Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread4. (28th January 2016)

• Record Type: Journal Article
• Authors: Hoorens, I.; Batteauw, A.; Van Maele, G.; Lapiere, K.; Boone, B.; Ongenae, K.
• Is Part Of: British journal of dermatology. Volume 174:Number 4(2016)
• Page Start: 847
• Page End: 852
• Publication Date: 2016-01-28
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.14308
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: The incidence of basal cell carcinoma (BCC) is rising and BCC treatment has an important impact on healthcare budget. Mohs micrographic surgery (MMS) has the highest 5‐year cure rate but is an expensive technique. Objectives: To study the indication criteria for MMS, using a series of 1062 patients treated for facial BCCs between 1998 and 2011. Methods: The accuracy of the indication criteria was evaluated by comparing the characteristics of BCC requiring one vs. more than one round of MMS. Predictors for extensive subclinical spread (three or more rounds) were examined using the preoperative patient and all tumour characteristics. Results: BCCs with a surface > 1 cm 2 and aggressive histology (morphoeaform and micronodular), and a patient age > 80 years are strong predictors for two or more rounds of MMS being required. Extensive subclinical spread was present in recurrent tumours, morphoeaform BCC or BCC with mixed histology. Conclusions: 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. Abstract : What's already known about this topic? Basal cell carcinoma (BCC) is the most common skin cancer and its incidence is rising dramatically. Some tumours have unpredictable subclinical extension. Conventional surgical excision does not always completely remove the tumour. Mohs micrographic surgery (MMS) has the highest 5‐year cure rate but is labour intensive and expensive. What does this study add? According to these findings, MMS is indicated for facial BCC > 1 cm 2 and of mixed histology. Age > 80 years cannot be a contraindication. Complete clearance with a 2‐mm standard excision was possible in 25% of tumours; for the 119 nasal BCCs there would have been a significant loss of healthy tissue. Morphoeaform and mixed histology, as well as recurrent tumours, are most likely characterized by extensive subclinical spread. Linked Comment: Moehrle and Läuchli. Br J Dermatol 2016;174: 719–720 . Plain language summary available online