Understanding Recurrence Rate (RR) as an Outcome Measure
No, a higher recurrence rate (RR) indicates a WORSE intervention—lower recurrence rates represent superior treatment outcomes and should always be the goal. 1
Why Lower RR Means Better Treatment
In skin cancer management, recurrence rate is an inverse measure of treatment success:
- Lower RR = Better intervention: Mohs micrographic surgery achieves a 1.0% 5-year recurrence rate for primary basal cell carcinoma compared to 10.1% with standard excision, demonstrating its superiority 1
- Higher RR = Worse intervention: Standard excision shows 17.4% recurrence for recurrent BCC versus only 5.6% with Mohs surgery 1
Clinical Evidence Demonstrating RR as Quality Metric
For Basal Cell Carcinoma:
- Primary BCC: Mohs surgery achieves 99% 5-year cure rates (1% recurrence) versus 88-90% with standard excision (10-12% recurrence) 1
- Recurrent BCC: Positive surgical margins result in 26.8% recurrence compared to only 5.9% with negative margins 2
For Squamous Cell Carcinoma:
- Primary cSCC: Mohs surgery demonstrates 3.1% recurrence versus 8.1% with standard excision 1, 3
- Recurrent cSCC: Mohs surgery shows 10.0% recurrence versus 23.3% with standard excision 1, 3
- High-risk features: Poorly-differentiated cSCC has 32.6% recurrence with Mohs versus 53.6% with standard excision 1
Critical Pitfall to Avoid
Never interpret higher recurrence rates as indicating better treatment. The medical literature universally uses recurrence rate as a negative outcome measure—interventions that minimize recurrence are superior because they reduce morbidity (need for additional surgery, disfigurement), mortality (from metastatic disease), and impair quality of life (repeated treatments, anxiety, functional impairment) 2, 4, 5.
Why This Matters for Treatment Selection
- Regional nodal involvement in squamous cell carcinoma significantly increases both recurrence risk and mortality 2
- High-risk patients with locoregional recurrence after resection and radiotherapy experience 30% locoregional recurrence, 25% distant metastasis, and only 40% 5-year survival 2
- Metastatic cutaneous squamous cell carcinoma demonstrates mortality rates exceeding 70% 4
The goal is always to achieve the LOWEST possible recurrence rate to optimize patient survival and quality of life. 2, 1, 5