scholarly journals Patient indications for Mohs micrographic surgery: a clinical practice guideline

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Murray ◽  
D. Sivajohanathan ◽  
T. P. Hanna ◽  
S. Bradshaw ◽  
N. Solish ◽  
...  
Keyword(s):  
Basal Cell ◽  
Relevant Literature ◽  
Standard Of Care ◽  
Surgical Oncology ◽  
Evidence Based ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Disease Site ◽  
The Face ◽  
Evidence Based Care

Objective The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.Methods The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews.Recommendation 1 Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer.Recommendation 2 Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face.Recommendation 3 Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.

Patient Indications for Mohs Micrographic Surgery: A Systematic Review

2018 ◽  
Vol 23 (1) ◽  
pp. 75-90 ◽  
Author(s):  
Christian Murray ◽  
Duvaraga Sivajohanathan ◽  
Timothy P. Hanna ◽  
Scott Bradshaw ◽  
Nowell Solish ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Retrospective Studies ◽  
Standard Of Care ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Skin Cancers ◽  
Cochrane Database ◽  
The Face ◽  
Aggressive Histology

The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.

Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial

The Lancet ◽  
2004 ◽  
Vol 364 (9447) ◽  
pp. 1766-1772 ◽  
Author(s):  
Nicole WJ Smeets ◽  
Gertruud AM Krekels ◽  
Judith U Ostertag ◽  
Brigitte AB Essers ◽  
Carmen D Dirksen ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Controlled Trial ◽  
Surgical Excision ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
The Face ◽  
Randomised Controlled

scholarly journals Standard Surgical Excision of Basal Cell Carcinomas in the Non-H Area of the Face: A Case Series Illustrating an Alternative to Mohs Micrographic Surgery

2019 ◽  
pp. 1-4
Author(s):  
S Wang ◽  
J Au ◽  
K Ashack ◽  
O Lai ◽  
LS Chan
Keyword(s):  
Basal Cell ◽  
Case Series ◽  
Surgical Excision ◽  
Mohs Micrographic Surgery ◽  
Cure Rate ◽  
Micrographic Surgery ◽  
High Cure Rate ◽  
Increased Risk ◽  
Basal Cell Carcinomas ◽  
The Face

Introduction: Basal cell carcinoma (BCC) is the most common cutaneous malignancy among Caucasians. Most studies compare the efficacy of standard surgical excision versus Mohs micrographic surgery (MMS) for the treatment of non-melanoma skin cancers in the high-risk or H area of the face. This case series focuses on the lesser-studied non-H area and suggests the use of standard surgical excision as an alternative to MMS for these regions of the face. Methods: A total of 10 patients with BCCs of the non-H area of the face underwent standard surgical excision with repair at the James A. Lovell Federal Health Center between October 2014 to October 2018. The average age of this group was 77.3 years and all patients were males. Nine of the 10 patients had nodular type BCCs and 1 patient had micronodular type BCC with ulceration. BCCs were located on the forehead in 8 cases and the cheek in 2 cases. Diameters of the lesions ranged from 6mm-8mm. Excision margins were 3- to 5-mm. Defects were repaired using local flaps in 9 cases and linear closure in 1 case. Results: Histopathologic evaluation of the excision specimens revealed clear surgical margins in 9 out of 10 cases. There was one case in which positive deep margins were identified, although the patient had a BCC with a more aggressive histologic pattern. Of the 9 cases with clear surgical margins, none had clinical evidence of local recurrence at follow-up ranging from 2 to 38 months. Discussion: BCCs in the non-H area of the face can be successfully treated using standard surgical excision with a high cure rate and low postoperative complications. MMS should be reserved for BCCs at increased risk for recurrence on the basis of factors such as location in the H area on the face and an aggressive histologic growth pattern (e.g. micronodular, morpheaform, infiltrating, metatypical). Practice points: • Basal cell carcinomas in the non-H area of the face can be successfully treated using standard surgical excision with a high cure rate and low postoperative complications. • Mohs micrographic surgery should be reserved for BCCs at increased risk for recurrence on the basis of factors such as location in the H area on the face and an aggressive histologic growth pattern (e.g. micronodular, morpheaform, infiltrating, metatypical).

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