Appropriate use criteria for basal cell carcinoma Mohs surgery at a single center in the face of high-burden skin cancer: a retrospective cohort study

Abstract

Background: Mohs micrographic surgery (MMS) promotes high cure rates, but accessibility to MMS is limited in distinctive realities and countries.

Objective: We sought to verify applicable criteria for MMS indication and prioritization regarding basal cell carcinoma (BCC) in the face of various limitations.

Methods: We analyzed MMS-excised BBC, without patient exclusion, through a retrospective cohort study at a single university center.

Results: Mohs micrographic surgery was performed in 101 BCCs, average size = 5.44 ± 11.91 cm², 56.44% ≥ 20 mm. Most BCCs were in the H-zone (87.13%) and on the nose (52.47%). Histology showed high-risk pattern in most of tumors (69.31%), primary (64.71%), and recurrent (74.0%) BCC. Nasal (p = .01) and recurrent BCC (p = .03) had increased risk for two or more MMS stages. Appropriate use criteria were considered for all cases of BCC removed by a single stage (60.40%), two or more stages (39.60%), and three or more MMS stages (10.89%). The latter two conditions were associated with a higher number of MMS criteria (p = .02; p = .03, respectively).

Conclusions: All excised BCCs fulfilled criteria for MMS indication, among them recurrent and nasal BCCs stood out. The greater number of criteria may be a predictive factor for subclinical extension and can help prioritize indications for MMS.

Keywords:

• Basal cell carcinoma
• Mohs surgery
• neoplasm recurrence
• local

Acknowledgments

We wish to thank Abel Dorigan Neto and their team at the Pathology Service of the Hospital of the Ribeirão Preto Medical School, University of São Paulo (SERPAT) for access to the facilities and for assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.