular
436 (6)
334 (7)
Temples
509 (7)
233 (5)
Nose*
1501 (19)
1210 (27)
Cheek
1122 (14)
638 (14)
339 (4)
341 (8)
Ear*
1178 (15)
150 (3)
Chin Neck
186 (2) 316 (4)
139 (3) 104 (2)
Perioral*
Chest
113 (1)
73 (2)
Back
121 (2)
55 (1)
Arms
227 (3)
103 (3)
Hands
225 (3)
120 (3)
Legs*
148 (2)
228 (5)
Feet
7 (
BACKGROUND Nonmelanoma skin cancer is the most common cancer in the United States, and when indicated, Mohs micrographic surgery (MMS) is an effective method for tumor removal. Few studies have focused on gender-specific characteristics among those undergoing MMS. OBJECTIVE
To elucidate patient- and tumor-specific characteristics in female MMS patients.
MATERIALS AND METHODS We performed a retrospective chart review of 12,344 consecutive patients undergoing MMS from 2005 to 2012. RESULTS There was a 1.5:1 male predominance in the presentation of basal cell carcinoma (BCC) for MMS. However, BCC comprised 72% of tumors in women compared with 63% in men. Presenting tumor sizes of BCCs were smaller in women (0.9 vs 1.2 cm2, p < .01). Superficial BCCs were more common in women (p < .001). Women had fewer squamous cell carcinoma (p < .01) and squamous cell carcinoma in situ (p < .01). They were more likely to present with tumors on their legs and central facial areas, whereas men had more tumors on their scalps and ears. Plastic surgery referral was over twice as common in the female population (p < .01). CONCLUSION In our data set, significant gender-specific differences were found in women compared with men undergoing MMS. These findings may be the result of discrepancies in sun exposure, protective behavior, and cosmetic concern. The authors have indicated no significant interest with commercial supporters.
N
onmelanoma skin cancer (NMSC) is the most common cancer in the United States, and its increasing incidence is well documented.1 Mohs micrographic surgery (MMS) for the treatment of NMSC is an effective method for the eradication of skin cancers.2 Several differences in tumor and patient characteristics may exist between women and men undergoing MMS. This study further delineates differences in the female MMS population. Methods A retrospective chart review was performed on consecutive patients treated with MMS for basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from January 2005 to December 2012. This population was treated at an academic MMS practice and comprised 85% to 90% referrals from private practice
physicians, with the remainder from a VA Medical Center. The affiliated academic hospital serves as the major referral center for the state and neighboring regions. For this study, data were collected on patient age and sex, tumor location, histologic type and subtype, initial area, subclinical extension (defect size and number of layers), and type of repair. Chi-square tests were used to compare male and female population, as well as ttests, and linear and multivariate regressions were used to compare tumor characteristics and locations. The institutional review board approved this study before initiation of data collection. Results Four different surgeons who perform Mohs surgery performed a total of 12,344 MMS procedures during the study time period (2005–2012). Of these, 7839
*All the authors are affiliated with the Department of Dermatology, Brown University, Providence, Rhode Island
·
© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins ISSN: 1076-0512 Dermatol Surg 2014;40:686–690 DOI: 10.1111/dsu.0000000000000020
·
·
·
686
Copyright © American Society for Dermatologic Surgery. Unauthorized reproduction of this article is prohibited.
LEE ET AL
surgeries were performed on men (63.5%). At the time of tumor removal, women were slightly younger (70 6 14 years) when compared with men (72 6 12 years). Tumor Type BCCs were the most common tumor in both sexes, comprising 67% of all tumors reviewed. There was a 1.5:1 predominance of males to females with BCCs. In women, BCCs made up 72% of all tumors. In men, BCC made up 63% of all tumors. Women had more superficial BCCs and fewer basosquamous (metatypical) BCCs (Table 1). There were no differences in the age of presentation between men and women when looking at the subtypes of BCC. SCC and SCC in situ (SCCIS) were the second and third most prevalent NMSC in our data set (20.7% and 10.1% of all tumors, respectively). Women had fewer SCCs (16% of women vs 24% of men, p < .01) and SCCIS (8% of women vs 11% of men, p < .01). Location
TABLE 1. Subtypes of BCCs by Gender Male, n (%)
Female, n (%)
2578 (63)
1634 (61)
117 (3)
120 (4)
Infiltrative
930 (23)
651 (25)
Morpheaform Micronodular
61 (1) 139 (3)
37 (1) 102 (4)
Basosquamous* (metatypical)
290 (7)
138 (5)
4115
2682
*p # .05.
Scalp* Forehead*
Female, n (%)
650 (8)
184 (4)
708 (9)
556 (12)
Periocular
436 (6)
334 (7)
Temples
509 (7)
233 (5)
Nose*
1501 (19)
1210 (27)
Cheek
1122 (14)
638 (14)
339 (4)
341 (8)
Ear*
1178 (15)
150 (3)
Chin Neck
186 (2) 316 (4)
139 (3) 104 (2)
Perioral*
Chest
113 (1)
73 (2)
Back
121 (2)
55 (1)
Arms
227 (3)
103 (3)
Hands
225 (3)
120 (3)
Legs*
148 (2)
228 (5)
Feet
7 (
