MOHS micrographic surgery for head and neck nonmelanoma skin cancer: An approach for ENT surgeons

Abstract

Surgery is the main approach for skin cancer, with Mohs micrographic surgery (MMS) allowing the highest cure rates, best esthetics and superior functional outcomes. Ear, nose, and throat (ENT) surgeons are often challenged with patients presenting skin cancer, needing appropriate expertise to its adequate management. This paper highlights the most important aspects of MMS, enabling ENT surgeons to become familiar with its fundamental aspects. A review of the literature was performed, concomitantly presenting the author's outcomes as an ENT surgeon. A total of 51 MMSs were performed in 41 patients, and 78.4% of the tumors were cutaneous basal cell carcinomas (cBCCs), 19.6% were cutaneous squamous cell carcinomas (cSCCs), and one case was a microcystic adnexal carcinoma. Most tumors were located in high‐risk areas (88.2%), and 84.3% of them were ≥10 mm in diameter. Most tumors (90.2%) required no more than two MMS excision steps to be completely removed. All cases were managed by reconstruction either using flaps or grafts. Recurrence occurred in only 2% of the cases. This study addressed the main issues of MMS, which may be important in ENT surgeons' daily practice.

Clinicopathological features of head and neck cutaneous basal cell carcinoma observed at the Centro Hospitalar de Trás-os-Montes e Alto Douro ENT Department

“…These cases were specifically guided by the ENT consultation for MMS because they required tissue saving, with the need for accurate margin assessment to perform simultaneous reconstruction. 4 The most frequent locations of the MMS treated cBCCs were the nose (13/32, 40.6%) and the eyelids (9/32, 28.1%). None of these cBCCs recurred.…”

“… 2 Surgical modality is based on the risk assessment of cBCC with standard surgical excision reserved for low-risk tumors and Mohs micrographic surgery (MMS) for the excision of tumors in esthetically and functionally sensitive areas. 3 , 4 Because surgery is the treatment of choice, surgical margins are an important issue, with a need for a compromise between tumor eradication and acceptable cosmetic outcomes. 4 A meta-analysis performed by Gulleth et al 5 has shown that a 3-mm surgical margin can be safely used for nonmorpheaform cBCC to attain 95% cure rates for tumors 2 cm or smaller.…”

“… 3 , 4 Because surgery is the treatment of choice, surgical margins are an important issue, with a need for a compromise between tumor eradication and acceptable cosmetic outcomes. 4 A meta-analysis performed by Gulleth et al 5 has shown that a 3-mm surgical margin can be safely used for nonmorpheaform cBCC to attain 95% cure rates for tumors 2 cm or smaller. cBCC morbidity is dictated by local invasion and destruction, especially in the face and neck, where function and esthetics are major issues.…”

Clinical Retrospective Analysis of 243 Patients with Rhinofacial Ulcers

“…Second, repeated intraoperative inspection of the resection margin can ensure complete tumor removal, in order to significantly reduce the postoperative recurrence rate. 14 For the ala nasi, periorbital, eyelid margin, and medial canthus areas, especially when there are recurrent facial tumors with unclear clinical boundaries or tumors with an invasive growth pattern on histopathology (eg, morphea-like basal-cell carcinoma), Mohs micrographic surgery has obvious advantages. However, this surgery also has its shortcomings.…”