From the Guidelines
Mohs surgery is the most appropriate surgical treatment for basal cell skin cancer, particularly for high-risk tumors, due to its high cure rate and ability to preserve healthy tissue. This surgical technique involves progressively removing thin layers of cancer-containing skin and examining them until only cancer-free tissue remains 1. The procedure is typically performed under local anesthesia as an outpatient procedure, with recovery involving wound care for 1-2 weeks.
Key Considerations
- Mohs surgery offers the highest cure rate (up to 99%) for basal cell carcinoma while minimizing scarring and functional impairment, making it particularly valuable for cancers on the face, hands, or genitals, recurrent cancers, or those with aggressive growth patterns 1.
- The use of Mohs surgery for treatment of basal cell carcinoma has significantly increased and indications have expanded to include many other cutaneous malignancies 1.
- According to current NCCN guidelines, location of BCC in the H-zone constitutes high risk, independent of size, and Mohs surgery is recommended for high-risk BCC 1.
- Patients should protect the surgical site from sun exposure and attend follow-up appointments to monitor for recurrence, as those with a history of skin cancer have an increased risk of developing new cancers.
Surgical Technique
- During the procedure, a surgeon removes the visible tumor along with a small margin of surrounding tissue, which is immediately examined under a microscope 1.
- If cancer cells are still present, additional layers are removed only from areas where cancer remains, preserving as much healthy tissue as possible.
- This process continues until all margins are clear of cancer cells, ensuring the highest cure rate and minimizing scarring and functional impairment.
Post-Operative Care
- Recovery involves wound care for 1-2 weeks, and patients should protect the surgical site from sun exposure to prevent further skin damage and reduce the risk of recurrence 1.
- Follow-up appointments are crucial to monitor for recurrence, as those with a history of skin cancer have an increased risk of developing new cancers.
From the Research
Mohs Surgery for Basal Cell Skin Cancer
- Mohs micrographic surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins and is a good treatment option when tissue conservation is required for esthetic or functional reasons or for high-risk lesions 2.
- MMS is considered the best treatment option for high-risk basal cell carcinomas (BCCs) arising in the head and neck region or presenting as a recurrence, with a recurrence rate of 3.1% compared to 14% for traditional surgery 2.
- The available data suggest that surgical methods, including MMS, remain the gold standard in BCC treatment, with MMS typically utilized for high-risk lesions 3.
Treatment Options for Basal Cell Skin Cancer
- Surgical excision remains the standard of treatment for BCC, but several alternative treatment modalities exist, including radiotherapy, cryotherapy, photodynamic therapy, topical imiquimod, and topical 5-fluorouracil 3.
- Hedgehog pathway inhibitors have emerged as an important treatment option for advanced BCC, with vismodegib and sonidegib receiving regulatory approval for the treatment of certain subsets of patients with advanced BCC 4.
- Topical treatments, such as 5-fluorouracil and imiquimod, are efficacious and safe for the treatment of superficial BCC but not other BCC subtypes or squamous cell carcinoma 5.
Cost-Effectiveness of Mohs Surgery
- Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations 6.
- A cost analysis of treatment methods found that MMS provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis, making it a cost-effective option for BCC treatment 6.