Surgeon Perspective on Medicaid Participation for Mohs Micrographic Surgery: A Nationwide Survey of the Workforce

We analyzed 744 EPC cases in the SEER database (2000–2018). EPC has been reported to have a female predominance, or no sex predilectionWe found that EPC had a higher incidence among men in agreement with 2 prior studies. Demographic differences in EPC were majorly consistent with past epidemiologic studies indicating they are stable over time. EPC has a good prognosis; however, survival is dependent on affected region and intervention used. Survival rates at 1, 3, and 5 years demonstrated no significant differences between men and women. However, among all participants, our observed 3-year relative survival rate of 94.13% differs from past studies demonstrating a lower 3-year survival rate of 70.13%. We revealed that EPC cases in men occurred at older ages with 66.03% of cases occurring in men over 65, whereas 65.3% of cases occurred in women above 65. Our results support the literature that EPC occurs at advanced ages, typically the 7 decade of life, although we report differences in the age distribution of EPC by sex. We provide new data on differences in EPC stage by sex compared with other studies that grouped male and female cases, or combined data for all cutaneous adnexal carcinomas. In women, a greater proportion of EPC cases were localized (74.3%) compared to men (62.30%). Men exhibited a greater proportion of EPC cases at distant sites (1.87%) compared with women (0.32%). Overall, most of the total EPC cases were localized (67.34%), whereas only 3.63% of cases spread to regional or distant lymph nodes (1.21%). These values disagree with prior studies indicating that 20% of patients experience regional lymph node metastases and 10% experience distant metastases. This highlights the potentially more indolent nature of EPC, or greater delay to metastasis than what was previously reported. Women experienced a significantly greater proportion of EPCs of the trunk, and lower limb/hip, whereas men had a greater percentage of EPCs of the head/neck, and upper limb/shoulder. Consistent with the literature,most EPC cases occur on the head/neck region followed by the lower limbs/ hips.Our data are in contrast to 2 studies reporting that EPC cases most frequently affect the extremities and lower limbs/ hips. Our data on sex differences in the body location of EPC may inform screening guidelines for EPC in men versus women based on localization behavior/tendencies. We report novel sex-based differences in the epidemiologic and survival behavior of EPC.Namely, EPCmay be less likely to be detected at earlier stages in men because a greater proportion of cases in men were located at distant sites (indicating that the tumor has spread to nonadjacent tissues), whereas EPC was most likely to be localized in women. Furthermore, a greater percentage of men experienced malignancies before EPC diagnosis, which may provide evidence for an association between EPC and prior malignancy. In addition, we found that the incidence of EPCmay be increasing because of the fact that in the 35 year period from 1973 to 2008 only 203 porocarcinoma (used interchangeably with EPC) cases were identified in the SEER database, whereas we identified 744 cases in the 18 year period from 2000 to 2018. Our findings elucidate sex differences in EPC, contribute to the literature on epidemiological factors underlying EPC prognosis/survival, and inform future screening recommendations/patient education.