From the Guidelines
Mohs surgery is the preferred treatment for high-risk basal cell carcinoma (BCC) due to its high cure rates and ability to preserve healthy tissue, especially in cosmetically sensitive areas like the face. When considering treatment options for BCC, it's essential to weigh the benefits and drawbacks of each approach. Mohs surgery, also known as Mohs micrographic surgery (MMS), is a specialized technique that involves removing thin layers of cancer-containing skin and examining them until only cancer-free tissue remains 1. This approach offers the highest cure rates, ranging from 95-99%, while preserving the maximum amount of healthy tissue.
In contrast, Superficial Radiation Therapy (SRT) is a non-invasive alternative that uses low-energy radiation to destroy cancer cells over multiple sessions, typically 12-20 treatments over 2-4 weeks. SRT is particularly valuable for elderly patients who cannot tolerate surgery, those on blood thinners, or for cancers in areas where surgery might be challenging or cosmetically concerning. However, SRT has cure rates of approximately 90-95% for appropriate cases, which is lower than Mohs surgery.
The choice between Mohs surgery and SRT depends on various factors, including cancer type, location, patient age, medical history, and personal preference. While Mohs provides immediate results and pathological confirmation, SRT avoids surgical risks but requires multiple visits and doesn't provide tissue confirmation of complete 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.
Some key points to consider when deciding between Mohs surgery and SRT include:
- Cure rates: Mohs surgery has higher cure rates (95-99%) compared to SRT (90-95%)
- Tissue preservation: Mohs surgery preserves more healthy tissue, especially in cosmetically sensitive areas
- Patient suitability: SRT may be more suitable for elderly patients or those with certain medical conditions
- Treatment duration: SRT requires multiple sessions over several weeks, while Mohs surgery is typically a one-day procedure
- Pathological confirmation: Mohs surgery provides immediate pathological confirmation of complete removal, while SRT does not.
Ultimately, the decision between Mohs surgery and SRT should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, as well as the latest evidence-based guidelines, such as those published in the British Journal of Dermatology 1 and the Journal of the National Comprehensive Cancer Network 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, including basal cell carcinoma and squamous cell carcinoma.
- According to 2, Mohs micrographic surgery has the lowest recurrence rate among treatments, but is best considered for large, high-risk tumors or tumors in sensitive anatomic locations.
- 3 highlights the importance of tumor and patient risk stratification in choosing between Mohs surgery and standard local excision for facial skin cancers.
Comparison of Mohs Surgery for BCC and SCC
- 4 found significant differences in the characteristics of patients, tumors, and Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
- Patients with SCC were older, had larger tumors, and presented with immunosuppression more frequently than those with BCC.
- The incidence of perioperative complications and relapses in the first-year follow-up was higher in the SCC group.
Risk Factors and Recurrence Rates
- 5 identified risk factors for recurrence after Mohs surgery, including age, non-primary tumors, and more stages or unfinished surgeries for both BCC and SCC.
- Immunosuppression was also a risk factor for recurrence in SCC.
- The incidence rates of recurrence were 1.3 per 100 person-years for BCC and 4.5 for SCC, with constant rates over time (0-5 years).
- Follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to SCC (especially in immunosuppressed patients), elderly patients, non-primary tumors, and those procedures requiring more stages or unfinished surgeries.