From the Guidelines
Basal cell carcinomas (BCCs) that are modular and infiltrative on the arm should be treated with Mohs surgery. This recommendation is based on the high-risk nature of these tumors, which can extend beyond visible margins and have a higher potential for recurrence 1. The modular and infiltrative growth patterns are indicative of aggressive behavior, making complete margin assessment crucial for effective treatment. According to the guidelines of care for the management of basal cell carcinoma, Mohs micrographic surgery is recommended for high-risk BCC 1.
Some key points to consider in the management of BCC include:
- Location of the tumor: BCCs located in high-risk areas, such as the H-zone, are considered high-risk regardless of size 1
- Tumor characteristics: Modular and infiltrative growth patterns are associated with a higher risk of recurrence and require more aggressive treatment 1
- Treatment options: Mohs surgery offers the highest cure rate (up to 99%) for high-risk BCCs, while minimizing the removal of healthy surrounding tissue 1
- Importance of prompt treatment: Infiltrative BCCs can be more aggressive and potentially invasive if left untreated, making timely intervention crucial 1
The final treatment decision should be made in consultation with a dermatologic surgeon who can evaluate specific factors such as tumor size, exact location, patient health status, and previous treatments. Alternative treatments like standard excision, radiation, or topical therapies may be less effective for infiltrative BCCs and could lead to recurrence 1.
From the Research
Treatment Options for Basal Cell Carcinoma
- Basal cell carcinoma (BCC) is a common skin cancer that can be treated with various methods, including surgical excision, Mohs micrographic surgery, cryosurgery, electrodesiccation and curettage, topical application of imiquimod or fluorouracil, photodynamic therapy, and radiation therapy 2.
- Mohs micrographic surgery is considered the most effective treatment for high-risk tumors, especially for recurrent BCC, with a 5-year recurrence rate of 5.6% 3.
- For primary BCC, surgical excision is often sufficient, but Mohs surgery may be preferred for high-risk tumors or those in sensitive areas, such as the face 4.
Mohs Surgery for Modular and Infiltrative BCC on the Arm
- There is no specific study that addresses the treatment of modular and infiltrative BCC on the arm.
- However, Mohs surgery is generally recommended for high-risk BCC, which may include modular and infiltrative types, due to its high cure rate and ability to confirm complete tumor removal 5, 6.
- The decision to use Mohs surgery for BCC on the arm would depend on various factors, including the size and location of the tumor, the patient's overall health, and the risk of recurrence 2, 4.
Recurrence Rates and Cost-Effectiveness
- The recurrence rate for Mohs micrographic surgery is significantly lower than for other treatment modalities, with a 5-year recurrence rate of 5.6% compared to 19.9% for non-Mohs modalities 3.
- Mohs surgery is considered cost-effective, especially for high-risk tumors, due to its high cure rate and ability to minimize the need for additional treatments 6, 4.