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Study Title and Description

Tumor recurrence 5 years after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma.



Key Questions Addressed
1 Comparison of interventions
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Primary Publication Information
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TitleData
Title Tumor recurrence 5 years after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma.
Author Chren MM., Linos E., Torres JS., Stuart SE., Parvataneni R., Boscardin WJ.
Country Department of Dermatology, University of California at San Francisco, San Francisco, California 94143-0808, USA. chrenm@derm.ucsf.edu
Year 2013
Numbers Pubmed ID: 23190903

Secondary Publication Information
UI Title Author Country Year
Variation in care for nonmelanoma skin cancer in a private practice and a veterans affairs clinic. Chren MM., Sahay AP., Sands LP., Maddock L., Lindquist K., Bertenthal D., Bacchetti P. Dermatology Service, Research Enhancement Award Program of the Health Services Research and Development Service, Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA. mmchren@itsa.ucsf.edu 2004
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Quality-of-life outcomes of treatments for cutaneous basal cell carcinoma and squamous cell carcinoma. Chren MM., Sahay AP., Bertenthal DS., Sen S., Landefeld CS. Dermatology Service, San Francisco Veterans Affairs Medical Center and the Department of Veterans Affairs, San Francisco, California 94121, USA. chrenm@derm.ucsf.edu 2007
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Recurrence after treatment of nonmelanoma skin cancer: a prospective cohort study. Chren MM., Torres JS., Stuart SE., Bertenthal D., Labrador RJ., Boscardin WJ. Health Services Research and Development Service, Department of Veterans Affairs, San Francisco VA Medical Center 151R, 4150 Clement St, San Francisco, CA 94121, USA. chrenm@derm.ucsf.edu 2011
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Patient satisfaction after treatment of nonmelanoma skin cancer. Asgari MM., Bertenthal D., Sen S., Sahay A., Chren MM. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. 2009
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Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria Stuart SE 2017
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Extraction Form: Comparative studies
Arms
Number Title Description Comments
1 electrodessication and curettage
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2 excision
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3 Mohs
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Design Details
Question... Follow Up Answer Follow-up Answer
Publication or abstract? Publication
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Study design Prospective nRCS
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Multicenter etc. Multicenter
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Country/Region U.S.
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Funding No industry support
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Inclusion criteria consecutive patients with nonrecurrent nonmelanoma skin cancer diagnosed in 1999 and 2000 and treated in 2 sites, a university-affiliated private dermatology practice and the dermatology clinic at the nearby VA medical center affiliated with the university
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Exclusion criteria
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N Enrolled/Randomized/Analyzed 1253
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1174
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Notes/Comments
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Method of diagnosis ... Describe Biopsy/pathologic confirmation ... Biopsies were performed either by dermatology faculty members or by dermatology residents
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Preoperative assessment of clinical size of the tumor ... not reported ...
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Percent non-primary (recurrent) 0
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Secondary size assessment
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Baseline Characteristics
Question electrodessication and curettage excision Mohs Total Comments
AnswerFollow-up AnswerFollow-up AnswerFollow-up AnswerFollow-up
Continuous baselines 65.3 68.6 67.3
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16.6 15.5 16.8
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calculated from medians and IQRs calculated from medians and IQRs calculated from medians and IQRs
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9.0 mm 9.5 mm 7.8 mm
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5.6 mm 6.1 mm 4.4 mm
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calculated from medians and IQRs calculated from medians and IQRs calculated from medians and IQRs
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1.3 1.2 1.4
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0.7 0.6 0.9
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Gender/Racial descent 49 100 155
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21 21 33
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Lesion location H-Zone of face H-Zone of face H-Zone of face
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39 lesions 148 lesions 359 lesions
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10.7 25.9 64.6
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Skin type (Fitzpatrick score) I or II: 97 (41.1%) I or II: 180 (38.2%) I or II: 196 (42%)
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Number of lesions per patient No data entered.
Previous treatments No data entered.
Immunocompromized status 2 13 17
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1 2.8 3.6
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Hx of organ transplantation Hx of organ transplantation Hx of organ transplantation
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12 11 8
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5.3 2.3 1.7
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Hx of HIV Hx of HIV Hx of HIV
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Number of patients/lesions 236 471 467
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361 571 556
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Lesion extent number of people 299 lesions 393 lesions 428 lesions
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Lesion extent number of people 62 lesions 178 lesions 128 lesions
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Results & Comparisons


Results Data
Adj. Hazard Ratio (HR) Adj. 95% CI low Adj. 95% CI high Adjusted For:
Outcome: Recurrence or relapse      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure Mohs vs. excision Mohs vs. excision Mohs vs. excision Mohs vs. excision


5 years

N Analyzed 361 571 556 0.61 0.85 0.65 0.65
Counts 0.30 0.30 0.32 0.33
Percentage 1.24 2.42 1.33 1.27
propensity matched pairs (240 pairs) propensity adjusted adjusted for history of HIV, multiple NMSCs at presentation, tumor in H-zone, BCC vs SCC, pathology, clinical site unadjusted
Adj. Hazard Ratio (HR) Adj. 95% CI low Adj. 95% CI high Adjusted For:
Outcome: Recurrence or relapse      Population: Patients judged appropriate for MMS Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure Mohs vs. excision


