From the Guidelines
Mohs micrographic surgery is the recommended treatment for high-risk cutaneous squamous cell carcinoma (cSCC) due to its high cure rates and ability to preserve healthy tissue. The procedure involves removing thin layers of cancer-containing skin one at a time and examining them under a microscope until only cancer-free tissue remains. According to the most recent guidelines, Mohs surgery is particularly valuable for treating cSCC, especially when they occur in cosmetically or functionally important areas or when the cancer has recurred after previous treatment 1. The systematic microscopic examination of 100% of the surgical margins allows the surgeon to track and remove all cancer roots while sparing healthy tissue, resulting in lower recurrence rates compared to other treatment modalities.
The benefits of Mohs surgery for cSCC are well-documented, with a 5-year local recurrence rate of 3.1% compared to 8.1% for standard excision and 10.0% for radiation therapy 1. When high-risk factors are taken into account, Mohs surgery shows lower recurrence rates compared to standard excision and other non-Mohs treatment modalities. The procedure is also beneficial for treating aggressive or ill-defined tumors, large tumors, or those with indistinct borders.
Some key points to consider when using Mohs surgery for cSCC include:
- The importance of meticulous and complete margin assessment with Mohs surgery
- The potential limitations of Mohs surgery, such as aggressive histopathologic growth patterns poorly visualized with frozen sections
- The need for careful selection of tumors appropriate for treatment with Mohs surgery based on initial biopsy results
- The recommendation to use Mohs surgery for the treatment of high-risk cSCC, as stated in the guidelines of care for the management of cutaneous squamous cell carcinoma 1.
Overall, Mohs micrographic surgery is a highly effective treatment option for high-risk cSCC, offering high cure rates and minimal tissue loss, making it a valuable tool in the management of this disease 1.
From the Research
Overview of Moh's Procedure
- Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies 2.
- The procedure involves the excision and control of complete peripheral and deep resection margins in one plane, allowing orientation, mapping, and re-excision of microscopic tumor extension 3.
Role in Treating Skin Cancer
- Mohs micrographic surgery is the treatment of choice for certain uncommon cutaneous neoplasms and for certain variants of basal cell carcinoma, squamous cell carcinoma, and melanoma 4.
- It offers an extremely high cure rate and maximally preserves healthy tissue, which often allows for preservation of function as well as an optimal cosmetic outcome 4.
- The procedure is effective for high-risk cutaneous squamous cell carcinoma, with a low recurrence rate and disease-specific mortality 5.
Technique and Advancements
- Mohs micrographic surgery involves serial excision of a tumor followed by microscopic evaluation of the tissue 6.
- The technique has advanced in its methods and applications, including new imaging techniques such as immunohistochemistry and confocal mosaicing microscopy 6.
- The procedure has become the standard treatment for a variety of skin cancers, including basal and squamous cell carcinomas 6.
Benefits and Outcomes
- Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications 2.
- The procedure has a high cure rate, with none of the basal cell carcinomas recurring and only one squamous cell carcinoma recurring in an 8-year study period 3.
- Patients with one high-risk squamous cell carcinoma are likely to develop secondary primary squamous cell carcinoma and melanoma, highlighting the importance of prompt recognition and treatment 5.