From the Guidelines
Mohs micrographic surgery is the preferred treatment for high-risk basal cell carcinoma due to its high cure rates and ability to preserve healthy tissue, making it a better option than Superficial Radiation Therapy (SRT) for these cases. When considering the treatment of basal cell carcinoma, the primary goal is to achieve the highest cure rate while minimizing morbidity and preserving quality of life. Mohs surgery has been shown to offer cure rates of 95-99% for high-risk basal cell carcinoma, particularly in cosmetically sensitive areas like the face 1. This is because Mohs surgery allows for the removal of the cancer layer by layer, with microscopic examination of each section until all cancer cells are removed, providing histological confirmation of complete removal.
The advantages of Mohs surgery over SRT include:
- Higher cure rates for high-risk basal cell carcinoma
- Ability to preserve healthy tissue, resulting in better cosmetic outcomes
- Histological confirmation of complete cancer removal
- Suitable for cosmetically sensitive areas like the face
In contrast, SRT is a good option for:
- Elderly patients or those with medical conditions that make surgery risky
- Patients taking blood thinners
- Superficial skin cancers that are not high-risk
However, SRT typically requires multiple treatment sessions over several weeks and does not allow for histological confirmation of complete cancer removal. According to a study published in the Journal of the National Comprehensive Cancer Network, Mohs micrographic surgery is the preferred surgical technique for high-risk BCC because it allows intraoperative analysis of 100% of the excision margin 1. Another study published in the British Journal of Dermatology found that Mohs surgery results in extremely high cure rates for even the most high-risk lesions, together with maximal preservation of normal tissues 1.
Overall, the choice between Mohs surgery and SRT depends on factors including cancer type and location, patient age and health status, and patient preference regarding procedure type, recovery time, and cosmetic outcome. For high-risk basal cell carcinoma, Mohs micrographic surgery is the recommended treatment due to its high cure rates and ability to preserve healthy tissue 1.
From the Research
SRT vs Mohs: Treatment Options for Skin Cancer
- SRT (Superficial Radiation Therapy) and Mohs surgery are two treatment options for skin cancer, particularly for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) 2, 3.
- Mohs micrographic surgery has the lowest recurrence rate among treatments and is best considered for large, high-risk tumors or tumors in sensitive anatomic locations 2, 3.
- SRT is not explicitly mentioned in the provided studies as a treatment option, but other studies may discuss its effectiveness in treating skin cancer.
- The choice of treatment depends on the size, location, histology, and clinical features of the tumor, as well as the patient's overall health and preferences 4, 5.
Effectiveness of Mohs Surgery
- Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis 3.
- A study found that Mohs surgery had a recurrence-free survival rate of 100% at one year and 93.8% at 5 years for metatypical basal cell carcinoma, and 100% at both one and 5 years for basosquamous carcinoma 6.
- Mohs 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 3.
Other Treatment Options
- Other treatment options for skin cancer include surgical excision, electrodesiccation and curettage, cryotherapy, topical imiquimod and fluorouracil, and radiation therapy 2, 5.
- The choice of treatment depends on the specific characteristics of the tumor and the patient's overall health and preferences 4, 5.