Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma

Publication date: Available online 31 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Marloes S. van Kester, Jelle J. Goeman, Roel E. Genders

Abstract

Background

Mohs micrographic surgery (MMS) should lead to tissue sparing of healthy skin compared to standard surgical excision, because smaller surgical margins are used.

Objective

To quantify the tissue-sparing properties of MMS in primary basal cell carcinoma (BCC) with an infiltrative growth pattern.

Methods

A prospective study including 256 primary BCC with an infiltrative growth pattern was performed. Tumor sizes were measured in two perpendicular directions. Surface defect areas after MMS were measured. The suspected defect surface area with standard excision using a 5 mm margin was calculated. The primary outcome of this study was the size of the defect surface area spared with MMS compared to the calculated defect surface area with a standard excision.

Results

Median tumor size was 71 mm², median defect size after MMS was 154 mm². Median defect size calculated for standard surgical excision was 298 mm².

We show that MMS had a 46.4% tissue sparing effect compared to standard surgical excision of BCC with an infiltrative growth pattern (confidence interval 43.4-49.1.4%, p-value <0.001).

Limitations

Single-center study design. Lack of randomized control group, due to ethical reasons.

Conclusion

46% tissue sparing can be reached for primary BCC with an infiltrative growth pattern using MMS.

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