Evidence map›Paper›PMID 33742233›Full record

ArticleAnnals of surgical oncology2021

Total Margin-Controlled Excision is Superior to Standard Excision for Keratinocyte Carcinoma on the Nose: A Veterans Affairs Nested Cohort Study.

Paul R Massey, Sameer Gupta, Brooke E Rothstein, Nellie Konnikov, Meera Mahalingam, Emily S Ruiz, Chrysalyne D Schmults, Abigail Waldman

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Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.1field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 7 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Paul R Massey *Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Sameer Gupta *Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brooke E RothsteinDepartment of Dermatology, Tufts Medical Center, Boston, MA, USA.
Nellie KonnikovDepartment of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, MA, USA.
Meera MahalingamDermatopathology Section, Department of Pathology and Laboratory Medicine, Veterans Affairs, Boston Healthcare System, Boston, MA, USA.
Emily S RuizDepartment of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Chrysalyne D SchmultsDepartment of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abigail WaldmanDepartment of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. awaldman10@bwh.harvard.edu.
VA Boston Healthcare System · USHarvard University · USMassachusetts General Hospital · USTufts Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundKeratinocyte carcinoma (KC), including basal and squamous cell carcinoma, is the most common human malignancy. Limited real-world data have compared surgical outcome or cost between total margin-controlled excision (TMCE) and standard excision (SE), the two most common treatments for invasive KC. We compared reconstruction, margin status, and cost between TMCE and SE for KC on the nose at a Veterans Affairs (VA) healthcare system.

methodsRandomly selected primary KCs on the nose ≤3 cm that were confined to soft tissue, without nerve or lymphovascular invasion, and treated with SE or TMCE between 2000 and 2010, were assessed. Utilization of flap or graft reconstruction and margin status following all surgical attempts were recorded. Costs were based on Current Procedural Terminology codes standardized to 2019 Medicare payments.

resultsOverall, 148 cases were included in each treatment group. Baseline characteristics were similar between groups, although SE tumor median diameter was 1 mm larger. SE was associated with increased utilization of flap or graft reconstruction (odds ratio 2.05, 95% confidence interval 1.16-3.59, p = 0.01). Positive margins were present in 24% of SEs initially and remained positive after the final recorded excision in 9% of cases. No positive final margins were noted in TMCE cases. SE cost per tumor was significantly higher than TMCE ($429.03 ± 143.55; p = 0.003).

conclusionsSurgical management of KC with SE is associated with increased reconstruction complexity, a significant risk of positive margins, and higher cost compared with TMCE. The 23% risk of positive margins supports National Comprehensive Cancer Network guidelines for the treatment of high-risk KC with TMCE, unless delayed reconstruction is employed.

Indexed as

Skin NeoplasmsVeteransAgedCohort StudiesHumansKeratinocytesMedicareRetrospective StudiesUnited States

Identifiers

PMID33742233
OpenAlexW3136810903

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.