Regional Trends in the Reconstruction of Melanoma and Non-Melanoma Skin Cancer Defects
Sabine Egeler, MD, Anna Rose Johnson, MPH, Alexandra Bucknor MBBS, MSc, Austin Chen, BS, Anmol Chattha, BA, MPH, Samuel J. Lin, MD, MBA
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Background: This study analyzes on geographical trends in skin malignancy reconstruction of the head and neck area in the United States
Methods: Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database (NIS) for the years 2011-2014 was undertaken. Adult patients diagnosed with melanoma or NMSC of head and neck were included. Characteristics, surgical specifics and outcomes were retrieved. Pearson χ2 square was used to compare categorical variables. Trends over time in reconstruction techniques were analyzed using the Cochran-Armitage test.
Results: Overall, 17,292 patients with a diagnosis of skin malignancy of the head or neck were identified, of which 947 (5.5%) underwent a reconstruction. Patients were most commonly White 14,649 (84.7%), males (57.2%), with squamous cell carcinoma (26.0%) or basal cell carcinoma (19.6%). There was a 47.1% complication rate. A non-linear increase in overall reconstruction (p<0.001) was observed, which was driven by an increase in NMSC reconstruction (p<0.001), but not post-melanoma reconstruction (p=0.074). There were significant differences in the reconstruction of head and neck cancers (p=0.12), with the highest numbers occurring in the South (38.0%/37.8%). There were significant differences in the reconstruction of NMSC with overrepresentation in the South (37.8%, p=0.003). There were no regional differences in post-Melanoma reconstruction (p=0.158).
Conclusion: These results suggest that an increase in skin cancer leads to a corresponding increase in flap reconstruction; with increasing numbers in the South, which may be related to increased sun exposure.
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