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Do Older Patients with Large BCC Need Mohs?

Mohs micrographic surgery (MMS) has a better 5-year cure rate for Basal Cell Carcinoma (BCC) than surgical removal (known as standard excision) but it is costly and time consuming. A recent study examined whether the current criteria for Mohs was accurate for over 1,000 patients with head and neck BCCs. In this clinic, criteria for MMS included indistinct clinical margins; aggressive histopathological subtype (e.g. sclerosing and morphoeaform); diameter > 2 cm; location in the H zone; previously incompletely excised tumors; perineural invasion; or recurrent tumors.

The authors compared tumor characteristics and patient characteristics (including age and gender) of BCCs treated with one vs. multiple MMS stages. The authors determined that tumors that cleared in a single round of Mohs could also be defined as being appropriately treated by standard excision. The results showed that gender, tumor location and previous recurrence were not associated with a significant increased risk for more than one round of MMS. However, for patients with a tumor size larger than 1 cm2, or with an aggressive histology, or if the patient was older than 80, multiple stages of MMS were required. When these inclusion criteria were applied, only a small number of tumors needed one round of MMs. In other words, standard excision would not have been sufficient for most when the criteria were changed. The authors conclude that according to this data, MMS should be performed on any facial location and not be limited to areas of the face known as the H-zone.

 

Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: June 22, 2016

Source: British Journal of Dermatology

[Image: WikiMedia Commons]