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.