Surgical Margins of Nonmelanoma Skin Cancers in Mohs Surgery: Dermoscopy Versus Naked Eye

Abstract

BACKGROUND Mohs micrographic surgery (MMS) offers high cure rates for nonmelanoma skin cancer (NMSC) but relies on precise margin assessment, traditionally initiated by the naked eye. Dermoscopy has emerged as a potential tool to improve margin delineation. OBJECTIVE To compare the efficacy of dermoscopic versus naked eye evaluation in marking initial MMS margins for NMSC. METHODS A multicenter, prospective study on patients with NMSC undergoing MMS was conducted. Patients were randomized into dermoscopy and naked eye groups. Statistical analysis was performed using statistical package for social sciences. RESULTS A total of 127 patients were enrolled, with 63 in the naked eye group and 64 in the dermoscopy group. No significant differences in age, sex distribution, or histological subtype were found. The average number of MMS stages and accuracy of initial margins were comparable between groups. DISCUSSION Despite its potential, the authors' study found no significant reduction in total MMS stages using dermoscopy. Novel imaging modalities or standardized dermoscopic criteria should be explored to enhance margin assessment accuracy and improve outcomes in NMSC treatment. CONCLUSION Dermoscopic evaluation of presurgical margins does not effectively assess lateral/deep margins nor contribute to a reduction in total MMS stages. Improving the authors' understanding of presurgical margin assessment techniques can lead to better treatment outcomes for NMSC.