Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery)

Tomás‐Velázquez, Alejandra; Sanmartín-Jiménez, O.; Rodríguez-Prieto, Manuel Ángel; Ruiz‐Salas, Verónica; Eusebio‐Murillo, Esther De; Medrano, R. Miñano; Escutia‐Muñoz, Begoña; Flórez-Menéndez, Ángeles; Artola-Igarza, Juan L; Alfaro‐Rubio, A.; P, Gil; Delgado‐Jiménez, Yolanda; Sánchez‐Schmidt, Julia M.; Allende‐Markixana, Irati; Alonso‐Pacheco, M.L.; García‐Bracamonte, Beatriz; Cueva‐Dobao, P. de la; Navarro‐Tejedor, Raquel; Ciudad-Blanco, C.; Carnero‐González, L.; Vázquez‐Veiga, Hugo; Cano-Martínez, N.; Vilarrasa-Rull, Eva; Sánchez‐Sambucety, Pedro; López‐Estebaranz, José Luis; Botella‐Estrada, Rafael; González‐Sixto, B.; Martorell-Calatayud, A.; Morales‐Gordillo, Victoriano; Toll-Abelló, Agustí; Ocerin‐Guerra, Izascun; Mayor-Arenal, M.; Suárez‐Fernández, Ricardo; Sainz‐Gaspar, Laura; Descalzo, M.Á.; García‐Doval, I.; Redondo, Pedro

doi:10.2340/actadv.v101.544

Cited by 13 publications

(19 citation statements)

References 41 publications

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“…Re‐treatment of incompletely excised BCC may be complicated if a flap has been used for reconstruction, and may necessitate losing a large volume of normal tissue. In addition, there is no guarantee of clearance with further treatment as residual BCC has a higher recurrence rate than recurrent BCC after MMS 15,20 . This may reflect the difficulty in localizing residual tumour during surgery and/or the difficulty in interpreting the pathology after recent surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is no guarantee of clearance with further treatment as residual BCC has a higher recurrence rate than recurrent BCC after MMS. 15,20 This may reflect the difficulty in localizing residual tumour during surgery and/or the difficulty in interpreting the pathology after recent surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Other evidence for MMS efficacy comes largely from observational studies (Table 1 provides a summary of recurrence data). Only a few were multicentre [9][10][11][12][13][14][15] (many of which sampled the same Australian MMS database) with a follow-up of > 5 years, 9,[11][12][13][14][16][17][18][19][20][21][22] but there was significant loss to follow-up over time. Recurrence rates varied considerably.…”

Section: Recurrence/complete Excisionmentioning

confidence: 99%

“…Risk factors for recurrence after MMS include previous recurrence, number of previous treatments, tumour duration before MMS, presence of an infiltrative pattern or aggressive histological subtype, presence of perineural invasion and number of MMS stages 9,25 . Failure to achieve clear margins was also identified as a risk factor for recurrence in a study looking at the Spanish Mohs registry; however, a significant number of cases in that study were performed under general anaesthesia or with a ‘slow‐Mohs’ technique that was not defined in the study 15,26 …”

Section: Data Analysedmentioning

confidence: 99%

“…9,25 Failure to achieve clear margins was also identified as a risk factor for recurrence in a study looking at the Spanish Mohs registry; however, a significant number of cases in that study were performed under general anaesthesia or with a 'slow-Mohs' technique that was not defined in the study. 15,26 Although not a direct comparison of efficacy, an RCT comparing bread-loaf vs. three-dimensional (3D) microscopy (100% of margin examined) (n = 553), demonstrated that tumour extensions at the excision margin were found in 62 of 283 (21.9%) bread-loaf microscopy cases and in 115 of 270 (42.6%) 3D microscopy cases (P < 0.001). 27 The difference was maintained regardless of tumour subtype [infiltrative 32.9% vs. 57.5% (P = 0.003); nodular 16.1 vs. 34.2% (P < 0.001)].…”

Section: Recurrence/complete Excisionmentioning

confidence: 99%

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A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma

Brown

Brindley

Hunt

et al. 2022

Clinical and Experimental Dermatology

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Mohs micrographic surgery (MMS) is considered the gold-standard treatment for basal cell carcinoma (BCC) particularly for sites with a high risk of incomplete excision such as the central face, for tumours with an aggressive growth pattern and consequent unpredictable subclinical extension and for recurrent tumours. However, the process is more time-consuming than for standard excision (SE), and the magnitude of benefit is uncertain. This article aims to provide a more complete picture of current evidence, including a review of cosmetic outcomes, tissue-sparing ability and cost-effectiveness of MMS. Although robust evidence is lacking, there is a large volume of observational data supporting a low recurrence rate after MMS. The risk of incomplete excision and higher recurrence rate of SE favours the use of MMS at high-risk sites. There is some low-certainty evidence that MMS results in a smaller defect size compared with SE, and that incomplete excision with SE results in larger defects. Larger defects may affect cosmetic outcome but there is no direct evidence that MMS improves cosmetic outcome compared with SE. There is conflicting evidence regarding the cost of MMS compared with SE, as some studies consider MMS less expensive than SE and others consider it more expensive, which may reflect the healthcare setting. A multicentre 10-year randomized controlled trial comparing MMS and SE in the treatment of high-risk BCC would be desirable, but is unlikely to be feasible or ethical. Collection of robust registry data capturing both MMS and SE outcomes would provide additional long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%