Moh’s Micrographic Surgery May Be Superior to Surgical for Basal Cell Carcinoma

Cancer Connect

According to a recent article published in the Lancet, Mohs micrographic surgery may be superior to conventional surgical excision for large and aggressive basal cell carcinomas.

Basal cell carcinoma is typically a slow growing type of cancer that originates in the skin. Basal cell carcinoma is the most common cancer in the Caucasian population. Patients with basal cell carcinoma are usually treated with the surgical removal of the cancer and surrounding tissue, referred to as surgical excision. However, for over 60 years, an alternative approach has also been used, which is called Mohs micrographic surgery (MMS). MMS is a form of surgery for skin cancer developed by Frederick Moh in the early 1940s. This technique includes the removal of the part of the skin that involves the cancer. The skin is removed layer by layer, with the physician evaluating each layer as it is removed to determine if the cancer is still evident. Since MMS includes the evaluation of each layer of skin, while conventional surgical excision includes arbitrary parameters surrounding the cancer, MMS tends to reduce the severity of disfigurement following the procedure. If cancer cells exist in the sample of removed skin, another layer of skin is removed. MMS has never been compared to conventional surgical excision despite widespread use.

Researchers from the Netherlands recently conducted a clinical study to compare MMS to conventional surgical excision for the treatment of large, aggressive basal cell carcinomas. This study included 95 patients who were treated with MMS and 93 patients who were treated with surgical excision. At 18 months, the rate of cancer recurrence in initial basal cell carcinoma was nearly identical between the two types of treatment: 2% for patients treated with MMS and 3% for patients treated with surgical excision. The rate of cancer recurrence in basal cell carcinomas that had already recurred were 0% for MMS and 3% for conventional excision. Defects due to treatment were increased in the group of patients treated with surgical excision compared to MMS, but the cost of MMS was approximately twice that of surgical excision.

The researchers concluded that MMS may be superior to conventional surgical excision for the treatment of basal cell carcinomas, particularly larger cancers, as surgery can produce aesthetic defects. However, overall recurrence rates were virtually identical between the two treatments, leaving no conclusive benefits of one type of treatment over the other in terms of treatment efficacy. Patients with basal cell carcinoma may wish to speak with their physician about the risks and benefits of MMS or conventional surgical excision.

Reference: Smeets NWJ, Krekels GAM, Ostertag JU, et al. Surgical excision vs. Mohs micrographic surgery for basal-cell carcinoma of the face: randomized controlled trial. Lancet. 2004;365:1766-1771.

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