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Comment & Response
June 10, 2020

Clarification Regarding Noninferiority and a Discussion of Model Selection and Treatment Effects in Observational Research—Reply

Author Affiliations
  • 1Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
  • 2Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Dermatol. Published online June 10, 2020. doi:10.1001/jamadermatol.2020.0543

In Reply We appreciate the comments of Drs Hopkins and Secrest on our analysis of the survival outcomes after Mohs micrographic surgery (MMS) and wide margin excision (WME) in patients with early-stage invasive melanoma.1 We agree that the studies referenced in our article were not designed as noninferiority studies and, therefore, equality of outcomes between the 2 treatments cannot be affirmed. Nevertheless, given previous arguments that narrow margins with MMS would lead to poorer outcomes, it is noteworthy that these analyses did not find statistically poorer survival rates for patients treated with MMS vs WME. Drs Hopkins and Secrest also point out that 1 of the referenced studies did not directly compare the 2 techniques. That study reported 100% disease-specific survival following MMS for invasive melanoma, so those results further support the comparable effectiveness of MMS for invasive melanoma relative to published survival rates for patients with this disease who are treated with WME.2

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