What are the risks and benefits of Intensity-Modulated Gamma Stereotactic Radiosurgery (IG-SRT) versus Mohs surgery for basal cell carcinoma of the forehead?

From the Guidelines

Mohs surgery is the recommended treatment for basal cell carcinoma of the forehead due to its high cure rates and ability to spare healthy tissue, as supported by the most recent and highest quality study 1. When considering the treatment options for basal cell carcinoma (BCC) of the forehead, it is essential to weigh the risks and benefits of Intensity-Modulated Gamma Stereotactic Radiosurgery (IG-SRT) and Mohs surgery.

Key Considerations

• Mohs surgery is generally considered the gold standard for high-risk BCC due to its high cure rates (97-99%) and ability to spare healthy tissue, as reported in a study published in the Journal of the American Academy of Dermatology 1.
• The procedure involves sequential removal and microscopic examination of cancer tissue until margins are clear, typically completed in one day under local anesthesia.
• Risks associated with Mohs surgery include bleeding, infection, scarring, and potential nerve damage.
• IG-SRT is a non-invasive alternative that delivers precisely targeted radiation to the tumor while minimizing exposure to surrounding tissues.
• It's typically administered in 1-5 sessions and is particularly valuable for patients who are poor surgical candidates, have tumors in cosmetically sensitive areas, or prefer non-surgical approaches.
• Risks associated with IG-SRT include radiation dermatitis, edema, and potential long-term skin changes.
• IG-SRT has slightly lower cure rates (90-95%) compared to Mohs surgery, as reported in various studies, including one published in the Journal of the National Comprehensive Cancer Network 1.

Decision Factors

The decision between IG-SRT and Mohs surgery should consider:

• Tumor characteristics (size, location, subtype)
• Patient preferences
• Comorbidities
• Cosmetic concerns Ultimately, Mohs surgery is the preferred treatment option for basal cell carcinoma of the forehead due to its high cure rates and ability to spare healthy tissue, as supported by the most recent and highest quality study 1.

From the Research

Risks and Benefits of IG-SRT versus Mohs Surgery for Basal Cell Carcinoma of the Forehead

• Mohs Surgery Benefits:
  • High cure rates 2, 3
  • Minimally invasive 3
  • Tissue-sparing 3
  • Optimal closure of the surgical defect 3
  • Cost-effective, especially for high-risk, facial tumors 2, 3
• Mohs Surgery Risks:
  • High set-up cost, including specialized training and histology facility 3
• IG-SRT (Intensity-Modulated Gamma Stereotactic Radiosurgery):
  • There is limited information available on IG-SRT for basal cell carcinoma treatment in the provided studies
  • However, radiotherapy is mentioned as a suitable alternate treatment option for older patient populations or for those where surgery is contraindicated 4, 5
• General Treatment Considerations:
  • Treatment choice depends on tumor type, patient condition, and risk of recurrence 6, 4, 5
  • Surgical excision and Mohs surgery are commonly used due to their low recurrence rates and ability to confirm residual tumor pathologically 4, 5
  • Other treatment options, such as photodynamic therapy, cryosurgery, and topical treatments, may be preferred for low-risk lesions or based on patient condition and tumor location 6, 4, 5