A review of Mohs micrographic surgery for skin cancer. Part 3: Squamous cell carcinoma

Abstract

This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for costeffectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta-analyses. We categorized the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with perineural invasion, and cost-effectiveness. Although there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomized controlled trials (RCT) were identified. The evidence from comparitor studies suggests that MMS has a lower recurrence rate than that of other treatments for cSCC, including standard excision. Many studies identified were single-armed, but did demonstrate a low to very low recurrence rate of cSCC following MMS. A single recent study suggests MMS for intermediate cSCC is highly cost-effective compared with wide local excision when all-in costs are considered. Since the overall quality of included studies was mixed and highly heterogeneous, further methodologically robust studies with comparator arms or comprehensive long-term registry data would be valuable. It would be ideal to employ a definitive multicentre RCT but given the evidence to date and multiple advantages to MMS, the lack of clinical equipoise makes this difficult to justify. Comparison with current modalities would likely not be ethical/achievable on a like-for-like basis given MMS provides 100% margin assessment, enables histological clearance prior to reconstruction, and minimizes the removal of uninvolved tissue.

Keratoacanthoma‐like squamous cell carcinoma successfully treated by the surgery combined with ALA‐PDT

“…Meanwhile, Mohs surgery is not widely used due to its complexity and high cost. It has been documented that after surgical resection of SCC, the local recurrence rate ranges from 0.4% to 15.2% 8 . When there is still infiltration of malignant cells at the pathological tissue margins and in the underlying layer of the skin, the patient could only be treated with chemotherapy, immunotherapy or small‐molecule targeted drug, 9 such as anti‐PD‐1 antibodies and epidermal growth factor receptor (EGFR) inhibitors, these treatments are prone to generalized weakness and discomfort to patients 10 .…”

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition

“…There are reports of using Moh's surgery, as there are for small cutaneous SCC elsewhere in the head and neck, but with little data specifically on lip SCC. 750 Small lower lip lesions are managed by simple surgical excision and primary closure (such as pentagonal wedge excision or 'W'-plasty resection techniques). Small upper lip lesions can be treated in a similar manner to small lower lip defects, but issues of symmetry can affect the aesthetic outcome, especially in younger patients.…”

“…There are reports of using Moh's surgery, as there are for small cutaneous SCC elsewhere in the head and neck, but with little data specifically on lip SCC. 750…”

Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches

“…MMS has been demonstrated to be an effective technique for the treatment of high-risk cSCCs in large cohort studies, both retrospective and prospective [51,53,[74][75][76][77][78][79], and is recommended by the European and American guidelines in these subsets of patients [7,51,80].…”