A comprehensive guide to the surgical management of nonmelanoma skin cancer

Abstract

The ultimate goal in surgical management of nonmelanoma skin cancer (NMSC) is tumor eradication. Surgical procedures include Mohs micrographic surgery (MMS), surgical excision (SE), curettage and electrodessication (C&E), and cryosurgery. All of these interventions are useful tools in the surgical management of NMSC and each has its unique set of strengths and weaknesses. Tumor clearance rates, postsurgical complications, recurrence rates, cosmesis, and costs can vary greatly based on both the intervention chosen and the characteristics of the lesion being treated. In a large meta-analysis, average recurrence rates for primary squamous cell carcinoma (SCC) were 0.8% for cryotherapy and 1.7% for C&E, representing mostly small or lowrisk lesions. Larger or higher-risk primary SCC is more often treated with other modalities, with recurrence rates reported at 3% for MMS, 5.4% for SE, and 6.4% for radiation therapy. Data on the treatment of basal cell carcinomas (BCCs) are similar with an investigation showing that tumors treated with MMS had the lowest recurrence rates, followed, in order, by those treated with SE, cryosurgery, and C&E.