5 years

N Analyzed 139 523 672 0.6
Counts 6 25 19 0.3
Percentage 4.4 4.8 2.8 1.0
age, sex, history of HIV, history of KC, number of tumors at presentation, care site, number of dermatology visits per year, tumor location, tumor size (with missing values multiply imputed as described in the text), and histopathologic category (aggressive BCC, superficial/nodular BCC, invasive SCC, or SCC in situ).
Mean Difference (Net) 95% CI low 95% CI high P-Value
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 4.7 5.8 1.1
Mean 3.8 8.5 9.6 -0.2 0.8 -3.2
95% CI low -0.1 5.6 6.5 9.7 10.8 5.3
95% CI high 7.7 11.5 12.7 ns P=<0.05 ns
Mean Difference (Net) 95% CI low 95% CI high P-Value
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 13.7 20.6 7.0
Mean 3.2 16.9 23.8 7.7 14.9 1.9
95% CI low -1.1 13.2 20.3 19.7 26.3 12.1
95% CI high 7.5 20.6 27.3 P=<0.00001 P=<0.00001 P=<0.01
Mean Difference (Net) 95% CI low 95% CI high P-Value
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 4.6 5.7 1.1
Mean -0.4 4.2 5.3 0.3 1.1 -2.7
95% CI low -3.8 1.7 2.5 8.8 10.2 4.8
95% CI high 3.1 6.7 8.1 P=<0.05 P=<0.05 ns
Mean Difference (Net) 95% CI low 95% CI high P-Value N Analyzed
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 6.3 6.8 0.5 -1.6 9.2 4.0
Mean 3.4 9.7 10.2 1.3 1.5 -3.9 -9.8 -2.1 -3.1
95% CI low -0.9 6.9 7.4 11.3 12.1 4.9 6.7 20.5 11.1
95% CI high 7.6 12.5 12.9 P=<0.05 P=<0.05 NS NS NS NS
51 propensity-matched paris 24 propensity-matched paris 81 propensity-matched paris
Mean Difference (Net) 95% CI low 95% CI high P-Value N Analyzed
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 13.2 16.3 3.1 13.2 23.6 3.4
Mean 5.4 18.6 -1.9 6.8 9.4 -2.6 3.3 10.1 -3.8
95% CI low -0.2 15.1 -6.0 19.7 23.3 8.8 23.1 37.2 10.7
95% CI high 11.0 22.2 2.3 P=<0.001 P=<0.001 NS P=0.0029 P=0.0029 NS
51 propensity matched pairs 24 propensity matched pairs 81 propensity matched pairs
Mean Difference (Net) 95% CI low 95% CI high P-Value N Analyzed
Outcome: Quality of life (skin specific)      Population: All Participants Between-Arm Comparisons
Time Point Measure electrodessication and curettage excision Mohs Comparison Measure excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision excision vs. electrodessication and curettage Mohs vs. electrodessication and curettage Mohs vs. excision


2 years

N Analyzed 136 251 246 5.2 6.9 1.7 3.1 3.7 4.2
Mean -1.9 3.3 5.0 0.4 1.7 -2.5 -3.5 -4.6 -2.3
95% CI low -6.0 0.7 2.4 10.0 12.0 5.8 9.8 12.0 10.8
95% CI high 2.3 5.9 7.6 P=<0.05 P=<0.01 NS NS NS NS
51 propensity matched pairs 24 propensity matched pairs 81 propensity matched pairs
Outcome: Quality of life (skin specific)      Population: All Participants
Time Point Measure electrodessication and curettage excision Mohs


baseline N/A

N Analyzed 136 251 246
Mean 19.6 21.7 21.8
SD 23.6 23.2 23.5
Outcome: Quality of life (skin specific)      Population: All Participants
Time Point Measure electrodessication and curettage excision Mohs


baseline N/A

N Analyzed 136 251 246
Mean 33.0 38.9 46.3
SD 28.0 30.4 27.0
Outcome: Quality of life (skin specific)      Population: All Participants
Time Point Measure electrodessication and curettage excision Mohs


baseline N/A

N Analyzed 136 251 246
Mean 12.1 15.1 14.0
SD 21.7 24.6 21.1


Quality Dimensions
Dimension Value Notes Comments
RCT:....Adequate generation of a randomized sequence reported
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RCT:....Adequate allocation concealment reported
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RCT:....Adequate blinding of PATIENTS reported
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RCT:....Adequate blinding of PROVIDERS reported
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ALL....Adequate blinding of OUTCOME ASSESSORS reported Yes primary source of data on recurrence was the medical record. patients who consented were examined a median of 8.6 years after treatment by a dermatologist (MMC) blinded to treatment type.
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ALL.....Incomplete results data: are more than 20% missing for any eligible outcome in any group? No Patients lost to follow-up were similar to those with follow-up in most features but were more likely to be female (38% vs. 26%), to have worse mental health status (median SF-12 Mental Component Score 41.2 vs 51.5), and to have BCC rather than SCC (89% vs 75%).
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ALL.....Selective Reporting (judgement - put directly into notes field).
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RCT.....Is the treatment effect by Intention to treat?
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ALL....Group similarity at baseline. No Patients, tumors, and care differed in the treatment groups (Table 1). For example, tumors treated with destruction were much less likely to be located in the H-zone of the face, and much less likely to have histological risk factors for recurrence.
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ALL....Additional Bias: Bias due to problems not covered elsewhere. (judgement - put directly into notes field) Consecutive patients
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ALL (with AE results)....Were reported adverse events (of interest) precisely defined No Adverse events were not reported in any of the 4 papers from this study
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Overall, by outcome (judgement - put directly into notes field) For an NRCS, seems pretty good
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ALL.....Incomplete results data: Is there differential missingness (more than 20%) between arms for any eligible outcome? No
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Quality Rating
No quality rating data was found.