Moh’s micrographic surgery (MMS) for the treatment of recurrent basal cell carcinoma (rBCC) of the face results in fewer recurrences than surgical excision, according to the results of a study published in the December 2008 issue of the Lancet Oncology.1

Skin cancer is often divided into two broad categories: melanoma and non-melanoma. Nonmelanoma skin cancer refers to several different types of skin cancer, but the most common types are basal cell carcinoma and squamous cell carcinoma. Each year in the U.S., more than one million people are diagnosed with basal cell or squamous cell skin cancers. Unlike melanoma, these types of skin cancer are rarely deadly.

About Basal Cell Carcinoma

Basal cell carcinoma accounts for roughly 80% of all cases of non-melanoma skin cancer. It most commonly develops on sun-exposed skin, with the head (particularly the nose) and neck being the most common sites. This type of skin cancer very rarely metastasizes (spreads beyond the skin), but it can cause extensive local damage to the skin and surrounding tissues.

Basal cell carcinoma is typically treated with either surgical excision or Moh’s micrographic surgery (MMS). Surgical excision involves the use of a scalpel to remove the cancer and some surrounding normal tissue, which is then sent to the lab where the margins are checked for cancer. If the margins are clear, it’s likely that the cancer was completely removed. 

Moh’s micrographic surgery is a more complicated procedure, during which a doctor removes thin layers of skin one at a time and evaluates them for cancer while the patient waits. The doctor keeps removing layers of skin until he or she reaches a layer that is cancer-free. This procedure removes the least amount of normal tissue, and also has the highest cure rates for both primary and recurrent cancers. The procedure generally requires less than four hours to complete but can take longer if the cancer is extensive.

In a study performed in the Netherlands, 408 primary BCCs (pBCC) and 204 recurrent BCCs (rBCC) patients were randomly assigned to surgical excision or MMS. After five years of follow-up, the researchers found that MMS produced significantly lower recurrence rates than surgical excision in the rBCC group. (Two patients in the rBCC group treated with MMS experienced a recurrence of cancer, versus ten patients treated with surgical excision.) However, in the group of patients with pBCC, there was not a significant difference between the two surgical modalities.

The researchers concluded that MMS is preferred over surgical excision for the treatment of facial rBCC because it produces significantly fewer recurrences.

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Wound Care Following Surgery for Skin Cancer

Following the surgical removal of basal cell and squamous cell cancers of the skin doctors frequently recommend a topical antibiotic to prevent infection. But is this necessary and could it be harmful?

Neosporin is the most widely known over-the-counter topical antibiotic and contains neomycin sulfate, polymyxin B, and bacitracin. It was created in the 1950s and approved for use by the FDA in 1971. The problem with Neomycin is that it frequently causes the skin to become red, scaly, and itchy - this allergic reaction is called contact dermatitis, and the more Neosporin you use, the worse the dermatitis gets Neomycin is such a common allergen that it was named Allergen of the Year in 2010. Polymyxin B and bacitracin can cause contact dermatitis as well.

Neosporin does not actually speed up wound healing compared to petrolatum. In 1996, the Journal of the American Medical Association published a study comparing antibiotic ointment with plain petrolatum jelly and found no significant difference in the rate of infection between the groups. The only differences seen between the two groups was that a small number of patients in the antibiotic group developed allergic reactions. Meanwhile, no allergic reactions were reported in the petrolatum group. The most important component of antibiotic ointments is the petrolatum. Therefore, please skip the over-the-counter antibiotics. Instead, just use the petrolatum ointment.

Reference: 

  1. Smeets NWJ, Krekels GAM, Ostertag JU, et al. Surgical excision vs. Moh’s micrographic surgery for basal-cell carcinoma of the face: randomized controlled trial. Lancet. 2004;365:1766-1771.
  2. Mosterd K, Krekels GAM, Nieman FHM, et al. Surgical excision of Moh’s micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncology. 2008; 9:1149-1156.

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