Is your patient a candidate for Mohs micrographic surgery?
This guide for family physicians describes the advantages of Mohs surgery and which patients make good candidates for the procedure.
PRACTICE RECOMMENDATIONS
› Consider Mohs surgery for patients who have lesions located mainly in regions of the face that make excision difficult without significant scarring. A
› Consider Mohs surgery for basal cell carcinoma and squamous cell carcinoma that typically involve (but are not necessarily limited to) the face, as the procedure significantly reduces recurrence rates and leads to cure rates of up to 99%. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
For BCCs, recurrence rates for excisions vs MMS are 10% and 1%, respectively.14-16 A randomized trial reviewing 10-year recurrence of primary BCCs on the face showed recurrence rates for MMS of 4.4% compared to 12.2% for WLE.17 This study also showed recurrence rates for recurrent facial BCCs treated with MMS to be 3.9% vs 13.5% for standard WLE.17
SCC. The evidence similarly supports the efficacy of MMS for SCCs. A recent study showed primary T2a tumors had a 1.2% local recurrence rate with Mohs vs a 4% recurrence rate with WLE at an average follow-up of 2.8 years.18 Another study showed that primary tumors that were < 2 cm in diameter had a 5-year cure rate of 99% with Mohs surgery.11
Melanoma in situ. A few studies have shown no clinically significant benefit of MMS compared to WLE when it comes to melanoma in situ.19,20 However, a more recent article by Etzkom et al noted the ability to potentially upstage melanoma in situ and invasive melanoma after reviewing peripheral and deep margins during MMS.21 In this study, the authors uniquely delayed wound closure if upstaging was established and the need for a sentinel lymph node biopsy was warranted. This approach to MMS with delayed closure ultimately paved the way for very low recurrence rates.
CORRESPONDENCE
Andres Garcia, MD, 2612 112th Street, Lubbock, TX 79423; agarcia326@gmail.com
