What is the difference between Mohs surgery and Superficial Radiation Therapy (SRT)?

From the Guidelines

Mohs surgery is the recommended treatment for most non-melanoma skin cancers, particularly in cosmetically sensitive areas like the face, due to its high cure rates and tissue-sparing approach. This is based on the most recent and highest quality study available, which reported a 5-year local recurrence rate of 3.1% for primary cutaneous squamous cell carcinoma (cSCC) treated with Mohs micrographic surgery (MMS) 1. In comparison, other treatment modalities such as curettage and electrodesiccation (C&E), standard excision, and radiation therapy had higher recurrence rates.

Key Considerations

• Mohs surgery involves removing thin layers of cancer-containing skin and examining them until only cancer-free tissue remains, providing immediate confirmation of complete removal.
• Superficial Radiation Therapy (SRT) is typically recommended for patients who are poor surgical candidates due to age, medical comorbidities, use of blood thinners, or personal preference to avoid surgery.
• SRT uses low-energy radiotherapy delivered directly to the skin cancer over multiple sessions, with good cure rates (90-95%), but requires multiple office visits and may cause skin changes like redness or hypopigmentation over time.
• The choice between Mohs surgery and SRT should be individualized based on cancer type and location, patient health status, and personal preferences after discussion with a dermatologist who can evaluate the specific characteristics of the skin cancer.

Evidence-Based Recommendations

• The work group recommends MMS for the treatment of high-risk cSCC (on the basis of NCCN risk stratification) 1.
• A systematic review of the literature since 1940 reported a 5-year local recurrence rate of 3.1% for primary cSCC treated with MMS, compared to 3.7% for C&E, 8.1% for standard excision, and 10.0% for radiation therapy 1.
• For recurrent cSCC, the meta-analysis by Rowe et al revealed a 5-year recurrence rate after MMS of 10.0%, compared to 23.3% following standard excision 1.

From the Research

Mohs vs SRT: Treatment Options for Skin Cancer

• Mohs micrographic surgery is a surgical technique used to treat skin cancer, particularly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) 2, 3, 4.
• Superficial Radiation Therapy (SRT) is a non-surgical treatment option for skin cancer, which uses low-energy X-rays to target cancer cells 5.
• The choice between Mohs surgery and SRT depends on various factors, including the type and size of the tumor, location, and patient's overall health 5, 3.
• Mohs surgery is often recommended for high-risk lesions or those in sensitive areas, while SRT may be suitable for patients who are not surgical candidates or have a high risk of surgical complications 5, 3.

Indications for Mohs Surgery

• Mohs surgery is indicated for BCC and cSCC lesions that are high-risk or located in sensitive areas, such as the face or ears 2, 3, 4.
• It is also recommended for lesions that have a high risk of recurrence or have already recurred 3, 4.

Indications for SRT

• SRT is indicated for patients with BCC or cSCC who are not surgical candidates or have a high risk of surgical complications 5.
• It may also be used as an adjuvant therapy after surgical excision to reduce the risk of recurrence 5.

Comparison of Mohs Surgery and SRT

• Both Mohs surgery and SRT have high cure rates for skin cancer, but the choice between the two depends on individual patient factors 2, 5, 3, 4.
• Mohs surgery has the advantage of providing a high cure rate with minimal tissue loss, while SRT has the advantage of being a non-surgical option with minimal downtime 5, 3.