Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread

Abstract

We found that tumour size and aggressive histology are the strongest indication criteria for MMS. Recurrence and aggressive histology are predictors for extensive subclinical spread but not for two or more rounds of MMS. Evidence-based indications for MMS are necessary to ensure cost-effective management of BCC.

S2k Guidelines for Cutaneous Basal Cell Carcinoma – Part 2: Treatment, Prevention and Follow‐up

“…In particular, microscopically controlled surgery is indicated for tumors associated with an increased likelihood of subclinical spread and recurrence . This includes recurrent tumors with extensive subclinical spread and a likelihood of renewed recurrence between 11.6 and 17.4 % .…”

S2k‐Leitlinie Basalzellkarzinom der Haut – Teil 2: Therapie, Prävention und Nachsorge

“…Mikroskopisch kontrollierte Chirurgie ist insbesondere bei Tumoren indiziert, die mit einer erhöhten Wahrscheinlichkeit subklinischer Ausläufer und Rezidive einhergehen . Hierzu zählen auch Rezidivtumoren, die ausgedehnte subklinische Ausläufer aufweisen und deren Wahrscheinlichkeit zur Ausbildung erneuter Rezidive zwischen 11,6 und 17,4 % liegt .…”

Indications for micrographic surgery

“…3 In their series of more than 1000 BCCs, only 25% of the tumours were cleared by one single stage of MMS. Hypothetically, only these 25% would have been successfully treated by a 2-mm standard excision.…”

“…The authors concluded that MMS was the treatment of choice for facial BCCs larger than 1 cm 2 , with a morphoeiform, micronodular or mixed histology. 3 MMS on frozen sections is labour intensive, time-consuming and needs a specialized setting. The authors state that in Belgium, reimbursement, and thus costs for society, for MMS are approximately eight times higher than for standard excision.…”

“…The authors state that in Belgium, reimbursement, and thus costs for society, for MMS are approximately eight times higher than for standard excision. 3 The actual costs of surgical procedures depend on the setting in which they are performed and reimbursement varies greatly from country to country. Furthermore, the costs of recurrences have to be taken into account and the cost of more complicated reconstructions due to larger defect size.…”